Parts Per Million Definition

Parts Per Million Definition Parts per million (ppm) is a commonly used unit of concentration for small values. One part per million is one part of solute per one million parts solvent  or 10-6. Parts per million and other parts per notations (e.g., parts per billion or parts per trillion) are dimensionless quantities with no units. Preferred methods for expressing parts per million include  Ã‚ µV/V (microvolume per volume),  Ã‚ µL/L (microliters per liter), mg/kg (milligram per kilogram),  Ã‚ µmol/mol (micromole per mole), and  µm/m (micrometer per meter). The parts per notation is used to describe dilute solutions in chemistry and engineering, but its meaning is ambiguous and it is not part of the SI system of measurement. The reason the system is ambiguous is because the concentration depends on the original unit fraction that is used. For example, comparing one milliliter of a sample to a million milliliters is different from comparing one mole to a million moles or one gram to one million grams. Sources Milton R. Beychok (2005). Air Dispersion Modeling Conversions and Formulas. Fundamentals of Stack Gas Dispersion (4th ed.). Milton R. Beychok. ISBN 0964458802.Schwartz and Warneck (1995). Units for use in atmospheric chemistry (PDF). Pure Appl. Chem. 67: 1377–1406. doi:10.1351/pac199567081377

5-Complaints-You-Arent-Hearing-From-Your-Employees

5-Complaints-You-Arent-Hearing-From-Your-Employees Even the best leaders occasionally overhear the people they supervise griping about something at work- interdepartmental kvetching is normal, and it can even be healthy blow off steam! But that doesn’t mean it’s easy to hear. Heather Younger, Employee Experience Consultant writing for the Huffington Post, has some insights- the things your employees are probably thinking but don’t want to tell you. Maybe you can start making changes before discontent roils over into more disruptive activity.1. They want you to care about them as people.Yes it takes energy to get to know your employees and accommodate their needs, but it’s a crucial investment in the strength of your business and the resilience of your workforce. Be willing to listen- even to the things that are tough to hear- and willing to take action once you’ve received valid feedback.2. They feel they can’t provide honest feedback.Every employee can probably point to a time when they spok e up about something and were ignored or overruled or faced consequences later. Have you created a safe space? Do employees have an anonymous way to contribute feedback?Let them tell you what you could be doing better, and don’t punish them for noticing vulnerabilities. Provide positive recognition for employees who provide especially helpful ideas, and you will be rewarded with closer working relationships among your team.3. They often do not trust their manager or senior leaders.Mistrust, in my experience, arises when employers actions do not match their words. If your employees see you putting on one face in a meeting and another one behind closed doors, if you make promises you fail to fulfill, or if you violate their confidence, their trust in your may take a hit. This is particularly true for micromanagers- if you clearly don’t trust your employees to do the job you hired them for, why should they trust you to direct their talents and time?4. Recognize and cultiv ate meaningful work.Odds are you’ve already learned about at least a few of your employees’ outside passions- the things they would spend time on even if they weren’t paid to do it. How can you bring some element of those hobbies or interests into their daily work?At my most frustrating job experience with an arts education nonprofit, one of the best outlets my manager was able to give me was helping in an arts workshop after school. It gave me a break from writing grants and trying to manage board members and provided a really important window into the teaching I really wanted to be doing. Maybe it feels silly to have a conversation about how to bring private interests into the workplace, but it revolutionized the way I thought about that job.  5. Many are seeking opportunities to grow, inside or outside of your organization.Along the same lines, remember that your employees probably don’t see themselves in their current role permanently. If you donâ⠂¬â„¢t already have annual meetings to review their work and set short- and long-term goals, establish some ASAP. Make sure you know what they’re hoping to accomplish and take steps together to advance them towards those goals. If you don’t, some other company will.So open your door and listen up- try to hear what your employees aren’t saying and respond as though they had spoken up!5 Things Your Employees Aren’t Telling You But You Need to KnowRead More at Huffington Post

Battle of Okinawa Research Paper Example | Topics and Well Written Essays - 1000 words

Battle of Okinawa - Research Paper Example a period of 80 days, the â€Å"Typhoon of Steele† as it was referred to, raged on as the Allied Forces made headway in the battle to make Japan surrender. The attack itself took place on April 1, 1945. The Americans had sent in two United States Marine and Army Divisions to land via amphibious vehicle on the island of Okinawa. The Japanese troops were thought to number at least 150,000 covering ground, air, and naval troops. 10th U.S. Army Lieutenant General Simon Bolivar Buckner Jr. was in command of the Allied troops that consisted of III Amphibious Corps and XXIV Army Corps. Even though the Allied Forces had sent a formidable troop assignment to the island, the Japanese still felt that the war was going to end with them as the victors. After all, the Japanese were fighting on their home territory, 350 miles from the Japanese homeland. However the Americans had other plans for this battle as they pulverized the island of Kyushu. The Japanese by this point knew that the battle was lost and yet they soldiered on. The Japanese soldiers fought based upon honour and military logic. But the bombings of the American planes coming from the Marianas Islands would soon conquer Japan. Truth be told, there was too much land coverage in Okinawa for the troops that were first sent to cover. Thanks to the Army, the new 6th Marine Division, the war became a winnable battle for the Americans. Eric Hammel, noted Pacific War historian recounted the battle as follows: Coming to put their defense arrangement to the test was the Tenth Army. The new 6th Marine Division (1st Provisional Marine Brigade plus the 29th Marines and attachments) would land over the northernmost beaches on the western side of Okinawa a little south of the islands midpoint. It was to strike across the island, then turn north to pacify a little more than half of Okinawa on its own. To the right, the 1st Marine Division was also to strike across the island, then become part of the Tenth Army reserve.

Pollution Essay Example | Topics and Well Written Essays - 750 words

Pollution - Essay Example Perhaps people will be more willing to make an effort in curbing this rising problem within their residential communities for starters. This might also help minimize the health problems associated with pollution The main types of pollution that will cause health concerns are the noise pollution caused by the vast amount of people and cars. This is due to the fact there is a high volume of traffic which is motivated by the high amount of restaurants, cafes, clubs, theaters and stores all concentrated within a single area. The heath concerns of noise pollution are that people often suffer from sleep disturbances, decreased learning ability and increased stress levels which can affect many areas of their lives. This of course is to name but a few of the affects. There is also an increased amount of air pollution. The main culprits of this being automobiles exhausts that produce nitrogen oxides. This leads to respiratory complications and some people can end up developing asthma because of this type of pollution. Another source of pollution in my neighborhood is solid waste. This is due to all the trash that is lying around. The lack of garbage cans is the main reason for this, but also personal neglect. The main issue with solid waste is that is causes diseases. It is viable source where diseases can manifest and transfer from one person to another. It is clear that th What needs to change It is clear that the congested state that my neighborhood is in needs to change. There are no visible positive aspects of the pollution especially in terms of health issues. The first and foremost thing that needs handling is all the rubbish that is meeting in our streets. This can be done by getting more garbage bins. Furthermore a penalty needs to be paid if a person is caught littering. This can be incorporated by our local government. By making it legal people will more than willing to take responsibility for their actions. Indeed this form of punishment could seriously help curb the problem. In regards to noise and air pollution most of the businesses like the restaurants, bars, cafes, should unit to build a large secure parking lot. This way people will have to walk a few miles to get to where they need to go. This will decrease the amount to cars that have to drive on the road. The best way to incorporate this would be to convert some of the streets into walking streets. Conclusion It is clear that in order for a community to function they need to be concerned with each others health. Being selfish is not the way to progress, especially when the issue affects us all. Pollution is not one person's responsibility and when people are informed they might be willing to do something about it. Government support is also very important. People often function best when there are rules. When it comes to pollution the rules are almost non-existent for individuals. By incorporating small changes the health issues caused by pollution can be tackled. Also by informing everyone and making them responsible will help increase the awareness of the negative health issues that arise due to pollution. In terms of local government support it is appalling to think they would be willing to allow the rubbish accumulate to such heights. They need to incorporate more bins as

Len Bias Essay Example for Free

Len Bias Essay In one day all of one man’s dreams came true, and in one night all those dreams came spiraling down with a silent crash. I think about his friends with whom he spent his last hours with, and the nightmares that must have followed after helplessly watching their friend die at their feet. I think about his family who lost so much good fortune and, more importantly, a nephew, a cousin, a brother, and a son. I also think about the game of basketball. It lost a great player that day. Some believe he was going to be it’s greatest yet. Len Bias was the greatest player to never play the game, it’s brightest star to never shine. Cocaine had, once again, robbed the world of a truly one of a kind treasure. There has been a bit of poetic justice to come from this story, however. Bias’ mother has told stories of people who have randomly come up to her at the market or in the street telling her of how her son’s death has helped them kick their cocaine addiction. Seeing as how the story was told all over the nation, it wasn’t just locals who responded to it in this way. I have been affected by this story in a similar way. Len Bias is the sole reason I have never tried cocaine. Of course it’s very rare for a young athlete like myself to have a heart attack from drugs. Bias was definitely an exception, but he was not the rule. It goes deeper than fatality statistics for me, though. The death on Len Bias showed me that everything a human being has worked for could be stripped away in an instant with the involvement of drugs. For example, there’s the similar story of Earl â€Å"The G. O. A. T. † Manigault, who was deemed one of the greatest basketball players New York has ever seen but never reached his full potential because of a heavy heroin addiction. Unlike Bias, Manigault is still alive today. However, he is nowhere near being in the position he could’ve been in had he not picked up his drug habit. We’re talking about a possible difference of 20 million dollars! There’s no drug on earth worth making that sacrifice for in my opinion.

Dress Codes :: essays research papers

It is in the middle of summer and very hot and humid. You are in complete uniform, wearing the long wool pants with the shirt, tie and sweater. Your whole body is uncontrollably sweating. Instead of paying attention in class, you wipe yourself down every second.   Ã‚  Ã‚  Ã‚  Ã‚  Uniforms are uncomfortable, cause distractions and are expensive. They serve no purpose in getting the proper knowledge that one is in school to earn. One that is not comfortable, may not concentrate in class. He/she will move around their seat impatiently trying to get comfortable. Uniforms always cause problems in the summer and winter. The girls complain about wearing short dresses in the winter, arguing that it gets too cold to have their bare legs showing outside in the freezing weather conditions. The boys complain about wearing the hot long pants in the summer.   Ã‚  Ã‚  Ã‚  Ã‚  I attended a school that required a uniform. I wear boxers longer than the girls’ skirts. Although my values were strongly set on education, my mind wondered, trying to get a glimpse of a girl bending over. Some girls deny it, they wear their dresses too short. This causes a distraction. The guys will not pay attention in class, instead they will stare at the short dresses. This causes the boys to do work at a lower level. The schools should make a rule on the skirt lengths and enforce it with severe punishments such as detentions, suspensions, and expulsions. This rule should make the lengths below the knees.   Ã‚  Ã‚  Ã‚  Ã‚  Most uniforms are very expensive. The whole uniform may cost about $250.00. This is expensive for a normal family. Since some schools require uniforms, the family is forced to buy the uniform. This puts the family back financially. This might force the family to live on bread and water due to the fact that they have spent all the food money on ties dressshoes and dress pants.   Ã‚  Ã‚  Ã‚  Ã‚  How can uniforms change the way people act? They can not. No matter what the opposing argument may be, it can not be logically correct.

Edwardian family Essay

The furniture alone really shows the wealth and opulence of this upper class Edwardian family. The furniture and clothes also develops trust between the audience and characters as it gives off a cosy home feel.  It is obvious from when you first read act one that JB Priestley has made a deliberate effort to change the tone from how it was at the beginning (relaxed) to how it ended (tense). When we read the play for the first time, we get the impression that for people as superior as the Birlings to take any notice of somebody in a lower social class than them, somebody such as Eva Smith actually has to die. This shows huge injustice and makes us feel very sympathetic for Eva Smith. The main way he achieved this is by the use of the plot. This is because they are having a nice relaxed dinner party, and then an Inspector who they have never meet before knocks on their door, and begins to interrogate them about a suicide. This puzzles them as the police officer openly says that it was definitely a suicide, therefore what crime could they have committed.  Although this is the main reason for the drastic change in tone, Priestley does many other things to show this change. One aspect of his writing which does this is the way in which he wrote the inspectors lines. The inspector’s lines are all written so that it sounds extremely aggressive from the Birling’s point of view. One example of this, is when Shelia is being extremely honest, and is telling the Inspector how she got Eva Smith sacked. Shelia really shows how guilty she feels, how deeply sorry she is and how she would behave differently a second time. However the Inspector very bluntly says â€Å"Yes but you can’t. It’s too late. She’s dead. This is an extremely upfront and abrupt way of saying it. So he changes the mood from relaxed/happy to almost awkward and upsetting.  Due to this aggressiveness which the Inspector shows from the moment he walks in the door, Mr Birling almost tries to fight back which results in both of them almost competing in a childish game, where they keep trying to get one up on each other. E.g. (who’s the bigger man) This is shown by Mr Birling consistently mentioning that he has friends in high places. He does this in a very subtle and sly manor. At this point both of them know the involvement Mr Birling had with Eva Smith. Mr Birling remembered Eva Smith because he fired from his company her due to a campaign she led for higher pay. Therefore he last meet Eva Smith under unpleasant circumstances. This secret that both the inspector and Mr Birling had was probably what sparked off this aggressiveness. The first time we see this happening is when Mr Birling says â€Å"Perhaps I ought to warn you that he’s an old friend of mine, and that I see him fairly frequently. We play golf together at the West Bromley†. The â€Å"old friend† being the inspector’s chief constable. In a way Mr Birling is trying to tell the Inspector to tread carefully, by letting him know he has friends in high places.  This aggressiveness certainly demonstrates how Priestley changes the tone so drastically and so effectively. It also keeps the audience gripped making it very exciting.  All of the characters in this play have very strong personalities one way or another, and all of them represent some kind of portrayal above everybody else in the play. Shelia, for example, shows that she feels more remorse than anyone else by far and seems truly hurt and guilty by the whole thing. For example when the inspector asked Shelia â€Å"And was it the girls fault?†Ã‚  Shelia replies â€Å"No, not really. It was my own stupid fault†.  She has shown her honesty by owning up to it unlike her self obsessed father who would argue everything until he was proved completely wrong. She also displayed remorse by ridiculing herself, saying â€Å"It was my own stupid fault†.  Again she shows that she is sorry when she says â€Å"Oh-why had this to happen†. Rather than saying something like Mr Birling would say e.g.: â€Å"Well it was her own fault in the first place†. Shelia plays the kind understanding character to the play, who comes across as more innocent than anybody else. She brings reason to the equation and we probably feel the more sympathy for her than anyone else. This is because when she tells her story, Priestley writes it as if it was from the bottom of her heart/sincerely. Another reason we feel this sympathy for her is because we feel she has been conned out the most, when we find out that the inspector is a fake. This is because she seems to have poured her heart out more then everybody else and after she finds out that the inspector is a con she still defends the morals the Inspector was saying even though the entire Eva Smith scenario, was completely false based on the knowledge they had at the time. This happens in the 3rd act when Shelia says to Mr Birling â€Å"It doesn’t matter now of course, but was he really a police inspector?† Mr Birling then replies â€Å"Well if he wasn’t, it matters a devils lot. Makes all the difference.†Ã‚  Shelia then snappily responds â€Å"No it doesn’t†.  She says this meaning that just because the Inspector is gone nothing is changed because what he was saying was correct even if it was fictional. However Mr Birling cannot understand that the message has not changed, now they know the story was fiction and just says â€Å"Don’t be so childish, Shelia†.  This is another event in the play which supports Shelia’s kind, understanding and more mature than her father’s personality. She represents a possibility of social change and seems to have some basic morality.

Creative Writing “Into the Darkness” Essay

It had just turned night when Victoria heard the thunder roll in, and the lightening strike against the ground. This worried her for she was afraid of losing power. As the night grew on the storm worsened. Making sure she wasn’t forgetting her laptop, Victoria made her way upstairs to the comforts of her bedroom. She decided this would be the perfect opportunity to take advantage of her time and watch the latest shows Netflix had to offer. Settling into her bed with her laptop in hand Victoria reached over to plug her charger in. Just as she did so, the power went out. Startled by the sudden darkness, she reached under her bed for her flashlight. Grasping her flashlight tightly, Victoria headed back downstairs to see what may have caused the power to go out. As Victoria went downstairs she noticed her porch door was ajar. Cautiously she approached the door and peered outside to see who or what may have opened the door. Nothing seemed to be around. Certain that the storm had simply blown out the power, Victoria poured herself a glass of hot chocolate and returned upstairs. Something seemed different to Victoria, but she was unsure of what exactly. Much to her dismay her beloved laptop was missing. Appalled by this discovery, Victoria quickly became worried that someone may be in the house with her. Using her survival instincts she quickly grabbed the flashlight and headed out into the hallway, if someone was in the house with her laptop, Victoria was determined to catch them and get her laptop back. Shaky and nervous she slowly peered out into the hallway, no one was to be found. Once at the stairs she swiftly tumbled down them, only missing a few steps at the bottom, but redeeming herself with style. The power had yet to return, and the only thing Victoria had with her was a flashlight. Determined she would catch the culprit and get her laptop back, she sprang across the room and swung the bathroom door open. Still she found no one. Next she opened the closet, then her office, and finally the last room she had left to check was the basement. Victoria clenched onto the flashlight and slowly turned the nob and entered the dark stairwell leading to the basement. Taking each step one at a time, until she got to the final one. When she glanced around the corner Victoria could see someone standing there. She couldn’t make out the face for it was too dark, and her flashlight was dimming by the second. Victoria slowly inched towards the dark figure, getting closer and closer, until finally she was close enough. Just as she reached out to grab onto the dark figure, she dropped the flashlight. All hopes of seeing who they were went away as soon as Victoria’s flashlight hit the floor. The dark figure quickly turned around tightly grasping the laptop. Victoria got struck in the face by her own laptop, and was knocked onto the ground. When she awoke the power had returned, and the storm had stopped. As Victoria got up off the floors she quickly glanced to around to see if anyone was around. There was nobody to be found, and her laptop was gone.

Patient Satisfaction †Nursing Essay

Patient Satisfaction – Nursing Essay Free Online Research Papers Patient satisfaction scores in hospitals have steadily decreased in the United States. According to Zwillich (2007), â€Å"Americans are more dissatisfied than citizens of other nations with their basic health care, even while paying more of their own money for treatment†. Research has shown that the nursing shortage that has plagued the United States has played a large role in the downward trend of patient satisfaction. Citing a report by Press Ganey Associates, Inc., Sara Nemeth (2007) reports that the higher the ratio between working Registered Nurses in any given state, the higher the patient satisfaction scores will be. From this data, it can be surmised that patient satisfaction will increase as the number of nursing staff increases. These results demand a call to action, and patient satisfaction depends upon it. A study published by the American Association of Colleges of Nursing states that the shortage of nurses may be affecting health care quality and patient outcomes, quoting the New England Journal of Medine as reporting that 53% of physicians and 65% of the public cited the nursing shortage as a leading cause of medical errors. The same study also states, according to Joint Commission for Accreditation of Healthcare Organizations (2007), that the shortage of nurses in America is, â€Å"putting patients’ lives in danger†, and found that since 1996, low nursing staff levels were contributing factors in 24% of patient deaths and injuries. The nursing shortage is not going away any time soon. In the same article by the American Association of Colleges of Nurses, it is estimated that 30 states had shortages in the year 2000, and this projection is expected to intensify to where 44 states, plus the District of Columbia will have nursing shortages by the year 2020. In addition, according to the National Council of State Boards of Nursing, the number of nurses taking state boards for the first time decreased by 20% between 1995 and 2003. Finally, Dr. Amy Tuteur quotes results Press Ganey President and CEO, Melvin Hall (2007) as saying, â€Å"The American Consumer Satisfaction Index (ASCI) from the University of Michigan has shown that customers’ satisfaction with healthcare has decreased significantly over the past several years†. Her statement is reflective of the majority of research being done in this area. According to the ECRA group (2007), healthcare leaders must be held accountable for the quality of care they provide. Patient satisfaction is increasingly being looked at as an indicator of positive patient outcomes, and a better quality of life. ECRA states that the patients’ perceptions of the quality of care they receive, and the attention that is paid to them can be as important as clinical health measures when patients are viewing their clinical outcomes. With the research showing that the nursing shortage is going to be here for quite some time, health care professionals must find a way to effectively deliver care, and bring patient satisfaction scores back to baseline, and above. Communicating with patients is key. Levinson (2007) states that poor communication often leads to patient dissatisfaction, whereas, â€Å"Effective communication enhances patient satisfaction and health outcomes.† Levinson also stated that the combination of a bad outcome and patient dissatisfaction, â€Å"Is a recipe for litigation†. In a similar article, J.W. Pichert (2007) stated that healthcare professionals must understand patients’ specific dissatisfactions and prevent them in the first place, thereby rectifying patients’ concerns. These findings suggest that nurses must find a way to enhance their communication with patients, reverse the trend of dissatisfied patients, and change the culture of patient care in a positi ve way. In 2005, the Studer Group (2006) introduced a strategy into the healthcare market, called, â€Å"The Nursing Bundle†. It has been adopted by multiple hospitals across the United States, and has provided the tools for hospitals to significantly increase their patient satisfaction scores, and increase patient safety. The Nursing Bundle is comprised of five key strategies, all aimed at promoting excellent patient care, proactively meeting the needs of patients, and increasing the level of patient satisfaction. Each component of the Nursing Bundle raises the standard of care on it’s own merit, but together, the five components tie into each other and have had a profound effect on the care delivery system. The first component is Individualized Patient Care. This refers to identifying key priorities to the patient upon admission to the nursing unit. The nurse asks the patient what the two most important needs he or she has that if met, would allow them to feel as though they have received excellent care. This information is written on a dry erase board in the patient’s room, and alerts all staff to the patient’s individual needs. The patient’s individual pain scale is also assessed, and written on the board. The patient will see that the staff is concerned about them as individuals, and that they don’t treat everybody the same. The patient’s perspective is valued as being the most important, and they will be reassured that everybody is aware of what their specific needs are, thereby making them less anxious and more compliant with their care and treatments. Individualized patient care also allows staff the opportunity to ask about the patient’s individual needs when rounding, eliminating call lights for unmet needs. The nurse will be alerted to the patient’s pain needs, and the physician will be alerted to the patient’s desired pain level. Ultimately, the patients will be more satisfied that their individual needs are being met. The second component is Bedside Shift Report. Prior to the end of the shift, the nurse informs the patient that they will be doing bedside shift report very soon. The nurse tells the patient that their privacy is important, and asks if they would like the nurse to ask visitors to leave, should visitors be there at the time of shift report. This shows the patient that the nurse recognizes and facilitates their need for privacy. During the shift report, the nurse introduces the oncoming nurse to the patient. The patient’s condition, tests, and procedures are reported to the oncoming nurse, and any needed clarifications are made for the patient at this time. This serves to show the patient that the oncoming nurse is aware of their needs, and reduces anxiety that perhaps the next nurse does not know their case. They will be more satisfied because they know who their nurse is, and that things are being done and monitored throughout the shift. Finally, the process will aid in increasing communication. Studer has determined that communication issues are the root cause of about 30% of patient safety events, and improved communication between caregivers positively impacts patient care and outcomes. For the nurse, bedside shift report improves the sharing of information between healthcare providers by utilizing a standardized method of communicating. If asked questions, the nurse won’t have to say, â€Å"I haven’t seen my patients yet†, and will be more prepared. The off-going nurse can also use this time to use â€Å"hands-on† to show the oncoming nurse how to operate special equipment, or how special orders are being handled. Accountability will increase, since each nurse will know his or her patients’ condition at the beginning of the shift. Finally, bedside report improves the nurse’s understanding of the patient’s condition, as he or she is able to visualize the patient. With the nurse is better prepared and more comprehensively informed, the patient will have an increased sense of well being, and will ultimately be more satisfied. The third element of the nursing bundle, and the most important, is hourly rounding. In a study done by C.M. Meade (2007), â€Å"Specific nursing actions performed at set intervals were associated with statistically significant reduced patient use of the call light overall, as well as a reduction of patient falls, and increased patient satisfaction†. Hourly rounding has eight components that integrate to ensure that the patient is receiving the care that they need, and most important, the care they feel that they deserve. First, the nurse uses key words and/or actions to introduce themselves, their skill set, and their experience. The word â€Å"round† is used, because this is a word that is familiar to most people, and will help frame the context of the interaction. The patient is told when the nurse will round again, thereby decreasing anxiety and building trust. Second, the nurse performs any scheduled tasks during the hourly round. Performing tasks while rounding allows the nurse to include scheduled work into the rounds, thereby accomplishing everything in one trip to the patient’s room. If there is not a scheduled task, the patient still has the reassurance that the nurse is coming to the room, and has the opportunity to voice an unanticipated need. Third, the nurse addresses the â€Å"3 P’s† that Studer has identified as being the most common reasons patient use their call bells. These are pain, potty and position. Proactively assessing and treating pain keeps pain from becoming severe, and increases satisfaction as a result. Scheduling patients to use the bathroom on rounds avoids unassisted walks to the bathroom, which can lead to falls. Helping the patient change positions also helps to keep them comfortable, and reduces the chance of a pressure ulcer, especially in the elderly. Fourth, the nurse performs comfort measures, such as fluffing pillows, straightening sheets, filling water pitchers, and offering something to drink. These are basic nursing functions that often get left undone if not intentionally scheduled, and lead to additional call light requests, and ultimately result in patient dissatisfaction. Fifth, the nurse conducts an environmental assessment of the room. This allows the nurse to determine whether there are any needs the patient has not identified that could raise the potential for the patient needing the nurse to return before the next scheduled hourly round. These needs include making sure the call light and telephone are within reach, the garbage can is next to the bed, and the patient looks comfortable. Sixth, closing key words are used before the nurse leaves the room. These are words such as, â€Å"Is there anything else I can do for you before I leave?† I have time†. This will not only decrease the need for the patient to ring the call light, but will allow the nurse to accomplish any other task while he or she is still in the room. It also tells the patient that all needs, no matter how small, are being addressed. The patient will be more satisfied with the nursing care if he or she knows the nurse has time to meet their needs. Seventh, the nurse explains to the patient when he or she will be back. When the patients know the nurse will be back hourly, they will cluster their requests in the context of the nurses rounds, rather than relying on using the call bell, as long as they know the nurse will be back in an hour, and their request is not urgent. Finally, prior to leaving the room, the nurse documents the rounds on a hourly checklist inside the patient’s room. This allows the patient to visibly see that it’s been only an hour between rounds, it allows the family to see that their loved one is being attended to frequently, and it allows the nurse manager to ensure that rounds are being done appropriately. Hourly rounding not only has the benefit of proactively meeting the needs of the patient, but by decreasing the call lights, the nurse is able to stay focused and round on a schedule. According to Carla Cox, Administrative Director for Cardinal Health (2007), â€Å"A patient who is confident a nurse is checking on them regularly is more likely to wait for the nurse to stop in, rather than hit a call light†. In addition to the research performed by the Studer Group, a study by Christine Mead, PhD, Executive Director of the Alliance for Health Care Research ((2007), had similar findings in regard to rounding. She stated, â€Å"Nurses’ rounds conducted regularly, every 1 or 2 hours, may help decrease patients’ use of call lights, as well as increasing patient safety and level of patient satisfaction†. In another article, Mary Shepherd, RN, Nursing Project Manager at Methodist Hospital in Houston, TX (2007) perhaps brought it together when she said, â€Å"Too many times we take for granted that the patient knows what we are doing when we enter their room. But these are non-clinical people who have no idea why we are asking them their name and birth date 30 times a day. One concept of the hourly rounding program is to take the time to verbalize everything that we are doing, letting them know it is for their safety, for their benefit†. The fourth element of the nursing bundle is Manager Rounds on Patient. The unit manager visits every patient on his or her unit at least once per day, and validates that the elements of the nursing bundle are being accomplished. He or she asks the patient if they have had any difficulty accessing their nurse, if the nurse has been in to see them frequently, and if their pain has been adequately controlled. They also ask if the individual need listed on the board has been consistently met, and if they have had any difficulty accessing the bathroom. The patient has an increased sense of well being, not only knowing that they have been receiving individualized care, but also knowing that the unit manager is rounding daily to ensure that it is being provided. The fifth, and last element of the nursing bundle is Discharge Telephone Calls. Patient’s perspective is valued as being most important. Discharge telephone calls make the patients feel cared about as a person, they decrease patient anxiety, provide an opportunity to evaluate patient education, to determine patients’ compliance with discharge instructions, to assess the overall impressions of the hospital’s performance, and to reinforce the patient’s perception that excellent care has been provided. For the staff, they provide a positive experience for staff, since most discharge calls are positive, they provide an opportunity for service recovery, and they provide an opportunity to identify trends that may require improvement in practice. The discharge telephone call is also the last opportunity the nurse has to be sure the patient was satisfied. The nurse has a scripted dialogue, and begins by identifying him/herself, and asking if it is a good time for the patient to talk. This shows that the nurse respects and values their time. The patient is asked if they understood their discharge instructions, and if any questions have surfaced since their discharge. This shows the patient that even though he or she has been discharged, the staff of the hospital still has their well being in mind. The nurse then states that the hospital always likes to make sure their patients were very happy with their care, and states it just that way, following with, â€Å"How was your care?†. Next, the nurse thanks the patient for allowing the hospital to care for them, and makes sure they have a telephone number to call if they have any other questions. The discharge telephone call gives closure in a positive way to the patie nt, and brings their care into their home setting. When they receive their satisfaction survey in the mail, they are more likely to remember the care they received having received the discharge call as well. With no end in sight to the nursing shortage, and the grim ramifications research has shown as a result, healthcare providers need to find ways to get back to the basics of nursing to improve the care delivery system, without waiting for the tide to turn again. The Studer Group (2006) has put together an excellent program to raise the bar back to where it needs to be. Fox News [Internet]. New York (NY): FOXNews.com; [cited 2007 Jan 12]. Available from: foxnews.com/story/0,2933,136990,00.html Press Ganey Associates, Inc. [Internet]. South Bend (IN): pressganey.com; [cited 2007 Jan 12]. Available from pressganey.com/scripts/news.php?news_id=57 American Association of Colleges of Nursing [Internet]. Washington (DC): aacn.edu; [cited 2007 Jan 12]. Available from aacn.nche.edu/MediaBackgrounders/shortagesfacts.htm Press Ganey Associates, Inc. [Internet]. South Bend (IN): pressganey.com; [cited 2007 Jan 12]. Available from http://treatmewithrespect.blogspot.com/2006/05/gap-widens-in-hospital-patient.html Chicago Chronicle [Internet]. Chicago (IL): chicagochronicle.edu; [cited 2007 Jan 12] Available from http://chronicle.uchicago.edu/970220/malpractice.shtml National Center for Biotechnology Information [Internet]. Atlanta (GA): ncbi.gov; [cited 2007 Jan 12]. Available from ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=PubMedlist_uids=96 ECRA [Internet]. Rosemont (IL). Ecragroup.com [cited 2007 Jan 12]. Available from ecragroup.com/healthcare/patientsatisfaction.html National Center for Biotechnology Information [Internet]. Atlanta (GA): ncbi.gov [cited 2007 Jan 12]. Available from ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmedcmd=retrievedopt=Abstra Nursing Spectrum [Internet]. McLean (VA). Nursingspectrum.com [cited 2007 Jan 12]. Available from http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=24949 Medscape [Internet]. New York (NY). Medscape.com [cited 2007 Jan 12]. Available from medscape.com/viewarticle/544021 Methodist Health [Internet]. Houston (TX). Methodisthealth.com [cited 2007 Jan 12]. Available from methodisthealth.com/cgi-bin/hmdim/home/newsItem.do?channelId=-1073829 Cardinal Health Systam [Internet]. Muncie(IN). accesschs.org [cited 2007 Jan 12]. Available from accesschs.org/about_chs/Nurse_Rounding_Story.htm StuderGroup. Patient Care Model: Nursing and Patient Care Excellence. Pensacola, FL: 2006. 80 p. Research Papers on Patient Satisfaction - Nursing EssayArguments for Physician-Assisted Suicide (PAS)The Effects of Illegal ImmigrationThe Fifth HorsemanResearch Process Part OneInfluences of Socio-Economic Status of Married MalesTwilight of the UAWNever Been Kicked Out of a Place This NiceCapital PunishmentGenetic EngineeringThe Relationship Between Delinquency and Drug Use

Sacar la ciudadanía de Estados Unidos por adopción

Sacar la ciudadanà ­a de Estados Unidos por adopcià ³n Es una prctica comà ºn que los ciudadanos americanos, solteros o casados, adopten nià ±os en el extranjero. En estos casos se plantea la cuestià ³n de si los menores adoptados adquieren la ciudadania estadounidense. La respuesta es: depende del caso y del cumplimiento de una serie de requisitos. Adems, hay que tener en cuenta que los trmites muy diferentes segà ºn los dos posibles casos: cuando el menor ingresa a Estados Unidos para vivir aquà ­ con su padre/s adoptivos.cuando el nià ±o residen habitualmente en otro paà ­s en compaà ±Ãƒ ­a de su progenitor estadounidense. En este artà ­culo se explica cà ³mo y cundo los adoptados adquieren la ciudadanà ­a segà ºn los diferentes casos, cà ³mo se prueba, cul es la ley que aplica en estos momentos y estadà ­sticas sobre cuntos nià ±os son adoptados por estadounidenses en Latinoamà ©rica y Espaà ±a. Papeles y ciudadanà ­a para nià ±os en el extranjero adoptados por ciudadanos que ingresan a USA para residir aquà ­ En este caso el proceso se inicia rellenando los formularios I-600 o su variacià ³n del I-600A para peticionar a un huà ©rfano como familiar inmediato o el I-800 o su versià ³n de I-800A, que son para peticià ³n de familiar inmediato de un adoptado en un paà ­s firmante de la Convencià ³n de la Haya. Esta peticià ³n debe ser aprobada por el Servicio de Inmigracià ³n y Ciudadanà ­a de los Estados Unidos (USCIS, por sus siglas en inglà ©s).   A continuacià ³n y despuà ©s de que el paà ­s de origen del menor dà © su OK a la adopcià ³n tendr lugar una entrevista en el consulado o la embajada de los Estados Unidos. El oficial consular emitir una visa de inmigrante para el menor que podr ser: Una IR-3 cuando la adopcià ³n de un huà ©rfano ha sido completada fuera de los Estados Unidos en un paà ­s que no ha firmado la Convencià ³n de la Haya. Dicha adopcià ³n tiene que ser definitiva y reconocida por el paà ­s del menor y tambià ©n por los Estados Unidos. Adems, el adoptante, si est soltero, o uno de los miembros del matrimonio que adopta, si estn casados, debe haber conocido en persona al menor   Una IR-4, cuando el huà ©rfano procede de un paà ­s que no ha firmado la Convencià ³n de la Haya y se da alguna de las siguientes circunstancias: la adopcià ³n se finalizar en Estados Unidos, b) la adopcià ³n la realiza sà ³lo uno de los miembros de un matrimonio o, c) el/los adoptante/s no conoce al menor personalmente. Una IH-3, cuando la adopcià ³n del menor es definitiva y se ha completado en un paà ­s firmante de la Convencià ³n de la Haya. Una IH-4, cuando la adopcià ³n debe finalizarse en Estados Unidos y el nià ±o procede de un paà ­s acogido a la Convencià ³n de la Haya. Una IR-2, cuando  el menor haya vivido en el extranjero con su padre o madre estadounidense por un mà ­nimo de dos aà ±os y que à ©ste tenga la guardia y custodia del nià ±o. Estos son casos en los que el progenitor decide regresar a Estados Unidos y pide los papeles para su hijo adoptado no mediante los formularios que aplican a las visas anteriores sino mediante la planilla I-130.  Este camino no siempre es posible cuando el nià ±o es originalmente de un paà ­s que ha firmado el acuerdo de la Convencià ³n de la Haya.  ¿Cundo adquieren la ciudadanà ­a estadounidense los adoptados que ingresan a Estados Unidos con una IR-3/IR-3/IR-2/IH-3/IH-4? Los casos son distintos segà ºn el tipo de visa de inmigrante que corresponde para ingresar a los Estados Unidos.   Si se utiliza una IR-3 o una IH-3 y el menor ingresa a USA con menos de 18 aà ±os cumplidos y una vez en el paà ­s vive con sus padres adoptivos (o padre o madre, si la adopcià ³n fue monoparental), entonces se adquiere la ciudadanà ­a automticamente en el momento de cruzar la frontera. En estos casos se recibir en casa y gratis un Certificado de Ciudadanà ­a. Por el contrario, si se ingresa a Estados Unidos con la visa inmigrante IR-4/IH-4,  el menor recibir en su pasaporte un sello que se conoce como I-551 y, a las pocas semanas, se recibir por correo una tarjeta de residencia permanente, tambià ©n conocida como green card. Es decir, en estos casos  el adoptado adquiere la condicià ³n de residente permanente. Sin embargo, se convertir en ciudadano automticamente si la adopcià ³n se finaliza antes de que cumpla los 18 aà ±os de edad.  En estos casos, si asà ­ se desea, se pueden solicitar un Certificado de Ciudadanà ­a aplicando mediante la planilla N-600, pagando la cuota correspondiente. Por el contrario, si el menor no ha cumplido los 18 aà ±os de edad e ingresa utilizando una visa IR-2, adquirir automticamente la ciudadanà ­a tras su ingreso a los Estados Unidos, siempre y cuando viva con el adoptante. Sin embargo, si el IR-2 ya ha cumplido los 18 pero est soltero y es menor de 21 aà ±os, recibir una tarjeta de residente permanente, pudiendo ms tarde solicitar la ciudadanà ­a por naturalizacià ³n. En estos casos es importante conocer cà ³mo la edad afecta a las peticiones de green card. Cuando el menor adoptado por un ciudadano reside habitualmente en el extranjero   Puede suceder que un menor adoptado por un estadounidense tiene por residencia habitual un paà ­s distinto a los Estados Unidos plantendose en este caso la duda de si ese nià ±o algà ºn derecho a la ciudadanà ­a americana. La respuesta es que sà ­, siempre y cuando se cumplan una serie de requisitos y, adems, no se produce de forma automtica. Las condiciones para que pueda acceder a la ciudadanà ­a son: el adoptado tiene que tener menos de 18 aà ±os de edaddebe vivir en el mismo hogar que su progenitor estadounidense, quien debe tener su guardia legal.El progenitor estadounidense debe haber vivido al menos 5 aà ±os en los Estados Unidos, dos de dichos aà ±os, tienen que haber sido despuà ©s de que hubiera cumplido los 14. Si no puede cumplir este requisito, es suficiente si lo puede cumplir uno de los abuelos, que debe de estar vivo.el menor debe ingresar a Estados Unidos como no inmigrante. En la mayorà ­a de los casos lo har como turista pero puede utilizar otras visas no inmigrantes. En este punto tener en consideracià ³n que los consulados no estn obligados a aprobar ninguna visa por el simple hecho de que el menor sea hijo adoptado de ciudadano. Es decir, deben cumplirse todos los requisitos para que se apruebe la visa.Por à ºltimo, una vez que el menor adoptado ingresa a los Estados Unidos puede solicitar la ciudadanà ­a americana por el procedimiento de naturalizacià ³n. Dà ³nde solicitar informacià ³n para casos de papeles para adoptados por ciudadanos si se tienen dudas o inquietudes, es posible comunicarse con el Departamento de Estado por medio de un correo electrà ³nico escribiendo a: adoptionUSCAstate.gov, en el caso de adopciones en paà ­ses firmantes del Convenio de la HayaaskCIstate.gov, en los dems casos. Asimismo, estn disponibles los siguientes telà ©fonos 1 888 407 4747, si se marca desde los Estados Unidos 1 202 501 4444, si se marca desde otro paà ­s A tener en cuenta: un cambio de ley Actualmente, la ley que aplica a los casos de adopciones internacionales por parte de ciudadanos estadounidenses es la conocida como The Child Citizenship Act del aà ±o 2000, que dejà ³ fuera de su proteccià ³n a aquellas personas adoptadas en el extranjero que tenà ­an ya 18 aà ±os cuando la ley entrà ³ en vigor.   Como consecuencia, muchos de ellos nunca adquirieron la ciudadanà ­a estadounidense y algunos de ellos incluso han sido deportados por delitos menores. En otro orden de cosas, los estadounidenses que desean adoptar a un menor extranjero que se encuentra fuera de Estados Unidos para traerlo a vivir aquà ­ deben pasar por un examen de su historial (background check) y de huellas digitales. El mismo requisito deben cumplir todas las personas que residan en el hogar familiar y que tengan cumplidos los 18 aà ±os de edad o ms. Paà ­ses de procedencia de los adoptados por ciudadanos estadounidenses En el à ºltimo aà ±o fiscal los ciudadanos americanos adoptaron en otros paà ­ses un total de 6,438 nià ±os extranjeros, una cantidad muy inferior al los 22,991 que fueron adoptados en 2004. En la actualidad los 5 paà ­ses de origen por orden de mayor nà ºmero de adoptados son: China, Etiopà ­a, Rusia, Corea del Sur y Ucrania.   Desde 1999 a 2014, estos son los nà ºmeros de nià ±os adoptados por estadounidenses en los paà ­ses de habla hispana: Argentina: 2Bolivia: 180Chile: 57Colombia: 4093Costa Rica: 329Cuba: 1Ecuador: 451El Salvador: 172Espaà ±a: 2Guatemala: 29780Honduras: 170Mà ©xico: 1077Panam: 117Paraguay: 11Perà º: 437Repà ºblica Dominicana: 220Uruguay: 1Venezuela: 12 Consejos para rellenar los papeles con à ©xito En este artà ­culo se ha hecho referencia a varios formularios oficiales del Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s), como por ejemplo el I-600, el I-800 o el N-600. Todos esos formularios pueden ser descargados gratuitamente de la pgina oficial del USCIS. Deben ser firmados y rellanados con tinta negra. En el caso de que los documentos de apoyo que se deben adjuntar està ©n en un idioma distinto al inglà ©s, es necesario traducirlos a ese idioma e incluir una carta de certificacià ³n de la traduccià ³n.  Es decir, no es necesario obtener el sello de un notario ni pagar a un traductor jurado. Finalmente, mentir en un documento migratorio o de visa o ante un oficial consular o migratorio es considerado una violacià ³n migratoria que puede tener consecuencias muy graves, ya que se puede considerar como un fraude de ley. En caso de duda siempre se recomienda asesorarse con un abogado reputado con experiencia en casos de adopciones internacionales. Este artà ­culo es informativo. No constituye asesorà ­a legal para ningà ºn caso en particular.

A Staggering Work of Heartbreaking Genius Essay

A Staggering Work of Heartbreaking Genius - Essay Example Although the book A Staggering Work of Heartbreaking Genius touches upon a lot of serious problems (such as death, misfortune and children that stay without parents), there are critics that do not agree to the fact that Dave Eggers’s writing belongs to creative nonfiction (Forche 109). It is not very difficult to find out if it is so through analyzing the peculiarities of genre and style applied by the writer in A Staggering Work of Heartbreaking Genius. It should be noted that the title of A Staggering Work of Heartbreaking Genius is catching and interesting for the reader. It makes everyone think over its meaning and search for a certain signs that will help to explain why Dave Eggers has chosen this very title for his book. It is not very difficult to note that the title of the book ties into the book’s text. There are two arguments that can help to prove this point of view. The first one is the complexity of the situation described by the author. The protagonist (To ph) loses both mother and father because of illness. Dave is trying to represent two parents in one face for this child. It is practically impossible. One must be a real genius to do this. Dave’s attempts to bring up Toph are frequently heartbreaking. It is difficult for him to play the role of the child’s late parents. ... It is not better than the previous with his father and mother, but the catastrophe (that is death) helps Toph to look at the world from a quite new point of view. As for me, it is very difficult for unsophisticated reader to understand the meaning of the title, especially its symbolic nature. Everything becomes clear only when the reader takes a deeper look into Toph and Eggers’s souls and conduct. In any case, the title chosen by the author of A Staggering Work of Heartbreaking Genius fully coincides with the context of the whole writing (128). Although it may seem unclear at a glance, it is impossible to create more relevant title for this splendid writing. It is not very difficult to figure out the genre of the book. It is sure to be memoir that belongs to creative nonfiction. A Staggering Work of Heartbreaking Genius gives the information about Toph and Dave’s life after the death of Toph’s parents. The book has many extracts where the author portrays magazin e’s history. It was created by Dave and his friends. The extracts with the data about magazine may be considered to be unnecessary in the book, but they are also the sign that the writing belongs to creative nonfiction. A Staggering Work of Heartbreaking Genius consists of four hundred sixteen pages. This volume is normal for short biography. Nevertheless, there are critics that are sure that Dave omitted a lot of important details about the protagonist in his book. According to their point of view it would be better to shorten a number of information about the magazine and write more about Toph’s character, feelings and emotional experience. However, it is known that every reader expects something special to read after seeing the title of