Incorporating Telemedicine into a Surgical Practice

Incorporating Telemedicine into a Surgical Practice Kristen Harkey Complex wounds can create a challenge for the patient as well as the surgeon. The challenges faced include operative management, cosmesis, long-term management, effects on lifestyle for patient and caregiver, and self-image (Park, Copeland, Henry Barbul, 2010). Hospitalized patients will have the surgical team, the wound care specialist, and a bedside nurse to assist them in their daily care. When these patients are ready to leave the hospital they can feel anxiety about providing care for themselves, especially if they have a complex wound present. This anxiety can decrease once they learn how to care for themselves at home while having the readily available supplies, but then they must leave their homes to travel to come to the surgical office for a wound check. This can be a burden to not only the patient but their primary caregiver. The purpose of this paper is to introduce an evidence-based change project that focuses on providing patients with the option of telemedicine office visits. Background In 2010, approximately 51.4 million inpatient surgeries were performed in the US according to the National Center for Health Statistics (CDC/NCHS, 2010). Wound complications can be an important cause of postoperative morbidity following a laparotomy (Mizeell, Sanfrey, Collins, 2014). Acute wound care is needed in all patients with surgical and traumatic wounds, when an incision is made this creates a wound which will need further attention. There are a multitude of ways to address these wounds such as wet to dry dressings, dry packing strips, wound vac systems, and if needed further surgery such as a skin graft. These wounds can then become chronic when they have failed to proceed through the reparative process to produce anatomic and functional integrity in 12 weeks (Sen, 2009). Both acute and chronic wounds can become a significant financial burden on both the healthcare system and the patient’s themselves. Significance With the sheer number of surgeries listed above, this will create wounds that need to be managed appropriately. Not only are wounds created by surgery, they can also be created by trauma or massive soft tissue infections (Park, Copeland, Henry Barbul, 2010). Part of this management may be further surgical interventions to restore the fascia or possibly watchful waiting. In our facility in 2014, 3349 patients were evaluated by our wound care specialist. Of these 695 patients had surgically created wounds and approximately 656 were managed with wound vacs (G. Caldwell, personal communication, January 20, 2015). These patients will need to be followed in the outpatient setting for ongoing wound assessments, possible change in wound management, or further surgical intervention if indicated. The outpatient care to these patients will include discussions on proper nutrition to promote wound healing, activity levels, timing of dressing changes, and ongoing assessments of the wounds. It can create a significant burden to patient and caregiver to travel to office visits for ongoing assessment of the wounds which can take as little as ten to fifteen minutes to examine once they have arrived back to the exam room. This short office visit can create a significant burden to the patient and their caregiver, this burden can include ability to keep themselves clean throughout the trip, financial, and time-strain. PICO Question and Components Evidence-based practice (EBP) can be described as a â€Å"life-long problem solving approach to clinical decision-making that involves the conscientious use of the best available evidence with one’s own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities, and systems† (Melnyk Fineout-Overholt, 2011). EBP will help to ensure high quality, safe, relevant, and up-to-date care while at the same time improving patient outcomes (Robb Shellenbarger, 2014). One of the ways to create EBP in a way that will yield the most relevant information from a search is to form a question in the PICOT format. The PICOT format is composed of the following: â€Å"P† will describe the patient population, â€Å"I† will reveal the intervention or issue of interest, â€Å"C† will reveal the comparison intervention or status, â€Å"O† will reveal the outcome, and â€Å"T† will reveal the time frame in w hich the intervention/issue of interest will accomplish the outcome (Melnyk Fineout-Overholt, 2011). For the purpose of this paper, the author will include all components listed except for time which will be addressed at another juncture. Population The population of focus will be outpatient postoperative patients in the home health setting. The patient population will be those with acute/chronic wounds, ages eighteen and up, both male and female patients with no restrictions on ethnicity. The wounds will likely be compromised of complex abdominal wounds, however no limit will be placed on the type/cause of the wound. The patient’s will live in North Carolina or South Carolina and reside within a 4 hour drive from Charlotte, NC. No restrictions will be placed on the agency providing home health services to the patient. Intervention Telemedicine is defined by the World Health Organization (WHO) to be the practice of healthcare using video, interactive audio, and/or data communications (Chanussot-Deprez Contreras-Ruiz, 2008). With the use of telemedicine the patients will be able to stay in their own home. This will also provide an enhanced team based approach because we will have both the patient, patient’s caregiver if applicable, and the home health nurse. This will provide accurate documentation of wound measurements. The appropriate wound care will then be provided by the home health nurse, and if applicable the wound vac will be re-applied. Comparison The comparison group will be a standard office visit. The standard office visit will consist of the patient and their caregiver coming to our surgical practice, in one of our two locations. The patient will be required to wait for their appointment time and wait as required for the provider to see them. If a wound vac is present, this will be removed in the office and will not be re-applied per standard operating procedures. The patient will have a temporary dressing replaced and will then need the home health nurse to come to their home upon their arrival to re-apply the wound vac. This consists of a standard office visit in our practice. Outcome The anticipated outcome, will be no effect on wound healing when using telemedicine. For the practitioner, one important aspect of examination of the wound is not only using your sense of sight but also your sense of smell. The smell of a wound can be indicative of necrotic tissue that requires further debridement or possibly a wound infection. This sense will be missing with telemedicine and the practitioner will need to rely heavily on the home health nurse for this aspect of assessment. Another outcome for this study will be increased patient satisfaction. The patient with a complex abdominal wound may have difficulty at baseline maintaining adequate coverage for the drainage, this is more of a challenge when you add frequent position changes associated with traveling to a health care provider’s office. In summary, a postoperative surgical patient will require care for the surgical wound in an outpatient setting. This care can be frustrating for the patient, the patient’s caregiver, and the home health nurse. With the addition of telemedicine to a surgical practice this will decrease the burden of traveling to a standard office visit as well as enhance multi-disciplinary care for the patient. It is the hope of the author that for complex wounds that remain difficult to manage in the outpatient setting, the inpatient wound ostomy nurses who provided care inpatient will be able to assist more in the outpatient setting by providing continuity of care. Conclusion With every surgery performed a resultant wound is created. Wounds can also be created by trauma or massive necrotizing soft tissue infections (Park, Copeland, Henry Barbul, 2010). The surgical wound can heal without difficulty and the patient returns to his activities of daily living, however a multitude of wound complications can occur delaying wound healing. Some wound complications will require further surgery, however due to the nature of these wounds surgery may need to be delayed for up to one year or longer. This can cause caregiver strain and for the patient can take away many of the freedoms we enjoy on a daily basis. As part of a standard office visit the patient is expected to arrange transportation to our office, wait for his/her appointment time, have their wound examined, and then if a wound vac is used they are expected to have this re-applied when they get back to their home by the home health nurse. With the addition of telemedicine to the patient’s postopera tive care, they would be able to have a multidisciplinary team visit them in the home using telemedicine resources. This would significantly decrease the burden travel can create for these patients with complex wounds. References CDC/NCHS National Hospital Discharge Survey (2010). Retrieved from  http://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf Chanussot-Deprez, C. Contreras-Ruiz, J. (2008). Telemedicine in wound care. International  Wound Journal, 5(5), 651-654. Melnyk, B. Fineout-Overholt, E. (2011). Evidence-based practice in nursing healthcare: A  guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer|Lippincott Williams   Wilkins. Mizell, J., Sanfrey, H., Collins, K. (2014). Complications of abdominal surgery. Retrieved  from http://www.uptodate.com. Park, H., Copeland, C., Henry, S., Barbul, A. (2010). Complex wounds and their  management. The Surgical Clinics of North America, 90(6), 1181-1194.  doi: 10.1016/j.suc.2010.08.001 Rob, M., Shellenbarger, T. (2014). Strategies for searching and managing evidence-based  practice resources. The Journal of Continuing Education in Nursing, 45(10), 461-466. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T. K., Longaker, M. T.  (2009). Human skin wounds: A major and snowballing threat to public health and the  economy. Wound Repair Regeneration, 17(6), 763-771. doi:10.1111/j.1524-475X.2009.00543.x Incorporating Telemedicine into a Surgical Practice Incorporating Telemedicine into a Surgical Practice Kristen Harkey Imagine presenting to the hospital for your planned cesarean section, a time of great anxiety and joy. During the procedure you unfortunately have a complication and an enterotomy (cut into the intestines) is made, but missed at the time. Hours later you develop increasing abdominal pain and a rash spreads quickly across your abdomen. Your healthcare providers explain you have an infection called necrotizing fasciitis and this requires further surgery to treat the condition. The individual then wakes up possibly weeks later with most of their abdominal wall, upper thigh skin, some muscle layers missing of both the abdomen and thigh, as well as stool draining from the middle of the wound. The individual is informed they have an enterocutaneous fistula that will likely not be able to be repaired for several months to a year. This person is finally able to transition home with their newborn, a gaping abdominal wound, stool draining from the wound, not allowed to have anything to eat or drink, and are attached to intravenous nutrition twenty-four hours a day. This would be overwhelming for the most health literate patient, much less an individual with limited resources and low health literacy. Our health can change quickly with an unexpected surgery that causes a complex surgical wound. This wound must be monitored closely in the outpatient setting to prevent further complications including loss of limb or possibly life. Typically the patient’s wound care has been provided in the home by a home health nurse. Subsequently the patient and family caregiver are then expected to travel to the doctor’s office for intermittent follow-up examinations of the wound over a weekly to monthly schedule which could last up to one year or more postoperatively. Leaving the patient’s home with these complex wounds can be a burden due to factors such as increased pain, time-consumption, financial costs, and possible embarrassment if the wound or ostomy appliance leaks. Some of this burden could be relieved with virtual visits. Overview of Problem of Interest In the United States 6.5 million individuals are affected with chronic wounds that require ongoing care (Sen et al., 2009). Patients are expected to travel to their healthcare provider’s office for follow-up examinations and sometimes this requires a long care ride, wait in the office, and then travel home. It is difficult to maintain a dressing on the wound in the most basic of circumstances, such as during times of everyday activity in their home. With the addition of traveling this can become an overwhelming and untidy endeavor while the healthcare provider will likely only spend minutes examining you. Due to this some patients will not come to their follow-up appointment and this can be detrimental to their health by prolonging wound healing, increasing risk for infection, and delay future surgical repairs. When the individual is at home, they require home health services for ongoing wound care as well as provision of supplies. The home health nurse sees the patient on a m ore regular basis than the healthcare provider and will call the providers’ office with important changes they note. Unfortunately this process may take several phone calls which takes valuable time for the home health nurse and increases wait time for care of the patient. Most patients have an expectation that surgery will help them heal or cure their disease. Unfortunately approximately 22% of patients may experience moderate to complete postoperative disability (Shulman et al., 2015). Home health nursing will provide some relief for the patient and a multidisciplinary approach is necessary to manage complex treatment modalities (Wilkins, Lowery, Goldfarb, 2007). In Carolinas Medical Center Main in 2014, 3229 patients had wound care provided by our wound ostomy care nurse team and of those 820 were surgical patients (G. Caldwell, personal communication, January 25, 2015). These are many of the patients that require ongoing care in the outpatient setting to prevent further complications. In the United States (US) in 2000, forty million inpatient surgical procedures were performed and at that time the need for post-surgical wound care was sharply on the rise (Chittoria, 2012). In the US the amount of money spent on wound care, diminished quality of life, and the loss of productivity for the individual and caregiver comes at a great cost to our society (Sen et al., 2009). Therefore it is in our best interest as providers to provide safe and effective care to our patients in the most convenient format for both the patient, caregiver, home health nurse, and the healthcare provider. Review of Literature One of the first steps to address a problem is reviewing evidence available to support the proposed intervention. Virtual care is currently being used in many different platforms such as urgent care, psychiatric care provided in ER’s, preventing readmissions in heart failure patients, and many other venues. The examination of acute and chronic wounds is one venue that has found success. In the plastic surgery population where visual exam is heavily relied upon for decision-making, telemedicine has been shown to have great potential. Gardiner and Hartzell (2012) performed a systematic review of twenty-nine articles. Twenty-eight of the articles noted a benefit including improved access to expertise and cost reduction through conserving hospital resources and avoiding unnecessary transfers (Gardiner Hartzell, 2012). Wallace, Hussain, Khan and Wilson (2012) had similar findings in the burn population where they noted improved assessment and triage, avoidance of unnecessary trans fers and a potential for health care savings when using virtual care. In the trauma population a 90% accuracy was noted in assessing traumatic plastic surgery injuries whether the practitioner was using bedside visual exam or transmitted digital images (Gardiner Hartzell, 2012). Wilkins, Lowery, and Goldfarb (2007) used their initial investigation to determine the feasibility of virtual wound care and then moved forward with performing a pilot study using a store and forward technique. At the time of initial referral the mean wound surface area was noted to be 5.85 cm2. Using virtual care the authors noted in 58.2% of the wounds, the diagnosis or treatment plan was changed. This change in diagnosis or treatment plan resulted in an average decrease of 58% from the initial wound size over an average time period of 40.2 days. The authors went on to note 95.5% of patients found telemedicine consultation more convenient than traveling and 98.2% of patients were either satisfied or very satisfied with the care they received (Wilkins, Lowery, Goldfarb, 2007). An article published in 2014 by Kidholm, Dineseen, Dyrvig, Rasmussen, and Yderstraede was noted to be the largest and most comprehensive research project to evaluate telemedicine effectiveness and costs for patients with chronic diseases. The results revealed telehealth reduced mortality with an odds ratio of 0.54. Mortality in the control group was noted to be 8.3% while the intervention group was 4.6%. The authors also noted a 10.8% lower hospital admission rates in the intervention group with an odds ratio of 0.82 (Kidholm, Dinessen, Dyrvig, Rasmussen, Yderstraede, 2014). Telemedicine may be applied to many different aspects of medicine, but a benefit has been shown in the examination and long-term treatment of wounds (Wilkins, Lowery, Goldfarb, 2007). Telemedicine has been shown to satisfy both the clinician as well as the patient, while continuing to provide quality care. Therefore a solution to the burden of traveling to the doctor’s office, decreasing financial strain, decreasing caregiver strain, and improving access to care are all potential benefits of providing care using virtual visits. Purpose of Project The purpose of incorporating telemedicine into our surgical practice is to provide our patients with the most efficient high quality care in the most appropriate setting for the patient. A standard office visit consists of the patient traveling to our office, being evaluated by the medical team, and then having to travel back to their home. This evidenced based project will allow the patient to stay in their own home and have the providers visit them via a virtual visit. Upon discharge from the hospital the patient will be evaluated for inclusion into the virtual visit program. If the patient is determined to meet the criteria including living in NC, using Healthy at Home to provide home health services and have a complex surgical wound; then an appointment will be made for the virtual visit. The home health nurse will proceed to the patient’s home at the assigned appointment time and use their tablet for the visit. The provider will then join the home health nurse in the virt ual setting and the patient’s wound will be evaluated. Appropriate changes in the treatment plan for the wound will occur and the provider will assure all questions/concerns are addressed with the patient, caregiver, and home health nurse. One desired outcome for this project will be to maintain a high level of patient satisfaction, as we do in our office. As providers, we would like to provide more efficient care and this may be possible by having one provider performing postop visits virtually while another provider evaluates new consults in the office. It will be important for this project to provide the same level of care that we provide in the brick and mortar office, as well as following all current standards of care. Project Management The facility where this project takes place is a Magnet facility. To receive this designation an organization must prove they have several key characteristics including empirical outcomes as well as integrating evidenced based practice and research into operational and clinical processes (American Nurses Credentialing Center, 2014). An important goal for our organization this year will be to provide care in new ways, one of which will be providing more opportunities for our patients to experience virtual care. This innovative project is meant to assure that we are improving quality, enhancing value and dealing with the complexity of health care today (Harris, Roussel, Walters, Dearman, 2011). Implementation Team The backbone of quality improvement work is the team and their teamwork (Ogrinc et al., 212). The team for this project will include individuals from different disciplines to ensure success. The author of this paper will serve as the operational lead on the project, assuring all aspects of the project are coordinated. Our administrative lead will be the practice manager for our outpatient sliding scale clinic. He will be able to assist the project in assuring we meet meaningful use standards as we do in the office, as well as building templates in our scheduling software, and facilitate changes in the organization. A management associate with the virtual care division will remain part of the team, as she has had past experience with implementing similar projects and has provided invaluable support. The next member of the team will be a member of the IT department and will assist the team in choosing the right technology/platform for this project. He will not only assist in the beginn ing stages of this project but will be a constant resource for ongoing IT support. The administrator for the home health agency will be a member of this team, she will provide information regarding her organization and provide us with establishing workflow for the home health nurse. This will be an important step as this project is meant to provide multidisciplinary care, however it will not be beneficial for it to provide more efficiency for our team but not the home health team. The chairman of surgery who also serves as the interim lead of the acute care surgery team, as well as the two surgeons who practice on the same service. This team will serve to bring virtual care visits to our surgical practice. Risk Management Strategy It is important to examine every project to identify external and internal items that either positively or negatively affect the project. One type of assessment that can be performed is the strengths, weaknesses, opportunities, and threats analysis (SWOT analysis). During the SWOT analysis the system is fully examined from the clinical micro to the macrosystem perspective (Harris, Roussel, Walters, Dearman, 2011). For this project some strengths noted include other departments within the facility using virtual visits and a department dedicated to assisting new groups to use this technology. Another strength is the patients included in this project will remain in the global ninety day postoperative fee which will not require reimbursement from insurance companies and keep the cost incurred limited. It is important to then examine some of the weaknesses which include removing a provider from an already overbooked clinic to participate in this project, the additional cost of the techno logy, and surgical postoperative care has not been provided in this manner in our facility prior to this. When further evaluating opportunities associated with this project, the ability to be the only surgical providers providing care virtually will set this team apart and appeal to more consumers and home health agencies. Another opportunity would be to include all home health care providers in our area and obtain licensure to be able to provide virtual visits in South Carolina. Some threats to this project include newer technology that hasn’t been tested, a good working relationship with the home health agency must be in place, and is it possible for the team to provide confidential care to our patients using virtual visit technology. Organizational Approval Process Initially this project was approved at the departmental level after multiple discussions with the chairman of surgery for the metro division of our healthcare system. Prior to proceeding to the IRB process, the facility requires submission of your proposal to the Nursing Scientific Advisory Council (NSAC). Once NSAC has evaluated a proposal fully and any revisions have been completed you may move forward with your submission to the IRB. Role of Information Technology in this Project Information technology will play an integral part of this project. Although virtual visits are used throughout the hospital system, they have not been incorporated into the surgical practices within our system. This project will include an IT tech to assist in choosing the best platform to serve our patient population while being user friendly for our home health nursing colleagues. It will be important for our platform to work well with the technology available to the home health nursing team. This will assure we are able to provide the best quality visit and address not only the provider’s needs, but also the home health team, patient, and caregiver. The project needs IT support for both the onsite provider as well as the home health team in the patient’s home. Plans for IRB Approval An institutional review board (IRB) is a committee that is mandated by the National Research Act, Public Law 93-948 and is required in institutions that conduct biomedical or behavioral research that involves human subjects (Harris, Roussel, Walters, Dearman, 2011). IRB approval will be sought for this project using the Carolinas Healthcare System’s IRB. The submission type will be expedited. This approach was chosen because it is evidenced based research and poses minimal human risk to the participants (Chatham University). Prior to approval by the IRB this project must be submitted to the NSAC therefore this will be performed in September 2015. Once approval has been obtained by the NSAC the information will then be submitted to the IRB for approval, likely in November 2015. This letter can be reviewed in Appendix A of this paper. References American Nurses Credentialing Center. (2014). Magnet model. Retrieved  fromhttp://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model Chatham University. (n.d.). Institutional Review Board (IRB). Retrieved from  http://my.chatham.edu/tools/irb/ Chittoria, R. (2012). Telemedicine for wound management. Indian Journal of Plastic Surgery,  45(2), 412-417. Gardiner, S., Hartzell, T. L. (2012). Telemedicine and plastic surgery: A review of its  applications, limitations and legal pitfalls. Journal of Plastic, Reconstructive   Aesthetic Surgery: JPRAS, 65(3), 47–53. doi:10.1016/j.bjps.2011.11.048 Harris, J., Roussel, L., Walters, S., Dearman, C. (2011). Project planning and management:  A guide for CNLs, DNPs, and nurse executives. Sandbury, MA: Jones Bartlett  Learning. Kidholm, K., Dinesen, B., Dyrving., A, Rasmussen, B., Yderstraede, K. (2014). Results from  the worlds largest telemedicine project-The whole system demonstrator. EWMA journal,  14(1), 43-48. Ogrinc, G., Headrick, L., Moore, S., Barton, A., Dolansky, M., Madigosky,  W. (2012).Fundamentals of health care improvement: A guide to improving your  patients’ care(2nded.). Oakbrook Terrace, IL: The Joint Commission and the Institute  for Healthcare Improvement. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T., . . . Longaker, M. T.  (2009). Human skin wounds: A major and snowballing threat to public health and the  economy. Wound Repair and Regeneration, 17, 763-771. Shulman, M. A., Myles, P. S., Chan, M. V., McIlroy, D. R., Wallace, S., Ponsford, J. (2015).  Measurement of Disability-free Survival after Surgery.Anesthesiology,122(3), 524-536.  doi:10.1097/ALN.0000000000000586 Wallace, D., Hussain, A., Khan, N., Wilson, Y. (2012). A systematic review of the evidence  for telemedicine in burn care: With a UK perspective. Burns, 38, 465-480. Wilkins, E., Lowery, J, Goldfarb, S. (2007). Feasibility of virtual wound care: A pilot study.  Advances in Skin Wound Care, 20(5), 275-278.

Charisma: Psychology and Enormous Overwhelming Presence Essay

Whenever we want to define any word we usually look at the meaning in the dictionary. In Greek, charisma is any special grace conferred by God on an individual. Charisma refers to the enormous overwhelming presence that some people have. It is the ability to influence others by being connected with them physically, emotionally, and culturally. Although it is difficult to have a specific definition of charisma, but we could describe some people as a charismatic person who have an extraordinary ability to inspire, influence, and draw other’s attention. Charisma is usually associated with leaders who have a power and high positions, but it could be a characteristic of actors, public speakers, mathematicians, scientists, singers, or any other people. Charisma indicate a positive meaning; however, it could has it own dark side. Some leaders how have charisma causes huge damage to the world in the human history such as Hitler. Hitler was able to get a wide popularity by his support to the nationalism and anti-communism ideas. Later, he established the Nazism organization which believes in racism against other races and the altitude of certain races to others. The real number of his victims is unknown but it said that it reached more than 10 million victim. Some philosophers believe that charisma is innate characteristic while psychologists believe that it could be learned by increasing the individual’s awareness of his emotions and linking it to other people’s feeling, emotions, and needs. So, how can we have a magnesium personality? There are some some tips you could do to be a charismatic person, some of it are: having self-esteem, matching the body language to your speech, thinking before speaking and arranging your ideas, accepting criticism, and being unique in finding practical ideas to develop your character and your surroundings.

Are You a Good Listener Quiz

Are you a good listener? Lets find out. On a scale of 25-100 (100 highest), how do you rate yourself as a listener? _____ Let’s find out how accurate your perception is. Rate yourself in the following situations and total your score. 4 Usually, 3 Frequently, 2 Sometimes, 1 Seldom ____ I try to listen carefully even when I’m not interested in the topic. ____ I’m open to viewpoints that are different from my own. ____ I make eye contact with the speaker when I’m listening. ____ I try to avoid being defensive when a speaker is venting negative emotions. ____ I try to recognize the emotion under the speaker’s words. ____ I anticipate how the other person will react when I speak. ____ I take notes when it’s necessary to remember what I’ve heard. ____ I listen without judgment or criticism. ____ I stay focused even when I hear things I don’t agree with or don’t want to hear. ____ I don’t allow distractions when I’m intent on listening. ____ I don’t avoid difficult situations. ____ I can ignore a speaker’s mannerisms and appearance. ____ I avoid leaping to conclusions when listening. ____ I learn something, however small, from every person I meet. ____ I try not to form my next response while listening. ____ I listen for main ideas, not just details. ____ I know my own hot buttons. ____ I think about what I’m trying to communicate when I speak. ____ I try to communicate at the best possible time for success. ____ I don’t assume a certain level of understanding in my listeners when speaking. ____ I usually get my message across when I communicate. ____ I consider which form of communication is best: email, phone, in-person, etc. ____ I tend to listen for more than just what I want to hear. ____ I can resist daydreaming when I’m not interested in a speaker. ____ I can easily paraphrase in my own words what I’ve just heard. ____ Total Scoring 75-100 You’re an excellent listener and communicator. Keep it up.50-74 You’re trying to be a good listener, but it’s time to brush up.25-49 Listening isn’t one of your strong points. Start paying attention. Learn how to be a better listener: Active Listening. Joe Grimms Listen and Lead project is a fabulous collection of listening tools. If your listening could be improved, get help from Joe. Hes a professional listener.

Essay about Atomic Bomb - 1788 Words

The Atomic Bombing of Hiroshima and Nagasaki nbsp;nbsp;nbsp;nbsp;nbsp;The first atomic bomb was dropped on Hiroshima, on August 6, 1945. The world would never be the same. This paper will discuss the significance of the atomic bombs dropped on Hiroshima and Nagasaki and how they led to the success of the Allied forces. It will also discuss how the United States developed the atomic bomb, the decision to drop the bomb, the weakening of Japan, the actual bombing an destruction of both cities, the surrender of Japan and the impact the atomic bomb would have in the future. nbsp;nbsp;nbsp;nbsp;nbsp;During World War II, the United States was afraid that Germany would develop the atomic bomb first. Germany had taken over Norway,†¦show more content†¦The committee was headed by Secretary of War, Henry Stimson. The committee argued about whether to drop the bomb on a Japanese city or to have a demonstration explosion in an isolated part of Japan. However, some committee members thought that the plane may be shot down or the bomb may not explode. Therefore, they decided not to have a demonstration bomb. The committee decided that the bomb needed to be dropped directly on a city. Stimson wrote the President, quot;We can propose no technical demonstration likely to bring an end to the war; we see no acceptable alternative to direct military use.quot; Soon after that a group of scientists wrote Harry Truman asking not to drop the bomb on any city. They knew that the atomic bomb could cause too much destruction to be dropped on a populated area. Yet, the decision was made by the President. In order to save thousands of Americans lives, the bomb would be dropped (Feinberg, 1995, 26-27). nbsp;nbsp;nbsp;nbsp;nbsp;The primary target in the bombing was Hiroshima. The day Hiroshima would be bombed was August 6, 1945 and it would be the first time ever that an atomic bomb would be dropped from a plane. Before the primary plane took off, four weather planes flew over Hiroshima, Niigata, Kokura, and Nagasaki. The weather over Hiroshima was perfect. The B-29 bomber that dropped the first atomic bomb was named the Enola Gay. It was named after the maiden name of the pilots mother. With the atomic bomb in theShow MoreRelatedThe Atomic Bomb1214 Words   |  5 Pagessurviving an atomic bomb is a perfect example of surviving.. A man with a miracle on his side. His story became famous throughout the world. This man had the courage to tell his story to the world. Surviving the two atomic bombs is not a small thing to comprehend. Therefore, it would take a man who had the courage and integrity to survive it all. On August 9, 1945, the B-29 bomber wedged through the clouds in a Japanese city of Nagasaki that unleashed a 22-kiloton plutonium bomb known as â€Å"FatRead More The Atomic Bomb1719 Words   |  7 PagesThe Atomic Bomb Albert Einstein predicted that mass could be converted into energy. This was the basis for the atomic bomb. Throughout this research paper, I will trace the history of the atomic bomb. In addition, who was involved and why, what happened in this event, and explain the impact that it had on the world. After Einstein predicted, that mass could be converted into energy. This was confirmed experimentally by John D. Cockcroft and Ernest Walton. â€Å"Physicists from 1939 onward conductedRead MoreAtomic Bomb : The Birth Of The Atomic Bombs2008 Words   |  9 PagesThe Atomic Bomb The birth of the Atomic bombs was during WWII, when the nations around the world were fighting against each other, due to disagreements between one another. At the beginning of the war, America was at a stalemate because they did not want to get involved in the war. Even though they were not involved in the war they were helping friendly allies with food supplies and ammunition. And then there was island to the east of the Korean peninsula, also known as Japan, who suddenly decidedRead MoreThe Atomic Bomb2530 Words   |  11 PagesThe beginnings of the Nuclear Age started when Albert Einstein wrote to President Franklin Roosevelt warning him of a dangerous weapon the Nazis had begun researching, known as the atomic bomb. (1) Though, when President Roosevelt first read this letter, he was too preoccupied with events in Europe to be bothered with such ideas. He at the time did not take the creation of such weapon to seriously, nor did he believe America had the resources for such a task. (2) Finally, on October 19, 1939 PresidentRead MoreThe Atomic Bomb1584 Words   |  7 Pagesthe choice to drop the atomic bomb or to attempt more land invasions was a choice that shaped the outcome of the war. There were major influences and side effects from the dropping of the atomic bomb and what it did to the country of Japan. Having the option and the weight of the moral decision weighing on Truman’s shoulders about what decision should be made, he was the only one who was capable of making the decision that shaped the outcome of the war. Having dropped the bomb on Japan, as a statementRead MoreThe Atomic Bombs910 Words   |  4 PagesDuring the 20th century, specifically the year 1945, the United States of America had two atomic bombs that the commander and chief, and president at the time, Harry Truman, knew about. President Truman plan was to drop the bombs on two of Japans cities, Hiroshima first and then Nagasaki. Truman’s plans went accordingly, whi ch to this day leads to a very controversial topic on whether or not dropping the atomic bombs was a good or bad thing. There is evidence and reasoning to back up both claims, inRead MoreThe Atomic Bomb1470 Words   |  6 Pagesover 70 years since the atomic bombings of Hiroshima and Nagasaki, they remain controversial as conscientious struggle with the ethics of using such weaponry in the course of armed conflict. President Truman had a number of options apart from the atomic bomb. He could have left the invasion of Japan to the Russians, whom wanted revenge for the Russo-Japanese War of 1904-05, as well as the more recent conflict in Manchuria (Goldman, 2012). The dropping of the atomic bombs must have shocked many whoRead MoreThe Atomic Bomb Essay1094 Words   |  5 PagesPost World War II, fear and anxiety consumed the subconscious of many Americans. Many feared atomic matter and the mystery of what it really was. Under the Atomic Energy Act, all information regarding the mat ter was classified. â€Å"The Big Secret,† as it was called was both a point of interest and pillar of anxiety for many. Everyday life was consumed by thoughts and worries but driven by the curiosity of this new science (Osteen 1994). The ability to split the uranium atom was discovered in 1938 inRead MoreAtomic Weapons And The Atomic Bomb1709 Words   |  7 Pagessurviving the dropping of the atomic bomb on her city, Eiko Taoka would watch helplessly as her infant son died of radiation poisoning--something she blames herself for to this day (Taoka). There are thousands of stories like these, and each one describes the incredible destructive power behind atomic weapons and the deep wounds they leave behind. Even now, seventy years after that fateful day, writers and filmmakers utilize the terror induced by the thought of atomic warfare in their stories andRead More The Atomic Bomb Essay1549 Words   |  7 Pages it will be discussed why the Atomic Bomb is the biggest method of destruction known to man. The paper will be discussing the results of the Atomic Bombs, along with the effects years after the initial explosion. People always wonder how many people actually died in the two Atomic Bombs which were dropped in Japan. This question will be answered, along with the method that citizens were actually killed by the bomb. Besides the initial blast winds that an Atomic Bomb gives off, people may be killed