Intermediate Level English for Medical Purposes

Intermediate Level English for Medical Purposes This sample conversation is for a physical examination. Doctor: When did you last come in for a physical exam?Patient: I had my last physical two years ago. Doctor: Have you had any other exams recently? Blood work, an EKG or an ultra-sound?Patient: Well, I had a few X-rays at the dentist. Doctor: How have you been feeling in general?Patient: Pretty well. No complaints, really. Doctor: Could you roll up your left sleeve? Id like to take your blood pressure.Patient: Certainly. Doctor: 120 over 80. Thats fine. You dont seem to be overweight, thats good. Do you exercise regularly?Patient: No, not really. If I run up a flight of stairs, it takes me a while to get my breath back. I need to get out more. Doctor: That would be a good idea. How about your diet?Patient: I think I eat a pretty balanced diet. You know, Ill have a hamburger from time to time, but generally, I have well-balanced meals. Doctor: Thats good. Now, Im going to listen to your heart.Patient: Ooh, thats cold! Doctor: Dont worry its just my stethoscope. Now, breathe in and hold your breath. Please pull up your shirt, and breathe deeply... Everything sounds good. Lets take a look at your throat. Please open wide and say ah.Patient: ah Doctor: OK. Everything looks ship shape. Im going to order some blood work and thats about it. Take this slip to the front desk and theyll arrange an appointment for the tests.Patient: Thank you, doctor. Have a nice day. Key Vocabulary physical examination (exam)blood workEKGultra-soundx-raysto roll up sleevesoverweight - underweightto exercise regularlybalanced dietwell-balanced mealsstethoscopeto breath into hold ones breathto pull on ones shirtto breathe deeplyto open wideto look ship shapeslipfront deskto arrange an appointment

The DREAM Act Explained

The DREAM Act Explained The Development, Relief, and Education for Alien Minors Act, also called the DREAM Act, is a bill last introduced into Congress on March 26, 2009. Its purpose is to give undocumented students a chance at becoming permanent residents. The bill provides students with a path to citizenship regardless of the status passed on to them by their undocumented parents. A previous version of the bill states that if a student entered the U.S. five years before the passage of the legislation and was under age 16 when they entered the U.S., they would be eligible for a six-year conditional residency status after completing an associates degree or two years of military service. If at the end of the six-year period the individual has demonstrated good moral character, he or she could then apply for U.S. citizenship. More information about the DREAM Act can be found on the DREAM Act Portal. Why Support the DREAM Act? Here are some of the points supporters of the DREAM Act make to justify it: These young immigrants are blameless for their current predicament. They were brought here at a young age by their parents and had no say in the matter. It makes no sense and is morally wrong to punish them for the offenses of their parents. The government should treat them as victims, not offenders. The country has already made a substantial investment in many of these young immigrants and it would be senseless to throw that away. Most of them have attended public schools. They have earned high school diplomas in the public system. Many have benefited from public healthcare and some from other public assistance. The government could get a return from these investments by allowing them to contribute to the U.S. economy and society. Many have completed high school but cannot attend college because of their undocumented status. Studies show DREAM Act immigrants could provide a powerful boost to the U.S. economy.Many of the typical complaints about immigrants don’t apply to these young people. Most are as American as the native-born citizens around them. They speak English, understand American life and culture, and they are fully assimilated. They tend to be highly motivated and prepared to accept the responsibilities of U.S. citizenship. DREAM Act legislation could transform this lost generation of young people into U.S. taxpayers. Even some conservative Republicans such as former Texas Gov. Rick Perry support the DREAM Act because it would make these immigrants taxpayers who contribute to the economy, instead of people forced to live unproductive lives in the shadows of a nation that won’t acknowledge them. â€Å"Are we going to create a class of tax wasters or are we going to create taxpayers?† Perry said. â€Å"Texas chose the latter. Every state has the freedom to make that decision.†Bringing these young immigrants out of the shadows would enhance national security. As long as the government considers them here illegally, they will not come forward. National security is strengthened when everyone in the country lives openly and contributes to society. To take advantage of the DREAM Act, young immigrants would be required to pass background checks and give their addresses and contact informati on to the government.Giving legal status to these young immigrants through the DREAM Act would not cost the government. In fact, the fees immigration officials could charge applicants could more than cover the administrative costs of running the program. Former President Barack Obama’s deferred action, DREAM Act alternative program already uses fees to cover its costs. Many of the eligible young immigrants are willing to give public service to the country, either through the U.S. military or non-profit enterprises. The DREAM Act could be the catalyst for a wave of service and social activism across the country. Young immigrants are eager to contribute their time and energy to a nation that embraces them.The DREAM Act is in keeping with the United States’ heritage as a nation that treats immigrants fairly and makes special efforts to reach out to young people. American tradition as a sanctuary for exiles dictates that we allow these innocent immigrants a chance to move on with their lives and not cast them as refugees without a homeland.

Identify an assesment tool analyse and critically discuss the validity Essay

Identify an assesment tool analyse and critically discuss the validity and reliability issues in relation to the tool - Essay Example The multitude of assessment tools, on the one hand, presents medical professionals with a unique opportunity to choose and use the tools that fit their needs and the needs of their patients. On the other hand, the multiplicity of tools creates conditions, in which variations in wound care practices may work against the principles of effective monitoring and measurement of ulcer healing. The Pressure Ulcer Scale for Healing (PUSH) and the Bates-Jensen Wound Assessment Tool (BWAT/ PSST) are the two most popular assessment tools in wound care, but it is more important and even interesting to reconsider the validity and reliability (if possible) of other wound assessment instruments. This paper will seek to evaluate and investigate the reliability and validity of the Sussman Wound Healing Tool (SWHT). Pressure ulcers or pressure sores present a ‘chronic problem of debilitated elders who are mainly bed or chair bound or unable to reposition themselves. The pressure ulcer is a localized area of tissue necrosis that develops when soft tissue is compressed against a bony prominence and an external surface for a long period of time† (Ebersole, Hess & Luggen 2004, p. 144). Pressure ulcers are usually the results of pressure, skin breakdown, maceration, or shearing (Baranoski & Ayello 2003; Ebersole, Hess & Luggen 2004). They can range from simple reddening to severe craters with exposed bone or muscle (Bluestein & Javaheri 2008). They are staged in four different categories: stage I can heal rapidly; stage II is treated effectively if patients avoid pressure and other risk factors; stage III requires using antiinfective agents and sometimes enzymatic debridement, whilst stage IV is associated with large and deep ulcers that often require surgical debridement of the necrotic tissue (Bates-Jensen et al 2003; Coleman et al 2002; Ebersole, Hess & Luggen, 2004). Given the importance of wound healing in different groups of

Razer Essay Example | Topics and Well Written Essays - 500 words

Razer - Essay Example There is a proper database with back-end and front-end that stores all information regarding the gaming inventory, personnel, and customers. 3. To protect their information systems and data, Razer is implementing many important security measures. There are security architectures like AWS, GCE, Azure, and Rackspace. Web application firewalls, IDS/IPS, network security monitoring, and log management solutions are some of the few aspects of the information security systems implemented in Razer gaming solutions. Highly qualified personnel run the security systems. All of these information security measures ensure that the data remains secure and protected within the company, and that it does not get into the hands of unauthorized persons. 4. I would suggest creating a comprehensive technology plan which would include methodical replacement of aging workstations. The plan would include regular appraisal of emerging technologies. I would consider how the nature of the company is changing and at what pace, so as to make appropriate changes to the system. I would schedule periodic maintenance downtime to manage system updates and virus scans. I would also like to train the personnel according to the best international standards. 5. The company is marketing its gaming hardware and other gaming services through online social networks and online advertisements. The business process of marketing is being supported by this method. When people surf the internet or use online social networks to get connected to each other, they come across the advertisements placed by the company. This way, they get familiar with all the new gaming hardware that the company is providing. They can click on the advertisements and get to know which service is best for them and which gaming hardware they want to buy. The existing social media infrastructure stores all conversations on

Managerial Leadership role for Nurses’ Use of Research Evidence Essay Example for Free

Managerial Leadership role for Nurses’ Use of Research Evidence Essay The rapid noticeable change in healthcare delivery coupled with professional responsibilities of nurses to incorporate research evidence into their decision making underscores the need to understand the factors involved in implementing evidence-based practice. Linking current research findings with patients’ conditions, values, and circumstances is the defining feature of evidence-based practice. Significant and rational for using evidence in practice in nursing care Evidence-based practice (EBP) is an approach to health care where the best evidence possible is used in health professionals to make clinical decisions for individual. It involves complex and conscientious decision-making based on the available evidence, patient characteristics, situations, and preferences( McKibbon, 1998). Evidence-based practice in nursing is defined as â€Å"integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served† (Sigma Theta Tau International position statement on evidence-based practice February 2007 summary, 2008). The gist of evidence based health care is the integration of individual clinical expertise with the best available external clinical evidence and the values and expectations of the patient. There are different recourses of evidence which includes the following: †¢Research Evidence: which refers to methodologically sound, clinically relevant research about the effectiveness and safety of interventions, the accuracy of assessment measures, the strength of causal relationships and the cost-effectiveness of nursing interventions. †¢Patients Experiences and Preferences: identification and consideration of patient’s experiences and preferences are central to evidence-based decision making. Patients may have varying views about their health care options, depending on factors such as their condition personal values and experiences, degree of aversion to risk, resources, availability of information, cultural beliefs, and family influences. †¢ Clinical Expertise. AS the mixing of these different types of evidence may be influenced by factors in the practice context such as available resources, practice cultures and norms leadership styles, and data management, we must consider the level of evidence while using the research evidence to take the proper decision, look to appendix A which is represent the level of evidence. (Haynes, Devereaux, Guyatt, 2002; Sigma Theta Tau International position statement on evidence-based practice February 2007 summary, 2008). Evidence-based practice is a prominent issue in international health care which is intended to develop and promote an explicit and rational process for clinical decision making that emphasizing the importance of incorporating the best research findings into clinical care to ensure the best possible treatment and care derived from the best available evidence (E. Fineout-Overholt, Levin, Melnyk, 2004) Once a new research is completed new evidence comes into play every day, technology advances, and patients present with unique challenges and personal experiences(Krainovich-Miller, Haber, Yost, Jacobs, 2009). The nurse who bases practice on what was learned in basic nursing education soon becomes outdated, then becomes dangerous. Patients are not safe if they do not receive care that is based on the best evidence available to assist them at the time their needs arise, so all aspects of nursing, from education to management to direct patient care, should be based on the best evidence available at the time (Reavy Tavernier, 2008). Through reviewing the literature there is a dramatically changing and advancing in the technology, available body information and quality of care provided, the rapid pace of change in healthcare delivery coupled with professional responsibilities of nurses to incorporate research evidence into their provided care and decision making underscores the need to understand the factors involved in implementing evidence-based practice (Bostrà ¶m, Ehrenberg, Gustavsson, Wallin, 2009; Ellen Fineout-Overholt, Williamson, Kent, Hutchinson, 2010; Gerrish, et al., 2011; Gifford, Davies, Edwards, Griffin, Lybanon, 2007). Before that nurses must first believe that basing their practice on the best evidence will lead to the highest quality of care and outcomes for patients and their families(Ellen Fineout-Overholt, et al., 2010; Melnyk, et al., 2004). To let change occuring, â€Å"there must be a clear vision, written goals, and a well-developed strategic plan, including strategies for overcoming anticipated barriers along the course of the change†(Melnyk, et al., 2004). Emerging evidence indicates that the  leadership behaviors of nurse managers and administrators play an important role in successfully utlizing research evidence into clinical nursing(Amabile, Schatzel, Moneta, Kramer, 2004; Antrobus Kitson, 1999; Gifford, et al., 2007). There is a consistency between many researches that clamethe importance role of the leadership and leadership factors such as support and commitment of managers on the staff at the implication of EBP(Aitken, et al., 2011; Antrobus Kitson, 1999; Melnyk, et al., 2004; Winch, Creedy, Chaboyer, 2002). Nurse managers and administrators are responsible for the professional practice environments where nurses provide care, and are strategically positioned to enable nurses to use research. As being a role model, administrators must be committed to provide the necessary resources such as EBP mentors, computers, and EBP education. Some administrators have tried to encourage a change to EBP by integrating EBP competencies into clinical promotions. However, Miller (2010) argue that this extrinsic motivational strategy is unlikely to be as effective as when people are intrinsically motivated to change. Also there is a claimed that if people are involved in the strategic planning process, they ar e more likely to change to EBP. Intervention protocol for promoting nurses compliance to EBP As the Decision making in health care has changed dramatically, with nurses expected to make choices which based on the best available evidence and continually review them as new evidence comes to light (Pearson et al, 2007). Evidence-based practice involves the use of reliable, explicit and judicious evidence to make decisions about the care of individual patients. As an important role in providing safe and high quality care the nurses must take into account the quality of evidence, assessing the degree to which it meets the four principles of feasibility, appropriateness, meaningfulness and (Doody Doody, 2011; Johnson, Gardner, Kelly, Maas, McCloskey, 1991). What nurses need to operate in an evidence-based manner, is to be aware of how to introduce, develop and evaluate evidence-based practice. There more than one model for introducing the EBP in health care one of them that I chose is the Iowa model. The Iowa model focuses on organization and collaboration incorporating conduct use of research, along with other types of evidence(Doody Doody, 2011; Johnson, et al., 1991). Since its origin in 1994, it has been continually referenced in nursing journal articles and extensively used in clinical research programmes. This model uses key triggers that can be either problem focused or knowledge focused, leading staff to question current nursing practices and whether care can be improved through the use of current research findings(Bauer, 2010; Doody Doody, 2011; Johnson, et al., 1991; Titler, et al., 2001). By using Iowa Model; a question is generated either from a problem or as a result of becoming aware of new knowledge. Then a determination is made about the question relevance to organizational priorities. If the question posed is relevant, then the next step is to determine if there is any evidence to answer the question. Once the evidence has been examined, if there is sufficient evidence, then a pilot of the practice change is performed. If there is insufficient evidence, then the model supports that new evidence should be generated through research (Bauer, 2010). Step one of the Iowa model is to formulate a question. The question if asked in a PICO format is easier to use to search the literature. A PICO format uses the following method to frame the question: Frame question in PICO format †¢ P= Population of interest †¢ I= Intervention †¢ C= Comparison of what you will do †¢ O= Outcome(Hoogendam, de Vries Robbà ©, Overbeke, 2012). The final step to the process is to share the outcomes of the practice change with other in the form of an article or poster. In using the Iowa model, there are seven steps to follow in detail as it is outlined in the figure shown in appendix B. Step 1: Selection of a topic In selecting a topic for evidence-based practice, several factors need to be considered. These include the priority and magnitude of the problem, its application to all areas of practice, its contribution to improving care, the availability of data and evidence in the problem area, the multidisciplinary nature of the problem, and the commitment of staff. Step 2: Forming a team The team is responsible for development, implementation, and evaluation. The composition of the team should be directed by the chosen topic and include all interested stakeholders. The process of changing a specific area of practice will be assisted by specialist staff team members, who can provide input and support, and discuss the practicality of guideline. A bottom-up approach to implementing evidence-based practice is essential as change is more successful when initiated by frontline practitioners, rather than imposed by management. Staff support is also important. Without the necessary resources and managerial involvement, the team will not feel they have the authority to change care or the support from their organization to implement the change in practice. To develop evidence-based practice at unit level, the team should draw up written policies, procedures and guidelines that are evidence based. Interaction should take place between the organization’s direct care providers and management such as nurse managers, to support these changes(Antrobus Kitson, 1999; Cookson, 2005; Doody Doody, 2011; Hughes, Duke, Bamford, Moss, 2006). Step 3: Evidence retrieval Evidence should be retrieved through electronic databases such as Cinahl, Medline, Cochrane and up-to-date web site. Step 4: Grading the evidence To grade the evidence, the team will address quality areas of the individual research and the strength of the body of evidence overall (see appendix A for level of evidence). Step 5: Developing an Evidence-Based Practice (EBP) standard After a critique of the literature, team members come together to set recommendations for practice. The type and strength of evidence used in practice needs to be and based in the consistency of replicated studies. The design of the studies and recommendations made should be based on identifiable benefits and risks to the patient. This sets the standard of practice guidelines, assessments, actions, and treatment as required. These will be based on the group decision, considering the relevance for practice, its feasibility, appropriateness, meaningfulness, and effectiveness for practice. To support evidence-based practice, guidelines should be devised for the patient group, health screening issues addressed, and policy and procedural guidelines devised highlighting frequency and areas of screening. Evidence-based practice is ideally a patient centered approach, which when implemented is highly individualized. Step 6: Implementing EPB For implementation to occur, aspects such as written policy, procedures and guidelines that are evidence based need to be considered. There needs to be a direct interaction between the direct care providers, the organization, and its leadership roles (e.g. nurse managers) to support these changes. The evidence also needs to be diffused and should focus on its strengths and perceived benefits, including the manner in which it is communicated. This can be achieved through in-service education, audit and feedback provided by team members. Social and organizational factors can affect implementation and there needs to be support and value placed on the integration of evidence into practice and the application of research findings(Aitken, et al., 2011; Doody Doody, 2011; Gerrish, et al., 2011; Reavy Tavernier, 2008) Step 7: Evaluation Evaluation is essential to seeing the value and contribution of the evidence into practice. A baseline of the data before implementation would benefit, as it would show how the evidence has contributed to patient care. Audit and feedback through the process of implementation should be conducted and support from leaders and the organization is needed for success. Evaluation will highlight the programme’s impact. Barriers also need to be identified. Information and skill deficit are common barriers to evidence-based practice. A lack of knowledge regarding the indications and contraindications, current recommendations, and guidelines or results of research, has the potential to cause nurses to feel they do not have sufficient training, skill or expertise to implement the change. Awareness of evidence must be increased to promote the translation of evidence into practice . A useful method for identifying perceived barriers is the use of a force field analysis conducted by the team leader. Impact evaluation, which relates to the immediate effect of the intervention, should be carried out. However, some benefits may only become apparent after a considerable period of time. This is known as the sleep effect. On the contrary, the back-sliding effect could also occur where the intervention has a more or less immediate effect, which decreases over time. We must not to evaluate  too late, to avoid missing the measures of the immediate impact. Even if we do observe the early effect, we cannot assume it will last. Therefore, evaluation should be carried out at different periods during and following the intervention (Doody Doody, 2011). Nursing leadership is an essential role for promoting evidence-based practice while the nurse managers and administrators are responsible for the professional practice environments where nurses provide care, are strategically positioned to enable nurses to use research. AS the leadership is essential for creating change for effective patient care the leadership behaviors are critical in successfully influencing the stimulation, acceptance, and utilization of innovations in organizations (Antrobus Kitson, 1999; Gifford, et al., 2007). From my perspective I consider that the leaders and managers are the corner stone for utilizing researches and make practices based on evidence. By playing a role model for staff and handling the authority they have a magic force to urges the staff to use evidence based in there practice. Leaders can encourage the staff to use EBP in their practice in several ways such as increase the staff awareness, stimulating the intrinsic motivation of people, implying an effort to increase the will and internal desire to change through support encouragement, education, and appealing to a common purpose, monitoring performance, strengthen the body of knowledge that the staff have by forcing them to attend and participate in conferences, workshops Journal clups, giving rewards to staff who collaborate in finding, utilizing and applying the EBP and make promotion and appraisal according to adherence to application of EBP. Implication of EBP For implementation to occur, aspects such as written policy, procedures and guidelines that are evidence based need to be considered. There needs to be a direct interaction between the direct care providers, the organization, and its leadership roles (e.g. nurse managers) to support these changes. The evidence also needs to be diffused and should focus on its strengths and perceived benefits, including the manner in which it is communicated. This can be achieved through in-service education, audit and feedback provided by team members. Social and organizational factors can affect implementation and there needs to be support and value placed on the integration of evidence into practice and the application of research findings. There are many ways that can be used to create an environment to implement and sustain an area of EBP such as : -Development of EBP champions; Use of EBP mentors; Provision of resources such as time and money; Creation of a culture and expectation related to EBP; Use of practical strategies including EBP workgroups, journal club and nursing rounds (Aitken, et al., 2011). EBP is being used in every aspect of the life, especially in the health care. The most common application of EBP is not only in intervention or treatment plane, but also the EBP process has been applied to making choices about diagnostic tests and protocols to insure thorough and accurate diagnosis, selecting preventive or harm-reduction interventions or programs, determining the etiology of a disorder or illness, determining the course or progression of a disorder or illness, determining the prevalence of symptoms as part of establishing or refining diagnostic criteria, completing economic decision-making about medical and social service programs. Nursing research proves pivotal to achieving Magnet recognition, yet the term research often evokes an hunch of mystery. Most of the policy, guidelines. And protocols that guide the work in the organization are based on evidance (Weeks Satusky, 2005). Also, it is also useful to think of EBP as a much larger social movement. Drisko and Grady (2012) argue that at a macro-level, EBP is actively used by policy makers to shape service delivery and funding. EBP is impacting the kinds of interventions that agencies offer, and even shaping how supervision is done. EBP is establishing a hierarchy of research evidence that is privileging experimental research over other ways of knowing. There are other aspects of EBP beyond the core practice decision-making process that are re-shaping social work practice, social work education, and our clients lives. As such, it may be viewed as a public idea or a social movement at a macro level (Evidence-Based Practice: Why Does It Matter?, 2012). Cost effectiveness of using EBP in health care  Beneficial outcomes of the implementation and use of evidence-based practice by staff nurses include increased ability to offer safe, cost-effective,  and patient-specific interventions. Critical thinking skills and leadership abilities can also grow because of the use of evidence based practice; it is a way for staff nurses to become involved in change and regain ownership of their practice (Reavy Tavernier, 2008). EBP used in clinical practice lead to make improvement in quality of provided care, which lead to improve the patients outcome, patient satisfaction and employee satisfaction. All these aspect are directly and indirectly lead to increase the cost effectiveness of the organization. When the patient satisfaction increased the patient acceptance to the organization increased, the employee satisfaction also increases and turnover will decrease all these things will increase the financial revenue to the organization. Also when using EBP in health care this will lead to decrease errors, complications and losses (e.g. compliance of evidence based infection control guidelines will lead to decrease incidence of infection, decrease length of stay an d decrease the cost of patient treatment), another example is using EBP to treat diabetic foot will result in decreasing the loses and increases the satisfaction so adherence to EBP will be costly effective when it result in better outcome, quality of care and satisfaction. Sometimes using EBP in certain area is costly; in such cases we must weighing the benefits ( immediately and after considered period of time) and mak e our decision based on the collected data and information. References: Aitken, L. M., Hackwood, B., Crouch, S., Clayton, S., West, N., Carney, D., et al. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process. Australian Critical Care, 24(4), 244-254. Amabile, T. M., Schatzel, E. A., Moneta, G. B., Kramer, S. J. (2004). Leader behaviors and the work environment for creativity: Perceived leader support. The Leadership Quarterly, 15(1), 5-32. Antrobus, S., Kitson, A. (1999). Nursing leadership: influencing and shaping health policy and nursing practice. Journal of Advanced Nursing, 29(3), 746-753. Bauer, C. (2010). Evidence Based Practice:Demystifying the Iowa Model Providing optimal care through promotion of professional standard, networking and development, 25(2). Bostrà ¶m, A.-M., Ehrenberg, A., Gustavsson, J. P., Wallin, L. (2009). Registered nurses application of evidence-based practice: a national survey. Journal Of Evaluation In Clinical Practice, 15(6), 1159-1163. Cookson, R. (2005). Evidence-based policy making in health care: what it is and what it isnt. Journal Of Health Services Research Policy, 10(2), 118-121. Doody, C. M., Doody, O. (2011). Introducing evidence into nursing practice: using the IOWA model. British Journal of Nursing, 20(11), 661-664. Evidence-Based Practice: Why Does It Matter? (2012). ISNA Bulletin, 39(1), 6-10. Fineout-Overholt, E., Levin, R. F., Melnyk, B. M. (2004). Strategies for advancing evidence-based practice in clinical settings. Journal of the New York State Nurses Association, 35(2), 28-32. Fineout-Overholt, E., Williamson, K. M., Kent, B., Hutchinson, A. M. (2010). Teaching EBP: strategies for achieving sustainable organizational change toward evidence-based practice. Worldviews On Evidence-Based Nursing / Sigma Theta Tau International, Honor Society Of Nursing, 7(1), 51-53. Gerrish, K., Guillaume, L., Kirshbaum, M., McDonnell, A., Tod, A., Nolan, M. (2011). Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey. Journal of Advanced Nursing, 67(5), 1079-1090. Gifford, W., Davies, B., Edwards, N., Griffin, P., Lybanon, V. (2007). Managerial leadership for nurses use of research evidence: an integrative review of the literature. Worldviews on Evidence-Based Nursing, 4(3), 126-145. Haynes, R. B., Devereaux, P. J., Guyatt, G. H. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. ACP Journal Club, 136(2), A11-A14. Hoogendam, A., de Vries Robbà ©, P. F., Overbeke, A. J. P. M. (2012). Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. Journal Of The Medical Library Association: JMLA, 100(2), 121-126. Hughes, F., Duke, J., Bamford, A., Moss, C. (2006). Enhancing nursing leadership: Through policy, politics, and strategic alliances. Nurse Leader, 4(2), 24-27. Johnson, M., Gardner, D., Kelly, K., Maas, M., McCloskey, J. C. (1991). The Iowa Model: a proposed model for nursing administration. Nursing Economic$, 9(4), 255-262. Krainovich-Miller, B., Haber, J., Yost, J., Jacobs, S. K. (2009). Evidence-based practice challenge: teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186-195. Melnyk, B. M., Fineout-Overholt, E., Feinstein, N. F., Li, H., Small, L., Wilcox, L., et al. (2004). Nurses perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing, 1(3), 185-193. Reavy, K., Tavernier, S. (2008). Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process. Journal of Continuing Education in Nursing, 39(4), 166-172. Sigma Theta Tau International position statement on evidence-based practice February 2007 summary. (2008). Worldviews on Evidence-Based Nursing, 5(2), 57-59. Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, C. L. Q., et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America, 13(4), 497-509. Weeks, S. K., Satusky, M. J. (2005). Demystifying nursing research: to encourage compliance with Magnet accreditation standards, further you r facilitys research initiatives. Nursing Management, 36(2), 42. Winch, S., Creedy, D., Chaboyer, W. (2002). Governing nursing conduct: the rise of evidence-based practice. Nursing Inquiry, 9(3), 156-161.

Julius Caesar Essay -- essays research papers

SUMMARY: Shakespeare's Julius Caesar is the story of the resulting conflicts from the assassination of perpetual dictator and Roman emperor, Julius Caesar. A great friend of Caesar, Mark Antony, comes to the senate to see the dead body of their dictator. He pretends to not be angry at those who took part in the assassination, and asks to speak at his funeral, a request which he is granted. However, after the men leave, he begins a soliloquy in which he suggests that Caesar's spirit will take revenge upon his murderers and invoke a war involving the entire country. Antony begins the revenge of his death by speaking at the funeral about the wrong done to Caesar, the man's generosity to the people, and how Brutus tried to persuade them to believe his justification of the murder. The crowd turns to agreement with Antony and then accuse the conspirators of murder. The accused men flee, eventually leaving the bounds of the city, and the citizens leave to loot and burn the houses of the guilty men. The armies of Brutus and Cassius set up camps near another city and knowing that Antony's soldiers are coming, they decide to march toward the enemy at once. The fighting begins with the confrontation of the two sides, as Cassius' and Brutus' armies arrive. Antony and his partner challenge the assassins to fight, and the bloody battle begins. The armies of the conspirators fall into vulnerability many times, and their side does poorly, losing many men. Cassius hears mistakenly that one...

Love and Marriage

Essay: ENG 101 Romantic Love and Marriage Love for the opposite sex has always been a controlling factor for mankind. (Brown 2nd Paragraph) Even so, romantic love is a poor basis for marriage. Many married couples are often asked, â€Å"Why did you two finally decide to get married? † A question that is answered over seventy-five percent of the time with, â€Å"Well because we are in love. † Of course, love should be a factor considered when making the decision to get married, but considering marriage in the eyes of most individuals is forever romantic love shouldn’t be the only basis for deciding to â€Å"tie the knot. There are five myths the revolve around making the decision to marry that many people consider true because of the old fashioned values their parents raised them with. Some of which are the deciding factors for those individuals when they are faced with the choice of getting married or not. Those false truths are as follows: (1) married families are happier; (2) marrying and having children is the â€Å"natural† thing to do; (3) â€Å"good† families are self-sufficient; (4) every family is a bastion of love and support; and (5) married couples should strive for the â€Å"perfect† family (Benokaritis).These myths are not only common to many Americans, but they are believed to be true as well. These myths, along with romantic love are as I stated earlier a poor basis for something as complex as marriage. There are several factors that should be considered and ever present within the relationship before a marriage should take place. Besides romantic love, commitment should be present before a couple makes the decision to get married.When you are committed to another person you are dedicated to them, but according to the Urban Dictionary commitment is what transforms a promise into reality. You are realistically making a choice to be responsible if you will, for another individual. Making the decision to st and by your significant other in all aspects of one another’s lives. You commit yourself to help that person aspire to their hopes and fulfill their obligations as well as their responsibilities. Unlike in the dating situation once you are married you are obliged to stay committed to our significant other. You can’t just utter the words, â€Å"Its over,† and expect to walk away with all of your responsibilities lifted. So, commitment is an important factor that should be present before a couple chooses to dedicate themselves to one another until â€Å"death do us part. † Trust, according to Webster’s Dictionary is defined as reliance on integrity, strength, ability, and the surety of a person; confidence. As well as the confident expectation of something; hope. I’ve heard may people say, â€Å"Without trust a relationship is nothing. A statement that I agree with whole heartedly. In a relationship, especially in a marriage you have to have a level of trust for your partner. You have to know you can rely on that person, be confident within that persons strengths, abilities, and the sureness of their choices and decisions. Along, with having the confidence to expect greater things from your partner because in a marriage two becomes one, which means the actions taken and decisions made by one partner affects both individuals within the relationship. Note: Rough copy of my essay; my entire essay isn’t included but a couple of my main points as well as my thesis are. My bibliography is also included, but I may add more sources depending on the sources I choose for the remaining points of my essay. BIBLIOGRAPHY Benokaritis, Nijole. â€Å"Marriages and Families. † Changes, Choices, and Constraints. Fourth Edition (2009) May, William. â€Å"Marriage The Rock On Which The Family Is Built. † Second Edition (2009-2010)

Public Speech on Sharks

Sharks! What are they? Big scary monsters? Do you think of sharks coming out of the depths at you? Our active imaginations have made sharks into modern day monsters. But do you really know what your chances are of getting attacked by a shark? We all know this about sharks, don’t we? They’re vicious, they’ll eat anything, they all want to eat people, and they’re everywhere. Well, just think about this. Most shark species (about 80%) have never even attacked a human.And of the ones that do, it adds up to about 100 people,  each year,  worldwide†¦Ã‚  and most of these victims survive. In fact, most sharks are small, harmless and don’t live anywhere near us. So now that we know the facts, let’s look a little more closely at the life of a shark and how they really behave. First things first: how keen are they to get themselves some human flesh? Hardly at all, as it turns out. Their job is to live by eating, breathing and reproducing †“ just like any other animal. They eat fish and other marine animals.People are not part of their normal diet. Some sharks are even plankton-eaters. And they don’t eat all that much! According to the Natural History Museum of Los Angeles, sharks that have been studied eat about 2% of their body weight per day – slightly less than most humans. That means a 45-kilogram (100 pound) shark would probably eat food equal to about five hamburgers a day! And think about this: If white sharks really were attacking humans for food, why is it that nearly 75% of these attacks are non-fatal? Why do they stop eating?The answer, according to most experts is that they’re looking for something with more fat. People are too scrawny. And that’s why; after it takes a first bite,  a great white will usually turn up its nose at whatever remains. So why exactly do they attack, if they don’t want us? About the only time sharks attack humans on purpose is when their ter ritory is invaded or their courtship rituals are interrupted. Anyone with a pet knows that any animal can become fierce when strangers invade its space. Sharks are just the same.Most other shark attacks are probably also cases of mistaken identity:   a swimmer's flapping feet and hands may look like the movements of a fish darting through the water;  a human, especially one wearing a black wet suit and flippers, may look something like a seal. But don’t even assume that because you can aggravate them, that there’s danger waiting on your beach. The beaches aren’t full of great white sharks, just waiting for us. Far from it. In fact, great whites are relatively uncommon, and they prefer cooler waters. What’s more, in some parts of their range, great whites are close to being endangered.

Seaweed, Kelp and Other Brown Algae (Phaeophyta)

Seaweed, Kelp and Other Brown Algae (Phaeophyta) Brown algae are  the largest, most complex type of marine algae and get their name from their brown, olive, or yellowish-brown color, which they get from the pigment  called  fucoxanthin.  Fucoxanthin is not found in other algae or plants like red or  green algae, and as a result, brown algae are in the Kingdom Chromista. Brown algae are often rooted to a stationary structure such as a rock, shell or dock by structures called holdfasts, although species in the genus Sargassum are free-floating. Many species of brown algae have air bladders which help the blades of the algae float toward the ocean surface, allowing for maximum sunlight absorption. Like other algae, the distribution of brown algae is broad, from tropical to polar zones, but brown algae can be found in intertidal zones, near coral reefs, and in deeper waters, with a NOAA study noting them at 165 feet in the Gulf of Mexico. Classification of Brown Algae The taxonomy of brown algae can be confusing, as brown algae can be classified into the Phylum Phaeophyta or Heterokontophyta, depending on what you read. Much information on the subject refers to brown algae as phaeophytes, but according to AlgaeBase, the brown algae are in the Phylum Heterokontophyta and Class Phaeophyceae. About 1,800 species of brown algae exist. The largest, also among the most well-known, is kelp. Other examples of brown algae include seaweeds in the genus Fucus commonly known as rockweed, or wracks, and the genus Sargassum, which form floating mats and are the most prominent species in the area known as the Sargasso Sea, which is in the middle of the North Atlantic Ocean. Kelp, Fucales, Dictyolaes, Ectocarpus, Durvillaea Antarctica, and Chordariales are all examples of brown algae, but each belongs to a different classification determined by individual attributes and features of each. Natural and Human Uses of Brown Algae Kelp and other brown algae provide a number of health benefits when consumed by both humans and animals alike; brown algae are eaten by herbivorous organisms such as fish, gastropods and sea urchins, and Benthic (bottom-dwelling) organisms also utilize brown algae such as kelp when pieces of it sink to the sea floor to decompose. Humans find a variety of commercial uses for these marine organisms. Brown algae are used to produced alginates, which are used as food additives and in industrial manufacturing- common uses include food thickeners and fillers as well as stabilizers for the ionization process of batteries. According to some medical research, several chemicals found in brown algae can work as antioxidants, which are thought to prevent damage to the human body. Brown algae can also be used as a cancer suppressant as well as an anti-inflammatory and immunity booster.   These  algae provide not only food and commercial utility; they also provide valuable habitat for certain species of marine life as well as significantly offsetting carbon dioxide emissions through photosynthesis processes of certain populous species of kelp.

How to Choose the Career and Where to Find Guidance

How to Choose the Career and Where to Find Guidance Guiding Lines for the Career Choosing Process It is a rare case when the person thinks of the future career since school. In most cases, students start choosing possible future profession after school graduation and entering college. And even then they use as guiding lines the opinion of their parents, teachers, and peers. It is normal to consider various points of view. But you need to realize that the last word should always be yours and it should not be affected or altered with someone’s opinion. This is your life choice, and you will be the one who will have to deal with it. We hope that recommendations from our article will help you in defining your path. Usually, students think that their education defines their career. And in most cases this is true. While you study at the college or university, even in school, you gain valuable knowledge that you will be able to use in your potential profession. From another point of view, we can for sure find people, whose career is connected with completely different disciplines they study at university. The author of this article has the same story. I have graduated from Harvard Business School and get an MBA degree. But now I work as a writer and blogger and provide recommendations for students and beginners on the professional paths. While I do not directly use my degree, the received knowledge and skills still are very useful in my work now. For instance, this is about writing, researching and communicating. But having an education, especially a higher one provides more opportunities today. You can receive assistance from the writing professionals to create the best essay in order to raise your chances to reach the target school. Top Career Choices of 2018-2019 The main criteria should be your passion. But earning money is an important aspect as well. Even the most attractive work can exhaust you without bringing sufficient sums of money. You need to consider the fact that you will have to provide your life, and you need enough money. You may check the following list of careers that are well-paid and in a way interesting: Dentist (or another position in the dental industry). Biomedical field (vet, for instance). Sports fitness (consider the industry that helps people to keep fit and healthy). IT industry (we all now know how this field is rewarded). Nursing (you may have good career perspectives there as well). Health administration (saving lives is both rewarding and significant). Law business law (protect justice and human rights). This list shows that the basic required careers remain the same for the last decade. It is a result of technological development. Apart from this list and your thoughts, you can ask for help in career counseling. How to Find a Job that Brings Pleasure? Now let’s discuss more what can help you to make the right career choice considering your own wishes and passion. If you want to find a job that will be rewarding in a financial and emotional way, then you need to read the following factors. What are your hobbies and interests? (for instance, if you are passionate about the music, you do not have to think of the musician career only, as you can also become a great manager for a band or the stage technician); What is your education? (choose the specialization on your own to implement your desires for the future); How you make decisions? (in most cases, to reach the career success you need to be good at decision making); What makes you happy? What you hate doing? What are your language skills (this aspect is important for international students); What are your time management skills? (this is important wherever you work); What your cultural specifications? Do you have any previous working experience? (This element can be valuable in your resume even of your last job was not connected with your desired one); What opportunities and threads do industries interesting to you have? What are your communicational and interpersonal skills? What are your life and family values? What are your financial requirements for your monthly needs? That is all you need to keep in mind. Unfortunately, we cannot exclude the financial factor. The whole modern world is based on the economy and money, so you need to have a decent living level first of all. That is why career choice should be affected by the financial opportunities as well. Considering the approximate salary, you can make some necessary calculations. Think of how much money you spend days and what monthly expenses you have/might have. Then mark the salary requirements considering this information. Do not stop your choice on the first decent opportunity. Do some researches and learn about the potential position as much as possible. Keep in mind that your career should not be like slavery. Your work should be fairly rewarded and the received finances should cover all your basic needs at least. Think of the profession as an opportunity for personal growth instead of being a part of a big corporation for the rest of your life. But everything is suitable for the first start. So you can get your potential employer interested by providing an excellent companion letter along with your resume. You can order quality writing in order to save time.

Cross cultural management Term Paper Example | Topics and Well Written Essays - 3000 words

Cross cultural management - Term Paper Example During the spring festival, people living in far places travel back home in order to celebrate together with their relatives. The events taking place during this festival makes it period the busiest event in the Chinese calendar. Mostly, the festival falls during the first day of the first lunar month, which in most cases comes later than the Gregorian calendar. The Chinese history traces the origin of this festival back to the Shang Dynasty, an era when people used to sacrifice to the gods, and their ancestors at the end and the beginning of the year (Wei, 2011). To them, it was a way of thanksgiving to the gods. Although the event lasts for a long period, the first three days of the month are most important days. With the event becoming more important in the celebration of the Chinese heritage, the government now stipulates that people should have at least seven days off in its celebration (Pan & Tang, 2004). This shows how the event is important even at the national level. People celebrate many events during the spring festival. ... ry eve, which falls on the twenty third day of the twelfth month, people start preparing for the event called â€Å"Seeing the New year in.† the busiest people in the society at this time are store owners as people buy food to cook on the big occasion, new clothes, house decorations, among others (Pan & Tang, 2004). On the day of the New Year, people dress up early in the morning, and the first thing is extending greetings to their parents. The elder ones then give gifts to the children in form of money wrapped in red paper. Then the celebrations, which involve specially prepared and good food prepared in accordance to their culture (Wei, 2011). The lantern Festival The lantern festival, which falls on the fifteenth day of the first lunar month, in the Gregorian calendar falls between the February and March. The event, having begun in the Western Han Dynasty, over time has gained significance, until the present day China. Interestingly, just as the name suggests, the most impo rtant event that takes place during this festival is watching lanterns. History points out that during the Han Dynasty, Buddhism flourished more in china than in any other part of the world. One of the Chinese emperors on hearing that Buddhist monks would watch sarira (remains of the cremated body of Buddha), on the fifteenth day of the first lunar month under the light of lanterns, he ordered the rest of the people to respect the Buddha on this day (Wei, 2011). With time however, the event became more popular among the Chinese people, thus maintaining its popularity in the Chinese society. People, during these celebrations prepare special food called yuanxiao or rice dumping, hence the common name, â€Å"yuanxiao festival† among the people. Additionally, people guess lantern riddles at night, while