Migrant workers - The opposite way of the American dream essays

Migrant workers - The opposite way of the American dream essays Migrant Workers: the opposite way of the American dream II ABOUT THE AUTHOR 03 III MIGRANT WORKERS IN THE USA AT THE DECADE OF 30 04 IV OF MICE AND MEN MIGRANT WORKERS 06 This present paper is about one of the most important American novels called Of Mice and Men by the Pulitzer Prize winner John Steinbeck. It is a story focused on two men who move from ranch to ranch in order to find work. It is set is Salinas, California, the authors birth place and it takes place during the Great Depression. Despite all the other themes and elements present on it, there is one that calls out attention most. We found very interesting the fact that all the characters, but the farmer owner and his son, were migrants and all of them had dreams and that throughout their histories none of those dreams came true. So, in order to understand that bad fortune it was necessary to study about that time period and learn more concerning the effect of the Great Depression on the Americans life. This could be seem unimportant at a first sight but it becomes very important when one realizes that it was not only the financial world that suffered with the stock market crash but the whole nation in its most far places and that all lives in America were affected in any way. Our aim is to show that in going to California looking for their dreams, the migrants were caught in a kind of mousetrap, a no way out situation. They were far from their houses, friends, parents, with no money on them. They were exploited and forced to work long and hard hours for insulting wages. They had no choice if they wanted to work. There were lots of them in the same situation and near them there was always another one that will be glad on taking the job. There are many other interesting themes such as lonely, loyalty, camaraderie presents on this novel but as we said above we are going to try to demonstrate how ...

The United Monarchy of Israel and Judah

The United Monarchy of Israel and Judah After the Exodus and before the division of the Hebrew people into two kingdoms was a period known as the United Monarchy of Israel and Judah. After the Exodus, which is described in the Biblical book of the same name, the Hebrew people settled in Canaan. They were divided by tribe, with the bulk of the tribes residing in the northern regions. Since the Hebrew tribes were frequently at war with neighboring tribes, the tribes of Israel formed themselves into a loose confederation, which required a military commander to lead it. Judges, who partially served in this capacity (as well as serving in legislative and judicial capacities), accrued power and wealth over time. Eventually, for military and other reasons, the followers of Yahweh decided they needed more than a military commander a king. Samuel, a judge, was chosen to appoint a king for Israel. He resisted because a king would compete with the supremacy of Yahweh; however, Samuel did as bid [see: 1 Samuel 8:11-17], and anointed Saul*, from the tribe of Benjamin, as the first king (1025-1005). David (1005-965), from the tribe of Judah, followed Saul. Solomon (968-928), son of David and Bathsheba, followed David as king of the united monarchy. When Solomon died, the United Monarchy fell apart. Instead of one, there were two kingdoms: Israel, the much larger kingdom in the north, which split apart from the southern kingdom of Judah (Judaea). The United Monarchy period ran from c. 1025-928 B.C. This period is part of the archaeological period known as Iron Age IIA. Following the United Monarchy, the Divided Monarchy ran from about 928-722 B.C. *There is a problem with the dates of Saul since it is said that he ruled two years, yet must have ruled longer to encompass all the events of his reign.

New Treatment of Aortic Stenosis by Transcatheter Aortic Valve Research Paper

New Treatment of Aortic Stenosis by Transcatheter Aortic Valve Implantation - Research Paper Example The most common of aortic stenosis undergo in patients 65 years of age and over (called senile calcific aortic stenosis) (Kulick, 2012). General symptom of aortic stenosis patients are exertional dyspnea (shorten fatigue), angina pectoris (chest pain), syncopy (fainting), and congestive heart failure. Every aortic stenosis patient will be investigated by multidisciplinary team; 2 interventional cardiologists, 1 cardiac surgeon, and an anaesthesiologist (Bedogni et al., 2011). In general, the treatment for aortic stenosis patients, who are not showing symptoms of the disease, is to take medicine while the severely symptomatic aortic stenosis patients must have surgical aortic valve replacement. Transcatheter aortic valve implantation (TAVI) is the new procedure for severe aortic stenosis treatment. The progression of this treatment makes it suitable for patients who are inoperable or very high risk with standard surgical aortic valve replacement. In addition, the procedure of TAVI is executed in a catheterization laboratory or hybrid operating room, under general anaesthesia and without cardiopulmonary bypass (Jean-Bernard et al., 2009). The procedure of TAVI is the device implant with two transcatheter aortic valves (the Edwards SAPIEN valve, ESV or the Medtronic Corevalve, MCV) with three approaches used (transfemoral, transaxillary, or transapical) (Godino et al., 2010). The transcatheter aortic valve implantation (TAVI) was underwent with the first patient in 2002 (Rodes-Cabau, 2010). Furthermore, TAVI clearly achieved safety and efficacy of the percutaneous treatment in aortic stenosis towards the end of 2010 (success rates > 90% and 30 days procedural mortality rates < 10%) (Rodes-Cabau, 2010). The aim of this case study will be to capture the progression of transcatheter aortic valve implantation, for patients who are inoperable or with very high surgical risk in standard aortic valve replacement. Firstly, it will briefly review the cause of aortic stenos is, followed by an explanation of transcatheter aortic valve implantation procedure with two difference transcatheter aortic valves and three difference approaches. Finally, the major effective procedure of TAVI and future development of TAVI will be discussed. Impact of Aortic Stenosis Degenerative Aortic Stenosis is the most common valve disease, and its prevalence is projected to increase in the coming years due to aging populations. This has implications not only for those specializing in cardiovascular disease; Aortic Stenosis is increasingly diagnosed and treated by other medical specialties, including internal medicine, geriatrics and intensive care. This point to the increasing rang of the impacts that aortic Stenosis has been established to have. The Aorta, both ascending and descending, is responsible for the circulation of oxygenates blood throughout the body. It is no wonder that the partial or complete Stenosis of the Aorta would lead to varied conditions that can be de tected either in Intensive care Unit, when the patient is in a stupor, or by the gastric, as a result of ventral pooling of blood, caused by its stagnation in the veins, venules, and arterioles. This pooling is caused by the lack of, or limited pressure from the Aorta, to help in the circulation of

Astronomical objects Essay Example | Topics and Well Written Essays - 2750 words

Astronomical objects - Essay Example One of the most impressive achievements of science is the development of a quite detailed understanding of the physical properties of the Universe, even at its earliest stages. Astronomy and Cosmology is a fundamental part of our natural sciences today. Through close interaction with other disciplines, above all with mathematics and physics, it is been expanding, which on one hand triggers from knowledge, and then on the other profits from them. The great majority of astronomical objects are characterized by large masses and enormous energies. These generally cause matter to exist under extreme conditions of temperature and density, which, even today still lie well beyond what can be realized in a physicals laboratory. The various forms of matter that is encountered away from the Earth, at great distances is being studied as an area of interest. In current astrophysical cosmology there is some interesting and more or less generally accepted observational facts. Thus, in any active-ga lactic-nucleus phenomenon massive central objects like black holes, tachyons, neutrinos, WIMPS etc are expected to be common, and they are surrounded in a variety of scales, by gas clouds commonly termed circumnuclear gas, with liner a dimensions of a few ten kilo space. All these and few other astronomical objects and their current position in the study of cosmology is being discussed in this thesis.Neutron Stars: Neutron stars are highly compact stellar objects with masses ~ 1-2 M (where M is the mass of the sun), and radii of order 10km. ... observational data on neutron stars, gathered with a wide variety of detectors from radio to gamma-ray, provides increasingly stringent constraints on theories of their constitution. Precision radio and optical timing measurements show that pulsars have remarkable long-term timing stability, and thus the neutron stars forming them must have reasonably thick rigid crusts anchoring stable magnetic fields. Despite substantial work over the past half century, the nature of matter at the extreme densities in the cores of neutron stars remains uncertain. A better understanding of the possible states of matter in neutron stars interiors can also enable the world of cosmology to infer whether an independent family of denser quark stars, composed essentially of quark matters can exist (Rowan, 1996). Strings: Strings are extended objects with an intrinsic tension (energy per unit l length). Recent years have seen a radically different approach to the problem of quantum gravity this has led to a different idea of the possible structure of the quantum gravity theory. One of the most exciting ideas is that the fundamental entities upon which quantum operations must be performed are not point-like but are one dimensional. Such objects are usually known as strings, or more often super strings. In the last decades string theory has become a promised candidate for the underlying theory of the fundamental interactions of nature. However, even though lots of progress has been done it has not been yet possible to confront it with real physics. One possibility to achieve this is through cosmology by studying the cosmological implications of string theory. On the other hand string theory would

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.