1. Student uses MS Excel to calculate income tax expense or refund, taxable income, and total taxes using the full-cost method for transfer pricing. There are no errors.
2. Student uses MS Excel to calculate income tax expense or refund, taxable income, and total taxes using the variable-cost method for transfer pricing. There are no errors.
3. Student produces a thorough and detailed Word document that incorporates specific details from the MS Excel spreadsheet, a detailed recommendation based on those specific details as to how the organization should proceed is included, and the recommendation is justified with at least 3 examples from the week's resources and/or additional research in the Walden Library.
4. Writing exhibits strong evidence of thoughtful critical analysis and thinking; careful examination is made of assumptions and possible biases, with detailed supporting rationale. Writing synthesizes the classroom experiences and content; analyzes patterns or connections between theory and practice; and draws logical conclusions based on well-reasoned arguments. New questions are presented based on synthesis of ideas and input.
5. Writing is clear, logical, well-organized and appropriate. Work is free from spelling and grammar/syntax errors. Tone is professional and free from bias (i.e., sexism, racism). There are no errors.
6. Student effectively and directly integrates discussion/assignment content with relevant and compelling personal experiences, additional research, or current events from credible news sources. Specifically adds a new and/or different insight or perspective on the subject area(s) being discussed or treated in the assignment.
7. Student demonstrates full adherence to scholarly or credible reference requirements and adheres to APA style with respect to source attribution and references. There are no APA errors.
CASE STUDY—BEWARE: One Emergency May Hide Another!
A hospital submitted a report to the State Board of Nursing reporting that an RN had been terminated after the death of a patient following surgery for a tubal pregnancy.
THE NURSE'S STORY—SALLY SIMMS, RN
I had worked the medical-surgical units at the General Hospital ever since graduating from my nursing program 4 years before. This was the worst night, the worst shift, of my nursing career.
I was assigned to care for eight patients that night, which is not an unusual number of patients, but they all were either fresh post-ops or so very sick. Four patients had just had surgery that day. One patient was on a dopamine drip to maintain his blood pressure, so he needed frequent monitoring. One patient was suspected to have meningitis, one patient had pneumonia, and a patient with suspected histoplasmosis completed my assignment.
One of my post-op patients was Betty Smith, a young woman in her early thirties who had laparoscopic surgery late in the day. She had been transferred from the recovery room late in the evening shift and was very uncomfortable when I fi ...
CASE STUDY—BEWARE One Emergency May Hide Another!A hospital subMaximaSheffield592
CASE STUDY—BEWARE: One Emergency May Hide Another!
A hospital submitted a report to the State Board of Nursing reporting that an RN had been terminated after the death of a patient following surgery for a tubal pregnancy.
THE NURSE'S STORY—SALLY SIMMS, RN
I had worked the medical-surgical units at the General Hospital ever since graduating from my nursing program 4 years before. This was the worst night, the worst shift, of my nursing career.
I was assigned to care for eight patients that night, which is not an unusual number of patients, but they all were either fresh post-ops or so very sick. Four patients had just had surgery that day. One patient was on a dopamine drip to maintain his blood pressure, so he needed frequent monitoring. One patient was suspected to have meningitis, one patient had pneumonia, and a patient with suspected histoplasmosis completed my assignment.
One of my post-op patients was Betty Smith, a young woman in her early thirties who had laparoscopic surgery late in the day. She had been transferred from the recovery room late in the evening shift and was very uncomfortable when I first made my rounds. At 12:05 am, I called Betty's physician because she was vomiting and thrashing in bed. Per his order, I medicated the patient with Phenergan.
The next time I checked on Betty, she seemed to be more comfortable, but I realized that her IV had infiltrated. I was really overwhelmed with meeting the needs of all my patients, so I asked Joan Jones, the charge nurse, to restart Betty's IV. It was about 2:00 am when Nurse Joan restarted the IV.
I had been able to pretty much stay on top of everything at that point in the shift, and by 2:30 am I had assessed all my patients, given pain medications, and called four physicians to update them regarding their patients and for various orders. I thought things were settling down. I thought wrong.
Mrs. Holmes, the patient with histoplasmosis, seemed a bit off from when I had cared for her the previous two nights. Mrs. Holmes' vital signs were unstable and her O2 saturation was only 80%. I notified her physician and he ordered stat arterial blood gases. The lab called with the results, and they were alarming. Mrs. Homes was losing ground, and her physician ordered us to transfer her to the ICU. I was preoccupied with accomplishing the transfer and accompanied Mrs. Holmes to the unit. I returned from the ICU at about 3:50 am.
On my return, I first checked the patient who was on dopamine, medicated another patient for pain, and did visual checks on the rest of the patients who all seemed to be sleeping. I began my charting.
At 6:05 am, I went to start IV antibiotics on Betty's roommate, and to my horror discovered Betty was not breathing. I called the code. The first time I discovered that Betty had had a low blood pressure and elevated pulse was when I checked the vital signs sheet when the ER physician (who responded to the code) asked how Betty's vital signs had been during the shift ...
Child abuseProtestRally HandoutChild abuseI have written a pJinElias52
Child abuse:Protest/Rally Handout
Child abuse
I have written a paper, which is about the Child Abuse, and it includes the following points:
• Child abuse.
• Physical Abuse.
• Sexual Violence.
• Negligence.
• Emotional Exploitation.
For this reason, I need a Protest/Rally Handout about my paper, which I wrote, and it has to be:
· 300 words minimum.
· Opening: headline.
· Action/Organization/Cause Introduction: two to three sentences maximum. Strong, direct writing.
· Bulleted list of statistics (with sources); quotes; and action needed. Practice parallelism by matching first words in bulleted list; use active verbs to introduce bulleted items, when possible; and, highlight necessary stats and quotes with bold and/or italics.
· Closing: Call to Action and ways to reach you/org.
Note: the Protest/Rally Handout should include all of the points which were included in my paper. Child abuse, Physical Abuse, Sexual Violence, Negligence and Emotional Exploitation.
Example
Protest/Rally has to be the same of this example.
SUBDOMAIN 734.3 ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP
Competencies: 734.3.1: Principles of Leadership The graduate applies principles of leadership to promote highquality
healthcare in a variety of settings through the application of sound leadership principles.
734.3.2: Interdisciplinary Collaboration The graduate applies theoretical principles necessary for effective participation in an
interdisciplinary team.
734.3.3: Quality and Patient Safety The graduate applies quality improvement processes intended to achieve optimal healthcare
outcomes, contributing to and supporting a culture of safety.
734.3.4: Healthcare Utilization and Finance The graduate analyzes financial implications related to healthcare delivery,
reimbursement, access, and national initiatives
Introduction:
Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any
sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a
failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the
hospital described in this scenario, you have been selected as a member of the team investigating the incident.
Scenario:
It is 3:30 p.m. on a Thursday and Mr. B, a 67yearold patient, arrives at the sixroom emergency department (ED) of a sixtybed
rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe
pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR88 (regular), T98.6, R32, and his weight was
recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area ...
This is an actual TMLT medical malpractice case. It involves a family physician treating a patient with chest pain. This presentation illustrates how action or inaction on the part of the physician led to allegations of professional liability, and how risk management techniques may have either prevented the outcome or increased the physician's defensibility. The case has been modified to protect the privacy of the physician and the patient.
HISTORICAL CASE STUDY #2 Attentiveness and SurveillanceTHE IMPOSusanaFurman449
HISTORICAL CASE STUDY #2: Attentiveness and Surveillance
THE IMPORTANCE xOF CROSS-MONITORING TEAM MEMBERS' PERFORMANCES
HISTORY
This case involved three shifts of nurses over a 24-hour period working in a long-term care (LTC) facility. The facility included three separate units with 40 beds per unit. A licensed practical nurse charge nurse was assigned to each unit. One registered nurse supervisor was responsible per shift for the oversight of all three units.
Ms. Kathy Chin had been admitted to the LTC facility in October with heart failure, bipolar disorder with depression, constipation, history of gastrointestinal bleed, glaucoma, and discomfort. She required total care and was not able to effectively express her needs to the LTC staff. In January she had a bowel impaction, and Fleet enemas were administered. She was discovered unresponsive in her room the next afternoon and was transported to the hospital. Blood work revealed that she had a urinary tract infection. She was administered antibiotics and discharged back to the LTC facility.
Six weeks later, Ms. Chin had another episode of constipation. The day shift Nurse Supervisor, Ms. Angela Guilarte, notified Ms. Chin's physician, Dr. Brian Fisher. Dr. Fisher ordered an x-ray of Ms. Chin's abdomen, and it revealed severe constipation with fecal impaction. Dr. Fisher ordered clear liquids only and “Fleet enemas until clear.” This was the same regime that was previously ordered and administered to Ms. Chin in January.
A licensed practical nurse, Ms. Margaret Reyes, took the order by telephone, notified day shift Nurse Supervisor Guilarte, documented the order in Ms. Chin's chart, as originally received from Dr. Fisher, and on the medication administration record [MAR] “enemas continuously until clear.” Practical Nurse Reyes, who received the order for “Fleet enemas until clear,” questioned the order and discussed it with Nurse Supervisor Guilarte. They determined that the enemas should be administered every 3 hours until the return was clear but did not clarify this with Dr. Fisher or pass this information on to the next shift.
The enemas were administered over a 12-hour period by three licensed practical nurses working various shifts. Again Ms. Chin was found unresponsive, and she was transferred to the hospital where she died 6 hours after admission.
THE NURSE'S STORY
I came to work early that evening and was told that the licensed practical charge nurse for one of the units had called in sick. I realized that I would have to cover the patients for the licensed practical nurse as well as provide supervision for the other two units. I received a short verbal report from Ms. Zellner, the evening shift registered nurse supervisor, who reported Ms. Chin's bowel impaction and the order to administer Fleet enemas until clear. I was told that Ms. Chin had been given three enemas prior to my shift.
It didn't occur to me that I should assess Ms. Chin and review her orders. I started administering ...
This is a presentation about medical error with the following Objectives:
1- Learn step-by-step what to do when medical error occurs and how to report it
2- Learn how to identify root cause of a medical error and how to prevent its recurrence
3- Motivate your colleagues to foster a patient safety culture
CASE STUDY—BEWARE One Emergency May Hide Another!A hospital subMaximaSheffield592
CASE STUDY—BEWARE: One Emergency May Hide Another!
A hospital submitted a report to the State Board of Nursing reporting that an RN had been terminated after the death of a patient following surgery for a tubal pregnancy.
THE NURSE'S STORY—SALLY SIMMS, RN
I had worked the medical-surgical units at the General Hospital ever since graduating from my nursing program 4 years before. This was the worst night, the worst shift, of my nursing career.
I was assigned to care for eight patients that night, which is not an unusual number of patients, but they all were either fresh post-ops or so very sick. Four patients had just had surgery that day. One patient was on a dopamine drip to maintain his blood pressure, so he needed frequent monitoring. One patient was suspected to have meningitis, one patient had pneumonia, and a patient with suspected histoplasmosis completed my assignment.
One of my post-op patients was Betty Smith, a young woman in her early thirties who had laparoscopic surgery late in the day. She had been transferred from the recovery room late in the evening shift and was very uncomfortable when I first made my rounds. At 12:05 am, I called Betty's physician because she was vomiting and thrashing in bed. Per his order, I medicated the patient with Phenergan.
The next time I checked on Betty, she seemed to be more comfortable, but I realized that her IV had infiltrated. I was really overwhelmed with meeting the needs of all my patients, so I asked Joan Jones, the charge nurse, to restart Betty's IV. It was about 2:00 am when Nurse Joan restarted the IV.
I had been able to pretty much stay on top of everything at that point in the shift, and by 2:30 am I had assessed all my patients, given pain medications, and called four physicians to update them regarding their patients and for various orders. I thought things were settling down. I thought wrong.
Mrs. Holmes, the patient with histoplasmosis, seemed a bit off from when I had cared for her the previous two nights. Mrs. Holmes' vital signs were unstable and her O2 saturation was only 80%. I notified her physician and he ordered stat arterial blood gases. The lab called with the results, and they were alarming. Mrs. Homes was losing ground, and her physician ordered us to transfer her to the ICU. I was preoccupied with accomplishing the transfer and accompanied Mrs. Holmes to the unit. I returned from the ICU at about 3:50 am.
On my return, I first checked the patient who was on dopamine, medicated another patient for pain, and did visual checks on the rest of the patients who all seemed to be sleeping. I began my charting.
At 6:05 am, I went to start IV antibiotics on Betty's roommate, and to my horror discovered Betty was not breathing. I called the code. The first time I discovered that Betty had had a low blood pressure and elevated pulse was when I checked the vital signs sheet when the ER physician (who responded to the code) asked how Betty's vital signs had been during the shift ...
Child abuseProtestRally HandoutChild abuseI have written a pJinElias52
Child abuse:Protest/Rally Handout
Child abuse
I have written a paper, which is about the Child Abuse, and it includes the following points:
• Child abuse.
• Physical Abuse.
• Sexual Violence.
• Negligence.
• Emotional Exploitation.
For this reason, I need a Protest/Rally Handout about my paper, which I wrote, and it has to be:
· 300 words minimum.
· Opening: headline.
· Action/Organization/Cause Introduction: two to three sentences maximum. Strong, direct writing.
· Bulleted list of statistics (with sources); quotes; and action needed. Practice parallelism by matching first words in bulleted list; use active verbs to introduce bulleted items, when possible; and, highlight necessary stats and quotes with bold and/or italics.
· Closing: Call to Action and ways to reach you/org.
Note: the Protest/Rally Handout should include all of the points which were included in my paper. Child abuse, Physical Abuse, Sexual Violence, Negligence and Emotional Exploitation.
Example
Protest/Rally has to be the same of this example.
SUBDOMAIN 734.3 ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP
Competencies: 734.3.1: Principles of Leadership The graduate applies principles of leadership to promote highquality
healthcare in a variety of settings through the application of sound leadership principles.
734.3.2: Interdisciplinary Collaboration The graduate applies theoretical principles necessary for effective participation in an
interdisciplinary team.
734.3.3: Quality and Patient Safety The graduate applies quality improvement processes intended to achieve optimal healthcare
outcomes, contributing to and supporting a culture of safety.
734.3.4: Healthcare Utilization and Finance The graduate analyzes financial implications related to healthcare delivery,
reimbursement, access, and national initiatives
Introduction:
Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any
sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a
failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the
hospital described in this scenario, you have been selected as a member of the team investigating the incident.
Scenario:
It is 3:30 p.m. on a Thursday and Mr. B, a 67yearold patient, arrives at the sixroom emergency department (ED) of a sixtybed
rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe
pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR88 (regular), T98.6, R32, and his weight was
recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area ...
This is an actual TMLT medical malpractice case. It involves a family physician treating a patient with chest pain. This presentation illustrates how action or inaction on the part of the physician led to allegations of professional liability, and how risk management techniques may have either prevented the outcome or increased the physician's defensibility. The case has been modified to protect the privacy of the physician and the patient.
HISTORICAL CASE STUDY #2 Attentiveness and SurveillanceTHE IMPOSusanaFurman449
HISTORICAL CASE STUDY #2: Attentiveness and Surveillance
THE IMPORTANCE xOF CROSS-MONITORING TEAM MEMBERS' PERFORMANCES
HISTORY
This case involved three shifts of nurses over a 24-hour period working in a long-term care (LTC) facility. The facility included three separate units with 40 beds per unit. A licensed practical nurse charge nurse was assigned to each unit. One registered nurse supervisor was responsible per shift for the oversight of all three units.
Ms. Kathy Chin had been admitted to the LTC facility in October with heart failure, bipolar disorder with depression, constipation, history of gastrointestinal bleed, glaucoma, and discomfort. She required total care and was not able to effectively express her needs to the LTC staff. In January she had a bowel impaction, and Fleet enemas were administered. She was discovered unresponsive in her room the next afternoon and was transported to the hospital. Blood work revealed that she had a urinary tract infection. She was administered antibiotics and discharged back to the LTC facility.
Six weeks later, Ms. Chin had another episode of constipation. The day shift Nurse Supervisor, Ms. Angela Guilarte, notified Ms. Chin's physician, Dr. Brian Fisher. Dr. Fisher ordered an x-ray of Ms. Chin's abdomen, and it revealed severe constipation with fecal impaction. Dr. Fisher ordered clear liquids only and “Fleet enemas until clear.” This was the same regime that was previously ordered and administered to Ms. Chin in January.
A licensed practical nurse, Ms. Margaret Reyes, took the order by telephone, notified day shift Nurse Supervisor Guilarte, documented the order in Ms. Chin's chart, as originally received from Dr. Fisher, and on the medication administration record [MAR] “enemas continuously until clear.” Practical Nurse Reyes, who received the order for “Fleet enemas until clear,” questioned the order and discussed it with Nurse Supervisor Guilarte. They determined that the enemas should be administered every 3 hours until the return was clear but did not clarify this with Dr. Fisher or pass this information on to the next shift.
The enemas were administered over a 12-hour period by three licensed practical nurses working various shifts. Again Ms. Chin was found unresponsive, and she was transferred to the hospital where she died 6 hours after admission.
THE NURSE'S STORY
I came to work early that evening and was told that the licensed practical charge nurse for one of the units had called in sick. I realized that I would have to cover the patients for the licensed practical nurse as well as provide supervision for the other two units. I received a short verbal report from Ms. Zellner, the evening shift registered nurse supervisor, who reported Ms. Chin's bowel impaction and the order to administer Fleet enemas until clear. I was told that Ms. Chin had been given three enemas prior to my shift.
It didn't occur to me that I should assess Ms. Chin and review her orders. I started administering ...
This is a presentation about medical error with the following Objectives:
1- Learn step-by-step what to do when medical error occurs and how to report it
2- Learn how to identify root cause of a medical error and how to prevent its recurrence
3- Motivate your colleagues to foster a patient safety culture
1) It is 330 p.m. on a Thursday and Mr. B, a 67-year-old patien.docxdorishigh
1)
It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After the nurse completes Mr. B’s assessment, Nurse J informs the ED physician of admission findings and the ED physician proceeds to examine Mr. B.
Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at four out of ten on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by the ED physician and are awaiting further treatment or orders.
After evaluation of Mr. B, Dr. T, the ED physician, writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication (hydromorphone) is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepa ...
I performed a presentation to the board of directors in Labib Medical Center on the Early Warning Score with a view to introducing this tool which has been standardised across centers in the UK. The evidence states that this tool reduces mortality and morbidity rates and also reduces admissions into Intensive Care Unit.
Group Project Assignment Legal Malpractice Case Description.docxJeanmarieColbert3
Group Project: Assignment Legal Malpractice Case Description
Outcomes addressed in this Assignment:
MN506-2:
Critique ethical-legal concepts, principles, and dilemmas related to the provision of health care.
The group will write a10–15-page APA formatted paper (title page and references list do not count towards the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must have minimum of eight references. You may have an appendix that has samples of documents that support your positions or expands on the facts of the case.
Liability issues
Parties involved and who should be sued
Defenses of the parties
Standards of care
Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter, Deceased
People Involved in Case:
Mrs. Wilma Carpenter — patient, deceased
Mr. Howard Carpenter — husband and plaintiff in wrongful death suit
Mrs. Scale, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
Richard Washington, MD — orthopedic surgeon
Judy Gouda, RN, NP
Joseph Alsoff, LPN — post-surgical unit nurse
Kelly Wheeler, RN — post-surgical unit nurse
David Casler, LRT
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
Caring Memorial Hospital
Facts:
The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.
The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse's assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.
Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.
The lice.
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
T he fifteen year-old patient was scheduled for surgery on t.docxlillie234567
T he fifteen year-old patient was
scheduled for surgery on the right
side of his brain to remove a right tem-
poral lobe lesion that was believed to be
causing his epileptic seizures.
The surgery began with the sur-
geon making an incision on the left
side, opening the skull, penetrating the
dura and removing significant portions
of the left amygdala, hippocampus and
other left-side brain tissue before it was
discovered that they were working on
the wrong side.
The left-side wound was closed,
the right side was opened and the pro-
cedure went ahead on the right, correct
side.
The error in the O.R. was revealed
to the parents shortly after the surgery,
but only as if it was a minor and incon-
sequential gaffe.
The patient recuperated, left the
hospital, returned to his regular activi-
ties and graduated from high school
before his parents could no longer deny
he was not all right. After a thorough
neurological assessment he had to be
placed in an assisted living facility for
brain damaged individuals.
When the full magnitude of the
consequences came to light a lawsuit
was filed which resulted in a $11 mil-
lion judgment which was affirmed by
the Supreme Court of Arkansas.
A circulating nurse has a le-
gal duty to see that surgery
does not take place on the
wrong side of the body.
The preoperative documents
failed to identify on which side
the surgery was to be done.
It was below the standard of
care for the circulating nurse
not to notice that fact and not
to seek out the correct infor-
mation.
SUPREME COURT OF ARKANSAS
December 13, 2012
Operating Room: Surgical Error Blamed, In
Part, On Circulating Nurse’s Negligence.
Surgical Error Blamed, In Part, On
Circulating Nurse’s Negligence
The Court accepted the testimony
of the family’s nursing expert that a
circulating nurse has a fundamental
responsibility as a member of the surgi-
cal team to make sure that surgery is
done on the correct anatomical site,
especially when it is brain surgery.
The circulating nurse is supposed
to understand imposing terms like se-
lective amygdala hippocampectomy
and know the basics of how it is sup-
posed to be done.
Hospital policy called for the sur-
geon, the anesthesiologist, the circulat-
ing nurse and the scrub nurse or tech to
take a “timeout” prior to starting a sur-
gical case for final verification of the
correct anatomical site.
The circulating nurse should have
available three essential documents, the
surgical consent form, the preoperative
history and the O.R. schedule.
The full extent of the error, that is,
a full list of the parts of the brain that
were removed from the healthy side,
should have been documented by the
circulating nurse, and failure to do so
was a factor that adversely affected the
patient’s later medical course, the pa-
tient’s nursing expert said. Proassur-
ance v. Metheny, __ S.W. 3d __, 2012 WL
6204231 (Ark.
Case Study 16 Acute Coronary SyndromeDifficulty Asimisterchristen
Case Study
16 Acute Coronary Syndrome
Difficulty: Advanced
Setting: Emergency department, hospital, home care
Index Words: heart failure (HF), coronary artery disease (CAD), arm fracture, communication deficit, cultural diversity, geriatric, laboratory values, therapeutic nutrition, medications, electrolytes
Giddens Concepts: Care Coordination, Communication, Culture, Fluid and Electrolyte Balance, Perfusion
HESI Concepts: Assessment, Care Coordination, Communication, Cultural/Spiritual, Fluid & Electrolyte, Perfusion
You are just getting caught up with your work when you receive the following phone call: “Hi, this is Deb in the emergency department. We're sending you M.M., a 63-year-old Hispanic woman with a past medi- cal history of coronary artery disease (CAD). Her daughter reports that her mom has become increasingly weak over the past couple of weeks and has been unable to do her housework. Apparently, she has had complaints of swelling in her ankles and feet by late afternoon 'she couldn't wear her shoes' and has nocturnal diuresis× 4. Her daughter brought her in because she has had heaviness in her chest off and on over the past few days but denies any discomfort at this time. The daughter took her to see her family physician who immediately sent her here. Vital signs are 146/92, 96, 24, 99 ° F (37.2 ° C). She has an IV of D5W at 50 mL/hr in her right forearm. Her laboratory results are as follows: Na 134 mEq/L, K 3.5 mEq/L, Cl 103 mEq/L, HCO3 23 mEq/L, BUN 13 mg/dL, creatinine 1.3 mg/dL, glucose 153 mg/dL, WBC 8300/mm3, Hct 33.9%, Hgb 11.7 g/dL, platelets 162,000/mm3. PT/INR, PTT, and urinalysis are pending. She has had her chest x-ray and ECG, and her orders have been written.”
·
Scenario
1. What additional information do you need from the emergency department (ED) nurse?
2. How are you going to prepare for this patient?
1 Cardiovascular Disorders
3. M.M. arrives by wheelchair. As she transfers to the bed, what observations will you make? Why?
4. Given the previous information, you can anticipate orders for M.M. Carefully review each order to determine whether it is appropriate or inappropriate as written. If the order is appropriate, mark it as
A; if the order is inappropriate, mark it as
I and change the order to make it appropriate. Provide any other orders that might be appropriate for M.M.
1. Routine VS
2. Serum magnesium (Mg) STAT
3. Up ad lib
4. 10 g sodium (Na), low-fat diet
5. Change IV to a saline lock
6. Cardiac enzymes on admission and q8h × 24 hr, then daily every morning
7. CBC, BMP, and fasting lipid profile in morning
8. Schedule for abdominal CT scan for am
9. Heparin 10,000 units subcut q8h
10. Docusate sodium (Colace) 100 mg/day PO
11. Ampicillin 250 ...
Handing Taking Over by using SBAR. pptxHussain278181
ISBAR is a structured communication tool used in healthcare:
I: Introduce yourself
S: Situation (describe the problem)
B: Background (patient history)
A: Assessment (current status)
R: Recommendation (suggested action)
It promotes clear and concise communication for better patient c
HISTORICAL CASE STUDY #1 Failure to Adequately Monitor a PostsurgSusanaFurman449
HISTORICAL CASE STUDY #1: Failure to Adequately Monitor a Postsurgical Patient
DESCRIPTION OF THE EVENT
This error-event involved inadequate monitoring of a patient who had undergone an elective surgical procedure. A certified nursing assistant made a proximal error when she failed repeatedly to report abnormal vital signs to a registered nurse assigned to the patient. The patient was receiving narcotics via a patient-controlled infusion device. The patient was obese and had a large neck. He also had a history of sleep apnea. This combination of factors may have combined to cause respiratory depression that resulted in abnormal vital signs.
The nursing assistant's reporting was inadequate, and consequently the registered nurse was unaware of the patient's low blood pressure. The patient's condition subsequently deteriorated to the point where he was seriously compromised and near death, and may have been permanently harmed as a result.
DEMOGRAPHICS
This error-event occurred in a community hospital setting. In this event the investigation revealed that three people made errors that constituted unsafe acts and resulted in harm to the patient. These included the nursing assistant, the registered nurse (who was prepared at the associate degree level), the registered nurse in the charge/staff nurse role, and a board-certified surgeon.
The registered nurse and surgeon agreed to be interviewed, but the nursing assistant declined. Three additional people were indirectly involved and participated in the interview process. They were the oncoming registered nurse (prepared at the associate degree level of nursing), a registered (associate degree) respiratory therapist on duty, and the associate degree registered nurse house supervisor.
The root cause analysis group included two of the people who engaged in unsafe acts, one other person who was directly involved, and six additional people with expertise in the routine practices and processes of the surgical unit and related areas.
SETTING ELEMENTS
The incident occurred during one 12-hour shift between Friday at 7:00 pm and Saturday at 7:30 am. All of the individuals directly involved in the event were working a regularly scheduled shift. The two employees who carried out the unsafe acts were working the night shift. The surgeon involved in the case had not worked the night before.
BACKGROUND INFORMATION
In the hospital setting, patients often receive pain medication through a pump that provides a specific dose on demand with a programmed maximum dose allotment. The patient-controlled analgesia (PCA) pump is programmed to deliver specific, small dosages of the medication only when the patient pushes a specified button. Therefore, if the patient is unable to push the button, he/she does not receive any more of the medication via the pump.
NARRATIVE OF THE EVENT
A young man, Mr. Steve Goldberg, was admitted to a surgical unit at 6:00 pm after an elective laparoscopic gastric bypass surgical procedure. Mr. G ...
This is a Unfolding Case StudyPatient DetailsPrint Phase In.docxkenth16
This is a Unfolding Case Study
Patient Details:
Print Phase Info
|
Case Study History
Name:
James, Karen
Age:
57 Years
Gender:
Female
Karen James is a 57-year-old female who was admitted to the medical-surgical unit from her primary care physician’s office for treatment and evaluation of persistent and worsening influenza. She has a past medical history of asthma as well as depression and anxiety.
You are currently working on Phase 1. You have completed Phase 0 of this scenario.
Patient Details:
Print Phase Info
|
Case Study History
Name:
James, Karen
Age:
57 Years
Gender:
Female
Phase
1,
Wednesday
16:00
You have assumed care for Ms. James who is admitted to the medical-surgical unit for rehydration and management of respiratory distress.
Orient yourself to the patient and health record by locating the following pieces of information within the System Assessment Report and Patient Teaching, and type your answers in a Miscellaneous Nursing Note:
1). Run a report on all the System Assessments documented for the patient in the last 24 hours. You will need to go to Patient Charting > System Assessments > Show Saved Charting. What was documented for the respiratory effort? What was auscultated in the Lower Right Posterior lobe of the lungs? What was documented related to tissue perfusion?
2). What was the last documented temperature for Karen?
3). Does Ms. James use any sensory aides?
4) What does she rate her pain?
5) What is her MORSE Fall Risk Score?
Review the client's History and Physical, what indications can you see place this patient at risk for mobility issues or falls?
[LEARNER ACTION: In a misc nursing note identify risks for mobility and falls. Explain her score on the MORSE scale.]
When you are finished with this task, you may click Complete this Phase.
Patient Information
Chief Informant:
Patient
Chief Complaint:
Shortness of breath, productive cough
History of Current Problem:
Patient states she has had 3-week history of influenza. Has now developed a severe cough approximately 3 days ago with shortness of breath. Unable to sleep due to cough, which often causes bronchospasms. Patient also complains of fever, fatigue, and right-sided chest pain. Seen in urgent care 3 days ago and given Z-pack. No improvement in symptoms.
Allergies:
None known
Family History:
Mother died at age of 72 with breast cancer. Father is alive at the age of 79 and has congestive heart failure.
Past Medical History
Previous Illnesses:
Patient has asthma. Also states she gets bronchitis every 1-2 years.
Contagious Diseases:
None
Injuries or Trauma:
None
Surgical History:
Tonsillectomy and adenoidectomy as a child.
Dietary History:
Regular diet. Patient is 5'1" and 140 pounds. Has recently lost 20 pounds on Weight Watchers diet.
Other:
--
Social History:
No smoking, no drugs. Uses alcohol in social situations.
Current Medications:
Tylenol 650 mg PO every 4 hours PRN pain .
Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docxadampcarr67227
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
11Getting Started with PhoneGapWHAT’S IN THIS CHAPTERSantosConleyha
11
Getting Started with PhoneGap
WHAT’S IN THIS CHAPTER?
! History of PhoneGap
! Di! erences between HTML5 and PhoneGap
! Getting a development environment set up
! Implementing the Derby App
PhoneGap is an open source set of tools created by Nitobi
Solution
s (now part of Adobe)
that enables you to create mobile applications for multiple devices by utilizing the same code.
PhoneGap is a hybrid mobile application framework that allows the use of HTML, CSS,
and JavaScript to write applications that are based on the open standards of the web. These
applications also have access to the native functionality of the device. PhoneGap has been
downloaded more than 600,000 times, and more than 1,000 apps built with PhoneGap are
available in the respective app stores, which makes PhoneGap a viable solution for creating
cross-platform mobile apps.
HISTORY OF PHONEGAP
PhoneGap was started at the San Francisco iPhone Dev Camp in August 2008. iOS was shaping
up to become a popular mobile platform, but the learning curve for Objective-C was more work
than many developers wanted to take on. PhoneGap originally started as a headless browser
implementation for the iPhone. Because of the popularity of HTML/CSS/JavaScript, it was a
goal that this project use technologies with which many developers where already familiar.
Based on the growing popularity of the framework, in October 2008 Nitobi added support
for Android and BlackBerry. PhoneGap was awarded the People’s Choice award at the Web2.0
Expo Launch Pad in 2009, which was the start of developers recognizing PhoneGap as a
valuable mobile development tool. PhoneGap version 0.7.2 was released in April 2009, and
was the fi rst version for which the Android and iPhone APIs were equivalent.
c11.indd 309c11.indd 309 28/07/12 6:08 PM28/07/12 6:08 PM
310 " CHAPTER 11 GETTING STARTED WITH PHONEGAP
In September 2009 Apple approved the use of the PhoneGap platform to build apps for the iPhone
store. Apple required that all PhoneGap apps be built using at least version 0.8.0 of the PhoneGap
software. In July 2011, PhoneGap released version 1.0.0.
WHY USE PHONEGAP?
PhoneGap enables you to leverage your current HTML, CSS, and JavaScript skill sets to create a mobile
application. This can greatly speed up development time. When you develop for multiple platforms
using PhoneGap, you can reuse the majority of the code you have written for the mobile project, further
reducing development costs. It isn’t necessary to learn Java, C#, and Objective-C to create an applica-
tion with PhoneGap that can target iPhone, Android, BlackBerry, and Windows Phone 7.
If you fi nd native functionality missing from PhoneGap, you can extend the functionality of the
PhoneGap platform using native code. With the PhoneGap add-in structure, you can create an add-in
using the native language of the device and a JavaScript API that will call the native plug-in you
created. Cross-platfo ...
11Proposal Part One - Part 1 Influence of Internet on TourismSantosConleyha
11
Proposal Part One - Part 1: Influence of Internet on Tourism Industry
Research Proposal: Influence of Internet on Tourism Industry
Introduction
The tourism industry has been among the best-valued sectors within the nation to generate massive revenue for the government. Besides, the industry is considered among the earliest since it started several decades ago. For an extended period, the industry uses Integrated Marketing Communications to promote their various products and services to the entire world. The introduction of technology in the industry leads to improvements in the sectors. Most individuals without extensive information on the tourism industry can access the data in their comfort zones. It implies that IT and internet technology play a significant role in ensuring effective strategy due to its existence globally.
Most European countries have tried to promote and implement internet technology in ensuring satisfactory delivery of products and services (Kayumovich, 2020). Since it has a custom within the tourism and hotel industry to provide intangible products and services, including but not limited to services alongside comfort, the internet has been an effective method of delivering its messages to the targeted customers. Also, through internet technology, the industry has achieved more customers in the global market, including the European market. The promotion of branding within the European tourism industry has been effective due to the introduction and implementation of internet technology. Thus, the internet is believed to significantly influence the tourism industry in various sectors, including but limited to infrastructure, travel, alongside the marketing sector. Before introducing the internet alongside the IT, travelling of customers was dangerous and unpleasant since travellers had constraint understanding of locations they were visiting.
As a result, the existing vacationers of time had limited knowledge of the cultures and terrain alongside the climate change and patterns necessary to stimulate the travelling issues. Therefore, tourism sectors, including but not limited to tour companies, travel agencies and other like hotels, had developed strategies necessary to promote booking and reservation processes (David-Negre et al. 2018). However, several decades ago, popular sites were visited by tourists. It implies that the tourism sectors within the local or remote area faced challenges of securing sufficient clients as people were could not define the destination. Also, shortage of information on a particular region leads to reduced travelling by visitors. The research involved the utilization of relevant literature review on the subject matter to provide factual information. Therefore, the report offers adequate information on the influence of the internet on the tourism industry. This research would give me the stage to show my finding and view and also propose how the internet can be leveraged to an extend i ...
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Similar to 1. Student uses MS Excel to calculate income tax expense or refund
1) It is 330 p.m. on a Thursday and Mr. B, a 67-year-old patien.docxdorishigh
1)
It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After the nurse completes Mr. B’s assessment, Nurse J informs the ED physician of admission findings and the ED physician proceeds to examine Mr. B.
Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at four out of ten on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by the ED physician and are awaiting further treatment or orders.
After evaluation of Mr. B, Dr. T, the ED physician, writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication (hydromorphone) is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepa ...
I performed a presentation to the board of directors in Labib Medical Center on the Early Warning Score with a view to introducing this tool which has been standardised across centers in the UK. The evidence states that this tool reduces mortality and morbidity rates and also reduces admissions into Intensive Care Unit.
Group Project Assignment Legal Malpractice Case Description.docxJeanmarieColbert3
Group Project: Assignment Legal Malpractice Case Description
Outcomes addressed in this Assignment:
MN506-2:
Critique ethical-legal concepts, principles, and dilemmas related to the provision of health care.
The group will write a10–15-page APA formatted paper (title page and references list do not count towards the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must have minimum of eight references. You may have an appendix that has samples of documents that support your positions or expands on the facts of the case.
Liability issues
Parties involved and who should be sued
Defenses of the parties
Standards of care
Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter, Deceased
People Involved in Case:
Mrs. Wilma Carpenter — patient, deceased
Mr. Howard Carpenter — husband and plaintiff in wrongful death suit
Mrs. Scale, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
Richard Washington, MD — orthopedic surgeon
Judy Gouda, RN, NP
Joseph Alsoff, LPN — post-surgical unit nurse
Kelly Wheeler, RN — post-surgical unit nurse
David Casler, LRT
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
Caring Memorial Hospital
Facts:
The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.
The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse's assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.
Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.
The lice.
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
T he fifteen year-old patient was scheduled for surgery on t.docxlillie234567
T he fifteen year-old patient was
scheduled for surgery on the right
side of his brain to remove a right tem-
poral lobe lesion that was believed to be
causing his epileptic seizures.
The surgery began with the sur-
geon making an incision on the left
side, opening the skull, penetrating the
dura and removing significant portions
of the left amygdala, hippocampus and
other left-side brain tissue before it was
discovered that they were working on
the wrong side.
The left-side wound was closed,
the right side was opened and the pro-
cedure went ahead on the right, correct
side.
The error in the O.R. was revealed
to the parents shortly after the surgery,
but only as if it was a minor and incon-
sequential gaffe.
The patient recuperated, left the
hospital, returned to his regular activi-
ties and graduated from high school
before his parents could no longer deny
he was not all right. After a thorough
neurological assessment he had to be
placed in an assisted living facility for
brain damaged individuals.
When the full magnitude of the
consequences came to light a lawsuit
was filed which resulted in a $11 mil-
lion judgment which was affirmed by
the Supreme Court of Arkansas.
A circulating nurse has a le-
gal duty to see that surgery
does not take place on the
wrong side of the body.
The preoperative documents
failed to identify on which side
the surgery was to be done.
It was below the standard of
care for the circulating nurse
not to notice that fact and not
to seek out the correct infor-
mation.
SUPREME COURT OF ARKANSAS
December 13, 2012
Operating Room: Surgical Error Blamed, In
Part, On Circulating Nurse’s Negligence.
Surgical Error Blamed, In Part, On
Circulating Nurse’s Negligence
The Court accepted the testimony
of the family’s nursing expert that a
circulating nurse has a fundamental
responsibility as a member of the surgi-
cal team to make sure that surgery is
done on the correct anatomical site,
especially when it is brain surgery.
The circulating nurse is supposed
to understand imposing terms like se-
lective amygdala hippocampectomy
and know the basics of how it is sup-
posed to be done.
Hospital policy called for the sur-
geon, the anesthesiologist, the circulat-
ing nurse and the scrub nurse or tech to
take a “timeout” prior to starting a sur-
gical case for final verification of the
correct anatomical site.
The circulating nurse should have
available three essential documents, the
surgical consent form, the preoperative
history and the O.R. schedule.
The full extent of the error, that is,
a full list of the parts of the brain that
were removed from the healthy side,
should have been documented by the
circulating nurse, and failure to do so
was a factor that adversely affected the
patient’s later medical course, the pa-
tient’s nursing expert said. Proassur-
ance v. Metheny, __ S.W. 3d __, 2012 WL
6204231 (Ark.
Case Study 16 Acute Coronary SyndromeDifficulty Asimisterchristen
Case Study
16 Acute Coronary Syndrome
Difficulty: Advanced
Setting: Emergency department, hospital, home care
Index Words: heart failure (HF), coronary artery disease (CAD), arm fracture, communication deficit, cultural diversity, geriatric, laboratory values, therapeutic nutrition, medications, electrolytes
Giddens Concepts: Care Coordination, Communication, Culture, Fluid and Electrolyte Balance, Perfusion
HESI Concepts: Assessment, Care Coordination, Communication, Cultural/Spiritual, Fluid & Electrolyte, Perfusion
You are just getting caught up with your work when you receive the following phone call: “Hi, this is Deb in the emergency department. We're sending you M.M., a 63-year-old Hispanic woman with a past medi- cal history of coronary artery disease (CAD). Her daughter reports that her mom has become increasingly weak over the past couple of weeks and has been unable to do her housework. Apparently, she has had complaints of swelling in her ankles and feet by late afternoon 'she couldn't wear her shoes' and has nocturnal diuresis× 4. Her daughter brought her in because she has had heaviness in her chest off and on over the past few days but denies any discomfort at this time. The daughter took her to see her family physician who immediately sent her here. Vital signs are 146/92, 96, 24, 99 ° F (37.2 ° C). She has an IV of D5W at 50 mL/hr in her right forearm. Her laboratory results are as follows: Na 134 mEq/L, K 3.5 mEq/L, Cl 103 mEq/L, HCO3 23 mEq/L, BUN 13 mg/dL, creatinine 1.3 mg/dL, glucose 153 mg/dL, WBC 8300/mm3, Hct 33.9%, Hgb 11.7 g/dL, platelets 162,000/mm3. PT/INR, PTT, and urinalysis are pending. She has had her chest x-ray and ECG, and her orders have been written.”
·
Scenario
1. What additional information do you need from the emergency department (ED) nurse?
2. How are you going to prepare for this patient?
1 Cardiovascular Disorders
3. M.M. arrives by wheelchair. As she transfers to the bed, what observations will you make? Why?
4. Given the previous information, you can anticipate orders for M.M. Carefully review each order to determine whether it is appropriate or inappropriate as written. If the order is appropriate, mark it as
A; if the order is inappropriate, mark it as
I and change the order to make it appropriate. Provide any other orders that might be appropriate for M.M.
1. Routine VS
2. Serum magnesium (Mg) STAT
3. Up ad lib
4. 10 g sodium (Na), low-fat diet
5. Change IV to a saline lock
6. Cardiac enzymes on admission and q8h × 24 hr, then daily every morning
7. CBC, BMP, and fasting lipid profile in morning
8. Schedule for abdominal CT scan for am
9. Heparin 10,000 units subcut q8h
10. Docusate sodium (Colace) 100 mg/day PO
11. Ampicillin 250 ...
Handing Taking Over by using SBAR. pptxHussain278181
ISBAR is a structured communication tool used in healthcare:
I: Introduce yourself
S: Situation (describe the problem)
B: Background (patient history)
A: Assessment (current status)
R: Recommendation (suggested action)
It promotes clear and concise communication for better patient c
HISTORICAL CASE STUDY #1 Failure to Adequately Monitor a PostsurgSusanaFurman449
HISTORICAL CASE STUDY #1: Failure to Adequately Monitor a Postsurgical Patient
DESCRIPTION OF THE EVENT
This error-event involved inadequate monitoring of a patient who had undergone an elective surgical procedure. A certified nursing assistant made a proximal error when she failed repeatedly to report abnormal vital signs to a registered nurse assigned to the patient. The patient was receiving narcotics via a patient-controlled infusion device. The patient was obese and had a large neck. He also had a history of sleep apnea. This combination of factors may have combined to cause respiratory depression that resulted in abnormal vital signs.
The nursing assistant's reporting was inadequate, and consequently the registered nurse was unaware of the patient's low blood pressure. The patient's condition subsequently deteriorated to the point where he was seriously compromised and near death, and may have been permanently harmed as a result.
DEMOGRAPHICS
This error-event occurred in a community hospital setting. In this event the investigation revealed that three people made errors that constituted unsafe acts and resulted in harm to the patient. These included the nursing assistant, the registered nurse (who was prepared at the associate degree level), the registered nurse in the charge/staff nurse role, and a board-certified surgeon.
The registered nurse and surgeon agreed to be interviewed, but the nursing assistant declined. Three additional people were indirectly involved and participated in the interview process. They were the oncoming registered nurse (prepared at the associate degree level of nursing), a registered (associate degree) respiratory therapist on duty, and the associate degree registered nurse house supervisor.
The root cause analysis group included two of the people who engaged in unsafe acts, one other person who was directly involved, and six additional people with expertise in the routine practices and processes of the surgical unit and related areas.
SETTING ELEMENTS
The incident occurred during one 12-hour shift between Friday at 7:00 pm and Saturday at 7:30 am. All of the individuals directly involved in the event were working a regularly scheduled shift. The two employees who carried out the unsafe acts were working the night shift. The surgeon involved in the case had not worked the night before.
BACKGROUND INFORMATION
In the hospital setting, patients often receive pain medication through a pump that provides a specific dose on demand with a programmed maximum dose allotment. The patient-controlled analgesia (PCA) pump is programmed to deliver specific, small dosages of the medication only when the patient pushes a specified button. Therefore, if the patient is unable to push the button, he/she does not receive any more of the medication via the pump.
NARRATIVE OF THE EVENT
A young man, Mr. Steve Goldberg, was admitted to a surgical unit at 6:00 pm after an elective laparoscopic gastric bypass surgical procedure. Mr. G ...
This is a Unfolding Case StudyPatient DetailsPrint Phase In.docxkenth16
This is a Unfolding Case Study
Patient Details:
Print Phase Info
|
Case Study History
Name:
James, Karen
Age:
57 Years
Gender:
Female
Karen James is a 57-year-old female who was admitted to the medical-surgical unit from her primary care physician’s office for treatment and evaluation of persistent and worsening influenza. She has a past medical history of asthma as well as depression and anxiety.
You are currently working on Phase 1. You have completed Phase 0 of this scenario.
Patient Details:
Print Phase Info
|
Case Study History
Name:
James, Karen
Age:
57 Years
Gender:
Female
Phase
1,
Wednesday
16:00
You have assumed care for Ms. James who is admitted to the medical-surgical unit for rehydration and management of respiratory distress.
Orient yourself to the patient and health record by locating the following pieces of information within the System Assessment Report and Patient Teaching, and type your answers in a Miscellaneous Nursing Note:
1). Run a report on all the System Assessments documented for the patient in the last 24 hours. You will need to go to Patient Charting > System Assessments > Show Saved Charting. What was documented for the respiratory effort? What was auscultated in the Lower Right Posterior lobe of the lungs? What was documented related to tissue perfusion?
2). What was the last documented temperature for Karen?
3). Does Ms. James use any sensory aides?
4) What does she rate her pain?
5) What is her MORSE Fall Risk Score?
Review the client's History and Physical, what indications can you see place this patient at risk for mobility issues or falls?
[LEARNER ACTION: In a misc nursing note identify risks for mobility and falls. Explain her score on the MORSE scale.]
When you are finished with this task, you may click Complete this Phase.
Patient Information
Chief Informant:
Patient
Chief Complaint:
Shortness of breath, productive cough
History of Current Problem:
Patient states she has had 3-week history of influenza. Has now developed a severe cough approximately 3 days ago with shortness of breath. Unable to sleep due to cough, which often causes bronchospasms. Patient also complains of fever, fatigue, and right-sided chest pain. Seen in urgent care 3 days ago and given Z-pack. No improvement in symptoms.
Allergies:
None known
Family History:
Mother died at age of 72 with breast cancer. Father is alive at the age of 79 and has congestive heart failure.
Past Medical History
Previous Illnesses:
Patient has asthma. Also states she gets bronchitis every 1-2 years.
Contagious Diseases:
None
Injuries or Trauma:
None
Surgical History:
Tonsillectomy and adenoidectomy as a child.
Dietary History:
Regular diet. Patient is 5'1" and 140 pounds. Has recently lost 20 pounds on Weight Watchers diet.
Other:
--
Social History:
No smoking, no drugs. Uses alcohol in social situations.
Current Medications:
Tylenol 650 mg PO every 4 hours PRN pain .
Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docxadampcarr67227
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
11Getting Started with PhoneGapWHAT’S IN THIS CHAPTERSantosConleyha
11
Getting Started with PhoneGap
WHAT’S IN THIS CHAPTER?
! History of PhoneGap
! Di! erences between HTML5 and PhoneGap
! Getting a development environment set up
! Implementing the Derby App
PhoneGap is an open source set of tools created by Nitobi
Solution
s (now part of Adobe)
that enables you to create mobile applications for multiple devices by utilizing the same code.
PhoneGap is a hybrid mobile application framework that allows the use of HTML, CSS,
and JavaScript to write applications that are based on the open standards of the web. These
applications also have access to the native functionality of the device. PhoneGap has been
downloaded more than 600,000 times, and more than 1,000 apps built with PhoneGap are
available in the respective app stores, which makes PhoneGap a viable solution for creating
cross-platform mobile apps.
HISTORY OF PHONEGAP
PhoneGap was started at the San Francisco iPhone Dev Camp in August 2008. iOS was shaping
up to become a popular mobile platform, but the learning curve for Objective-C was more work
than many developers wanted to take on. PhoneGap originally started as a headless browser
implementation for the iPhone. Because of the popularity of HTML/CSS/JavaScript, it was a
goal that this project use technologies with which many developers where already familiar.
Based on the growing popularity of the framework, in October 2008 Nitobi added support
for Android and BlackBerry. PhoneGap was awarded the People’s Choice award at the Web2.0
Expo Launch Pad in 2009, which was the start of developers recognizing PhoneGap as a
valuable mobile development tool. PhoneGap version 0.7.2 was released in April 2009, and
was the fi rst version for which the Android and iPhone APIs were equivalent.
c11.indd 309c11.indd 309 28/07/12 6:08 PM28/07/12 6:08 PM
310 " CHAPTER 11 GETTING STARTED WITH PHONEGAP
In September 2009 Apple approved the use of the PhoneGap platform to build apps for the iPhone
store. Apple required that all PhoneGap apps be built using at least version 0.8.0 of the PhoneGap
software. In July 2011, PhoneGap released version 1.0.0.
WHY USE PHONEGAP?
PhoneGap enables you to leverage your current HTML, CSS, and JavaScript skill sets to create a mobile
application. This can greatly speed up development time. When you develop for multiple platforms
using PhoneGap, you can reuse the majority of the code you have written for the mobile project, further
reducing development costs. It isn’t necessary to learn Java, C#, and Objective-C to create an applica-
tion with PhoneGap that can target iPhone, Android, BlackBerry, and Windows Phone 7.
If you fi nd native functionality missing from PhoneGap, you can extend the functionality of the
PhoneGap platform using native code. With the PhoneGap add-in structure, you can create an add-in
using the native language of the device and a JavaScript API that will call the native plug-in you
created. Cross-platfo ...
11Proposal Part One - Part 1 Influence of Internet on TourismSantosConleyha
11
Proposal Part One - Part 1: Influence of Internet on Tourism Industry
Research Proposal: Influence of Internet on Tourism Industry
Introduction
The tourism industry has been among the best-valued sectors within the nation to generate massive revenue for the government. Besides, the industry is considered among the earliest since it started several decades ago. For an extended period, the industry uses Integrated Marketing Communications to promote their various products and services to the entire world. The introduction of technology in the industry leads to improvements in the sectors. Most individuals without extensive information on the tourism industry can access the data in their comfort zones. It implies that IT and internet technology play a significant role in ensuring effective strategy due to its existence globally.
Most European countries have tried to promote and implement internet technology in ensuring satisfactory delivery of products and services (Kayumovich, 2020). Since it has a custom within the tourism and hotel industry to provide intangible products and services, including but not limited to services alongside comfort, the internet has been an effective method of delivering its messages to the targeted customers. Also, through internet technology, the industry has achieved more customers in the global market, including the European market. The promotion of branding within the European tourism industry has been effective due to the introduction and implementation of internet technology. Thus, the internet is believed to significantly influence the tourism industry in various sectors, including but limited to infrastructure, travel, alongside the marketing sector. Before introducing the internet alongside the IT, travelling of customers was dangerous and unpleasant since travellers had constraint understanding of locations they were visiting.
As a result, the existing vacationers of time had limited knowledge of the cultures and terrain alongside the climate change and patterns necessary to stimulate the travelling issues. Therefore, tourism sectors, including but not limited to tour companies, travel agencies and other like hotels, had developed strategies necessary to promote booking and reservation processes (David-Negre et al. 2018). However, several decades ago, popular sites were visited by tourists. It implies that the tourism sectors within the local or remote area faced challenges of securing sufficient clients as people were could not define the destination. Also, shortage of information on a particular region leads to reduced travelling by visitors. The research involved the utilization of relevant literature review on the subject matter to provide factual information. Therefore, the report offers adequate information on the influence of the internet on the tourism industry. This research would give me the stage to show my finding and view and also propose how the internet can be leveraged to an extend i ...
11Social Inclusion of Deaf with Hearing CongreSantosConleyha
11
Social Inclusion of Deaf with Hearing Congregants within a Ministerial Setting Comment by Stumme, Clifford James (College Applied Studies & Acad Succ): As you review this sample student paper, please keep in mind that there are some flaws in this paper (as with any piece of writing). However, it is one of the best INDS 400 research proposals received to date, so it is an excellent reference point.
Sample Student Comment by Stumme, Clifford James (College Applied Studies & Acad Succ) [2]: Also, remember that what you are looking at is an example of the overall research proposal, not just the literature review. If you are working on your literature review, refer to the portion marked “literature review” and remember that within that literature review portion, there is a unique introduction, body paragraphs, and conclusion. The first paragraph is the introduction for the proposal as a whole, which is different from the kind of introduction you should write for the literature review itself. Also remember that while this research proposal has an abstract, you do not need one for the literature review.
Liberty University
INDS 400: Knowledge Synthesis for Professional and Personal Development
January 3, 2020
Abstract Comment by Stumme, Clifford James (College Applied Studies & Acad Succ) [2]: Notice how the abstract gives a brief overview of the elements of the research proposal without arguing or getting ahead of itself by predicting results.
Culture can influence how people interact and the level of inclusion of different cultures in a particular setting.While numerous studies have been conducted examining deaf studies and deaf culture, there is a curious lack of research that has specifically considered the level of inclusion of deaf people in evangelical hearing churches. This research proposal includes an interdisciplinary including a literature review that examines a handful of studies on interactions among deaf and hearing populations to consider challenges of hearing and deaf integration. Examining these diverse perspectives, including Catholic ministry, disability ministry and deaf culture, provides a fresh interdisciplinary perspective to approach the challenges of deaf inclusion in ministerial settings. It was found through this literature review that a gap in scholarly research exists in this area. As further research would be necessary to address this gap, the goal of this research proposal is to conduct a qualitative study for further research by petitioning deaf perspective through online interviews utilizing the social media platform of Facebook. Although a low budget would be necessary, the implications of this research would provide a platform to open community conversation to address challenges and provide ideas on integration of deaf and hearing congregants in evangelical hearing churches. Examining deaf perspectives may provide additional information for fellowship, growth and exposure to the Gospel for deaf congr ...
11Mental Health Among College StudentsTomia WillinSantosConleyha
11
Mental Health Among College Students
Tomia Willingham
Sophia Learning
Eng 215
March 14, 2021
Introduction
Going to college can be demanding for many people. In addition to managing academic insistence, many students have to cope with their families' complex separation tasks. At the same time, some of them continue to deal with a lot of many family duties. Mental health experts and advocates contend that it is an epidemic that colleges need to investigate further. Depression, anxiety disorders are some of the significant mental health issues that affect college students. The effects of suicidal ideas on university students' academic achievement have not been explored, yet mental health conditions are associated with academic achievement (De Luca et al., 2016). A novel coronavirus has worsened the situation of mental health. Even before the onset of this virus, there was concern from mental health policymakers in America because of the rising mental health challenges. They claimed a need for additional aid for struggling university students and the capability for these institutions to provide it. Regrettably, many university students with mental health conditions do not seek and receive the necessary treatment. The primary reasons for not pursuing help include thinking that the challenge will get better with time, stigma from their peers and no time to seek the treatment because of a busy schedule (Corrigan et al. 2016). Without this treatment, college students experiencing medical conditions most of the time get lower grades, drop out of college, immerse themselves into substance abuse, or become unemployed. Because these mental health conditions are invisible, they can only be seen through academic performance or social behavior change. Should universities strike a balance between mental health conditions and academics? This review will conclude that the mental health condition of university students and scholars should be balanced. Comment by Dr. Helen Doss: You need to answer this question and present the answer as the thesis at the end of this paragraph. Comment by Dr. Helen Doss: This is not a review essay—it is an argumentative or persuasive essay. Comment by Dr. Helen Doss: What does this mean—should be balanced? By what? For what? And, by whom? Comment by Dr. Helen Doss: This paragraph is too long. See: https://www.umgc.edu/current-students/learning-resources/writing-center/writing-resources/parts-of-an-essay/paragraph-structure.cfm
Effects of not Balancing Mental Health and Academics
There are consequences of not balancing mental health and academics in higher learning institutions, mainly if they do not receive any treatment. For example, if depression goes untreated, it raises the chances of risky behavior like substance abuse. The condition affects how students sleep, eat, and it also affects how students think. Also, students cannot concentrate in class, and they cannot make rational decisions. By lack of concent ...
11From Introductions to ConclusionsDrafting an EssayIn this chapSantosConleyha
11From Introductions to ConclusionsDrafting an Essay
In this chapter, we describe strategies for crafting introductions that set up your argument. We then describe the characteristics of well-formulated paragraphs that will help you build your argument. Finally, we provide you with some strategies for writing conclusions that reinforce what is new about your argument, what is at stake, and what readers should do with the knowledge you convey
DRAFTING INTRODUCTIONS
The introduction is where you set up your argument. It’s where you identify a widely held assumption, challenge that assumption, and state your thesis. Writers use a number of strategies to set up their arguments. In this section we look at five of them:
· Moving from a general topic to a specific thesis (inverted-triangle introduction)
· Introducing the topic with a story (narrative introduction)
· Beginning with a question (interrogative introduction)
· Capturing readers’ attention with something unexpected (paradoxical introduction)
· Identifying a gap in knowledge (minding-the-gap introduction)
Remember that an introduction need not be limited to a single paragraph. It may take several paragraphs to effectively set up your argument.
Keep in mind that you have to make these strategies your own. That is, we can suggest models, but you must make them work for your own argument. You must imagine your readers and what will engage them. What tone do you want to take? Playful? Serious? Formal? Urgent? The attitude you want to convey will depend on your purpose, your argument, and the needs of your audience.◼ The Inverted-Triangle Introduction
An inverted-triangle introduction, like an upside-down triangle, is broad at the top and pointed at the base. It begins with a general statement of the topic and then narrows its focus, ending with the point of the paragraph (and the triangle), the writer’s thesis. We can see this strategy at work in the following introduction from a student’s essay. The student writer (1) begins with a broad description of the problem she will address, (2) then focuses on a set of widely held but troublesome assumptions, and (3) finally, presents her thesis in response to what she sees as a pervasive problem.
The paragraph reads, “In today’s world, many believe that education’s sole purpose is to communicate information for students to store and draw on as necessary. By storing this information, students hope to perform well on tests. Good test scores assure good grades. Good grades eventually lead to acceptances into good colleges, which ultimately guarantee good jobs. Many teachers and students, convinced that education exists as a tool to secure good jobs, rely on the banking system. In her essay “Teaching to Transgress,” bell hooks defines the banking system as an “approach to learning that is rooted in the notion that all students need to do is consume information fed to them by a professor and be able to memorize and store it” (185). Through the banking s ...
11Groupthink John SmithCampbellsville UnivSantosConleyha
1
1
Groupthink
John Smith
Campbellsville University
BA611 – Organizational Theory
Dr. Jane Corbett
January 17, 2021
Definition
Groupthink is a pattern of thought characterized by self-deception, forced manufacture of consent, and conformity to group values and ethics.
Summary
Valine (2018) discussed how powerful an effect groupthink can have on community and peers. It followed two case studies about JPMorgan Chase and Wells Fargo, which explains how many sources and credentials the author has used. The focus of the article is that circumstances have occurred inside these companies which were able to affect the entire economy as well. Groupthink is usually followed by irrational thinking and decision making which completely ignores alternatives and constantly goes for the primary decision. The large difference between group and groupthink is that the group consists of members of various backgrounds and experiences, while groupthink usually has members of similar ones. Further, there is no way for groupthink to recover from bad decisions mainly because all members have a similar understanding and point of the view towards a certain topic. The illusion of invulnerability is the main characteristic related to groupthink, where teammates ignore the danger, take extreme risks, and act highly optimistic.
Discussion
Groupthink is characterized by incorrect decisions that groups make mainly due to mental efficiency, reality testing, and moral judgment. Many conditions can cause groupthink to occur, and the most frequent ones are collective rationalization, belief in inherent morality, stereotyped views of out-groups, direct pressure on dissenters, and self-censorship.
The collective rationalization explains how different warnings are against the group thinking, so and where those opinions can create a misunderstanding. Belief in inherent morality points out that members ignore the ethical and moral consequences of decisions because they believe the correctness of their cause. The stereotyped views of out-groups are the characters to create a negative feeling about opposition outside the group environment. The direct pressure on dissenters is where team leaders discuss all members that have different opinions and philosophies than the group’s commitments and agreement. Lastly, the self-censorship is where teammates keep their thoughts and opinions without expressing them to others.
The case study about the London Whale explains how JPMC, one of the largest banks in the world, has lost 6.5 billion dollars due to bad and poor investment decisions. Everything occurred in April and May of 2012, where larger trading loss happened in Chase’s Investment Office throughout the London branch. The main transaction that affected Morgan Chase was credit default swaps (CDS) and it was shown that famous trader Bruno Iksil has gathered significant CDS position in the market at that time. Following this case, the internal control has risen o ...
11Sun Coast Remediation Research Objectives, Research QueSantosConleyha
11
Sun Coast Remediation: Research Objectives, Research Questions, and Hypotheses
4
Sun Coast Remediation
Unique R. Simpkins
Southern Columbia University
Course Name Here
Instructor Name
11-2-2021
Research Objectives, Research Questions, and Hypotheses
Based on the information amassed by the former health and safety director, the organization needs to pursue safety-related programs or initiatives to ensure employees' health. It is an appropriate approach to help the firm and the employees achieve goals and inhibit costs arising from injuries and illnesses while on duty. The completion of this task will provide managers with practicable insights on the approach to enhance safety and protect the firm from losses. This task accounts for the objectives, questions, and hypotheses of the research based on the provided statement of the problem.
RO1: Explore the correlation between the size of the Particulate Matter (PM) and the health of the employee.
RQ1: Is there a correlation between the size of the Particulate Matter (PM) and the health of the employee?
Ho1: There is no statistically significant evidence connecting the size of the Particulate Matter (PM) and the health of the employee.
Ha1: There is statistically significant evidence connecting the size of the Particulate Matter (PM) and the health of the employee.
RO2: Establish whether safety training is feasible in decreasing the lost-time hours.
RQ2: Is safety training feasible in decreasing the lost-time hours?
Ho2: There is no statistically significant evidence linking safety training and reduction in lost-time hours.
Ha2: There is statistically significant evidence linking safety training and reduction in lost-time hours.
RO3: Establish the effectiveness of predicting the decibels (dB) levels before the employee placement on determining the on-site risk.
RQ3: Is predicting the decibels (dB) levels before the employee placement on determining the on site risk effective?
Ho3: There is no statistically significant relationship between predicting the decibels (dB) levels before the employee placement and effective determination of the on-site risk.
Ha3: There is a statistically significant relationship between predicting the decibels (dB) levels before the employee placement and effective determination of the on-site risk.
RO4: Establish whether the revised training program is more practicable than the initially adopted initiative.
RQ4: Is the revised training program is more practicable than the previously adopted initiative?
Ho4: There is no statistically significant proof that the new training program is more feasible than the old program.
Ha4: There is statistically significant proof that the new training program is more feasible than the old program.
RO5: Determine the blood lead levels variation before and after exposure at the end of the remediation service.
RQ5: Do the blood lead levels before and after exposure at the end of the remediation service va ...
11Me Talk Pretty One Day # By David Sedaris From his bSantosConleyha
11
Me Talk Pretty One Day # By David Sedaris
From his book Me Talk Pretty One Day
At the age of forty-one, I am returning to school and have to think of myself as
what my French textbook calls Ba true debutant.D After paying my tuition, I was issued
a student ID, which allows me a discounted entry fee at movie theaters, puppet shows,
and Festyland, a far-flung amusement park that advertises with billboards picturing a
cartoon stegosaurus sitting in a canoe and eating what appears to be a ham sandwich.
IFve moved to Paris with hopes of learning the language. My school is an easy
ten-minute walk from my apartment, and on the first day of class I arrived early,
watching as the returning students greeted one another in the school lobby. Vacations
were recounted, and questions were raised concerning mutual friends with names like
Kang and Vlatnya. Regardless of their nationalities, everyone spoke what sounded to
me like excellent French. Some accents were better than others, but the students
exhibited an ease and confidence that I found intimidating. As an added discomfort,
they were all young, attractive, and well-dressed, causing me to feel not unlike Pa Kettle
trapped backstage after a fashion show.
The first day of class was nerve-racking because I knew IFd be expected to
perform. ThatFs the way they do it here # itFs everybody into the language pool, sink or
swim. The teacher marched in, deeply tanned from a recent vacation, and proceeded to
rattle off a series of administrative announcements. IFve spent quite a few summers in
Normandy, and I took a monthlong French class before leaving New York. IFm not
completely in the dark, yet I understood only half of what this woman was saying.
BIf you have not meimslsxp or lgpdmurct by this time, then you should not be in
this room. Has everyone apzkiubjxow? Everyone? Good, we shall begin.D She spread
out her lesson plan and sighed, saying, BAll right, then, who knows the alphabet?D
It was startling because (a) I hadnFt been asked that question in a while and (b) I
realized, while laughing, that I myself did not know the alphabet. TheyFre the same
letters, but in France theyFre pronounced differently. I know the shape of the alphabet
but had no idea what it actually sounded like.
BAhh.D The teacher went to the board and sketched the letter a. BDo we have
anyone in the room whose first name commences with an ahh?D
12
Two Polish Annas raised their hands, and the teachers instructed them to present
themselves by stating their names, nationalities, occupations, and a brief list of things
they liked and disliked in this world. The first Anna hailed from an industrial town
outside of Warsaw and had front teeth the size of tombstones. She worked as a
seamstress, enjoyed quiet times with friends, and hated the mosquito.
BOh, really,D the teacher said. BHow very interesting. I thought that everyone
loved the mosquito, but here, in front of all the world, you claim to ...
11Program analysis using different perspectivesSantosConleyha
11
Program analysis using different perspectives
Student's Name
Institution
Course
Professor
Date
TABLE OF CONTENTS
Introduction……………………………………………………………………………………
Program Description/ Analysis of a Classical Liberal perspective…………………………
Program Description/ Analysis of a Radical perspective……………………………………
Program Description/ Analysis of a Conservative perspective……………………………..
Program Description/ Analysis of a Mordern Liberal perspective...………………………
Comparisons of four perspectives……………………………………………………………
Assessment and modifications of the perspectives………………………………………….
Conclusion……………………………………………………………………………………..
Introduction
Program analysis using different perspectives
In a political economy, policies and programs are essential tools that assist in understanding the ongoing struggle for equality and social justice. Although both have an underlying difference, they serve an almost similar purpose. Essentially, understanding the goal of any program or policy can be achieved by analyzing the contending perspectives (Harvey, 2020). This involves the intentional bringing of different perspectives in contrast. They help examine core economic problems or concepts from an orthodox perspective, and others criticize it from a heterodox perspective. The perspectives are essential since both the heterodox and orthodox positions can be examined and reach a consensus.
In the United States, there has been a rise in spending on prescription drugs, which has led to the introduction of a Build Better Program. One proposal is driving down the cost of prescription drugs by allowing Medicare to negotiate with drugmakers over price; starting in 2025-ten drugs (plus insulin) would be on the table the first year, growing to 20 by 2028 (The White House, 2021). Although members of Congress have accepted the proposal, there is a need to analyze it using the different contending perspectives. This paper explores the proposal using the Classical Liberal, The radical, the Conservative Perspective, and the Modern Liberal Perspective. Individuals have the right to pursue their happiness, and proponents of the different political economy perspectives should work hand-in-hand to promote human development within society.
Analysis by Perspective
The Classical Liberal
The political philosophy and ideology belonging to liberalism emphasize securing citizens' freedom by limiting government power. Today, the proponents hold various thoughts and Perspectives, one being Neo-Austrian economics (Clark, 2016). Essentially, the program's main aim is to reduce the overall cost of prescription drugs. From the Perspective of Neo-Austrians, humans are self-interested. They can act autonomously by utilizing their capacity to discover an efficient means of satisfying their desires and basic needs (Harvey, 2020). Also, the government is created by the people to protect their natural rights. At the same time, justice requires safeguarding the people's rights established by the c ...
11Factors that Affect the Teaching and Learning ProcessSantosConleyha
11
Factors that Affect the Teaching and Learning Process
Lua Shanks
Dr. Thompson
Valley State University
10-6-2021
Factors that Affect the Teaching and Learning Process
Contextual Factors
The efficacious teaching and learning processes are important in generating the desired academic outcomes for students. Such processes entail the transformation and transfer of knowledge from the educators to students. It requires a combination of different elements within the procedure, in which an instructor determines and establishes the learning goals and objectives, and designs teaching resources. Thereafter, teachers implement the learning strategy that they will utilize to impart intellectual content into students. However, learning is a cardinal factor that an educator musty take into account while overseeing the process of knowledge acquisition and retention. Many factors play an important role in shaping the process of teaching and learning. Contextual factors, for instance, are associated with a particular context and characteristic that is distinct to a specific group, community, society, and individual. Such factors may take the form of a child’s educational, community, as well as classroom settings.
Community, District, and School Factors
Armstrong School District is a major public learning institution that occupies a geographical area of approximately 437 square miles. Located in Pennsylvania, it forms one of the 500 public school districts in the state, and hosts teachers and students from diverse racial, ethnic, and ethnic backgrounds. As a consequence, the institution partners with families, community leaders, and teachers to improve students’’ capacity to acquire knowledge ahead of their graduation. The community refers to the urban or rural environment in which both the teachers and learners operate. These may include the teacher and students’ ethnic, racial political or social affiliations that affect learning or knowledge acquisition. Additionally, parents and community members play an integral role in ensuring the quality of education in schools. They for, example, collaborate with teachers and school administrators to develop the most effective ways of improving their students’ learning outcomes. Indeed, community involvement in schooling issues is potentially a rich area for innovation that has immense benefits that far exceeds its limitations. Considering that governments are constrained in offering quality education due to contextual issues such as remoteness, bureaucracy, corruption, and inefficient management, community factors are pivotal in bridging the gap between government initiatives and community needs. This helps to adjust the child’s familial obligations to family interests, thereby shifting towards ways of mobilizing a sense of community by strengthening trust and relationships between community members, parents, governments, as well as teachers and school leaders. Other important community factors that af ...
11
Criminal Justice: Racial discrimination
Student’s Name:
Institutional Affiliation:
Instructor’s Name:
Course Code:
Due Date:
Racial discrimination
Abstract
When there is justice in society, every person feels satisfied with the way legal actions are carried out in the community. Unfortunately, there are several instances of racial discrimination in the United States. Most of the racial discrimination in the United States ate directed towards black people. Although everyone is required to have equal treatment in the United States, achieving zero discrimination has always been difficult.
Understanding racial discrimination in the USA is vital as it makes it easy for one to identify ways to eliminate the criminal injustices resulting from racial discrimination. This will be essential since it will help to eliminate racial discrimination in the criminal justice system.
Introduction
When there is justice in society, every person feels satisfied with the way legal actions are carried out in society. The criminal justice community is when people are not discriminated against based on their skin color. Laws applicable are carried out uniformly such that every person is treated equally. When the laws are applied equally to every individual, it increases the trust in the criminal justice system. However, when there are biases in applying the laws, the criminal justice system becomes compromised. According to Kovera (2019), there are many disparities in the criminal justice system as black people are discriminated against by police officers based on their race. As a result, black people suffer more as compared to white people when they violate similar laws.
There is a lot of disparity in the criminal justice system of the United States. Many people suffer as a result of racial discrimination in the United States. People are discriminated against a lot in the administration of the policies. According to Donnel (2017), there is racial inequality in how criminal justice is carried out in policymaking. The criminal justice system discriminates against people based on their race. For example, police officers harass black people for minor mistakes which white people are left to walk freely even after making similar mistakes. Black people suffer because of the color of their skin.
Hypothesis/Problem Statement/Purpose Statement
Racial discrimination affects the outcomes of the criminal justice system adversely. How does racial discrimination affect the judicial criminal justice system? The study aims to identify ways in which criminal justice racial discrimination is practiced in the United States. It will also provide insights on the racial discrimination cases, which are helpful in the development of policies that can be helpful in the elimination of racial discrimination in society hence promoting equality among the citizens.
Literature Review and Definitions included in the research
According to Hinton, Henderson, and Reed (2018), there is mu ...
11Communication Plan for Manufacturing PlantStudSantosConleyha
11
Communication Plan for Manufacturing Plant
Student’s Name
Institutional Affiliation
Instructor
Course
Date
Communication Plan of a Manufacturing Plant
Background
In manufacturing companies, organization employees are at the centre of an organization. Most of them are at the front lines with the ability to change strategy into results. At the culmination of the day, the plant employees have the responsibility of ensuring that the operations are conducted smoothly, a product reaches consumers timely, and quality products are manufacture with the appropriate specifications. However, despite the primary role they play, manufacturing plants are disjointed (Adejimola, 2008). That disengagement is embodied with a hefty price which is paying a negative role in the performance of manufacturing plants just as they are being challenged to increase their efficiency and effectiveness to the company compared to previous years. To realize rapid growth around the globe, the manufacturing industry is attempting to standardize operations and continuously leverage operations. Such kind of effort needs a company to possess highly invested employees (Obiekwe, O& Eke, 2019). For this reason, natural communication naturally is primary on the path to more highly engaged and motivated employees. However, it can sometimes be challenging to plant employees due to natural challenges that accompany workplace. Some may not frequently be on Smartphone’s or emails, or they may be having various shifts to manage, and the environment may be less conducive, which makes it challenging for them to have one-on-one conversations.
Policies for Oral, Written, and Non-Verbal Communications
Interpersonal communication in a manufacturing plant is the way employees or people communication with others. It may involve a group of p-people, another person or the members of the public. In some instances, it may encompass non-verbal, written or non-verbal communication. In the manufacturing industry, when an individual is communicating with others, they need to consider the person they are talking to, the type of information they want to deliver and the most appropriate and relevant form of communication change. In some instances, such issues may be determined by the information an individual wants to communication (Obiekwe, O& Eke, 2019). At all times, it is required that the staff members remain polite, respectful to both the clients and one another. At no time should they sear, raise their voice, speak in a way belittling another.
Cultural awareness is also another essential element when communicating in a cultural plant. All individuals working in the plant need to recognize that individuals emerge from varying backgrounds and cultures, and they also accompany various attitudes, different values and beliefs (Obiekwe, O& Eke, 2019). All staffs in the plant need to exercise non-judgmental communication remain respectful and are tolerant of the differences prevalence ...
11CapitalKarl MarxPART I. COMMODITIES AND MONEYCHAPTER I. SantosConleyha
11
Capital
Karl Marx
PART I. COMMODITIES AND MONEY
CHAPTER I. COMMODITIES
Section 1. The two factors of a commodity: use-value and value (the substance of value and the magnitude of value)
The wealth of those societies in which the capitalist mode of production prevails, presents itself as “an immense accumulation of commodities,”1 its unit being a single commodity. Our investigation must therefore begin with the analysis of a commodity.
A commodity is, in the first place, an object outside us, a thing that by its properties satisfies human wants of some sort or another. The nature of such wants, whether, for instance, they spring from the stomach or from fancy, makes no difference.2 Neither are we here concerned to know how the object satisfies these wants, whether directly as means of subsistence, or indirectly as means of production.
Every useful thing, as iron, paper, &c., may be looked at from the two points of view of quality and quantity. It is an assemblage of many properties, and may therefore be of use in various ways. To discover the various uses of things is the work of history.3 So also is the establishment of socially-recognised standards of measure for the quantities of these useful objects. The diversity of these measures has its origin partly in the diverse nature of the objects to be measured, partly in convention.
The utility of a thing makes it a use-value.4 But this utility is not a thing of air. Being limited by the physical properties of the commodity, it has no existence apart from that commodity. A commodity, such as iron, corn, or a diamond, is therefore, so far as it is a material thing, a use-value, something useful. This property of a commodity is independent of the amount of labour required to appropriate its useful qualities. When treating of use-value, we always assume to be dealing with definite quantities, such as dozens of watches, yards of linen, or tons of iron. The use-values of commodities furnish the material for a special study, that of the commercial knowledge of commodities.5 Use-values become a reality only by use or consumption: they also constitute the substance of all wealth, whatever may be the social form of that wealth. In the form of society we are about to consider, they are, in addition, the material depositories of exchange-value.
Exchange-value, at first sight, presents itself as a quantitative relation, as the proportion in which values in use of one sort are exchanged for those of another sort,6 a relation constantly changing with time and place. Hence exchange-value appears to be something accidental and purely relative, and consequently an intrinsic value, i.e., an exchange-value that is inseparably connected with, inherent in commodities, seems a contradiction in terms.7 Let us consider the matter a little more closely.
A given commodity, e.g., a quarter of wheat is exchanged for x blacking, y silk, or z gold, &c.—in short, for other commodities in the most different proportions. Ins ...
1
1
Criminal Justice System
Shambri Chillis
June 11, 2022
Criminal justice system
The criminal justice system is essential to identify and prevent crimes in the community. Various functions of the criminale system now adhere to the development of technology. Modern technology helps the criminal justice system in different ways. It has made the job easier and has assisted in the prevention of crimes.
Role of criminal justice practitioners in the technology development
The Ccriminal justice practitioners are responsible for identifying and analyzing different crimes in the community. They are responsible for developing and implementing the technology in the criminal justice system because they can use it for different purposes. They can introduce the new trends in the criminal justice system like the officers can collect and gather the data through the technology. Human error can be reduced through it. The dataset can be maintained, and it is also essential for criminal justice practitioners to develop the technology to locate the criminals and track their local places through GPS. The technology cannot be developed untill the criminal officers implement it in the routine. The criminal system now has to use robots and cameras that help them get information about the criminals. The practitioners can also implement the technology by guiding the juniors to use it. The training is needed to make them understand the use of advanced technologies and to ensure that they use them in the right direction. The high-performance computer and internet systems are also essential for developing the technology, and it has been seen that the future will be bright regarding implementing technology (John S. Hollywood, 2018).
Controversial issues criminal justice policymakers face when considering an expansion in the use of DNA in criminal justice
Tthere are various controversial issues that criminal justice policymakers must consider while using DNA in the criminal justice system. The first thing that is criticized during the use of DNA is the fundamental human error, and iIt has been observed that there can be errors in the investigation, and people have to suffer. The issue in technology is also referred to as the error in using DNA because it might be possible that the results do not come correct at the first attempt. It involves several people who are not linked to the crimes but have to go for the fingerprinting tests by courts. However, DNA technology in criminal justice is highly advanced and has multiple benefits compared to disadvantages, but it has always faced significant controversy in the criminal justice system. The criminal justice system has to make sure that if DNA technology is being used, it must be error-free. The controversy has two opinions. There are two schools of thought regarding the use of DNA. One of the classes of experts thinks that DNA can be used to catch the different criminals. It is helpful in the family c ...
11American Government and Politics in a Racially DividSantosConleyha
1
1American Government
and Politics in a Racially
Divided World
chap ter
In 2016, Gov. Jack Markell signed a long-awaited resolution officially apologizing for the state’s role
in slavery. The apology for slavery illustrates the long and sometimes painful history of the United
States’ struggle with race, from the time of Thomas Jefferson, a slave owner, to President Barack
Obama, the first Black president of the United States.
01-McClain-Chap01.indd 1 11/24/16 8:34 PM
08/20/2017 - RS0000000000000000000000562545 (Anthony Ratcliff) - American
Government in Black and White
2 CHAPTER 1: AmericAn Government And Politics in A rAciAlly divided World
intro
D
ecember 6, 2015, marked the 150th anniversary of the abolish-
ment of slavery, when the U.S. Congress ratified the Thirteenth
Amendment to the Constitution. There were numerous events
recognizing the end of slavery, including an official White House event
presided over by President Obama. On February 11, 2016, Delaware
joined eight other states to formally apologize for slavery when Gover-
nor Jack Markell (D) signed the state’s joint resolution. Delaware’s reso-
lution acknowledged its participation in 226 years of
slavery first of both Native Americans and Africans in
the mid-1600s; by the close of the 1700s its entire
slave population was of African descent. The resolu-
tion also included acknowledgments that Delaware
criminalized humanitarian attempts to assist slaves
and that in later times Delaware passed and enforced
Jim Crow laws to deny the rights of African American
citizens for much of the twentieth century.1
On July 29, 2008, the U.S. House of Representa-
tives passed a nonbinding resolution, introduced and
championed by Representative Steven Cohen (D-TN),
which offered a formal apology for the government’s
participation in African American slavery and the
establishment of Jim Crow laws. The resolution said, in part, “African
Americans continue to suffer from the consequences of slavery and Jim
Crow—long after both systems were formally abolished—through
enormous damage and loss, both tangible and intangible, including the
loss of human dignity and liberty, the frustration of careers and profes-
sional lives, and the long-term loss of income and opportunity.”2
On June 18, 2009, the U.S. Senate unanimously passed a similar reso-
lution apologizing to African Americans for slavery and Jim Crow. The
Senate resolution said explicitly that the apology could not be used in
support of reparations (or compensation for past wrongs).3
The story of apologies for slavery is a complex one that highlights some of the
underlying dilemmas that face the U.S. political system—how to reconcile its stated
principles of how individuals should be treated with how the government actually
treats and has treated individuals. The apologies are intended to acknowledge the
nation’s complicity in a destructive and immoral institution, at ...
11Cancer is the uncontrollable growth of abnormal cellsSantosConleyha
1
1
Cancer is the uncontrollable growth of abnormal cells in the human body. It is defined by a malfunction in cellular mechanisms that control cell growth. Cells evade checkpoint controls and begin growing uncontrollably which resulting in an increase in abnormal cells, cancer cells. These cancer cells form a mass tissue known as a tumor. In the United States of America, cancer has been determined to be among the leading causes of mortality rates after cardiovascular conditions, where one in every four deaths is caused by cancer. The most common types of cancer include prostate cancer, lung cancer, and breast cancer. Risk factors for cancer include excess smoking, radiation exposure, genetics, and environmental pollution. Colon cancer, or colorectal cancer, affects the distal third of the large intestine, the colon, as well as the rectum, chamber in which feces is stored for elimination. Colorectal cancer is the third leading cause of death in cancer-related issues in the United States in both males and females (Beadnell et al., 2018). This essay explores the physiology and pathophysiology of colon cancer.
Polyps are tissue growths that generally look like small, flat bumps and are generally less than half an inch wide. They are generally non-cancerous growths that can develop with age on the inner wall of the colon or rectum. There are several types of polyps, such as hyperplastic. They are common and have a low risk of turning cancerous. Hyperplastic polyps found in the colon will be removed and biopsied. Pseudo polyps also referred to as inflammatory polyps, usually occur in people suffering from inflammatory bowel disease and are unlike other polyps. This type of polyp occurs due to chronic inflammation as seen in Crohn's disease and ulcerative colitis. However, a polyp cells which can turn out to be malignant. Villous adenoma or tubulovillous adenoma polyps carry a high risk of turning cancerous. They are sessile and develop flat on the tissue lining the organs. They might blend within the organ, making polyps not easily identifiable and difficult to locate for treatment. Adenomatous or tubular adenoma polyps have a high chance of being cancerous. When a polyp is found, it must be biopsied, and then will regular screenings and polyp removal will follow.
An adenocarcinoma is a cancer formed in a gland that lines an organ. This cancer impacts the epithelial cells, which are spread throughout the human body. Adenocarcinomas of the colon and rectum make up ninety-five percent of all colon cancers (Chang, 2020). Colon adenocarcinomas usually begin in the mucous lining the spread to different layers. Two subtypes of adenocarcinomas are mucinous adenocarcinoma and signet ring cells. Mucinous adenocarcinomas contain about sixty percent mucus which can cause cancer cells to spread faster and become more hostile than typical adenocarcinomas. Signet ring cell adenocarcinoma is responsible for less than one percent of all colon cancer. It is g ...
11SENSE MAKING Runze DuChee PiongBUS 700 LSantosConleyha
1
1
SENSE MAKING
Runze Du
Chee Piong
BUS 700 Leadership and Creative
Solution
s Implementation
Feb 14th 2021
SENSE MAKING
Sensemaking refers to an action or a process of making sense where meaning is given to something. Sensemaking is a process through which individuals give meaning to their collective experiences. Sensemaking is also a process of structuring the unknown by inserting stimuli into some framework kinds to enable individuals to understand or comprehend, attribute, to extrapolate and predict the meaning of something. Sensemaking is an activity that allows people to turn the ongoing complexity in the entire world into a situation that can be understood. Sensemaking Therefore, Sensemaking requires articulating the unknown because, in many cases, trying to put meaning to something strange is the only means by which one can understand it. For instance, the occurrence or the origin of COVID-19 in the entire world has been a phenomenon that has disturbed the heads of many trying to understand what it is, where it came from, who caused it, how it can be prevented and how it can be cured. In attempting to understand COVID 19, people came up with the explanations of what it is, what caused it, and that is where the scientists realized that this is a disease that is caused by a virus known as Coronavirus, since the condition merged in the year 2019, the virus was given the name coronavirus 19, and the disease it caused known as COVID 19. This is how sensemaking enables individuals to give meaning to something that can be understood easily by individuals.
The organization that I am familiar with that has experienced a current change in its operations is Starbucks. Starbucks is an American company that is known for its production and sell of coffee products. It was started in 1971 as a coffee selling company where it was majorly involved in roasting, marketing and selling coffee globally. It has more than 300 stores all over the world selling coffee. This organization has sold coffee within its stores since its initiation. However, because of the corona's onset, the management of this organization decided to change its operation to accommodate the changes in the environment depending on the restrictions imposed on businesses by the ministries of health all over the world. Starbucks company reacted to the industry changes brought about by COVID 19, where businesses were required to close their doors to enhance the measures of curbing the spread of coronavirus disease. Thus, the company embraced technology where it introduced Starbucks-pick up only stores that replaced the over 300 stores globally. The new stores required that no one could sit in as they take their coffee. Instead, everyone would be allowed only to take their orders from the store and to avoid congesting people in one place. Starbucks introduced Starbucks pick-up stores that use technology to supply coffee to customers. The business submitted a mobile app ...
119E ECUTIVE BAR AININ CEOS NE OTIATIN THEIR PAWITH EMSantosConleyha
119
E ECUTIVE BAR AININ : CEOS NE OTIATIN THEIR PA
WITH EMPLO EES OR CORPORATE E ICIENC
By Nathan Witkin
I INTRODUCTION
Rising executive pay is a significant problem that points to a structural
flaw in American corporations. This article presents a solution to that flaw
through which Chief Executive Officers (CEOs) negotiate their pay in
company resources with lower-paid employees. Exploring this solution also
unearths an explanation for capitalism s apparent drive toward inequality and
examines the historical development of corporations and trade unions in the
United States.
The problem is that managers and corporate directors will raise pay at the
top so long as that pay-setting process does not consider the pay of average-
and low-wage workers. The solution is that CEOs and other top executives
negotiate their pay in company resources with employees in a process that
determines the pay and bonuses of both sides. Microeconomic theory indicates
that confronting the tradeoffs of raising executive compensation with other
potential corporate expenditures—by negotiating this compensation with
workers from different parts of the company—will make executive
compensation more efficient.1 Also, historical analysis indicates a pattern in
which executive compensation became aligned with public interest only during
the period in which workers had significant power to negotiate their wages and
Master of Public Policy Candidate at eorgetown University s McCourt School of Public
Policy J.D., The Ohio State Moritz College of Law. The Author is an independent researcher,
originator of a variety of social innovations (co-resolution, interest group mediation, consensus
arbitration, dependent advocacy, the popular tax audit, the hostile correction, a partnership
between citizen review boards and community policing, and a two-state/one-land solution to the
Israeli-Palestinian conflict), and author of several ambitious theories (the shift in sovereignty
from land to people under international treaties, the use of impact bonds as a solution to climate
change, and resistance to the accelerating expansion of the universe as the cause of gravitation).
He is also a former solo-practitioner in criminal and family law.
1 N. RE OR MAN IW, PRINCIPLES O MICROECONOMICS ( th ed. 2012) (describing the first
principle of microeconomics as centered on trade-offs). Many basic microeconomic models
involve trade-offs between potential allocations of resources to achieve efficiency. See DAVID
BESAN O RONALD R. BRAEUTI AM, MICROECONOMICS 20 07 (5th ed. 201 ).
120 KAN. J.L. & P B. POL’Y Vol. I :1
benefits. This is not to say that the solution to executive compensation is a
return to unions, which developed as a separate organizational structure with
their own flaws and inefficiencies. Rather, a corporation that synthesizes the
inputs of all its employees will be able to maximize efficiency and
productivity, producing profits for shareholders and growth for the overall
econ ...
11CALIFORNIA MANAGEMENT REVIEW VOL. 51, NO. 4 SUMMER 2009 CMR.BERKELEY.EDU
The Emergence and
Evolution of the
Multidimensional
Organization
J. Strikwerda
J.W. Stoelhorst
“In terms of its impact, not just on economic activity, but also on human life as a
whole, the multidivisional organizational design must rank as one of the major
innovations of the last century.”—John Roberts1
T
he multidivisional, multi-unit, or M-form, is widely acknowledged
as the most successful organization form of the twentieth century.2
Firms that employ the M-form organize their activities in separate
business units and delegate control over the resources needed to
create economic value to the managers of these units. This organization form is
widespread, is central to the “theory in use” of managers, and serves as the basis
of most accounting systems. However, the organization of productive activities
in many contemporary firms violates the principle that is central to the M-form:
that business units are self-contained. The quest for synergies that has been high
on the corporate agenda since the late 1980s has resulted in the widespread
adoption of corporate account management, shared service centers, and matrix
organizations. As a result, most business units now depend at least in part on
resources that are controlled by other units. This raises fundamental questions
about the status of the M-form in contemporary firms.
Questioning the status of the M-form is not merely a theoretical fancy,
but is high on the agenda of managers as well. In this article, we report on
research that was commissioned by the Foundation for Management Stud-
ies, a Dutch organization of management executives. These practical men and
women shared a fundamental uneasiness about structuring their organizations.
On the one hand, many of them experienced problems with the M-form: high
employee costs, internal battles over resources, lack of standardization, lack of
cooperation, and loss of market opportunities. On the other hand, they did not
The Emergence and Evolution of the Multidimensional Organization
UNIVERSITY OF CALIFORNIA, BERKELEY VOL. 51, NO. 4 SUMMER 2009 CMR.BERKELEY.EDU12
see any viable alternatives to the multi-unit organization form. The need to
exploit synergies across business units was widespread, but it was unclear which
organizational designs are most appropriate to achieve this. This led to a research
project to explore the ways in which leading Dutch organizations, including
subsidiaries of foreign multinationals, have adapted the M-form to better exploit
synergies across business units.
As we expected, the results of the study vividly illustrate the fundamen-
tal tension between the need for contemporary firms to exploit synergies and
their need for clear accountability. However, an additional and unexpected
finding was that a number of firms in the study have evolved an organiza-
tional form that signals a new way of res ...
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
1. Student uses MS Excel to calculate income tax expense or refund
1. 1. Student uses MS Excel to calculate income tax expense or
refund, taxable income, and total taxes using the full-cost
method for transfer pricing. There are no errors.
2. Student uses MS Excel to calculate income tax expense or
refund, taxable income, and total taxes using the variable-cost
method for transfer pricing. There are no errors.
3. Student produces a thorough and detailed Word document
that incorporates specific details from the MS Excel
spreadsheet, a detailed recommendation based on those specific
details as to how the organization should proceed is included,
and the recommendation is justified with at least 3 examples
from the week's resources and/or additional research in the
Walden Library.
4. Writing exhibits strong evidence of thoughtful critical
analysis and thinking; careful examination is made of
assumptions and possible biases, with detailed supporting
rationale. Writing synthesizes the classroom experiences and
content; analyzes patterns or connections between theory and
practice; and draws logical conclusions based on well-reasoned
arguments. New questions are presented based on synthesis of
ideas and input.
5. Writing is clear, logical, well-organized and appropriate.
Work is free from spelling and grammar/syntax errors. Tone is
professional and free from bias (i.e., sexism, racism). There are
no errors.
6. Student effectively and directly integrates
discussion/assignment content with relevant and compelling
personal experiences, additional research, or current events
from credible news sources. Specifically adds a new and/or
different insight or perspective on the subject area(s) being
discussed or treated in the assignment.
7. Student demonstrates full adherence to scholarly or credible
reference requirements and adheres to APA style with respect to
source attribution and references. There are no APA errors.
2. CASE STUDY—BEWARE: One Emergency May Hide Another!
A hospital submitted a report to the State Board of Nursing
reporting that an RN had been terminated after the death of a
patient following surgery for a tubal pregnancy.
THE NURSE'S STORY—SALLY SIMMS, RN
I had worked the medical-surgical units at the General Hospital
ever since graduating from my nursing program 4 years before.
This was the worst night, the worst shift, of my nursing career.
I was assigned to care for eight patients that night, which is not
an unusual number of patients, but they all were either fresh
post-ops or so very sick. Four patients had just had surgery that
day. One patient was on a dopamine drip to maintain his blood
pressure, so he needed frequent monitoring. One patient was
suspected to have meningitis, one patient had pneumonia, and a
patient with suspected histoplasmosis completed my
assignment.
One of my post-op patients was Betty Smith, a young woman in
her early thirties who had laparoscopic surgery late in the day.
She had been transferred from the recovery room late in the
evening shift and was very uncomfortable when I first made my
rounds. At 12:05 am, I called Betty's physician because she w as
vomiting and thrashing in bed. Per his order, I medicated the
patient with Phenergan.
The next time I checked on Betty, she seemed to be more
comfortable, but I realized that her IV had infiltrated. I was
really overwhelmed with meeting the needs of all my patients,
so I asked Joan Jones, the charge nurse, to restart Betty's IV. It
was about 2:00 am when Nurse Joan restarted the IV.
I had been able to pretty much stay on top of everything at that
point in the shift, and by 2:30 am I had assessed all my patients,
given pain medications, and called four physicians to update
them regarding their patients and for various orders. I thought
things were settling down. I thought wrong.
Mrs. Holmes, the patient with histoplasmosis, seemed a bit off
from when I had cared for her the previous two nights. Mrs.
3. Holmes' vital signs were unstable and her O2 saturation was
only 80%. I notified her physician and he ordered stat arterial
blood gases. The lab called with the results, and they were
alarming. Mrs. Homes was losing ground, and her physician
ordered us to transfer her to the ICU. I was preoccupied with
accomplishing the transfer and accompanied Mrs. Holmes to the
unit. I returned from the ICU at about 3:50 am.
On my return, I first checked the patient who was on dopamine,
medicated another patient for pain, and did visual checks on the
rest of the patients who all seemed to be sleeping. I began my
charting.
At 6:05 am, I went to start IV antibiotics on Betty's roommate,
and to my horror discovered Betty was not breathing. I called
the code. The first time I discovered that Betty had had a low
blood pressure and elevated pulse was when I checked the vital
signs sheet when the ER physician (who responded to the code)
asked how Betty's vital signs had been during the shift. The
nurse's aide who was assigned to monitor Betty had not
informed me, and I had not checked the vital signs sheet.
It was such a terrible night; I was so busy with the transfer and
caring for the other patients. Betty just had an outpatient
procedure; if she had been earlier on the surgical schedule, they
would have sent her home. I did not physically check her vital
signs, and the aide did not report the elevated pulse and low
blood pressure. I depended on the aide—my mistake. I know I
was responsible.
I was terminated from employment and reported to the board of
nursing. I have taken myself out of nursing; something died in
me when I found my patient.
EMPLOYMENT EVALUATIONS
An evaluation conducted a few weeks before the incident
showed mostly good ratings (11) with three excellent ratings.
The hospital would consider reemployment if Ms. Simms
improved her critical thinking skills.
PATIENT MEDICAL RECORD
Surgery Notes—Laparoscopy to remove unruptured ectopic
4. pregnancy from distal portion of the fimbriae with estimated
blood loss of 150 cc, three references to homeostasis, two
references to cautery, patient “… to recovery room in excellent
condition.”
Recovery Room Nurse's Notes—In recovery 2110 to 2300,
initial post-op flow sheet noted at 2210 BP 124/74, pulse 94; at
2225 BP 123/65; at 2240 BP 107/85, pulse 123. Assessment
signed at 2220 “abdomen distended with few faint bowel sounds
… patient shivering, c/o [complained of] abdominal pain,
medicated ×3 [three times] with IVP Demerol, total of 50 mg.
Patient awake, three dressings dry. No c/o N/V/D.” [No
complaints of nausea, vomiting or diarrhea.]
Medication Record—Patient received Demerol 50 mg. with 25
mg Phenergan IM at 2215 and 0200.
Cardiopulmonary Resuscitation Record—Compressions noted at
6:08 am. [RN had initiated code at 5:55 am], MD arrived at 6:15
am, patient intubated at 6:20 am, patient administered atropine
×3, Eppy [epinephrine] ×5 [five times], bicarbonate [of sodium]
×2 [two times]. Pacemaker never captured. Patient never had
return of spontaneous pulses and pronounced dead at 6:38 am.
Death Certificate—Immediate cause of death was
hemoperitoneum due to postoperative hemorrhage of placental
tissues after salpingotomy for a right tubal ectopic pregnancy.
BOARD ACTION
Ms. Simms entered into a consent agreement with the board of
nursing, admitting that her conduct constituted a failure to
practice in accordance with acceptable and prevailing standards
of safe nursing care. Nursing standards cited were failure to
assess and document the health status of the patient, failure to
provide ongoing patient monitoring, and failure to communicate
appropriately with members of the health care team.
Ms. Simms' license was probated with stayed suspension for 2
years, with requirements for successful completion of ordered
education including an advanced assessment course at an
educational/collegiate institution, continuing education hours in
risk management/legal issues in nursing (in addition to
5. continuing education hours required for license renewal). Or der
noted RN's voluntary evaluation by a mental health care
professional and her compliance with all aspects of the
treatment plan. Other terms included quarterly reports from
nursing employer and self-reports. Ms. Simms was required to
appear in person (as requested) for an interview with the Board
or a board-designated representative.
COMMENTARY
This case example illustrates a cascade of clinical events that
caused errors in clinical judgment, all of which are related to
work overload and consequent lack of surveillance and
monitoring of the patient. Nurse Simms made faulty
assumptions that the young patient with a tubal pregnancy was
her least acute patient. Of course the patient is the primary
victim, but Nurse Simms also suffered greatly from this tragi c
incident, which was precipitated by a collection of untoward
events and work overload.
TemplateWeek 4 ApplicationFull CostVariable CostDivision A
Taxes: Transfer Price Less Cost (subtract) Taxable Income00
Taxes in Low Country (or refund)Division B Taxes: Sales
Price Less Transfer Price (subtract) Taxable Income00 Income
Taxes Import Duty Taxes in High Country (or refund)00Total
Taxes