Reflection on postmortem care Research Paper Example | Topics and Well Written Essays - 500 words

Reflection on postmortem care - Research Paper Example Further, the involved nurse may be expected to contact the next of kin and seek permission for possible actions such as undertaking an autopsy and even donation of organs if such cases are involved in the will of the dead. The postmortem care involves three major elements, assessment, diagnosis, and planning. The assessment phase of the activity involves confirmation of the death, evaluation of the family’s emotional condition, and consultation with the family regarding autopsy and organ donation. The initial stage of the care is the verification that the heart and the lungs have stopped functioning and that the involved physician has pronounced the person dead. The nurse then evaluates emotional status of the bereaved family to offer necessary support. Diagnosis that may identify anxiety and insufficient knowledge among the family follows before contact with the next of kin and the actual care process. My team performed a postmortem care at Rose hospital in Lindsay, Ontario. It was my first time to participate in the activity and I did not know the patient, neither had I attended to him before his death. Our instructor led us into the room after the family had left and she talked to us in a low voice, probably to ensure that nobody heard us because it was a training exercise and not a professional practice. The activity involved the instructor, four other students, and I. I was the team leader and led the team as we performed postmortem care on the body by removing all the tubes such as the urine and IV catheters. We then cleaned the body and put the identification tag on it. We left the gown on to ensure respect for the body, bagged it, and transferred it to the morgue. I felt sad at watching the dead body but the experience did not have significant emotional effect on me and I treated the body in a similar way that I would to a patient. A major issue in the post mortem care is ethical

Teacher Leadership - Deciion Making Assignment Example | Topics and Well Written Essays - 250 words

Teacher Leadership - Deciion Making - Assignment Example The school culture fundamentally relies on sharing values, beliefs and visions of school which highlight high standard of ethics and moral considerations. They are designed to inculcate sense of responsibility and accountability so that they can grow up into responsible adults. The teachers as leaders share decisions which promote shared goals and higher sense of social responsibility within students. Shared decisions also become strong facilitator for creating effective learning environment for students (Hasham, 2010). When teachers encourage decision making through informed choices, students are motivated to learn more skills and tend to pay more attentive in their classes. In the current environment of rapid globalization and changing social dynamics, understanding cross cultural values become hugely pertinent issues for building constructive social relationship. Indeed, teachers as leaders are in a position to influence students’ outlook towards diversity and encourage positive relationship building amongst students coming from diverse background. School culture that thrives on excellence is intrinsically linked to shared decision making process and collective goals as defined by educational leaders. Various processes and events like celebrations, acknowledgement, sharing of stories of high achievement, ceremonies to award students etc. serve to inspire students for higher academic

Outback Steakhouse Essay Example | Topics and Well Written Essays - 1000 words

Outback Steakhouse - Essay Example This paper seeks to assess how employee selection methods at Outback Steakhouse help it to have a competitive advantage. It also seeks to establish the importance of fit to the organization. Moreover, it seeks to evaluate the organization’s employee selection process and whether or not its selection methods are valid. The employee selection methods at Outback Steakhouse have, no doubt, given it a competitive advantage. It has made good use of some of the most effective intangible human resource factors, and these together with a wide knowledge in organization have helped it to have advantages over its competitors. The intangible factors also make it hard for Outback’s competitors to imitate its operations. Outback aims at maintaining its competitive advantage, especially through the use of its already established intangible factors, which are mostly employee-centered. It uses a precise process of employee selection for both its hourly and management employees, and this process is one of the things that have helped it to hire and retain the best employees. During the hiring process, Outback always assesses the qualifications of all applicants before selecting the most appropriate for the vacancies in question. This selection process keeps in mind Outback’s objectives, and such, the successful candidates are always those who have proven beyond doubt that they are ready to work within its vision and values, and also adhere to its organizational culture. These employees must be competent enough to work in teams, and be responsible and accountable (Jackson and Randall, 2008). To efficiently perform in a competitive business world, every player needs to understand that structural flexibility is very crucial for success (Vesey, 1991). This is what Outback seems to have understood so well. Outback Steakhouse employs personality test when recruiting new employees. This is majorly aimed at identifying those candidates who â€Å"adaptable, highly soc ial and meticulous.† Thereafter, it keeps the records of all the successful candidates, which are later used to set the cutoff scores for hiring other employees in future. Only those who attain the set cutoff scores get hired, and as such Outback Steakhouse uses this opportunity to recruit only those applicants with characteristics almost similar to those of existing successful employees, a factor which has helped it maintain its competitive advantage. Moreover, its selection process has helped it to keep its employee turnover levels as low as possible. The low employee turnover is equally important as Outback Steakhouse maintains almost all the skills and talents it nurtures. The process is also very cost effective compared to other recruitment processes, since basing recruitment on the traits of established employees helps it to get simply the best employees (Jackson and Randall, 2008). Fit has proven to be very important for Outback Steakhouse. By matching the personal qual ities of all potential employees to Outback Steakhouse’s culture and values, fit provides it with the most effective employees. It helps it to get the most appropriate hourly and management staff, that is, it helps in hiring the right staff. This fit is also relatively important in meeting the organizations objectives, as it ensures that the best employees are retained as they develop their careers within the organization. This not only leads to better performance but it also increases the loyalty of the employees, who are likely to be more committed to achieving the organizational goals (Jackson and Randall, 2008). Most restaurants in the US are reportedly doing badly partly

Immigration and the Immigrant Policy Initiative in Britain and the EU Essay

Immigration and the Immigrant Policy Initiative in Britain and the EU - Essay Example The law, introduced in February 2005, obliged people born outside the European Union and who only had a six-months to one year visa to seek special permission from the Home Ministry to marry even if their partner was a British or an EU national. The plight of the many people caught up in this intricate legal tangle had complained of pain, misery, suffering, and humiliation. The move by the High Court came as a relief to many. Rights campaigners had opposed it saying that it did not make a distinction between genuine and sham marriages and sought to tar all non-EU nationals who applied for marriage as potential fraudsters. The law was challenged when one immigrant was refused permission to marry a woman from within the "European Economic Area" (EEA) who had been living legally in Britain. The court ruled that it was incompatible with human rights law as it did not apply to those who wanted to marry within the Church of England. This amounted to discriminating against people of other faiths, including Hinduism, Islam, and Sikhism. It was not persuaded by the argument put forward by the Home Office that the exemption for the Church of England was valid because there was no evidence of any sham marriage rackets involving Anglican ceremonies. This act was a knee-jerk reaction based on speculation rather than evidence. The House of Lords complained that the Act had not received proper scrutiny. By this judgment of the High Court, their concerns have proved to be correct. Doctors, other than those from the European Union and favoured countries need to have a work permit under new immigration rules. This is for non-European countries starting July 2006. Those already here and do not have a work permit will have to return to their home country and apply for the same. However, work permit will be given against specific vacancies for which suitable "home-grown" doctors are not available. The move has sparked criticism not only from overseas doctors but also from British medical experts. It is termed as a blow to "Meritocracy" as hospitals would have to give preference to "sons-of-the soil" over better qualified foreign applicants. The decision to scrap the traditional permit-free training arrangement for international doctors is intended to give more opportunities to local doctors and those from the European Union countries. Under the new rules, hospitals will have to show that they are not able to find suitable local candidates. Overseas doctors from non-EU countries will

Violence and the Emergency Room Essay Example | Topics and Well Written Essays - 1750 words

Violence and the Emergency Room - Essay Example Many of these elders must be cared for in the home which puts them in harm's way when violence occurs. The stress of caring for them at home and the lack of funds increases the chance of violence and or the use of alcohol. All of these things affect the emergency room on a daily basis and many times they are fueled by alcohol which makes the encounter that much more volatile. This paper will examine domestic violence fueled by alcohol and how it might affect the emergency room. Intentional and unintentional violence and its effects take a toll on human health and the quality of life. Globally more than 5 million people die from injuries every year; violence kills more people than HIV/AIDS and malaria combined, yearly (World Health Organization, 2002). Every week in Wales and England, two women are killed by their current or former partner (Reeves & Sully, 2007) and many more are damaged for life. This is not an unusual statistic throughout the world at this time. This kind of violence in families has a very long history. It consists of a pattern of coercive control that is designed to isolate the victim (Davis, 2007). This all presents in major health issues in which the cost is high. Those in the violent situation and the communities in which they live have lost positive community participation and increased costs in healthcare. This type of violence usually manifests itself in physical, sexual, and or psychological abuse which involves fear, intimidation , and emotional depravation of not only the victim but those around them (Davis, 2007). It often engrains the victim in poverty that becomes difficult to climb out of. When fueled with alcohol, the violence can be much more sudden and heightened for the victims as well as the emergency room staff. There are some social, political, and legal context in Australia that should be considered here. In the last decade of conservative Federal government in Australia, there has been an erosion of services to women living with domestic violence. There has been a concerted move toward the consolidation of family which may force a situation in which the perpetrator is in the victims life longer. This has also caused the dismantling of policies and services that are available, including such things as child care subsidies, youth training schemes, youth allowances, legal aid, supported accommodation schemes, and movement to negotiated settlements. All of this affects programs that support women and children in trouble (Wright & Waugh, 2007). This makes it more difficult to get these women and children to safety and keep them there. When violence occurs the victims often come to the emergency room and many of them have never seen a primary physician so the violent episode may just be the tip of what is wrong with them. There is a often a revolving door situation in which the same victims come back with injuries on a regular basis. They may also keep coming back with complaints of things like headaches and stomach pain in an attempt at safety. Studies show that this may be the only safe place in which these victims can disclose or plan for escape. These same studies show that a woman's decision to expose abuse can depend on the attitude of the clinician that is caring for her as a victim (Janssen & Holt, 2002) and that nurses attitude may be the victims only hope for escape. It should be noted,

Influence of Optimist and Pessimist for Success Essay Example for Free

Influence of Optimist and Pessimist for Success Essay For example, an optimist will look at a sunset and think, â€Å"Look how beautiful nature is, thank god, life is a wonderful present,† where a pessimist will look at the same one and think, â€Å"The sunset means another day of life passed over and I have one day closer to death. † It is just like an optimist seeing a half-water filled bottle as half full when the pessimist sees half empty. Scientists believe that people with an optimistic attitude towards life can be more successful than pessimists. It is no doubt about that, but people need pessimistic thinking to triumph. Despite everyone knowing optimists are more likely successful, too much optimism or over confidence will lead to negative consequences, even disaster. For example, in ancient times there were three most undoubtedly powerful and prosperous dynasties: Ancient China, Ancient Babylon and Ancient Egypt. Once Ancient China ruled the world. Over a period of 5,000 years the Chinese people developed a unique, self-contained and self-centered society at the extreme eastern end of the Eurasian landmass. The Chinese complacently thought that they did not want what modern science offered—greater technology, power over the natural world, and an improved standard of living. Unlike Westerners, the over-optimistic Chinese felt no need to develop modern science to conquer the natural world. Eventually, as a consequence, Chinese people had been suffering from catastrophic warfare for more than hundreds of years, and there had been not less than one hundred million dead. The only reason why it happened was just because of an unintelligent decision that secluded China from the outside world made by an over-confident and over-optimistic empire. A perfect piece of art or invention, as I have observed, cannot be made simply by those are without pessimistic thinking or critical thinking. Steve Jobs (February 24, 1955-October 5, 2011) was a co-founder, chairman and CEO of Apple Inc. He had such an active professional life that it would not be easy to list all his incredible achievements in one article, but many people knew he had been a over-optimistic loser when the Apple III model came to the public. Jobs thought everything would be going well as he wanted, but truthfully it was not. The over optimism got him fired from the Apple company for eleven years before he finally returned to the Apple company that he established. After that, Jobs became a revolutionary inventor of the digital world. He made legends; he amazingly changed the world. What made Jobs success was that he turned from an optimist to a critical thinker during a low tide of his life. He no longer thought what he invented was perfection and began to criticize his work thousands of times before publishing. Having pessimistic think or called critical thinking makes it possible for people to be as successful as Jobs. However, the information above does not imply that it is wrong for us to be optimists. Optimists succeed more easily in all areas of life. Recent studies show that optimists excel in school, have a better love life, make more money, have better health and live longer. Optimists also do better in the face of stress. Even though optimists bite off more than they can chew, they still end up healthier and happier than pessimists. So the answer of which perspective is correct is neither. What is really important is not which way of thinking is correct but which is more beneficial. You can make a case for each side of the situation. Information about China history from I have learned in history class Information about Steve Jobs from Youtube Steve Jobs speeches The following list from http://www. centreforconfidence. co. uk/pp/overview. php? p=c2lkPTQmdGlkPTAmaWQ9NTY= The benefits of being optimistic include: * Better health * Longer life A happier life * Less stress and anxiety * Successful careers * Better educational qualifications * Better relationships * Better at problem-solving * More resilient in the face of adversity * Cope better with failure The costs of being pessimistic include: * Depression * Dying younger * Inertia in the face of adversity * Having a lower immune system * Suffering increased ill-health, both physical and mental * Not performing well at work * Failure when faced with crucial situa tions * Poorer relationships Even when things turn out badly, pessimists don’t feel good about making the * More fun and worthwhile. People’s Attitude towards Life Outline Thesis: It is no doubt that optimists are more likely to succeed, but success cannot be without pessimists. Opinion 1: the overoptimistic attitude will lead negative consequence. For example ancient China Opinion 2: the pessimistic thinking or called critical thinking can help you succeed. For example Steve Jobs Conclusion: we cannot totally deny the benefit brought by optimistic attitude.

Use of Lidocaine and Sodium Thiopental for Pain Management

Use of Lidocaine and Sodium Thiopental for Pain Management Different premedication admixture with propofol to attenuate pain severityinduced by propofol injection: a double blind randomized controlled clinical trial Abstract Background and Objective Propofol has widely used due to providing pleasant anesthesia and rapid recovery. However; injection pain is one of the main side effects of a propofol that has remained as an undesirable problem. This study compares the effect of thiopental, lidocaine, fentanyl , normal saline admixture with propofol compared with only propofol on injection pain induced by propofol Materials and methods A double blind randomized controlled clinical trial was conducted on 257 patients that were randomly allocated to one of five groups to receive only 2mg/kg of Propofol type Fresenius One percent in group I, 2 cc of Lidocaine 1% in group II, 2 ml of Normal Saline 0.09% in group III, 50 mg Sodium Thiopental in Group IV and Group V were injected 100Â µg Fentanyl before injection of Propofol. Verbal Rating Scale was used for assessing pain. Results A significant decrease in pain severity during injection was achieved in group II (lidocaine ) and IV (Thiopental) compared to other groups. Fentanyl was also effective in reducing moderate pain. Conclusion: We found that Thiopental and lidocaine reduce more effectively incidence and pain severity than other groups. It seems that aforementioned drugs bee more appropriate as an alternative method to diminish propofol injection pain than others treatment in this study. Key Word: propofol, injection pain, premedication Introduction Preoperative care cause satisfaction for patient in recent years(1)Propofol is the drug that has attained popularity which has widely used owing to its fast onset time ,short-acting duration , and trivial adverse effects (2) despite these favorable attributes, the prevalence of injection pain has been reported 68-90% and has been ranked seventh among the 33 undesirable clinical problem in anesthesia(3-6). Injection pain severity was reported 5.6 Â ± 2.3 by measuring system of Visual Analog Scale , which represents unfavorable pain (7). Up to now, different ways have been studied and recommended to reduce the incidence and pain severity of Propofol injection. Among various methods, emollient of Propofol (8, 9) and using numerous drugs including Lidocaine (10), Thiopental(11) ,Alfentanil (12) and Gransytron or Ondansetron(13)can be noted. There are different emollients of Propofol in Iran such as Fresenius Propofol 1% which has a side branch of a long triglyceride (LCT) and Lipuro Pro pofol 1% which has side branches of medium and long triglyceride (MCT/LCT) ,that is assuming that later one is more effective in reducing injection pain(14). Lidocaine as a local anesthetic inhibits the beginning and conduction of nervous impulses by decreasing the penetration of nerve membrane to Na+. It prevents the membrane depolarization, effluence and conduction of potential . It’s systemic absorption is rapid via skin and phlegm (throat, respiratory system) (15).Fentanyl is a drug which usually used as a premedication, because of the rapid and short onset, intense analgesia, Stable cardiovascular hemodynamic as well as less histamine release (16). Thiopental from barbiturate family causes hypotension but has a high ability to protect nerves and control ICP (17). Ondansetron is a modern antiemetic drug which is chosen as the antagonist of Hydroxyl Triptamin type 3. This drug reduces nausea and vomiting and its complications are also very low(18). Different advantages of aforementioned drugs for pain persuaded us to use them to understand that how much they can reduce propofol injection pain and which one is more effective. Methods: A double blind randomized controlled clinical trial was performed on 257 patients, after obtaining confirmation from both Golestan University of medical science and 5th Azar hospital ethical committee approval. Signed written consent was taken from all subjects before surgery. Including criteria were patient aged between 15 to 55 years old with ASA ÃŽâ„¢, ΙΙ (American Society Anesthesiologist) that candidated for elective surgery, such as bowel obstruction, hernia, laparatomy , during 1390 to 5th Azar educational hospital in Gorgan, northeast of Iran. Alcohol consumption or taking any pain medication during 24 hours before surgery, a history of neurological disease, chronic pain syndrome, thrombofelebit, advanced systemic disease (such as advanced diabetes), and any contraindication based on injection of Propofol led to patient withdrawal from the study. Measuring patients pain using VRS (Verbal Rating Scale) from zero to three which has been developed by MC Hunter and Crirrick. Detail shown in (table 1). After patient’s entering into the operation room ,a No. 20 cannula were inserted in the biggest vein in no dominate hand. (without injection of a local anesthetic) and was connected to normal saline solution (without start of infusion). Difference between the two independent proportion formula calculated 24 samples for each group, however, considering five groups in our study, adjusted for sampling (19) was calculated, (= = 2*24 = 48 48*5= 245 ) g assume as the number of groups that 245 samples calculated. To achieve as s ame power as parametric tests we also used the efficiency power of nonparametric test, so that the sample size was multiplied by inverse 95 percent (20)which finally 260 samples was considered. Simple randomization allocation method was used to assign patients into five groups, so that five envelopes which containing the name of drugs was prepared and one out of five randomly selected for a patient and this approach repeated for all patients. In the first group (53 patients) 2mg/kg of Propofol type Fresenius One percent (MCT/LCT) was injected. In the second group (50 patients), 2 cc of Lidocaine 1% before use of Propofol was injected . The third group (48 patients), received 2 ml of normal saline 0.09% before the injection of Propofol .Group IV (54 patients) 50 mg Sodium Thiopental before injection of Propofol type Fresenius was injected. Group V (55 patients) also received 100Â µg Fentanyl before injection of Propofol. The place of injection is the dorsal vein of the hand. None of the patients received premedication and they were asked about the pain in injection place, 5-10 seconds after injection of 25% of anesthetic induction dose. And it was inscribed in questionnaire and after lessening the level of patients’ consciousness the rest of the anesthetics were injected. Anesthesia method were be same in all patients. The Propofol we wanted to use kept at room temperature (21 centigrade). Patients and the anesthesia nurse who filled out the questionnaires won’t know about the injected solution. And there is no chance to distinguish the solutions because they had the same color, volume and also the same shape. The first anesthesia nurse prepared the medication and injected by the second anesthesia nurse, the measure of pain and discomfort in hand examined by third anesthesia nurses and the questionnaire filled out by the fourth anesthesia nurse .To determine the relationship between premeditation and a measure of the pain Mann-Whitney and Kruskal- Walis test was used and demographic feature was also compared using ANOVA and Chi Square test with Spss 11.5. Results 257 out of a total 260 participated patients were analyzed in our study and 3 cases due to lack of condition were exclude. Characteristic of study subject including age, gender, weight and ASA physical status were presented in table2. No statistically significant difference saw in demographic characteristics of all groups and were comparable. (Table 2)(p>0.05)The overall and detailed of pain incidence shown for all groups in (table 3).Pain intensity at propofol injection in lidocaine and thiopental groups was much lower than three other groups especially in severe pain however fentanyl were also better than normal saline combined with propofol and using propofol only. No patient experienced spo2 less than 95% and heart rate lower than 50/min. No complication and adverse effect (eg, pain, allergic reaction, inflammation, edema, wheal ) were observed at the injection location 24 h after surgery. There was no conflict of interest . Discussion Pain during propofol injection causes anxiety and can interfere an appropriate anesthesia. Pain during Propofol injection mechanism is not well known yet, But it is suggested that perhaps a direct stimulating effect causes the immediate feeling of pain, or an indirect effect dependent on mediators release lead to begin pain.(15) dilatory pain (after 10 to 20 seconds) results from an indirect effect on the endothelium owing to the release of Cyanogens(21). Fat-soluble causes the increased activity of plasma’s kallikrein-kini system that leads to production of bradykinin. These interactions cause dilation and increased permeability in the peripheral veins, lead to an increase in Aqueous phase of Propofol with the endothelium and free efferent nerve endings between the media and intima of vessel wall and eventually cause pain (22). Finally we can say Propofol is a kind of drugs which stimulate skin, phlegm and inner vein wall(23). Gozal and Freeman (24-26) have debated, confined area size between the endothelium and drug is more influential than absolute drug concentration. A various method such as temperature(27) dilution(28) concurrent use of drugs(29-31) , give a variety to speed injection(32) has been used to attenuate propofol injection pain but different lidokaine dose and technique mostly use to attenuate for such pain (33)Analgesia results of Lidocaine in pain reduction following Propofol injection is not only because of it’s local analgesia but also it causes the decrease in Propofol Ph, and according to a hypothesis, Ph decrease causes Propofol moving into lipid phase and decrease Propofol in Aqueous phase and therefore lead to decreasing pain.(34, 35). In the present study, injection of Lidocaine before Propofol injection leading reduction in pain that the findings are compatible with other studies (23, 26, 36) but with the exception that their doses which were more than ours. Nevertheless controversy still exists (37) maybe for using higher dose in our study . The effect of Sodium Thiopental in pain reduction was accorded with other s tudies (8, 35, 38, 39). Fentanyl is also diminishes such pain but not as much as lidocaine and thiopental that is consistent in diminishing pain with others investigations (40-42) Conclusion This study finding shows that use of Lidocaine and Sodium Thiopental in comparison with other medications cause more reduction in pain especially in severe pains but lidocaine is more available cheaper than thiopental . Although no significant observed between some groups in pain reduction but pay attention to our founding in frequency of pain suggest using propofol with any premedication even normal saline better than injected propofol alone.