Interventions for Ventilator Associated Pneumonia

Interventions for Ventilator Associated Pneumonia Ventilator associated pneumonia is defined as pneumonia developing in persons who have received mechanical ventilation for at least 48 hours (Shi et al., 2010). It is a major threat to critically ill patients receiving mechanical ventilation (Feider, Mitchell, Bridges, 2010) and it is the most common complication of patients in Intensive Care Units (Soh et al., 2011). Nosocomial pneumonia is caused by bacteria that colonize within the oral cavity of patients in the ICUs (Ewig et al., 1998). Bad oral health is pivotal in the pathogenesis of this harmful complication (Blot, Vandijck Labeau, 2008). Thus, good oral hygiene measure has a critical role in preventing the spread of these bacteria from the oral cavity to the lower respiratory tract thereby reducing the chances of nosocomial pneumonia (McNeill, 2000 cited in Abidia, 2007). There are a couple of interventions which are recommended to prevent Ventilator – Associated Pneumonia. The Institute of Healthcare Improvement suggested the VAP bundle of interventions in preventing Ventilator Associated Pneumonia. (Fields, 2008) In addition to these interventions, oral hygiene care is a nursing intervention that may also help prevent ventilator-associated pneumonia (Feider, Mitchell Bridges, 2010). Evidence shows that comprehensive oral care is an effective preventive strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation (Cutler Davis, 2005). There are a lot of research studies supporting oral hygiene care in reducing VAP cases among mechanically ventilated patients. In the study of Mori et al., (2006), the incidence of VAP was significantly lower in patients who received oral care than the patients who did not. Similarly, Fields’ (2008) study showed that VAP rate dropped to zero within a week of beginning the every hours tooth brushing regimen in the intervention group. Another study shows that pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care (Yoneyama et al., 2002). Various methods and equipment in providing oral care for intubated patients were also studied. Toothbrushes and topical antimicrobials (Binkley, Furr, Carrico McCurren, 2004; Grap, Munro, Ashtiani Bryant, 2003), oral decontamination (Bergmans et al., 2001) and oropharyngeal decontamination with 0.12% Chlorhexidine Gluconate oral rinse (Shi et al., 2010; Tantipong, Morkchareonpong, Jaiyindee Thamlikitkul, 2008; Koeman et al., 2006; Houston et al., 2002; Genuit, Bochicchio, Napolitano, McCarter Roghman, 2001; DeRiso, Ladowski, Dillon, Justice Peterson, 1996) were found to be effective in reducing the bacteria in the mouth and in reducing the incidence of VAP. The AACN (2010) came up with a comprehensive oral hygiene program for patients in critical care and acute care settings who are at high risk for ventilator-associated pneumonia. This includes brushing teeth, gums and tongue at least twice a day using a soft pediatric or adult toothbrush; providing oral moisturizing to oral mucosa and lips every 2 to 4 hours; and using an oral chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative period for adult patients who undergo cardiac surgery. The routine use of oral chlorhexidine gluconate (0.12%) in other populations is not recommended at this time. These interventions are supported by the existing evidence of oral hygiene. Past research studies have focused on assessing the oral care knowledge, attitude and practices among ICU nurses. Studies had shown that ICU nurses lack sufficient knowledge on oral care (Jordan, Badovinac, Ã…  palj, Par, Ã…  laj PlanÄ ak, 2014; Chan Hui-Ling Ng, 2012). The methods used to provide oral care were also found to be varied between nurses in the same unit (Soh et al., 2011; Chan Hui-Ling Ng, 2012). Moreover, the oral care currently provided in ICUs may be ineffective in eradicating dental plaque and respiratory pathogens that may cause VAP to ventilated patients (Binkley, Furr, Carrico, McCurren, 2004). There was also existing discrepancies between reported practices and policies on oral care provided to intubated patients (Feider, Mitchell Bridges, 2010). Though oral care is perceived to be high priority in mechanically ventilated patients, difficulties, problems and barriers still exist in providing the care (Rello et al., 2007; Feider, Mitchell Bridges, 20 10; Soh, Soh, Japar, Raman Davidson, 2011). These challenges include mechanical barriers and equipment issues, perception on the importance of oral care and empathy to patients’ discomfort by nurses, altered patient sensory perception and discomfort, and communication problems. (Berry Davidson, 2006) The existence of variation in oral care practices, the ineffective provision of oral care and the lack of sufficient knowledge of ICU nurses warrants a standardized protocol or guideline that is based on existing evidence. (Soh et al., 2011; Lin, Chang, Chang Lou, 2011) In the past years, Evidence – Based Practice (EBP) is gaining its momentum in the healthcare sector. It has been the focus of discussions and research in the medical field. Its importance to the medical practice has been evident and thus encouraged to be integrated in the practice. However, translating evidence into clinical practice remains a big challenge at the moment. Significant gaps between what is known to improve health, and what is done to improve health is evident (Holmes, Scarrow Schellenberg, 2012). These gaps maybe caused by unawareness or unfamiliarity of clinicians to EBP guidelines or recommendations; or the clinicians disbelief towards the EBP recommendations; or the clinicians personal opinion on the recommended management; or the clinicians’ perception that the guideline is too complicated or difficult to use in their own practices; patient-related factors; and the mentality that altering established practice is often difficult. (Pierson, 2009) Evide nce – based guidelines for providing oral care to patients in mechanical ventilators were formulated by international organizations, but, not all intensive care unit nurses are knowledgeable about it. Past study indicated that nurses lacked the evidence-based knowledge to deliver proper care (Chan, Lee, Poh, Ng Prabhakaran, 2011). In addition, a study also showed that ICU nurses did not follow procedures and steps recommended by current evidence-based practice (Lin, Chang, Chang Lou, 2009). Various knowledge translation strategies such as opinion leaders, audits and feedback, small group consensus, provider reminder systems, incentives, clinical information systems, and computer decision support systems can be utilized to integrate EBP into the clinical world. These knowledge translation strategies should be attempted and researched in clinical setting and should be used to further improve clinical practice. (Ganz et al, 2013) Therefore, the focus of this current research is to translate knowledge of Evidence based oral care practice guideline for mechanically ventilated adult ICU patients to clinical practice using a provider reminder system strategy. Further, it will determine the effect of the provider reminded system strategy in improving the Evidence – Based oral care practices for mechanically ventilated patients among ICU nurses. Provider reminder system is one of the Quality Improvement (QI) strategies. Example of provider reminder system includes reminders in charts for providers, computer – based reminders for providers, and computer – based decision support. (Hughes Hughes, 2008)

Internet Addiction ( Pathological Internet Use ) Essay -- Essays Paper

Internet Addiction ( Pathological Internet Use ) The Internet has become one of the most universal methods for communication with over 100 million users worldwide. From e-mail to the possibly billions of web pages, there is an infinite amount of information flowing. And another enticing aspect of the Internet, is the opportunity to interact with other people. Chat Rooms and MUD (Multi-User Dimensional) games offer the person the ability to talk and mingle with others online. But with this newfound freedom, also comes the possibility of abuse and addiction. Internet addiction, also known as Pathological Internet use, has emerged as a very destructive force in today’s society. David Greenfield believes â€Å"an estimated 6 percent of the web users 100 million people are thought to be online addicts, and that number is growing everyday.† But what causes Internet Addiction? There are many different causes, but one of the most essential, is thought to be a personality disorder. Carol Potera, an author in Psychology Today says, â€Å"The lone, bored, depress, introverted, lacking self-esteem, or have a history of addictions are most vulnerable.† This group of people seems to be the most susceptible to all mental disorders, psychologically or physical. These people need to fill the void that has been created by not having any real life relationships, so they turn to the Internet, just as if someone would turn to drugs. Greenfield thinks â€Å"people feel closer, quicker to the people they communicated with onli ne than in real life; time passes freely, and people like the anonymity.† (Greenfield) A study conducted by the Stanford Institute for the Quantitative Study of Society and InterSurvey (headed by Norman H Nie and Lutz Erbing) had some interesting findings. Twenty-five percent of the surveyed participants (4,113 in 2,689 households) say that web time has reduced their time spent with friends and family and participating in events outside the home. They also found that nearly 60% of the surveyed cut back on television viewing also, in which Erbing added that â€Å"the Internet could be the ultimate isolating technology that further reduces our participation in communities, even more than TV did before.† (Erbing) This is a relatively new disorder, and there hasn’t been much studying or research of it. So how does one know if he or she is a patholo... ...es. Another treatment is Motivational Enhancement Treatment (MET). â€Å"MET is less familiar. Its aim is to help patients acknowledge that they have a problem and need to change their behavior. The stages of change are contemplation, determination, action, maintenance, and contemplation again after a relapse.† Therapists also assess the computer the use of patients in great detail and reaffirm their acknowledgment of the need for help. Therapy groups are the most advised way for treatment. When you can relate to others with others who also have the same problem. The Internet has opened the door of the information age to many people. Actually, the information age was created due to the Internet. Yet, the negatives will never out shadow all the positives that the Internet has done for the world probably, and the Internet is almost assuredly here to stay. So people must be able to use it, without abuse. This isn’t the first time that something has been reared a society-destructive force, and it probably won’t be the last. It is just another way that people can escape the real world, and enter their own sort of utopia. Whether drug-induced or via e-mail, its all the same.

Stereotype and Prejudice Marjorie

Title: Prejudice Prejudice Marjorie W. Davis PSY/285 February 28, 2012 Michael Ford Abstract Our discussion is about how does society confirm prejudicial attitudes? How does ones social identity contribute to prejudice? How do emotions encourage prejudicial attitudes? What cognitive processes influence prejudice? Our text has explained competition; competition is an important source of frustration that can fuel prejudice. When two groups compete for jobs, housing, or social prestige, one group’s goal fulfillment can become the other group’s frustration. PrejudiceSociety confirms prejudice by what you possess and how much money you have. If you are not in a certain bracket such as (high class or middle class), you are considered poor. Prejudice helps justify the economic and social superiority of those who have wealth and power. Of course they will not give a chance at credit to buy a house, car, or start a business. Society, also confirm prejudice by the way you dress o r the car you drive. Society confirms prejudicial attitude by focusing on personal individuality and Independence, as opposed to becoming a team with neighbors and friends.I am so glad that God looks at the heart and man looks at the outer appearance. One's social identity contributes base on a realization of limited environmental control. The more you believe that you can impact your environment or social status, the less roll social identity plays Emotions really affect prejudicial attitudes because most of the time people make decisions based on their emotions. Emotions of fear and sadness or joy and gladness, which can cause you to project feelings in a hurtful way, rather than in a helpful manner Cognitive process influence prejudice through stereotyping, which cause prejudice.This can be a result of the normal ways in which we simplify and organize the world. Stereotypes are the social scripts we have in our heads about others and the roles we believe they should play in our s ocially constructed world. It is important to have the understanding of the basic concepts of prejudice and racism, and how to lessen their destructive effect (Rosado,  1995-2012). Reference Rosado, C. (1995-2012). Critical Multicultral Pavilion Research Room. Retrieved from http://www. edchange,org/multicultral/papers/caleb/racism. html

The Elusive Concert essays

The Elusive Concert essays Be it the first flyer or the scalpers frenzy, the third encore or the first note to a lip synched live performance- a massive to do list has been prepared and is being checked off by concert goers, lighting crew, hot dog vendors, multimillion dollar rap superstars and every other homosapien who has anything and everything to do with the perparation leading up to concert night. First off, the record company executives, tour managers and the band/performer(s) have a power lunch to discuss the possibility of a tour. Appetizers, entrees and the whole bar lateR, dates, range (ex. A tour of Europe? South west Aasia?...), price, venues and every other aspect of a tour is battled and finally decided upon. Mind you, this decision (assuming a concensus is the ulimate goal) takes more than a few lunches, powerful as they may be. Big questions need to be answered, expensive decision need to be made. The size of the tour, has to be thought out, is/are the performer(s) going for an intimate club like feel, or is a multi million dollar world wide arena tour preferred? Venues need to be confirmed and booked, then lighting, sound, transportation, caterers, drug dealers, pimps, advertising reps, and the rest of the free world has to be chosen (within a set budget) and ultimately booked. After someone looses an eye, and probably a few limbs, the record companies spread a few rumours to local media outlets which leads to a buzz in the air of a possible concert (even after everyone has signed on the dotted line, presumably in blood). Finally, after months of word of mouth the shows are confirmed. Flyers, newspaper articles, radio/TV announcements fill the air. Now being an avid concert goer myself, this time is crucial. Plans, friendships and financial aids have to be carefully examined, and priorities need to be made. This is what it boils down to, you want to be the first person to ...

Investment and Normal Economy Essay Example

Investment and Normal Economy Essay Example Investment and Normal Economy Essay Investment and Normal Economy Essay Portfolio Risk| | | | | | | | | | | | | | Scenario Analysis. The common stock of Leaning Tower of Pita, Inc. , a restaurant chain, will generate the following payoffs to investors next year:| | | | | | | | | | | | | | | | | | | Dividend| Stock price| | | | | | | | | | | | Boom| | 5| 195| | 150. 00%| | | | | | | | | | Normal economy| 2| 100| | 27. 50%| | | | | | | | | | Recession| | 0| 0| | -100. 00%| | | | | | | | | | | | | | | | | | | | | | | | | The company goes out of business if a recession hits. Calculate the expected rate of return and standard deviation of return to Learning Tower of Pita shareholders. Assume for simplicity that the three possible states of the economy are equally likely. The stock is selling today for $80. | | | | | | | | | | | | | | | | | Current stock price=| $80| | | | | | | | | | | | | | | | | | | | | | | | | | | | | Â  | Dividend| Stock price| Capital gains| Â  | Total gain (dividend + capital gain)| Â  | Return| Â  | Â  | | | | | Boom| | $5| $195| $115| =$195 $80. | $120| =$5 + $115. | 150. 00%| =$120 / $80. | 25. 83%| | | | Normal economy| $2| $100| $20| =$100 $80. | $22| =$2 + $20. | 27. 50%| =$22 / $80. | | | | | Recession| Â  | $0| $0| -$80| =$ $80. -$80| =$ -$80. | -100. 00%| =-$80 / $80. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Scenario| Probability| return| return x Probability| Difference from mean, i. e. 0. 2583| Difference 2 | Probability x Difference 2| | | 25. 83%| | | | | | Boom| 33. 33%| 150%| 50. 00%| 124. 17%| 1. 541819| 0. 513888| | | | | | | | | Â  | Â  | Â  | =150. %x0. 3333| =150. %-25. 83%| =1. 24 17^2| =0. 33331. 541819| | | | | | | | | Normal economy| 33. 33%| 27. 5%| 9. 17%| 1. 67%| 0. 000279| 0. 000093| | | | | | | | | Recession| 33. 33%| -100%| -33. 3%| -125. 83%| 1. 583319| 0. 527720| | | | | | | | | Total| | | 25. 83%| | | 1. 041701| | | | | | | | | | | | | | | | | | | | | | | | Probability = 1/3 as all the three states are equally likely| | | | | | | | | | | | | | | | | | | | | | | | | | Expected return=| 0. 2583| or| 25. 83%| | | | | | | | | | | Variance=| | 1. 041701| | | | | | | | | | | | | Standard deviation=vVariance=| 1. 0206| or| 102. 06%| =v1. 041701| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Question:| | | | | | | | | | | | | | | | | | | | | | | | | | | | | Portfolio Risk. Who would view the stock of Learning Tower of Pita as a risk reducing investment – the owner of a gambling casino or a successful bankruptcy lawyer? Explain. | | | | | | | | | | | | | | | | | A successful bankruptcy lawy er would view stock of leaning Tower Of Pta a risk reducing investment because in recession his business would do well and Leaning Tower of Pita would not whereas, in boom times his business would not do well but Leaning Tower of Pita would do well. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

Business law assignment Essay Example | Topics and Well Written Essays - 1000 words

Business law assignment - Essay Example Additionally, the tax rates and reliefs are more favourable. Nevertheless, there are numerous administrative requirements in order to commence trading and companies are subject to strict financial reporting requirements, which can be cumbersome. Another option would be to set up a partnership, which can open up other business opportunities. The Partnership Act 1890 (the Act) regulates partnerships at common law. Unlike sole traders, partners share the business and control, decision making and profit and losses. All partners are jointly and severally liable for debts and â€Å"owe duty of good faith to each other5†. Section 28 of the Act further imposes a statutory duty to account and Law v Law6 determined that the impact of section 29 of the Act was to prohibit secret profits. The Act governs liability of partners and their legal obligations and provides that each partner is equally liable for the business regardless of their share of the ownership. Additionally, depending on the number of partners, partners can terminate and dissolve the partnership at any point resulting in automatic dissolution7. Therefore the main disadvantage of this trading medium is exposure to potential liability for acts of other partners under section 10. The other alternative would be to set up a limited liability partnership (LLP) under The Limited Liability Partnerships Act 2000 (LLPA). The LLP has certain similarities to limited companies and section 1(2) of the LLPA states that an LLP is a separate corporate entity with legal personality separate to its members. Accordingly, the distinct advantage compared to a general partnership is that an LLP can hold land and other assets in its own name, enter intro contracts with its own name and goes further in protecting partners from wrongful acts of other partners8. Moreover, in contrast to a limited liability company, as an LLP does not have any share

Business and Professional Ethics Essay Example | Topics and Well Written Essays - 1500 words

Business and Professional Ethics - Essay Example a company should be to maximise its profits and consequently return a part of these profits to the shareholder group as the reward and return for the risks that they have borne by investing their money in the company. Milton Friedman’s view advocates that the shareholders of a company can decide what social responsibilities they want to take part in. This report is prepared with the aim of evaluating the pros and cons of these arguments by referring to the theoretical works presented by different scholars and practitioners in this domain. The report is concluded by presenting a view as to whether the arguments presented by Friedman still hold ground in the current corporate world. The arguments proposed by Milton Friedman suggest that a company does not have to have any kind of social responsibility towards the community and society because the only concern of the company should be to increase its financial gains and returns for the shareholders who have invested in the company (Friedman, 1970). Nevertheless, as per the contemporary theories of business ethics and corporate social responsibility, focusing on giving back to the societies and communities in which the companies operate is a necessity for achieving sustainable competitive advantage. Also, the use of suitable corporate social responsibility initiatives is mandatory for ensuring that the company remains ethically, morally as well as socially compliant (Kerr, Janda and Pitts, 2009, pp. 22-25). As per the theory proposed by Friedman, the focus of the profit oriented businesses on adding value to the society may lead to totalitarianism which is a particular type of political system in which the  federal or state authorities have total control over the community and society and thus, seeks to control all the relevant aspects of both private and public lives whenever and wherever possible. But, it can be seen in the global corporate environment that totalitarianism as a political system does not prevail