JONA
Volume 47, Number 1, pp 41-49
Copyright B 2017 Wolters Kluwer Health, Inc. All rights reserved.
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N
The Effect of Reported Sleep,
Perceived Fatigue, and Sleepiness on
Cognitive Performance in a Sample of
Emergency Nurses
Lisa A. Wolf, PhD, RN, CEN, FAEN
Cydne Perhats, MPH
Altair Delao, MPH
Zoran Martinovich, PhD
OBJECTIVE: The aim of this study is to explore
the relationship between reported sleep, perceived
fatigue and sleepiness, and cognitive performance.
BACKGROUND: Although evidence suggests that
fatigue and sleepiness affect the provision of care in
inpatient units, there is a lack of research on the sleep
patterns of emergency nurses and the effects of dis-
turbed sleep and fatigue on their cognitive abilities
and susceptibility to medical errors.
METHODS: A quantitative correlational design was
used in this study; in each of 7 different statistical models,
zero-order relationships between predictors and the
dependent variable were examined with appropriate
inferential tests.
RESULTS: Participants reported high levels of
sleepiness and chronic fatigue that impeded full
functioning both at work and at home.
CONCLUSIONS: Although high levels of self-reported
fatigue did not show any effects on cognitive function,
other factors in the environment may contribute to
delayed, missed, or inappropriate care. Further research
is indicated.
Studies of worker fatigue in the military and com-
mercial trucking industries1,2 suggest that long hours,
especially extending into overnight, can be hazardous
in terms of the potential for errors due to sleepiness
and reduced vigilance. Medical providers, both nurses
and physicians, are at risk because of the need for
around-the-clock coverage and the number and type
of decisions they must make in a given time span; in
1989, the Bell Commission Report cited sleep depri-
vation in medical house officers as a major contrib-
utor to the 1984 death of Libby Zion, an 18-year-old
who died at New York Hospital, leading to a restruc-
turing of the hours involved in medical residencies.3
The long (up to 36 hour) shifts of the medical resi-
dents in charge of her care and the consequences of
their fatigue on the decisions that were made were
cited as factors in her death. As a result of their inves-
tigation of the case, the Bell commission recommen-
ded limiting the work hours of medical residents to
less than 80 hours a week and no more than 24 hours
in a row, and subsequent research has led to similar
recommendations for the nursing workforce.4,5
Emergency care settings are chaotic environ-
ments, where there is high patient turnover, constantly
changing priorities and frequent changes in patient
condition. High demand work settings are associated
with increased fatigue, which can impair nurses_ at-
tentiveness and ability not only to recognize potential
errors they might commit but also to recognize and
mitigate the errors of others, inc ...
Evaluation of Research Essay Discussion.pdfsdfghj21
This document provides guidelines for an assignment to evaluate empirical research related to a PICOT question. Students are instructed to write a 1,250-1,500 word paper evaluating literature on their PICOT question by addressing study conclusions, merits, and limitations. Feedback from instructors is also discussed, noting a revised PICOT question focusing more specifically on patient outcomes and data collection time period.
Physician burnout is a significant problem, with nearly half of physicians experiencing at least one symptom of burnout. Primary care physicians, especially those in family medicine, internal medicine, and emergency medicine, have the highest rates of burnout. However, physicians spend less than half (45%) of their time in direct patient care activities, with the rest spent on tasks like documentation, care coordination, and follow up for patients not present. New models are needed that leverage technology, protocols, and team-based care to automate tasks and delegate work to reduce burdens on physicians in order to address burnout and make primary care sustainable.
Literature ReviewA search was conducted using electronic database.docxssuser47f0be
Literature Review:
A search was conducted using electronic databases in the fields of nursing, medicine, education, psychology, and sociology. Using ProQuest Direct and EBSCO search engines, the following databases were accessed: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE in PubMed, Ovid, and PsycINFO. The search terms were grouped in the following key concepts: (a) occupational stress in nursing, (b) stress perception in nursing, (c) occupational stressors in nursing, (d) nursing generational diversity, and (e) coping in nursing. In a commentary on patient safety in nursing practice from the Agency for Healthcare Research and Quality, Hughes and Clancy7 reported that complexity and bullying represent 2 clear examples of nurse stressors. Li and Lambert8 concluded that nurses who are more satisfied with their job are more likely to remain in the workforce and to be committed to delivering high-quality patient care. Hall9 found that healthcare professions have some unique characteristics leading to occupational stress including physical responsibility for people, potential catastrophic effects on the patient and the employee, frequent exposure to pain and suffering, and exposure to infectious diseases and potential hazardous substances. Hamaideh et al10 identified that death and dying were the strongest stressors perceived by Jordanian nurses. In this study, workload and guidance were found to be the most supportive behaviors provided to nurses facing stress followed by emotional support.10
Carver and Candela11 concluded that considering the global nursing shortage, managers should increase their knowledge of the generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.11 Repar and Patton12 found that the combined effects of compassion fatigue, chronic grief, and emotional and physical exhaustion led to significant burnout and prolonged job dissatisfaction in the nursing profession. In this study, using guided sessions, a massage therapist gave 10-minute chair massages, and a visual, language, or musical artist engaged participants in imaginative and creative activities such as poetry reading, free writing, guided imagery, and listening to live music.12 The results suggest that the activities reduce some of the unpleasant, stressful, and tension-producing emotions that nurses typically experience at work, leaving them more peaceful and energized.12 Based on the findings of this review of the literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention. In addition, most studies identified some differences that exist between the present generational nursing cohorts in terms of values and beliefs. No studies were identified reporting how work-related stress affects different generations of nurses, how the generations perceive stress, and what coping styles are used.
Study Des ...
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The document discusses sleep disturbance in patients with chronic pain. It notes that sleep disturbance is common in this population, occurring in 50-80% of patients, and that there is a bidirectional relationship between pain and sleep, where pain can interfere with sleep and poor sleep can exacerbate pain. It reviews tools for assessing sleep disturbance and discusses non-pharmacological interventions like cognitive behavioral therapy for pain, insomnia, or a combination, as well as pharmacological options for improving sleep.
PICOTIn hospitalized medsurg patients , does med reconciliatio.docxstilliegeorgiana
PICOT:
In hospitalized med/surg patients , does med reconciliation compliance compared to non-compliant medication reconciliation impact 30 day readmission rates?
During Unit 5, you will be working on the following unit outcomes:
· Identify levels of measurement in data collection instruments (CO 2)
· Discuss the implications of levels of measurement for statistical analysis (CO 2)
· Appraise the validity and reliability of data collection methods (CO 4)
· Examine data collection methods in published research studies (C
Here is some more information on variables...
The dependent variable is the variable a researcher is interested in. The changes to the dependent variable are what the researcher is trying to measure with all their fancy techniques. The variable that depends on other factors that are measured.
An independent variable is a variable believed to affect the dependent variable. This is the variable that you, the researcher, will manipulate to see if it makes the dependent variable change. The variable that is stable and unaffected by other variables you are trying to measure. It is the presumed cause.
According to Tappen (2016), the independent variables are defined as the variables that the researcher will manipulate to see if a change occurs in the dependent variables. The independent variable is the presumed cause of change. The dependent variables are what the researcher is attempting to measure.
WEEK 4
Ethical concerns in nursing research often do not have straight forward solutions. Nursing research relies on collaboration and partnerships based on mutual trust. When that trust is breached the damage is irreversible. Honesty, openness, respect and sensitivity to others provide the cornerstones for ethical research. It is important that all nursing research is undertaken from a clear ethical stance, with ethical concerns identified at the outset and reevaluated on an ongoing basis throughout the project.
Take a look at this video about ethical issues and human subjects (9:38)
https://www.youtube.com/watch?v=-O5gsF5oyls (Links to an external site.)
As nurses, our primary observations are of persons thus we need to think about how to ethically collect data from persons.
The National Research Act of 1974 established three ethical principles for research:
· Respect for persons
· Beneficence
· Justice
· Check out this video on Types of Sampling Methods ---
· https://www.youtube.com/watch?v=pTuj57uXWlk
Carmen,
· Probability sampling is the gold standard for ensuring generalizability, as it uses some form of random selection in choosing the sample units. The reason that this sample is called a probability sample is each sampling unit has a known chance (probability) that it will be selected (Houser, 2018). Nonprobability sampling does not use random selection so there is no known chance of being selected (Houser, 2018). Nonprobability samples are selected by nonrandom methods. They are often called convenience samples, as the sel ...
This qualitative study examined the unintentional induction of nocebo phenomenon (NP) through doctor-patient communication among surgeons and anesthetists. The study found that NP occurred frequently in interactions and was associated with female doctors, residents, and those with less experience (<5 years). None of the doctors were aware of the concept of NP despite acknowledging their words could impact patient well-being. The study concluded NP exists in clinical practice and awareness should be raised to avoid nocebo words and educate professionals on their negative effects.
Evaluation of Research Essay Discussion.pdfsdfghj21
This document provides guidelines for an assignment to evaluate empirical research related to a PICOT question. Students are instructed to write a 1,250-1,500 word paper evaluating literature on their PICOT question by addressing study conclusions, merits, and limitations. Feedback from instructors is also discussed, noting a revised PICOT question focusing more specifically on patient outcomes and data collection time period.
Physician burnout is a significant problem, with nearly half of physicians experiencing at least one symptom of burnout. Primary care physicians, especially those in family medicine, internal medicine, and emergency medicine, have the highest rates of burnout. However, physicians spend less than half (45%) of their time in direct patient care activities, with the rest spent on tasks like documentation, care coordination, and follow up for patients not present. New models are needed that leverage technology, protocols, and team-based care to automate tasks and delegate work to reduce burdens on physicians in order to address burnout and make primary care sustainable.
Literature ReviewA search was conducted using electronic database.docxssuser47f0be
Literature Review:
A search was conducted using electronic databases in the fields of nursing, medicine, education, psychology, and sociology. Using ProQuest Direct and EBSCO search engines, the following databases were accessed: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE in PubMed, Ovid, and PsycINFO. The search terms were grouped in the following key concepts: (a) occupational stress in nursing, (b) stress perception in nursing, (c) occupational stressors in nursing, (d) nursing generational diversity, and (e) coping in nursing. In a commentary on patient safety in nursing practice from the Agency for Healthcare Research and Quality, Hughes and Clancy7 reported that complexity and bullying represent 2 clear examples of nurse stressors. Li and Lambert8 concluded that nurses who are more satisfied with their job are more likely to remain in the workforce and to be committed to delivering high-quality patient care. Hall9 found that healthcare professions have some unique characteristics leading to occupational stress including physical responsibility for people, potential catastrophic effects on the patient and the employee, frequent exposure to pain and suffering, and exposure to infectious diseases and potential hazardous substances. Hamaideh et al10 identified that death and dying were the strongest stressors perceived by Jordanian nurses. In this study, workload and guidance were found to be the most supportive behaviors provided to nurses facing stress followed by emotional support.10
Carver and Candela11 concluded that considering the global nursing shortage, managers should increase their knowledge of the generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.11 Repar and Patton12 found that the combined effects of compassion fatigue, chronic grief, and emotional and physical exhaustion led to significant burnout and prolonged job dissatisfaction in the nursing profession. In this study, using guided sessions, a massage therapist gave 10-minute chair massages, and a visual, language, or musical artist engaged participants in imaginative and creative activities such as poetry reading, free writing, guided imagery, and listening to live music.12 The results suggest that the activities reduce some of the unpleasant, stressful, and tension-producing emotions that nurses typically experience at work, leaving them more peaceful and energized.12 Based on the findings of this review of the literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention. In addition, most studies identified some differences that exist between the present generational nursing cohorts in terms of values and beliefs. No studies were identified reporting how work-related stress affects different generations of nurses, how the generations perceive stress, and what coping styles are used.
Study Des ...
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The document discusses sleep disturbance in patients with chronic pain. It notes that sleep disturbance is common in this population, occurring in 50-80% of patients, and that there is a bidirectional relationship between pain and sleep, where pain can interfere with sleep and poor sleep can exacerbate pain. It reviews tools for assessing sleep disturbance and discusses non-pharmacological interventions like cognitive behavioral therapy for pain, insomnia, or a combination, as well as pharmacological options for improving sleep.
PICOTIn hospitalized medsurg patients , does med reconciliatio.docxstilliegeorgiana
PICOT:
In hospitalized med/surg patients , does med reconciliation compliance compared to non-compliant medication reconciliation impact 30 day readmission rates?
During Unit 5, you will be working on the following unit outcomes:
· Identify levels of measurement in data collection instruments (CO 2)
· Discuss the implications of levels of measurement for statistical analysis (CO 2)
· Appraise the validity and reliability of data collection methods (CO 4)
· Examine data collection methods in published research studies (C
Here is some more information on variables...
The dependent variable is the variable a researcher is interested in. The changes to the dependent variable are what the researcher is trying to measure with all their fancy techniques. The variable that depends on other factors that are measured.
An independent variable is a variable believed to affect the dependent variable. This is the variable that you, the researcher, will manipulate to see if it makes the dependent variable change. The variable that is stable and unaffected by other variables you are trying to measure. It is the presumed cause.
According to Tappen (2016), the independent variables are defined as the variables that the researcher will manipulate to see if a change occurs in the dependent variables. The independent variable is the presumed cause of change. The dependent variables are what the researcher is attempting to measure.
WEEK 4
Ethical concerns in nursing research often do not have straight forward solutions. Nursing research relies on collaboration and partnerships based on mutual trust. When that trust is breached the damage is irreversible. Honesty, openness, respect and sensitivity to others provide the cornerstones for ethical research. It is important that all nursing research is undertaken from a clear ethical stance, with ethical concerns identified at the outset and reevaluated on an ongoing basis throughout the project.
Take a look at this video about ethical issues and human subjects (9:38)
https://www.youtube.com/watch?v=-O5gsF5oyls (Links to an external site.)
As nurses, our primary observations are of persons thus we need to think about how to ethically collect data from persons.
The National Research Act of 1974 established three ethical principles for research:
· Respect for persons
· Beneficence
· Justice
· Check out this video on Types of Sampling Methods ---
· https://www.youtube.com/watch?v=pTuj57uXWlk
Carmen,
· Probability sampling is the gold standard for ensuring generalizability, as it uses some form of random selection in choosing the sample units. The reason that this sample is called a probability sample is each sampling unit has a known chance (probability) that it will be selected (Houser, 2018). Nonprobability sampling does not use random selection so there is no known chance of being selected (Houser, 2018). Nonprobability samples are selected by nonrandom methods. They are often called convenience samples, as the sel ...
This qualitative study examined the unintentional induction of nocebo phenomenon (NP) through doctor-patient communication among surgeons and anesthetists. The study found that NP occurred frequently in interactions and was associated with female doctors, residents, and those with less experience (<5 years). None of the doctors were aware of the concept of NP despite acknowledging their words could impact patient well-being. The study concluded NP exists in clinical practice and awareness should be raised to avoid nocebo words and educate professionals on their negative effects.
428 Biomedical Instrumentation & Technology November/December 2016
Features
Abstract
Monitor watchers, or personnel whose job it is to
watch the central cardiac monitor and alert
clinicians of patient events, are used in many
hospitals. Monitor watchers may be used to
improve timely response to alarms and combat the
effects of alarm fatigue. However, little research
has been done on the use of monitor watchers,
and their practices have not been well described.
Therefore, the purpose of our study was to
examine the use of monitor watchers and their
characteristics, training, and practices.
Participants were recruited to complete an online
survey on monitor watcher practice via two
professional nursing organizations. A total of 413
responded to the survey, including 411 nurses and
two non-nurse professionals, and 61% reported
that their hospital used monitor watchers. Of
these, 60% indicated that their hospitals have
been using monitor watchers for more than 10
years, and 62% said that the monitor watchers
were located remotely from the patient care unit.
Many (68%) reported that monitor watchers
worked 12-hour shifts, and a majority said that
monitor watchers were required to have a
certificate in electrocardiographic monitoring
(67%) and be high school graduates (64%). Most
(70%) respondents reported that monitor
watchers alerted the nurse of an event via a
mobile phone carried by the nurse. The results of
this survey revealed that monitor watcher
practices varied widely. Further research is needed
to determine if the use of monitor watchers has an
impact on patient outcomes.
Failure to respond to clinical alarms in a
timely fashion is a critical patient safety
issue. Hospital personnel are looking for
strategies to improve the response to alarms
in an effort to ensure that critical events are
identified in a timely manner. Various alarm
notification strategies have been proposed to
ensure that those providing care to patients
are notified of true and actionable alarms.
These methods include the use of middle-
ware that sends alarms to the bedside
clinician’s wireless device, as well as the use
of monitor watchers.
Monitor watchers, or personnel whose job
it is to watch the central cardiac monitor and
alert clinicians of patient events, are used in
many hospitals. However, little research has
been done on the use of monitor watchers
and little is known about whether they make
a difference in the detection of arrhythmias
or in the outcomes of patients. Anecdotal
evidence suggests that the practices and
responsibilities of these monitor watchers
vary across institutions.
The little available research has focused on
monitor watcher arrhythmia detection,
communication, response times, workload,
effect on nurses’ electrocardiographic
knowledge, and patient outcomes.1–10 A
single-site study from 1997 showed that the
presence of dedicated monitor watchers was
not associated with lowe.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
OutlineThesis Statement Due to racism, African Americans are molianaalbee2qly
Outline
Thesis Statement: Due to racism, African Americans are more likely to face higher sentencing than the average American.
Argument #1- Mass Incarceration
Argument #2- Effects from Racial Sentencing
Argument #3- Community Damage
Opposing View Point
Body Paragraph #1
Argument#1- Mass Incarceration
Example #1- Overcrowded Jails/ Prisons
Example #2- Physical/ Mental Health Issues
Example #3- History
Body Paragraph #2
Argument #2- Effects of Racial Sentencing
Example #1- Broken Families
Example #2- Suicide / Death
Body Paragraph #3
Argument #3- Community Damage
Example #1- Employment
Example #2- Homelessness
Body Paragraph #4
Opposing View Point- How African Americans are sentenced fairly
Conclusion
Sum up Thesis Statement/ Body
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, O ...
NURS 4435 TUTA Critically Read and Critique Nursing Research Articles.docxstirlingvwriters
This study examined differences in illness perceptions between injured patients and their caregivers 3-6 months after hospital discharge. A total of 127 patient-caregiver pairs completed questionnaires assessing their perceptions of the patient's injury. The study found that both patients and caregivers held negative views of the injury. Patients perceived more physical symptoms than caregivers. Caregivers of more severely injured patients or those admitted to the ICU had more negative perceptions than other caregivers. Caregivers who did not share care responsibilities also had more negative views than those who did share responsibilities. The results suggest clinicians should explore perceptions to better meet the individual needs of patients and caregivers after injury.
This study examined the relationship between organizational factors of the nurse practice environment and untoward clinical outcomes reported by psychiatric nurses in Pennsylvania hospitals. The study found that hospitals rated as having an "unfavorable" nurse practice environment had more frequent reports of medication errors, infections, injuries, and verbal abuse compared to hospitals with "mixed" or "favorable" environments. Specifically, higher ratings of overall nurse practice environment quality, skilled unit managers, and nurse-physician relationships were associated with fewer reported incidents of infections, falls, and injuries.
The document summarizes research on the role of nurses in activating rapid response teams (RRTs). It finds that nurses who use an analytical decision-making model activate RRTs more frequently and achieve better patient outcomes than those using intuitive or mixed models. Analytical decision-making involves collecting data, forming hypotheses, further data collection, analysis, and decision-making. The study emphasizes the importance of nurses' ability to recognize patient decline and respond effectively through frequent monitoring and timely RRT activation.
Traditionally, physicians recruited clinical trial subjects, but pharmaceutical companies have become ever more involved through centralized campaigns. Physicians are vital to a trial and the pharmaceutical effort helps shift some of the recruitment demands away from the site to allow them to focus on the subjects. Thus, it is practical to understand if different recruitment methods could change or skew the study population. This study determines if differences or similarities occurred between subjects recruited by physicians and pharmaceutical companies. It discovered that some of both occurred. The pharmaceutical company efforts helped recruit potential subjects from the general population that were similar to subjects recruited by the physicians, but this particular campaign was limited by language which affected recruitment of Hispanic subjects. The social impact of this study provides insight about pharmaceutical company recruitment. Since the National Library of Medicine has indicated that clinical trials should reflect the broader diseased population, the efforts of the pharmaceutical company can help support the physicians’ efforts by recruiting from the broader population. Together, both efforts can create a global good by allowing the trial to reflect the population of post-approval use. These findings still raise a question about the proper balance between the two recruitment groups so that the intended characteristics of the diseased population are maintained. Because differences between physician and pharmaceutical recruited subjects can exist, the potential of one group to bias the trial results exist. As such, some analysis by recruitment method can help ensure that variations in the study population are minimal without skewing the data to create positive study results.
This document discusses a study analyzing the transition from verbal to electronic surveys of clinicians in a neonatal intensive care unit (NICU). The study aimed to increase confidentiality and efficiency by moving from verbal/paper surveys to non-verbal/electronic surveys. Statistical analysis found that more surveys were collected daily per patient after transitioning to the electronic method. Therefore, enhancing confidentiality through the use of technology also increased the number of surveys clinicians completed.
OutlineThesis Statement Due to racism, African Americans are mo.docxkarlhennesey
Outline
Thesis Statement: Due to racism, African Americans are more likely to face higher sentencing than the average American.
Argument #1- Mass Incarceration
Argument #2- Effects from Racial Sentencing
Argument #3- Community Damage
Opposing View Point
Body Paragraph #1
Argument#1- Mass Incarceration
Example #1- Overcrowded Jails/ Prisons
Example #2- Physical/ Mental Health Issues
Example #3- History
Body Paragraph #2
Argument #2- Effects of Racial Sentencing
Example #1- Broken Families
Example #2- Suicide / Death
Body Paragraph #3
Argument #3- Community Damage
Example #1- Employment
Example #2- Homelessness
Body Paragraph #4
Opposing View Point- How African Americans are sentenced fairly
Conclusion
Sum up Thesis Statement/ Body
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, O ...
NR 439 CCN Week 6 Relationship Between Nursing Job.pdfbkbk37
1) The study aimed to examine the relationships between nurse staffing, job satisfaction, and nurse retention in acute care hospitals.
2) It was a quantitative, correlational study where nurses completed an online survey about staffing, job satisfaction, and retention.
3) The findings suggested a moderate negative relationship between job satisfaction and retention, and a slight positive relationship between satisfaction and staffing levels. Nurses reported dissatisfaction from high patient assignments.
This study explored sleep and daytime function in cardiac surgery patients before and after surgery. It found that patients perceived their nighttime sleep as ineffective throughout their recovery, requiring increased daytime naps. Nighttime routine care like checks were found to disrupt sleep. The study concluded larger and more diverse studies are needed to understand how to improve sleep and subsequent patient outcomes, and that nurses should lead efforts to transform nighttime care processes to better promote patient sleep, health, and well-being.
Nurse Staffing And Quality Of Careللطالب عامر آل الريTsega Tilahun
This document discusses a study on the relationship between nurse staffing levels and quality of patient care. The study will be conducted at King Khaled Hospital University in Riyadh, Saudi Arabia, surveying 1,300 nurses. Previous research has found mixed results on the impact of nurse staffing levels, with some studies finding higher nurse levels associated with better outcomes. The methodology will use a descriptive correlational design to collect daily staffing data and patient outcomes over time to analyze the relationship between staffing levels and quality indicators.
This document discusses the evidence that resident work hours should be reformed to improve resident and patient well-being. It summarizes research showing that sleep deprivation impairs clinical performance and increases medical errors. Studies found residents had high rates of depression, motor vehicle accidents, and obstetric complications due to long work hours and lack of sleep. The document advocates for collaborative efforts between medical schools, hospitals, and unions to implement work hour limits and enforce policies to promote resident and student health and safety.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
1000 words, 2 referencesBegin conducting research now on your .docxvrickens
1000 words, 2 references
Begin conducting research now on your company/client. After brainstorming on your company’s industry and after your preliminary research information-gathering techniques, create a research profile proposal to deliver to your company’s management that includes the following:
State the specific research goal for the proposal.
What is the company’s current business problem?
Who is the company’s competition?
Establish your population sample for researching customer attitudes and behaviors about the company and product.
Identify the steps in the research process.
.
1000 words only due by 5314 at 1200 estthis is a second part to.docxvrickens
1000 words only due by 5/3/14 at 12:00 est
this is a second part to this assignment due at a different time
Part 1
Your fast-food franchise has been cleared for business in all 4 countries (United Arab Emirates, Israel, Mexico, and China). You now have to start construction on your restaurants. The financing is coming from the United Arab Emirates, the materials are coming from Mexico and China, the engineering and technology are coming from Israel , and the labor will be hired locally within these countries by your management team from the United States. You invite all of the players to the headquarters in the United States for a big meeting to explain the project and get to know one another. The people seem to be staying with their own groups and not mingling.
What is the cultural phenomenon at play here (what is it called/ term)?
How do you explain the lack of intercultural communication and interaction?
What do you know about these cultures—specifically their economic, political, educational, and social systems—that could help you in getting them together?
What are some of the contrasting cultural values of these countries?
You are concerned about some of the language barriers as you start the meeting, particularly the fact that the United States is a low-context country, and some of the countries present are high-context countries. Furthermore, you only speak English, and you do not have an interpreter present.
How will this affect the presentation?
What are some of the issues you should be concerned about regarding verbal and nonverbal language for this group?
What strategy would you use to begin to have everyone develop a relationship with each other that will help ease future negotiations, development, and implementation?
.
More Related Content
Similar to JONAVolume 47, Number 1, pp 41-49Copyright B 2017 Wolters .docx
428 Biomedical Instrumentation & Technology November/December 2016
Features
Abstract
Monitor watchers, or personnel whose job it is to
watch the central cardiac monitor and alert
clinicians of patient events, are used in many
hospitals. Monitor watchers may be used to
improve timely response to alarms and combat the
effects of alarm fatigue. However, little research
has been done on the use of monitor watchers,
and their practices have not been well described.
Therefore, the purpose of our study was to
examine the use of monitor watchers and their
characteristics, training, and practices.
Participants were recruited to complete an online
survey on monitor watcher practice via two
professional nursing organizations. A total of 413
responded to the survey, including 411 nurses and
two non-nurse professionals, and 61% reported
that their hospital used monitor watchers. Of
these, 60% indicated that their hospitals have
been using monitor watchers for more than 10
years, and 62% said that the monitor watchers
were located remotely from the patient care unit.
Many (68%) reported that monitor watchers
worked 12-hour shifts, and a majority said that
monitor watchers were required to have a
certificate in electrocardiographic monitoring
(67%) and be high school graduates (64%). Most
(70%) respondents reported that monitor
watchers alerted the nurse of an event via a
mobile phone carried by the nurse. The results of
this survey revealed that monitor watcher
practices varied widely. Further research is needed
to determine if the use of monitor watchers has an
impact on patient outcomes.
Failure to respond to clinical alarms in a
timely fashion is a critical patient safety
issue. Hospital personnel are looking for
strategies to improve the response to alarms
in an effort to ensure that critical events are
identified in a timely manner. Various alarm
notification strategies have been proposed to
ensure that those providing care to patients
are notified of true and actionable alarms.
These methods include the use of middle-
ware that sends alarms to the bedside
clinician’s wireless device, as well as the use
of monitor watchers.
Monitor watchers, or personnel whose job
it is to watch the central cardiac monitor and
alert clinicians of patient events, are used in
many hospitals. However, little research has
been done on the use of monitor watchers
and little is known about whether they make
a difference in the detection of arrhythmias
or in the outcomes of patients. Anecdotal
evidence suggests that the practices and
responsibilities of these monitor watchers
vary across institutions.
The little available research has focused on
monitor watcher arrhythmia detection,
communication, response times, workload,
effect on nurses’ electrocardiographic
knowledge, and patient outcomes.1–10 A
single-site study from 1997 showed that the
presence of dedicated monitor watchers was
not associated with lowe.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
OutlineThesis Statement Due to racism, African Americans are molianaalbee2qly
Outline
Thesis Statement: Due to racism, African Americans are more likely to face higher sentencing than the average American.
Argument #1- Mass Incarceration
Argument #2- Effects from Racial Sentencing
Argument #3- Community Damage
Opposing View Point
Body Paragraph #1
Argument#1- Mass Incarceration
Example #1- Overcrowded Jails/ Prisons
Example #2- Physical/ Mental Health Issues
Example #3- History
Body Paragraph #2
Argument #2- Effects of Racial Sentencing
Example #1- Broken Families
Example #2- Suicide / Death
Body Paragraph #3
Argument #3- Community Damage
Example #1- Employment
Example #2- Homelessness
Body Paragraph #4
Opposing View Point- How African Americans are sentenced fairly
Conclusion
Sum up Thesis Statement/ Body
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, O ...
NURS 4435 TUTA Critically Read and Critique Nursing Research Articles.docxstirlingvwriters
This study examined differences in illness perceptions between injured patients and their caregivers 3-6 months after hospital discharge. A total of 127 patient-caregiver pairs completed questionnaires assessing their perceptions of the patient's injury. The study found that both patients and caregivers held negative views of the injury. Patients perceived more physical symptoms than caregivers. Caregivers of more severely injured patients or those admitted to the ICU had more negative perceptions than other caregivers. Caregivers who did not share care responsibilities also had more negative views than those who did share responsibilities. The results suggest clinicians should explore perceptions to better meet the individual needs of patients and caregivers after injury.
This study examined the relationship between organizational factors of the nurse practice environment and untoward clinical outcomes reported by psychiatric nurses in Pennsylvania hospitals. The study found that hospitals rated as having an "unfavorable" nurse practice environment had more frequent reports of medication errors, infections, injuries, and verbal abuse compared to hospitals with "mixed" or "favorable" environments. Specifically, higher ratings of overall nurse practice environment quality, skilled unit managers, and nurse-physician relationships were associated with fewer reported incidents of infections, falls, and injuries.
The document summarizes research on the role of nurses in activating rapid response teams (RRTs). It finds that nurses who use an analytical decision-making model activate RRTs more frequently and achieve better patient outcomes than those using intuitive or mixed models. Analytical decision-making involves collecting data, forming hypotheses, further data collection, analysis, and decision-making. The study emphasizes the importance of nurses' ability to recognize patient decline and respond effectively through frequent monitoring and timely RRT activation.
Traditionally, physicians recruited clinical trial subjects, but pharmaceutical companies have become ever more involved through centralized campaigns. Physicians are vital to a trial and the pharmaceutical effort helps shift some of the recruitment demands away from the site to allow them to focus on the subjects. Thus, it is practical to understand if different recruitment methods could change or skew the study population. This study determines if differences or similarities occurred between subjects recruited by physicians and pharmaceutical companies. It discovered that some of both occurred. The pharmaceutical company efforts helped recruit potential subjects from the general population that were similar to subjects recruited by the physicians, but this particular campaign was limited by language which affected recruitment of Hispanic subjects. The social impact of this study provides insight about pharmaceutical company recruitment. Since the National Library of Medicine has indicated that clinical trials should reflect the broader diseased population, the efforts of the pharmaceutical company can help support the physicians’ efforts by recruiting from the broader population. Together, both efforts can create a global good by allowing the trial to reflect the population of post-approval use. These findings still raise a question about the proper balance between the two recruitment groups so that the intended characteristics of the diseased population are maintained. Because differences between physician and pharmaceutical recruited subjects can exist, the potential of one group to bias the trial results exist. As such, some analysis by recruitment method can help ensure that variations in the study population are minimal without skewing the data to create positive study results.
This document discusses a study analyzing the transition from verbal to electronic surveys of clinicians in a neonatal intensive care unit (NICU). The study aimed to increase confidentiality and efficiency by moving from verbal/paper surveys to non-verbal/electronic surveys. Statistical analysis found that more surveys were collected daily per patient after transitioning to the electronic method. Therefore, enhancing confidentiality through the use of technology also increased the number of surveys clinicians completed.
OutlineThesis Statement Due to racism, African Americans are mo.docxkarlhennesey
Outline
Thesis Statement: Due to racism, African Americans are more likely to face higher sentencing than the average American.
Argument #1- Mass Incarceration
Argument #2- Effects from Racial Sentencing
Argument #3- Community Damage
Opposing View Point
Body Paragraph #1
Argument#1- Mass Incarceration
Example #1- Overcrowded Jails/ Prisons
Example #2- Physical/ Mental Health Issues
Example #3- History
Body Paragraph #2
Argument #2- Effects of Racial Sentencing
Example #1- Broken Families
Example #2- Suicide / Death
Body Paragraph #3
Argument #3- Community Damage
Example #1- Employment
Example #2- Homelessness
Body Paragraph #4
Opposing View Point- How African Americans are sentenced fairly
Conclusion
Sum up Thesis Statement/ Body
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, O ...
NR 439 CCN Week 6 Relationship Between Nursing Job.pdfbkbk37
1) The study aimed to examine the relationships between nurse staffing, job satisfaction, and nurse retention in acute care hospitals.
2) It was a quantitative, correlational study where nurses completed an online survey about staffing, job satisfaction, and retention.
3) The findings suggested a moderate negative relationship between job satisfaction and retention, and a slight positive relationship between satisfaction and staffing levels. Nurses reported dissatisfaction from high patient assignments.
This study explored sleep and daytime function in cardiac surgery patients before and after surgery. It found that patients perceived their nighttime sleep as ineffective throughout their recovery, requiring increased daytime naps. Nighttime routine care like checks were found to disrupt sleep. The study concluded larger and more diverse studies are needed to understand how to improve sleep and subsequent patient outcomes, and that nurses should lead efforts to transform nighttime care processes to better promote patient sleep, health, and well-being.
Nurse Staffing And Quality Of Careللطالب عامر آل الريTsega Tilahun
This document discusses a study on the relationship between nurse staffing levels and quality of patient care. The study will be conducted at King Khaled Hospital University in Riyadh, Saudi Arabia, surveying 1,300 nurses. Previous research has found mixed results on the impact of nurse staffing levels, with some studies finding higher nurse levels associated with better outcomes. The methodology will use a descriptive correlational design to collect daily staffing data and patient outcomes over time to analyze the relationship between staffing levels and quality indicators.
This document discusses the evidence that resident work hours should be reformed to improve resident and patient well-being. It summarizes research showing that sleep deprivation impairs clinical performance and increases medical errors. Studies found residents had high rates of depression, motor vehicle accidents, and obstetric complications due to long work hours and lack of sleep. The document advocates for collaborative efforts between medical schools, hospitals, and unions to implement work hour limits and enforce policies to promote resident and student health and safety.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
1000 words, 2 referencesBegin conducting research now on your .docxvrickens
1000 words, 2 references
Begin conducting research now on your company/client. After brainstorming on your company’s industry and after your preliminary research information-gathering techniques, create a research profile proposal to deliver to your company’s management that includes the following:
State the specific research goal for the proposal.
What is the company’s current business problem?
Who is the company’s competition?
Establish your population sample for researching customer attitudes and behaviors about the company and product.
Identify the steps in the research process.
.
1000 words only due by 5314 at 1200 estthis is a second part to.docxvrickens
1000 words only due by 5/3/14 at 12:00 est
this is a second part to this assignment due at a different time
Part 1
Your fast-food franchise has been cleared for business in all 4 countries (United Arab Emirates, Israel, Mexico, and China). You now have to start construction on your restaurants. The financing is coming from the United Arab Emirates, the materials are coming from Mexico and China, the engineering and technology are coming from Israel , and the labor will be hired locally within these countries by your management team from the United States. You invite all of the players to the headquarters in the United States for a big meeting to explain the project and get to know one another. The people seem to be staying with their own groups and not mingling.
What is the cultural phenomenon at play here (what is it called/ term)?
How do you explain the lack of intercultural communication and interaction?
What do you know about these cultures—specifically their economic, political, educational, and social systems—that could help you in getting them together?
What are some of the contrasting cultural values of these countries?
You are concerned about some of the language barriers as you start the meeting, particularly the fact that the United States is a low-context country, and some of the countries present are high-context countries. Furthermore, you only speak English, and you do not have an interpreter present.
How will this affect the presentation?
What are some of the issues you should be concerned about regarding verbal and nonverbal language for this group?
What strategy would you use to begin to have everyone develop a relationship with each other that will help ease future negotiations, development, and implementation?
.
1000 words with refernceBased on the American constitution,” wh.docxvrickens
1000 words with refernce
Based on the American “constitution,” which internal and external stakeholders, in the policy making process, possess “constitutional legitimacy” for their role in making public policy? Do entities with explicit power have more influence than those entities with implied powers in making public policy? Should they? Why or why not?
1000 words with reference
Accountability and ethical conduct are important concepts in public administration. In Tennessee, recent political stakeholders and some bureaucratic stakeholders have been caught up in various scandals (Operation Tennessee Waltz, Operation Rocky Top etc.). Based on the readings, what could Tennessee do to make political and bureaucratic functionaries more accountable?
.
10.1. In a t test for a single sample, the samples mean.docxvrickens
10.1. In a
t
test for a single sample
,
the sample
'
s mean is
c
o
m
par
ed to the
population
.
10.2. When we use a paired-samples
t
test to compare the pret
es
t and
p
ostt
est
scores for a group of 45 people, the degrees of freedom
(
df
)
ar
e _____.
10.3. If we conduct a
t
test for independent samples
,
and
n1
=
32 and
n2
=
35,
the degrees of freedom
(df)
are
_____.
10.4
.
A researcher wants to study the effect of college education on p
eo
p
le's
earning by comparing the annual salaries of a randomly
-
selecte
d g
ro
up
of 100 college graduates to the annual salaries of 100 randoml
y-selected
group of people whose highest level of education is high
schoo
l.
To
compare the mean annual salaries of the two groups
,
th
e resea
r
cher
should use a
t
test for
______.
10.5. A training coordinator wants to determine the effectiveness
of a program
that makes extensive use of educational technology when t
raining new
employees. She compares the scores of her new emplo
yees who
completed the training on a nationally-normed test to th
e
me
a
n
s
c
ore of
all
those in the country who took the same test.
The a
p
pro
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statistical test the training coordinator should use for h
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i
s the
t
test for ______.
10
.
6. As part of the process to develop two parallel forms o
f a q
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es
t
io
nn
aire
,
the persons creating the questionnaire may admin
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t
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a
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are
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.
Circle the
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answer:
10.7. A difference
o
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homogeneous group
s
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ly to
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s
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heterogeneous
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when all fou
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number of subjects.
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y t
w
o g
rou
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more/less
statistically significant than a difference of 3 po
i
nt
s on a 30-item test taken by the sa
m
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t
w
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r
oups.
10.9 When
a
t
test for paired samples is u
s
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c
ompare th
e
p
re
t
est an
d
the posttest
means
,
the number of pretest scores i
s
the
same as/different than
the number of
po
s
t-t
e
st scor
e
s.
10.10. W
hen
w
e
w
ant to compar
e w
h
e
th
e
r female
s
' scor
es
on th
e
G
MAT are
di
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rom males' scores
,
we should use a
t
test for
paired samples/independen
t
samples
.
10
.11 In studi
e
s
w
h
e
re the alte
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h
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poth
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i
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,
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should b
e us
ed t
o
d
e
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i
ne the
l
e
vel o
f
signi
fi
cance (i
.
e.
,
the
p
va
lue).
10.12 W
h
e
n
t
h
e
alt
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ve
h
y
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si
s
is: H
A
: u1=u2
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e
u
se.
100 WORDS OR MOREConsider your past experiences either as a studen.docxvrickens
100 WORDS OR MORE
Consider your past experiences either as a student, early child care professional, or teacher. Describe a creative episode similar to the two boys who found a frog in the text (Creativity and the Arts with Young Children, p.309), when the teacher (maybe you) seized the opportunity (the teachable moment) to inspire the children to branch out using their imagination, creativity, and interests. Why do you think this was such a memorable moment?
WHAT WAS OBSERVED?
Two boys were exploring the outdoors and found a small frog. The teacher recognized their high interest and determined that this was an appropriate topic for a study. Their experience in nature provided the interest and stimulus for a long-term project on frogs. The teacher demonstrated her belief that this study could not only include informational learning but also be enriched by the use of the arts. She didn't know a lot about frogs, so she joined the children in looking for information about them. Stories provided the content for the drama about frogs, and the music selection encouraged listening and moving to the “frog music.” A group mural was created through the collaboration of several children, who created visual representations of the frog's environment. Another group of children investigated building a habitat for the frog in their classroom aquarium. All of the children were involved in active learning and used methods that matched their interests. At the conclusion of the study, the children shared their learning by making a giant book about frogs, creating a song about frogs, and demonstrating the development of the frog aquarium that emulated its outdoor environment. Finally, they returned the frog to its home, which led to their understanding that it needed to live in its natural habitat.
.
1000 to 2000 words Research Title VII of the Civil Rights Act of.docxvrickens
1000 to 2000 words
Research Title VII of the Civil Rights Act of 1964 and discuss why it is so significant.
Your paper should discuss the state of race relations in the United States prior to the Civil Rights Act of 1964. It should also discuss the political environment that led to the passing of the Civil Rights Act of 1964. Additionally, please include a response to the following in your analysis:
What is the purpose of this law?
What groups does it protect? What groups does it not protect?
How were the Jim Crow laws tested during this time period?
What is the U.S. Supreme Court case
Plessy v. Ferguson
about? Is the rule established in the Plessy case still the rule today?
.
1000 word essay MlA Format.. What is our personal responsibility tow.docxvrickens
1000 word essay MlA Format.. What is our personal responsibility toward the natural world, toward what we term our natural resources? Use one of these readings and interpet it to the question reflecting your answer. Add perentheses when using quotes.
“May’s Lion” (Le Guin)
“Deer Among Cattle” (Dickey)
“Meditation at Oyster River” (Roethke)
“The Call of the Wild” (Snyder)
“Eco-Defense” (Abbey)
“The Present” (Dillard)
“Time and the Machine” (Huxley)
Mending wall(Frost)
.
100 wordsGoods and services that are not sold in markets.docxvrickens
100 words
Goods and services that are not sold in markets, such as food produced and consumed at home and some household articles, are generally not included in GDP.
How might the absence of these values mislead one when comparing the economic well-being of the United States and India?
What other items are not included in GDP and how might their exclusion impact policy?
.
100 word responseChicago style citingLink to textbook httpbo.docxvrickens
100 word response
Chicago style citing
Link to textbook: http://books.google.com/books?id=zutRiJJMBQYC&printsec=frontcover#v=onepage&q&f=false
Article is attached
The overwhelming similarities between the articles are perception of identity through self-focus or self-identity through culture. Mulvaney tells us “truth is socially constructed through language and other symbol systems” (Mulvaney, 222). And as an example, it was just such self-focus that landed Galileo in jail by asserting that the universe was sun-centered as opposed to earth centered. The people of that time had socially constructed their own truths based on their perceptions of that time, although we now know that both were incorrect. It was from this perception of correctness that power was assumed and asserted by the majority, which in this case led to Galileo’s arrest (Mulvaney 2004).
Jandt touches on an interesting fact regarding existentialism, the idea of the “other” and the idea that both the observer and the observed are changed in the process. He states, “that the observer is not independent of the observed; the observed is in some sense “created” or changed or both by the act of observation” (Jandt, 212). It is from this dynamic that Jandt speaks of that we can see the formation of societal roles, i.e. the roles of those in positions of power and those in a subservient roles.
The interesting culmination of the information from all three articles is that the process is not a stagnant one, but rather one that can, and often times does change. Through introspective analysis, asking ourselves the question “Who am I?” we can embrace our cultural differences and through the acceptance of our individual qualities can take back some of the power that was perhaps lost (Jandt, 210). For example, take the labels “Feminist” and “Gay” along with “queer” and “Chicano,” which were certainly negative when created, have been transformed into positive labels embraced by those within each perspective community (Jandt 2004).
Works Cited
Jandt, Fred E., Dolores V. Tanno. "Decoding Domination, Encoding Self-Determination - Intercultural Comminication Research Process." In Intercultural Communication: A Global Reader, by Fred E. Jandt, 205 - 221. Thousand Oaks, CA: Sage Publications, Inc., 2004.
Mulvaney, Becky Michelle. "Gender Differences in Communication - An Intercultural Experience." In Intercultural Communication - A Global Reader, by Fred E. Jandt, 221 - 229. Thousand Oaks, CA: Sage Publications, Inc., 2004.
.
100 word response to the followingBoth perspectives that we rea.docxvrickens
100 word response to the following:
Both perspectives that we read referenced Hofstede’s work. Merrit and Helmreich focused closely on Hofstede’s principles of individualism and power distance. They studied how American flight crews differed in these areas from Asian flight crews. The American flight crews proved to have much more individualism than the Asian, although power distance perceptions were mixed between pilots and flight attendants, with the flight attendants perceiving more power distance than the pilots (in Jandt, 2004). Aldridge also focused on individualism and power distance, with regards to the American culture. It is Aldridge’s thesis that it is the idea of the “natural rights of man” that underpins American culture (in Jandt, 2004, p.94). The natural rights of man are a value that is espoused by a culture with high individuality and low power distance. If man has natural rights, then he is an independent being, and in order to value all men, we must have a lower perception of the distance between those of high status and those with lower status.
I enjoyed both perspectives. I felt that the aviation study was very strong, as they were careful to make sure that they accounted for cultural differences in their measurements. I agree with the authors that although they confirmed some sociological theories and demonstrated that flight crews tend to follow their cultural norms, the study is likely skewed. In order to understand how different flight crews behave from standard Asian social norms, the surveys would have to be done from an Asian perspective and even then, there is not just one Asian culture, so that should be taken into account. We likely miss many of the subtle differences between Asian flight crews and their home culture, by not having a sensitive test to that culture.
My main complaint about Aldridge’s perspective is a lack of strong comparison to other cultures. I felt that the argument that American culture is strong based on our belief in natural human rights would have been better served by showing more comparison to other cultures that also espouse this value and/or to cultures that clearly do not. The comparison to Nazi culture was a start, but one that gets kind of old after a while, and is not a culture that is as current as I would prefer in a comparison.
Readings:
Texbook: Jandt, Fred E. (editor) Intercultural Communication: A Global Reader. Thousand Oaks, CA: Sage. 2004
“Human Factors on the Flight Deck: The Influence of National Culture,” Merritt and Helmreich, Jandt pages 13-27
“What is the Basis of American Culture,” Aldridge, Jandt pages 84-98
100 word response to the following
The perspectives learned this week relate to the evolution of human beings and their ability to evolve and survive. As it was state in Aldridge’s readings human beings have the capability to communicate and this ability makes them superior, than animals. All human beings came from the same land and eventually with th.
100 word response to the followingThe point that Penetito is tr.docxvrickens
100 word response to the following:
The point that Penetito is trying to make is that it is important for indigenous cultures to survive. He uses the case of the education of the Maori in New Zealand as an example to exhibit the declining influence of the culture because of the influence of the more dominant British culture. Penetito strengthens his argument by referencing problems that come with colonization and the negative on natives, most notably, the educational system. By attacking this one issue and using facts about the culture to enrich the discussion helps to focus his message that cultures being dominated is a bad thing. The Maori educational system has been moulded to fit the mainstream framework rather than a Maori one (Jandt, 2004, p. 173) and this creates many of the problems and contributes to the extinction of culture. He could use other examples of how colonizing countries leads to the destruction of less important areas of indigiounous cultures such as dress, language, or food in order to strengthen his arguments about the educational systems. The lack of attention in the educational field is having lasting effects on Maoris living in New Zealand and any more information he could use to support this would be important to know. Also examples of educational systems in other colonized countries, to compare and contrast them to New Zealand's would also help to influence readers. He references a report done by the Ministry of Maori Development which states that, "disparities between Maori and non-Maori in a variety of economic sectors such as employment and income" (Jandt, 2004, p. 181). The Maori are just an example of one culture that is fighting for survival out of many. The problem is that through colonization, diversity dwindles. Penetito's writing is valid for all endangered languages because all cultures can use it as a template and useful knowledge for preserving their cultures before they are completely gone.
Textbook: Jandt, F. (2004). Intercultural Communication:A Global Reader. Thousand Oaks, CA: Sage Publications Inc.
---------------------------------------------------------------------------------------------------------------------------
100 word response to the following:
I would like to ask a provocative question, or two.
Given that all of the indigenous languages in the USA are on the brink of extinction, should there be federal funding to protect these languages and these cultures?
Along the same lines, what do you think of English-only initiatives? Do these aid or hurt American culture?
http://www.endangeredlanguages.com/
.
100 word response to the folowingMust use Chicago style citing an.docxvrickens
The document discusses different perspectives on culture from authors Levi-Strauss and Hofstede. Levi-Strauss was interested in structuralism and the differences between cultures. He believed cultures should remain distinct from one another. Hofstede analyzed business cultures and categorized them into symbols, heroes, rituals, and values. He identified four dimensions of national cultural variation: power distance, individualism, masculinity, and uncertainty avoidance. When interacting with those from other cultures, it is important to understand these cultural dimensions and not force our own values, but rather be respectful of different perspectives and find common values to effectively communicate.
100 word response using textbook Getlein, Mark. Living with Art, 9t.docxvrickens
100 word response using textbook: Getlein, Mark. Living with Art, 9th Ed., New York: McGraw-Hill, 2010. Citing in MLA Format:
Between the Baroque and Rococo era, according to Getlein in Living with Art 2010, Rococo is a development and extension of the baroque style. Rococo is not only a play on the word baroque, but also French for rocks and shells. Rococo is known for its ornate style and several points of contrast. Baroque on the other hand was an art of cathedrals and palaces (Getlein p. 397). The Mirror Room of the Amailienburg in Nymphenburg is a great example of the Rococo style of art with its gentle pastels, overall intimacy, multiple mirrors and its illusion of the sky and with that baroque is large in scale and rococo is lighter. According to Getlein p. 398, Rococo architecture first originated in France but was soon exported, some examples of this type of art are found in Germany. Hall of mirrors on page 392 by Charles Le Brun is an example of baroque art, it is a more intense piece of work that is more vibrant and energetic vice the lighter decoration s used in The Mirror Room.
100 word response using textbook: Getlein, Mark. Living with Art, 9th Ed., New York: McGraw-Hill, 2010. Citing in MLA Format:
The Renaissance covered the period from 1400 to 1600, which brought numerous changes that included new techniques in art, the way art was viewed, and how people viewed themselves. The term renaissance means "rebirth" and it refers to the renewal of interest in Roman and Greek cultures. During the period scholars who called themselves humanists believed in the pursuit of knowledge and striving to reach their full creative and intellectual potential. This new way of thinking had many impacts for art during this period. Artists became interested in observing the natural world and studied new techniques on how to accurately depict it. Various techniques were developed such as the effect of light known as chiaroscuro; noting that distant objects appeared smaller than nearer ones they developed linear perspective; seeing how detail and colored blurred with distance, they developed atmospheric perspective. (Getlein page 361) The nude also reappeared in art, for the body was one of God's most noble creations; an example of this can be seen in figure 16.8 the statue of David, by the artist Michelangelo. (Getlein page 368) The primary difference between the Renaissance and the prior period of time was that artists were no longer viewed craftsmen, they were now recognized as intellectuals. (Getlein page 362)
The Northern Renaissance developed more gradually than in Italy. Northern artists did not live among the ruins of Rome nor did they share the Italians’ sense of a personal link to the creators of the Classical past; thus affecting the focus and characteristics between the two cultures. (Getlein page 374) Renaissance artists in northern Europe focused more on small details of the visible world, such as decoration or the outer appearanc.
100 word response to the following. Must cite properly in MLA.Un.docxvrickens
This document summarizes key differences between Egyptian and Islamic architecture and art. It notes that unlike Egyptians, Muslims did not create statues or idols in their mosques due to Islamic doctrine prohibiting images of animate beings. Instead, Islamic architecture used geometry and plants in designs like the Egyptian pyramids. Mosques featured grand designs incorporating textiles, brick, ceramics and calligraphy. A popular example is the Cordoba mosque in Spain, which utilized Roman and Byzantine architectural techniques like arches and domes. Overall, Islamic art and architecture focused more on imagination than depicting history visually like Egyptian art.
100 original, rubric, word count and required readings must be incl.docxvrickens
This document outlines the requirements for an assignment involving a strategy audit report and presentation for a company. It requires conducting an internal and external assessment of the company including analyzing its value proposition, market position, competitive advantage, external environment, internal environment, SWOT analysis, and balanced scorecard. The strategy audit report must identify 5-7 strategic issues, provide recommendations in areas like products, structure, culture, and performance measures, and explain how the recommendations will help achieve the company's strategy and vision. It includes appendices with previously completed analyses. The assignment aims to integrate all coursework into a comprehensive strategy audit for a company.
100 or more wordsFor this Discussion imagine that you are speaki.docxvrickens
Play is important for children to learn and develop. Through play, children learn skills like problem solving, motor skills, social skills, and cognitive development. Parents and childcare professionals can encourage play by providing toys and opportunities for pretend play, outdoor active play, and creative arts to support children's learning and development.
10. (TCOs 1 and 10) Apple, Inc. a cash basis S corporation in Or.docxvrickens
10.
(TCOs 1 and 10) Apple, Inc. a cash basis S corporation in Orange, Texas, formerly was a C corporation. Apple has the following assets and liabilities on January 1, 2010, the date the S election is made:
Adjusted Basis
Fair Market Value
Cash
$200,000
$200,000
Accounts receivable
-0-
$105,000
Equipment
$110,000
$100,000
Land
$1,800,000
$2,500,000
Accounts payable
-0-
$110,000
During 2010, Apple collects the accounts receivable and pays the accounts payable. The land is sold for $3 million, and taxable income for the year is $590,000. What is Apple's built-in gains tax?
(Points : 5)
.
10-12 slides with Notes APA Style ReferecesThe prosecutor is getti.docxvrickens
10-12 slides with Notes APA Style Refereces
The prosecutor is getting feedback from local law enforcement officers explaining that they are discouraged from making arrests in cases of domestic violence and child abuse. They claim that they have been either not making arrests in domestic violence situations or arresting both parties when they go out on a call. It seems that abused women often go back to the abusers, and children who get removed from the homes where they have been abused often return after removal. These occurrences have been especially demoralizing to law enforcement.
One of your jobs in working as a victim witness assistant is to help educate law enforcement on the nature and behaviors involved in domestic violence and child abuse. The prosecutor’s office has decided that you should present each of these topics for the next training session:
Topic 1: Domestic violence:
Your goal is to educate law enforcement to use best practices in the investigation of domestic abuse cases. Include the following topics:
How to approach a domestic violence situation when responding to an emergency call
when the parties should be separated
how to interview parties
what information needs to be in the report and why
how best to help a victim
what laws protect victims, including the use of protection orders
why victims return to abusers
length of time it may take to stay away from their abusers
Arrests
the legal standard needed to make an arrest in a domestic violence case
What evidence should be collected at the arrest?
Are dual arrests effective law enforcement?
how to assist domestic violence victims
reluctant victims
help for victims
Topic 2: Child Abuse:
Your goal will be to educate law enforcement about the dynamics of abuse and neglect cases. Include the following topics:
signs of child abuse and categories (physical, sexual, emotional)
difference between abuse and neglect
legal description of neglect
use of guardian
ad litems
the legal standards that must be met in removal from the home
termination of parental rights
requirements of Indian Child Welfare Act (ICWA)
role of court-appointed special advocates (CASA) in child abuse and neglect cases
role of social services in abuse and neglect cases
For more information on creating PowerPoint Presentations, please visit the Microsoft Office Applications Lab.
.
10-12 page paer onDiscuss the advantages and problems with trailer.docxvrickens
10-12 page paer on
Discuss the advantages and problems with trailers for temporary housing, the issues for FEMA, and recommendations for improvements to the housing program. Discuss how Public Assistance was used in New York for Hurricane Sandy recovery, and why this was so different than previous housing policies.
.
10. Assume that you are responsible for decontaminating materials in.docxvrickens
10. Assume that you are responsible for decontaminating materials in a large hospital.
How would you sterilize each of the following? Briefly justify your answers.
a. A mattress used by a patient with bubonic plague
b. Intravenous glucose-saline solutions
c. Used disposable syringe
d. Tissues taken from patients
.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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For more information about PECB:
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Slideshare: http://www.slideshare.net/PECBCERTIFICATION
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Introduction to AI for Nonprofits with Tapp Network
JONAVolume 47, Number 1, pp 41-49Copyright B 2017 Wolters .docx
1. JONA
Volume 47, Number 1, pp 41-49
Copyright B 2017 Wolters Kluwer Health, Inc. All rights
reserved.
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A
T I O N
The Effect of Reported Sleep,
Perceived Fatigue, and Sleepiness on
Cognitive Performance in a Sample of
Emergency Nurses
Lisa A. Wolf, PhD, RN, CEN, FAEN
Cydne Perhats, MPH
Altair Delao, MPH
Zoran Martinovich, PhD
OBJECTIVE: The aim of this study is to explore
the relationship between reported sleep, perceived
fatigue and sleepiness, and cognitive performance.
BACKGROUND: Although evidence suggests that
fatigue and sleepiness affect the provision of care in
inpatient units, there is a lack of research on the sleep
patterns of emergency nurses and the effects of dis-
turbed sleep and fatigue on their cognitive abilities
and susceptibility to medical errors.
METHODS: A quantitative correlational design was
used in this study; in each of 7 different statistical models,
2. zero-order relationships between predictors and the
dependent variable were examined with appropriate
inferential tests.
RESULTS: Participants reported high levels of
sleepiness and chronic fatigue that impeded full
functioning both at work and at home.
CONCLUSIONS: Although high levels of self-reported
fatigue did not show any effects on cognitive function,
other factors in the environment may contribute to
delayed, missed, or inappropriate care. Further research
is indicated.
Studies of worker fatigue in the military and com-
mercial trucking industries1,2 suggest that long hours,
especially extending into overnight, can be hazardous
in terms of the potential for errors due to sleepiness
and reduced vigilance. Medical providers, both nurses
and physicians, are at risk because of the need for
around-the-clock coverage and the number and type
of decisions they must make in a given time span; in
1989, the Bell Commission Report cited sleep depri-
vation in medical house officers as a major contrib-
utor to the 1984 death of Libby Zion, an 18-year-old
who died at New York Hospital, leading to a restruc-
turing of the hours involved in medical residencies.3
The long (up to 36 hour) shifts of the medical resi-
dents in charge of her care and the consequences of
their fatigue on the decisions that were made were
cited as factors in her death. As a result of their inves-
tigation of the case, the Bell commission recommen-
ded limiting the work hours of medical residents to
less than 80 hours a week and no more than 24 hours
in a row, and subsequent research has led to similar
recommendations for the nursing workforce.4,5
3. Emergency care settings are chaotic environ-
ments, where there is high patient turnover, constantly
changing priorities and frequent changes in patient
condition. High demand work settings are associated
with increased fatigue, which can impair nurses_ at-
tentiveness and ability not only to recognize potential
errors they might commit but also to recognize and
mitigate the errors of others, including physicians.6,7
The work schedules of emergency nurses (ENs) are
characterized by increasing demands, irregular shifts,
and long hoursVall of which challenge their mental
and physical stamina. Although 12-hour shifts are
JONA � Vol. 47, No. 1 � January 2017 41
Author Affiliations: Director, Institute for Emergency Nursing
Research (Dr Wolf); Senior Research Associate (Mss Perhats
and Delao),
Emergency Nurses Association, Des Plaines; and Research
Assistant
Professor (Dr Martinovich), Department of Psychiatry,
Northwestern
University Feinberg School of Medicine, Evanston, Illinois.
The authors declare no conflicts of interest.
Correspondence: Dr Wolf, Institute for Emergency Nursing
Research, Emergency Nurses Association, 915 Lee St, Des
Plaines,
IL 60016 ([email protected]).
Supplemental digital content is available for this article. Direct
URL citations appear in the printed text and are provided in the
HTML and PDF versions of this article on the journal_s Web
site
5. making medical errors and potentially causing harm to
patients.13-15 The research of Rogers and colleagues8
demonstrated that the 12-hour shift is past the point
where safe decision making may be expected, and
both the Agency for Health Research and Quality4
and the Institute of Medicine5 have since recommended
limiting the length of nurses_ shifts. Although evidence
suggests that both mental and physical fatigue and
sleepiness affect the provision of care in inpatient
units,16 there is a lack of research on the sleep patterns
of ENs and the effects of disturbed sleep and fatigue
on their cognitive abilities and susceptibility to making
medical errors. The purpose of this study is to explore
the relationship between reported sleep quality, per-
ceived fatigue and sleepiness, and cognitive perfor-
mance in a sample of ENs.
Methods
Before recruitment of subjects, institutional review
board approval was obtained and the study was
approved (Chesapeake Research Review, Columbia,
Maryland). A Certificate of Confidentiality from the
National Institutes of Health was obtained to further
protect the respondents_ anonymity given the sensi-
tive nature of the question. A quantitative correla-
tional design was used to explore the relationship
between nurses_ reported sleep patterns, perceived
sleepiness and fatigue, and their ability to carry out
timed cognitive tasks. As part of a 35-item online
questionnaire, participants performed 3 medication
dosage calculations and correlations between fatigue
and cognitive performance were measured in the
6. same survey. Predictors were selected based on
empirically based associations with work fatigue
and its impact on task performance.17 In each of 7
different statistical models, zero-order relationships
(ie, simple relationships that do not hold constant
other predictors) between each of the predictors and
the dependent variable were examined with appro-
priate inferential tests.
Sample
Of the 2,419 ENs who were recruited via e-mail
and social media, 2010 met eligibility criteria and
consented to participate. Eligibility criteria required
that study participants were English speaking, currently
licensed ENs working at least 1 shift per week in a
US emergency department (ED). Among those who
consented, 504 survey respondents were excluded
because they did not meet study criteria (eg, worked 1
shift or less in the past 30 days, did not complete survey
in 1 sitting), resulting in a total sample of 1506 ENs.
Research Questions
On the basis of the existing body of evidence, we hy-
pothesized that ENs_ patterns and quality of sleep,
sleepiness, and fatigue would have an attenuating
effect on their performance in timed cognitive skill
tests. To investigate these effects, we posed the fol-
lowing research questions:
Q1: Is there a relationship between ENs_ day-
time sleepiness and performance in timed cognitive
tests?
Q2: Is there a relationship between ENs_
8. within the ESS18 (Cronbach_s ! = .88-.74 in 4 different
groups of subjects).
Q2 Instrument: We included 2 subscales (9-item
subscale: Bhow often have you had trouble sleeping[
and 6-item subscale: Bhow often have you used the
following substances to help you get to sleep[) from
the Pittsburgh Sleep Quality Index (PSQI), which is a
19-item well-validated self-rated questionnaire for
evaluating subjective sleep quality over the previous
month19 (Cronbach_s ! = .83). We developed a third
8-item subscale to assess Bhow often has it been difficult
to do the following things because you were fatigued[
(internal consistency and reliability coefficient = .85).
Q3 Instrument: The Occupational Fatigue Ex-
haustion Recovery (OFER15) Scale is a self-report
questionnaire of 15 questions, which form 3 sub-
scales: chronic fatigue, acute fatigue, and intershift
recovery, respectively. The OFER Scale produces
comparable scores between 0 and 100 for each
subscale, with cut-points into levels of low, low/
moderate, moderate/high, and high on each subscale
used to compute quartiles of scale score distribution.
The subscales have high internal reliability (9.84)
and face, construct, and discriminant validity.20
Timed cognitive performance was measured by
the speed and accuracy for 3 weight-based medication
calculations that are frequently performed in emer-
gency nursing practice. The first 2 medication ques-
tions required calculation of the initial bolus and the
total dose for a thrombolytic medication order for an
older adult patient with a diagnosis of ischemic stroke.
The 3rd medication question required calculation of
9. the 1st dose of an antibiotic for a pediatric patient
with a diagnosis of strep throat. Survey participants
were instructed to complete the survey in 1 sitting and
without interruption. This was done so that we could
determine the speed and accuracy of the medication
calculations in relation to their perceived state of fatigue
at that time. The online survey software recorded start
and stop times for the medication calculations and for
completion of the questionnaire. Seven people were
eliminated from the study sample because their
response times were extreme outliers. All results were
scored and compiled in an SPSS database (version 22;
Armonk, New York) for analysis.
Predictors
Predictors were selected because of a presumed impact
of work fatigue on cognitive performance. Interval-
scaled predictors included the standardized items
(based on analytic sample norms) from each of the
3 instruments used in this study. We examined 29
categorical predictors including work schedules
(total hours in the past 30 days), shift types (length
Table 1. Participants" Demographics
(n = 1506)
Percentage of Survey
Respondents
Gender
Male 15.5
Female 84.5
Intersex 0.1
Missing 0
10. Age
18-24 2.0
25-34 23.0
35-44 24.0
45-54 24.9
55-64 25.0
Q65 1.1
Missing 0
Primary ED role
Staff nurse 68.9
Charge nurse 16.3
Case manager 0.1
Clinical coordinator 1.8
Clinical educator 2.7
Clinical nurse specialist 0.6
Director 1.4
Manager 3.1
Nurse practitioner 1.6
Trauma coordinator 0.8
Other 2.7
Missing 0
Years of experience Mean (SD)
In nursing 17.5 (12.5)
In emergency nursing 12.8 (10.1)
In current ED 8.2 (8.4)
In all areas of emergency care,
excludingnursing (eg, tech, etc)
5.9 (9.3)
Table 2. Facility Characteristics
Percentage of
Survey Respondents
12. for 2 interval-scaled predictors were also obtained for
untransformed scores.
Data Analysis
Correlational analyses were performed using speed
and accuracy of the medication dosage calculations
as the dependent variable. Speed and accuracy data
were examined via 7 statistical models: OLS regres-
sion model predicting time in minutes on the page;
Cox regression model predicting time to fully correct
response (3/3 questions); Cox regression model predict-
ing time to partially correct response (2/3 questions);
3 logistic regression models predicting the probability
of a correct response for each individual medication
dosage calculation; and a polytomous logistic regres-
sion (PLUM) model predicting the number of correct
responses (of 3).
In each of 7 different statistical models, zero-
order relationships (ie, simple correlations or simple
contrasts of group vs full sample) between each pre-
dictor and the dependent variable (time and accuracy
of response) were examined with appropriate inferen-
tial tests (relative ratio, odds ratios, Wald z tests, P
values). Probability estimates were calculated for each
group and for the full sample. Inferential tests con-
trasted each group_s estimated probability of a correct
response to the medication calculation versus all other
groups combined (ie, contrasting each group versus the
full sample) and results were reported with associated
Wald z tests and P values.
Results
Descriptive Statistics
13. In this sample of 1506 participants who provided valid
responses on all items, it took an average of 21.6 minutes
to complete the 34 items in the online questionnaire. Cog-
nitive performance was measured by 3-timed medica-
tion dosage calculations (see Table, Supplemental
Digital Content 1, http://links.lww.com/JONA/A499).
Overall, respondents averaged 3.78 minutes to com-
plete the problem set and the average number of cor-
rect answers was 1.95 of 3. More specifically, the
percentages with 0, 1, 2, or 3 correct answers were
11.2% (n = 168), 17.4% (n = 262), 36.5% (n = 549),
and 35.0% (n = 527), respectively.
Work Schedules
The primary work schedule for this group of nurses
consisted of 12-hour shifts (74%), with a mean
shift length of 11 T 2 hours and an average of 152 T
50 hours worked in the preceding 30 days. Survey
data indicate that the mean number of shifts worked
in that period was 13 T 4, with 30% of the nurses
working all those shifts consecutively and 65%
working at least some consecutive shifts. The re-
ported numbers of extended work shifts ranged from
0 (39%), 1 to 3 (30%), 4 to 10 (25%), and 11 to
24 (5%). The primary reason given for working an
extended shift was to meet patient care needs (47%).
Sleep, Fatigue, and Cognitive Performance
Study participants reported varying levels of sleepi-
ness, sleep disturbance, and fatigue as measured by
their responses on the 3 scaled instruments. Most nota-
bly, 4 of every 10 nurses reported levels of daytime
sleepiness above the upper limit of normal (an ESS
15. Seven different statistical models were used to examine
zero-order relationships between each of the predictors
and the dependent variable (speed and accuracy of
response). Analysis of the interval-scaled predictors for
sleep patterns, sleep quality and fatigue (ESS, modified
PSQI, OFER15) did not detect any significant zero-
order effects within any of the 7 models (Table 4).
Nurses_ work schedules, caregiver status, and working
a 2nd job did show a significant effect on cognitive
performance. Nurses who worked the 7 AM to 7 PM
shift (n = 511) showed significantly poorer response
accuracy on several indicators (Table 5). These sub-
jects had a 25% lower probability (time-adjusted) of a
fully correct response set versus other nurses (mean, 1.87
vs 1.95; odds ratio [OR], 0.78; z = j2.45, P = .14). They
were also more likely to give an incorrect answer for the
pediatric dose calculation (mean, 41.3% vs 47.3%; z =
j3.36, P = .001). In contrast, nurses who worked the
7 PM to 7 AM shift (n = 418) had better time-adjusted
accuracy estimates based on the 2 Cox regression
models. Their probability of generating a fully
correct response was 1.27 times greater (z = 2.48,
P = .013). Similar effects were found for subjects
with a 2nd part-time or full-time job (n = 426) and
for those who were primary caregivers of children
(n = 541), with both groups completing the problem
set faster and more accurately than those with no
additional job or caregiver responsibilities.
Discussion
Based on the existing body of evidence, we hypoth-
esized that ENs_ sleep pattern, sleep quality, and
Table 3. Activities of Daily Living (ADL): Functional Impact of
16. Fatigue (Modified PSQI Subscale)
In the past month, how often has it been difficult for you to do
the following things because you were fatigued?
(valid percent; internal reliability and consistency coefficient =
.85)
Activity Never Difficult, % Sometimes Difficult, % Frequently
Difficult, % Always Difficult, %
Engage in social activities 14.8 46.9 28.1 10.2
Manage stress 17.5 52.9 23.4 6.2
Attend to family needs 25.8 48.2 21.4 4.6
Eat regular meals 21.9 35.7 29.4 13.0
Provide safe patient care 52.7 43.0 3.8 0.5
Safely operate a motor vehicle 61.2 33.8 4.3 0.7
Exercise 10.8 32.4 34.0 22.8
Attend to personal needs 27.6 45.4 21.6 5.4
Table 4. Effect of Sleep and Fatigue on Responses to
Medication Problem Set: 7 Statistical Models
for Interval Scale Predictorsa (n = 1506)
DV1: Correlation
With Time (Minutes
to Complete
Problem Set)
DV2: RR
of Fully
Correct
Response (3/3)
DV3: RR
17. of Partially
Correct
Response (2/3)
DV4: %
Correct
(Activase
Initial)
DV5: %
Correct
(Activase
Total)
DV6: %
Correct
(Amoxicillin
1st Dose)
DV7:
Number
Correct
(1-3)
r RR RR OR OR OR OR
Daytime sleepiness and fatigue
Daytime sleepiness 0.00 1.02 1.00 1.06 0.96 1.01 1.02
Chronic fatigue 0.04 0.93 0.95 0.95 0.97 0.95 0.95
Acute fatigue j0.01 1.02 1.02 0.97 1.02 1.00 1.00
Persistent fatigue 0.01 1.01 0.99 1.02 0.98 1.03 1.01
19. to fatigue (Table 3). Twelve-hour work shifts were the
norm among our study participants (74% of reported
shifts), with an average shift length of 11 hours. Thus,
any extension of work schedules places these nurses
at increased risk of potential harm to patients and
themselves.8-11 Of particular concern is the finding
that nearly half (46.8%) of study participants reported
that their fatigue made it difficult to provide safe
patient care at least some of the time.
Previous researchers have reported higher error
rates among nurses who worked rotating shifts21 and
night shifts.13 In contrast, nurses in our study who
worked the 7 AM to 7 PM day shift showed signifi-
cantly poorer response accuracy when compared
with nurses who worked any other shift (Table 5).
Participants who reported having specific stressors (ie,
being a primary caregiver or working a 2nd full or
part-time job in addition to their ED employment)
answered the problem set with greater speed and
accuracy than did those who did not have those res-
ponsibilities. These unexpected findings stimulate a
number of alternative hypotheses that have been raised
in the literature and are worth further consideration.
Effects of Job Demands and High-Stress
Environments
There is a substantial body of literature on the rela-
tionship between job performance, fatigue, and ex-
posure to repetitive, high levels of stress without
adequate recovery between episodes.9,13-24 Our
sample of ENs reported high levels of acute fatigue,
low intershift recovery, and difficulties with manag-
ing their daily routine (eg, eating regular meals, driv-
20. ing safely, providing safe patient care), consistent
with previous research that suggests that workers
Table 5. Effect of Shift Type on Responses to Medication
Problem Set: 7 Statistical Models for
Categorical Predictors
Survey question: During the past month, on which shift did you
primarily work in your ED? (n = 1506)
DV1: Time in Minutes to
Complete Problem Set
DV2: Relative RiskVFully
Correct Response (3/3)
DV3: Relative RiskVPartially
Correct (2/3)
n Mean t P RR Wald z P RR Wald z P
7 AM-3 PM 98 3.82 0.20 .842 1.07 0.38 .706 1.09 0.73 .463
7 AM-7 PM 511 3.90 1.36 .174 0.75 j3.04 .002 0.89 j1.85 .065
7 PM-7 AM 418 3.58 j1.94 .052 1.27 2.48 .013 1.15 2.06 .040
11 PM-7 AM 21 4.30 1.00 .316 0.45 j1.59 .112 0.71 j1.21 .226
11 AM-11 PM 136 3.63 j0.76 .446 1.08 0.54 .587 1.10 0.88 .380
3 PM-11 PM 31 3.61 j0.39 .694 1.81 2.40 .016 1.12 0.52 .606
3 PM-3 AM 51 3.67 j0.31 .758 0.96 j0.15 .883 0.93 j0.40 .687
DV4: % Correct
(Activase Initial)
DV5: % Correct
(Activase Total)
DV6: % Correct
22. work-related stress and fatigue, with adequate re-
covery being a key mediating factor.24-26 Additional
results from 2 Australian studies found that the psycho-
logical strain that nurses experience in high-paced,
demanding jobs and lower levels of fulfilling non-
work activities were associated with poorer sleep quality
and reduced ability to recover between shifts.27,28
Similarly, the unexpected finding that 12-hour
night shift workers performed better than 12-hour
day shift workers could be a function of differences in
environmental stress both within and between hospitals.
Possibly, the night shift manages fewer interruptions
from other hospital departments and fewer distractions
owing to comparatively fewer workplace and personal
demands than are experienced on the day shift. Re-
search suggests that fatigue, along with inadequate rest
and recovery between ED shifts, may reduce ENs_
ability to be vigilant and recognize the potential for
error.29 In his examination of the effects of sleep depri-
vation on cognition, Killgore17 concluded that sleep
loss has a differential effect on specific cognitive and
emotional processes, with some indication that higher-
level cognitive capacities (eg, memory, judgment,
decision-making) might remain degraded despite resto-
ration. The frequent extension of 12-hour shifts,
inadequate time off between shifts, and constant
exposure to demanding work may have contributed
to difficulties with performing some nursing tasks
(eg, medication calculations) within our sample of
ENs, nearly half of whom reported that fatigue made
it difficult for them to provide safe patient care.
Variations in nurses" vigilance between day and
night shifts and/or over the duration of individual
shifts may have contributed to performance differ-
23. ences in our sample. Surani and colleagues14 found
that vigilance improved over the duration of the shift;
in particular, fast reaction times were significantly
shorter in floor nurses after shift than before it. The
authors concluded that Bthere may also be impair-
ment related to the intensive care unit (ICU) setting,
where higher patient acuity requires even more
vigilance,[ suggesting that the high-acuity ED envi-
ronment may have an attenuating effect on ENs" job
performance. Because we did not collect data on these
types of parameters, we were not able to assess similar
effects that could have contributed to our findings.
Given the considerable costs of work-related fatigue (eg,
injuries), further research is warranted using chronobio-
logical objective sleep measures to more effectively
evaluate the effects of sleep deprivation30 as well as
recommended strategies (eg, work hour limits)31
that could improve the health and safety of the EN
workforce and the patients they care for.
Limitations
The sample was a self-selecting group of ENs who
reported on their sleep patterns and levels of fatigue;
no objective measures of fatigue were collected. We
also did not collect data on environmental factors that
may have affected results. In addition, although the study
instruments have been widely used, to our knowledge,
they have not been used to measure work-related fatigue
among ENsVa subgroup that reports high levels of acute
and chronic fatigue that may be above those found in the
general nursing population. As an example, researchers
found a greater discrepancy in test-retest ESS scores
among patients with possible sleep-disordered breathing
than has been previously reported in studies that
24. examined reproducibility only in normal subjects.32
Similarly, high levels of acute and chronic fatigue within
our study population could have resulted in limited
ability to detect effects of poor sleep quality and fatigue
on ENs" cognitive function. Moreover, because we did
not collect data on variables such as work environment,
vigilance, or the timing of survey completion (eg,
whether study participants completed the medication
problem set during midshift, postshift, or on a day off),
we can neither support nor reject the null hypothesis
that work-related fatigue has an attenuating effect on
ENs_ cognitive function.
Conclusions
A significant percentage of our sample of 1,506 ENs
reported high levels of sleepiness and chronic and
acute fatigue that impeded full functioning both at
work and at home. Although we could not determine
from this study whether levels of self-reported fatigue
affect cognitive function, participants did report
difficulty with providing both self-care and patient
care. Other factors in the environment may contrib-
ute to the effects of EN fatigue and resultant delayed,
missed, or inappropriate care. Further research on the
effect of ENs_ work schedules, physical and emo-
tional fatigue, patterns and quality of sleep, and work-
place conditions on their ability to safely and effectively
perform their jobs in the high-demand environment
of the ED is required. There is compelling evidence
to suggest that fatigue reduction interventions could
contribute to overall improvements in the delivery of
care, including reduction in medical errors.31 Nurse
administrators may consider a fatigue management
reduction system as described by Lerner et al in the
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JONA � Vol. 47, No. 1 � January 2017 49
33. · The network sits behind a gateway router and firewall.
Antivirus is in use, but is not automatically updated across the
company. Employees often work remotely and only use their
login and password to gain access to the corporate systems.
· There is a Director of IT who has a full time staff of 5
employees, one of which does security duties part time.
There are a few known issues with their IT infrastructure and
organization:
· Recently, a number of PCs and office equipment has been
stolen out of the office.
· It’s at the data owner’s discretion as to whether or not to
secure their data files or folders. Many do not secure their
files, while some lock them so only they have access. There
have been rumors that customer data and intellectual property
have been lost.
· Two employees recently left your company and went to your
biggest competitor, where they just landed a contract with your
largest account.
· Vendors are allowed access to the site and computers without
authorization or supervision.
· Onsite staff at each location provides IT support part time
along with their other responsibilities. Password resets are done
by giving out a generic password — Chiefs2017.
You are an independent auditor brought in by Dalton, Walton, &
Carlton’s management. They’ve tasked you with conducting an
audit of their entire IT infrastructure, organization, and
processed.
Bellevue University CYBR 515 as of: August 2017