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Issue and Solutions of Racial Prejudice in Police Communities

Some Six Feet Too Low, Others Six Feet Too High “Recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.” The Universal Declaration of Human Rights (UDHR) is the first document to universally outline and explain the basic human rights every single individual has, and that no one can take away from them, reinforced internationally by the United Nations (UN). The UN is an organisation that supplies worldwide aid and enforces peace, fulfilling the main roles of maintaining international peace and security, the protection of human rights, the suppliance of humanitarian aid, the promotion of sustainable development and the upholding of international law. Articles Two and Seven deal exclusively with discrimination and exclusion under law or the personal eye. Every single individual, regardless of race, colour, sex, language, religion, political or other opinions, national or social origin, property, birth or another status, as stated by Article Two of the UDHR, is entitled to all the rights and freedoms listed in the UDHR. Yet stands the issue of discrimination under the law, Article Seven clearly outlines that all are entitled to equal protection against any discrimination in violation of any previous declarations. In America, our country, first world, the land of the free, but not all are truly free, in the case of many racial minorities, either subconscious or blatant racism keeps them from being free and not discriminated against, creating racial prejudice in many communities, as well as police communities. This racial prejudice in police communities ends with atrocities, putting innocent people in jail and keeping guilty people out, putting innocent people six feet under, and murderers six feet too high. In December 2014 President Barack Obama issued an executive order creating the Task Force on 21st Century Policing-a special commission of law enforcement officers, legal scholars, civil rights attorneys, and youth leaders. The task force was charged with making recommendations to America’s state and local law enforcement agencies in order to “strengthen trust among law enforcement officers and the communities they serve,” according to a White House press statement announcing its formation. The White House announcement also referenced “recent events in Ferguson, Staten Island, Cleveland, and around the country” as reasons for why this executive order was necessary. These “recent events” referred to by the White House were a series of incidents in 2014 that drew widespread attention, sparked a nationwide debate over police use of force, and led many Americans to question the level of trust they had in their local police. In Ferguson (a suburb of St. Louis, Missouri), Michael Brown, a teenager, was shot multiple times by a police officer and left for dead in the middle of a city street. In Staten Island in New York City, forty-three-year-old Eric Garner was choked to death by a police officer in the course of being arrested by a group of police for illegally selling cigarettes. In Cleveland, Ohio, Tamir Rice, a twelve-year-old boy who was playing in a park with a toy gun, was fatally shot by a police officer responding to a dispatch call. None of the three victims was armed. Their untimely deaths because of police action created much public outcry, including protests and civil rights demonstrations. There were several reasons why these three incidents sparked social unrest. One reason is the question of whether racial discrimination played a part in the deaths. In all three incidents, the victims were African American males, and the police officers who killed them were white. Some people asserted that these and similar incidents were simply extreme examples of how racial minorities have been abused by the police. The human rights group Amnesty International investigated police use of lethal force in a June 2015 report and concluded that “the shooting of Michael Brown in Ferguson, Missouri and countless others across the United States has highlighted a widespread pattern of racially discriminatory treatment by law enforcement officers and an alarming use of lethal force nationwide.” Both established civil rights groups like the National Association for the Advancement of Colored People (NAACP) and new ones such as Black Lives Matter have sought to address concerns about police abuses against black men and women. Another reason why these incidents sparked nationwide concern is the police officers involved appeared to avoid any significant consequence for their actions. All three officers involved in the Brown, Garner, Rice killings were investigated by grand juries; all emerged unindicted and were thus relieved of being put on trial for their actions. Critics have argued that these cases are typical in that most police incidents of wrongful homicide or excessive use of force go unpunished. “There’s shockingly little accountability for police and other law enforcement….Indictments for police homicides are rare, and convictions almost nonexistent,” writes journalist Jamelle Bouie. Changing hiring practices is one typical reform measure. For example, Victor Hwang, a member of the San Francisco Police Commission, has called for his city to “revise its policies to encourage the hiring of officers who come from and live in the communities they serve.” Hwang and others argue that police officers as a group should be more representative of the places they patrol. If communities are racially and ethnically diverse, then police forces should reflect that diversity in hopes that systemic prejudices on the part of police forces will be neutralized and incidents of police brutality reduced. Katherine Spillar, executive director of the Feminist Majority Foundation, offers another simple hiring suggestion to prevent police brutality: Recruit more female police officers. She points to studies made over the past forty years that consistently demonstrate that female police officers are far less likely to be involved in excessive force or police shooting incidents or be named in civilian complaints than their male counterparts. One reason, many believe, is that women officers tend to rely more on communication than on physical force when dealing with people and may be better at defusing potentially violent confrontations before they turn deadly. A commission interviewed Los Angeles police officers to examine problems following the notorious police beating of Rodney King in 1991; they reported that “many officers, both male and female, believe female officers are less personally challenged by defiant suspects and feel less need to deal with defiance with immediate force or confrontational language.” Currently, females constitute between 12 per cent and 18 percent of police officers, and many smaller police departments have very few female officers (and even fewer female commanders). Spillar argues that these numbers could improve by changing how police departments recruit job applicants. “Too many police recruiting campaigns feature slick brochures and billboards focused on adrenaline-fueled car chases, SWAT incidents and helicopter rescues-the kind of policing featured in television dramas and that overwhelmingly appeals to male recruits,” she asserts. Such appeals may attract recruits (again, mostly men) who revel in action and displays of power-and may indirectly contribute to the problem of police brutality. Spillar says that recruiting should instead stress the reality that most day-to-day police work involves service-related activities and nonviolent interactions. In other words, “the kind of policing that appeals to women,” Spillar claims. Once people are recruited and hired, they need to be trained, both in police academies and later on the job. Many alternative ideas for combating police brutality and abuse focus on police training and what kind of norms and expectations of police are being taught. Criminal justice professor Maria Haberfeld argues that police officers in America are simply not getting enough training. “An average training in the United States is fifteen weeks,” she says. “Fifteen weeks is nothing.” She notes that police in other developed nations typically receive two or three times the amount of training that American police recruits do. And while some police departments provide continuing in-service training for police officers, the majority of police departments do not offer it, usually due to budget constraints. The result, she suggests, is an undereducated, undertrained police force that may be more prone to rely on shooting or using force when dealing with difficult situations or people. Haberfeld and other critics see shortcomings not only in the amount of training police receive but in the police academy curriculum. Police training (both in-service and at academies) resembles military boot camps and often focuses on personal safety, firearms, combat techniques, and using physical force to subdue subjects. To Haberfeld and others, less-combative skills are neglected. Journalist Patrik Jonsson writes that, for example, “US police cadets spend an average of 58 hours at the gun range and eight hours learning how to de-escalate tense situations.” Critics argue that police need more training on how to communicate and interact with people, how to avoid or de-escalate confrontations, and how police actions (such as use of force) may impact the department’s and officer’s relationship with the community. “The majority of police officers are overwhelmingly trained with a focus on the technical part of use of force, and are not trained enough in the emotional, psychological, physiological aspects of use of force,” says Haberfeld. The soldier’s mission is that of a warrior: to conquer. The rules of engagement are decided before the battle. The police officer’s mission is that of a guardian: to protect. The rules of engagement evolve as the incident unfolds. Soldiers must follow orders. Police officers must make independent decisions. Soldiers come into communities as an outside, occupying force. Guardians are members of the community, protecting from within. Police have jobs within the community, black or white, no matter the situation, they have a duty to protect. Acting with personal discrimination rather than judicial discrimination has only ended in the pointless killing and murder of innocent people. Police acting on racial bias can be stopped very easily, yet everyone who has tried has failed. Do people not want racism to end? Or are people content with the pointless killing of innocent people on American soil in your neighborhoods and on your sidewalks and streets just because they’re a different colour than you? It needs to stop, yet it hasn’t. Yet. Works Cited Matt Apuzzo and Sarah Cohen, “Data on Use of Force by Police Proves Almost Useless,” New York Times, August 11, 2015. Ronald Bailey, “Watched Cops Are Polite Cops,” Reason, August 30, 2013. Harvard Law Review, “Considering Police Body Cameras,” April 2015. William F. Jasper, “Are Local Police to Blame?,” New American, September 21, 2015. Kimberly Kindy, “Thousands Dead, Few Prosecuted,” Washington Post, April 11, 2013. Shaun King, “Cops Who Kill Unarmed Victims–like Cedrick Chatman or Eric Garner–and Fail to Give First Aid Demonstrate Their Wanton Disregard for Human Life,” New York Daily News, January 16, 2016. Chase Madur, “Why It’s Impossible to Indict a Cop,” Nation, November 25, 2014. Chris Mastrangelo, “The Face of Police Brutality,”, April 4, 2013. Michael S. Schmidt, “F.B.I. Director Speaks on Race and Police Bias,” New York Times, February 13, 2015. Rion Amalcar Scott, “The Etiquette of Police Brutality,” Crisis, Winter 2015. Seth Stoughton, “How Police Training Contributes to Avoidable Deaths,” Atlantic, December 12, 2014. John W. Whitehead, “Militarization Is More than Tanks and Rifles: It’s a Cultural Disease,” Huffington Post, May 21, 2015. Kevin D. Williamson, “No War on Cops, No War on Blacks: We Face Instead a Set of Conventional Intractable Systemic Failures,” National Review, October 5, 2015.
Alpena Community College Social Work & The Trials of Gabriel Fernandez Discussion.

The Trials of Gabriel Fernandez Term Paper
Guidelines and Prompt
With this term paper you will be required to watch the Netflix docuseries, “The Trials of Gabriel Fernandez.” We will be transitioning your volunteer term paper requirements to this docuseries. This term paper is a combination of your research of Child Welfare social workers, examination of the systems involved in Gabriel’s life, along with reflections of the textbook, class lectures, and small group discussions. In this term paper, please consider the following: were the social workers involved in this case practicing their job duties in alignment with the NASW code of ethics? What do you think you would have done differently if your supervisor instructed you to do something against your ethics? What did this film teach you both personally and professionally and how will you apply this to your role as a future social worker?You are expected to use a minimum of 3 quotations/citations from the Netflix Docuseries “The Trials of Gabriel Fernandez, and the “course textbook/outline,” to define and support the use of social work theories, approaches, values, and practice methods in this term paper.
Please note: All term papers must be word processed in APA format and between 6-7 pages NOT including the Title Page and References. All textbook quotations must cite the textbook source, not the chapter outline packet.
Each paper is to address the following:
Agency Introduction:
1. Briefly describe the Los Angeles Department of Child and Family Services (DCFS) and its mission statement. You will find a lot of information using the following link: (
2. Describe the target population in detail, including pertinent information related to age, gender, socio-economic status, race, culture, ethnicity, etc. (What population does the Department of Child and Family Services Serve)?
3. Does the agency respect self-determination? Describe how the agency does, or does not, uphold self-determination.
● Give one specific example to support your point of view.
Theories and Interventions
1. Social Work Theories and Approaches:
● Choose two of the following social work theories or approaches and apply them to the work being done at the LA DCFS. Give at least one specific example for each theory to illustrate your applications.
o The Strengths Perspective
o Ecological Systems Theory
o Systems Theory
o Person-in-the-Environment
2. Social Work Interventions:
● Based on the documentary and your research of Gabriel’s case, choose at least one social work intervention from your observations of the documentary:
o Individual Casework
o Case Management
o Individual or family counseling
o Group work, 5) Client advocacy
o Community organizing (to include outreach work and attempts to change social policy or legislation)
● What was your impression of the social worker’s involved in Gabriel’s case?
● State the intervention you chose and give at least one example of the intervention.
● How did the Social Workers utilize the intervention you chose? Would you have used the same intervention? Why or why not?
● Were these interventions effective or ineffective? Why or why not?
1. Recommendations for the Agency
● Which code of ethics did the social workers not abide by? Provide one example (refer to the NASW code of ethics on canvas).
● What do you think you would have done differently if your supervisor instructed you to do something against your code of ethics?
● What changes would you suggest to make for the DCFS agency to be more successful at delivering services? Give one example.
2. Self-Reflection
● What did you learn about yourself from watching this docuseries?
● Discuss how you would have demonstrated social work practices and ethics.
● What did this film te12-point font, Times New Roman and Word processed
3. APA Specific Format: Title Page with Running Head, Topic Headers, Reference page, Quotations/Citations properly formatted, In text citations match Reference page.
Organization, Grammar and Spelling
1. Sentences convey meaning clearly and are grammatically correct
2. Spelling and punctuation are accurateach you both personally and professionally and how will you apply this to your role as a future social worker.
Formatting Requirements
1. 6-7 pages in length
2. Formatting: 1-inch margins, page numbers, double spaced,
Alpena Community College Social Work & The Trials of Gabriel Fernandez Discussion

BBA 4951 Columbia Southern University Develop a Code of Business Conduct Discussion

BBA 4951 Columbia Southern University Develop a Code of Business Conduct Discussion.

If you owned a small business, would you develop a code of
business conduct? If yes, what variables would you include? If not, how
would you ensure that your employees were following ethical business
standards? Your response should be 75 words in length.Why is it important not to view the concept of “whistleblowing” as “tattling” or “ratting” on another employee? Your response should be 75 words in length.Discuss bribery. Would actions, such as politicians adding earmarks in legislation or pharmaceutical salespersons giving away drugs to physicians, constitute bribery? Identify three business activities that would constitute bribery and three actions that would not. Your response should be 75 words in length.How can firms ensure that their code of business ethics is read, understood, believed, remembered, and acted on rather than ignored? Your response should be 75 words in length.What do you feel is the relationship between personal ethics and business ethics? Are they or should they be the same? Your response should be 200 words in length.

BBA 4951 Columbia Southern University Develop a Code of Business Conduct Discussion

PSYCH 335 CCBC Study of Personality Disorders among Treatment Seeking Paper

cheap assignment writing service PSYCH 335 CCBC Study of Personality Disorders among Treatment Seeking Paper.

Before beginning this assignment review the guidance on “Writing an Article Review”Purpose: The purpose of this assignment is for you to show your understanding of peer-reviewed empirical articles through: 1) reviewing original research; 2) evaluating claims, methods, and conclusions; and 3) communicating your analysis in a way that translates scientific information into common terms for a general audience. In writing an article review, you gain skills in summarizing key points and findings, interpreting results, evaluating the validity of the methods used and results reported, and communicating information to an audience in ways they understand.Step 1: Read the tips from the UMGC library on “Finding Experimental (Empirical) Research Articles.” Pay special attention to the sections on “Scholarly Research Articles” the “Structure of An Experimental Article”Step 2: Using the UMGC Library electronic databases, find an article published in the last seven (7) years in an APA journal with a focus on Personality (e.g., Journal of Personality and Social Psychology or Personality and Personality Disorders). The article should describe, specifically, an experiment or empirical study by the researchers. This means that the researchers conducted a study that contains easily identifiable independent and dependent variables. (Do not select meta-analyses, summaries, editorials, or theoretical articles. It is your responsibility to make sure that the journal article you select is appropriate. If you are unsure about the relevance of your article, contact your instructor for approval.).Step 3: Read the article starting with the Title and Abstract, which will give you a quick preview of the purpose and results of the article.Step 4: Read the Introduction. Highlight the purpose of the article and the author’s hypothesis (e.g., what was studied, what the authors predicted, and why they found the topic worthy of study). Pay attention to the context provided for the research (i.e., what research has been done previously in the field? what issue or problem is this study trying to address?)Step 5: Read the Methods section. Note the description of the participants and any tests, surveys, questionnaires, apparatus, or other materials that were used. Pay particular attention to the details involved in the experimental procedure. How were the variables manipulated or measured? Recall that the Independent Variable (IV) is the variable that is manipulated by the research (i.e., whether the room is hot or cold (if that is the variable of interest) or whether participants are given a placebo, shown any type of media or other stimuli, given talk therapy, or instructed to take medication (if that is the variable of interest). Remember that the Independent Variable is what was different about the experiences of the different groups. Recall also that the Dependent Variable (DV) is that variable that is measured, or, the outcome of the study (i.e., test performance or lessening of depressive symptoms).Step 6: Read the Results. Try not to get intimidated by complex statistical analysis. Instead of focusing on the numbers, focus on the short descriptions that accompany the findings explaining what the researchers found (i.e., Did the researchers find evidence that supports their hypothesis?)Step 7: Read the Discussion. Pay special attention here to what the authors say about the importance of their findings or the lack of findings. Think about other things you could do to look at this issue.Step 8: Prepare a 2 to 5 page summary of the article in your own words. Be sure to address the following questions in your summary:What is the purpose of the research? (Address specifics regarding the overall purpose of the research in question.)What hypothesis is tested? (Provide a clear statement of the researchers’ prediction.)How did the researchers investigate their research question? (Provide details regarding the study methodology.)What are the pertinent results of the manipulation? (What were the findings and conclusions drawn?)What is your personal opinion of the study conducted? Should it be repeated? What could be improved?What is your overall impression of the work? What are the implications of the study for the practice of counseling psychology?Your summary should be written as a coherent essay (do not format as a list of answers to these questions). You may include additional insights in your analysis, but you must address these key issues.Step 9: Prepare your Article Review according to the following guidelines:Structure your paper utilizing APA Style; this includes title page, headers, subheadings, in-text citations, reference page, and general paper format (1-inch margins, double-spaced, 12-point font, etc.). An abstract is not required.
PSYCH 335 CCBC Study of Personality Disorders among Treatment Seeking Paper

Barriers of basic human needs

Barriers of basic human needs. Paper details Just a short paragraph answering this question :What are three barriers to achieving basic human needs? How can an individual combat these barriers. The basic human need I chose Was a persons Purpose. The three barriers would be mental, knowledge desire and decision. You’re just writing about how these barriers affect someone purpose and what they can do to combat them. Please make sure to include all three barriers. I will attach the list of barriers if you believe one may work better than the three I have suggested.Barriers of basic human needs

Systematic approach to problem solving for health care providers

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Evidence-based in nursing is the practical, clinical application of the best research in patient care. Nursing Knowledge International translates the best evidence into the best nursing research, education, administration, policy and practice. Nursing Knowledge is committed to providing a comprehensive synthesis of the best nursing evidence, proven nursing expertise and practical clinical application that take into account individual patient, family and community values decision making, in order to provide the most consistent and best possible care to patients. Health care delivered in ignorance of available research evidence, misses important opportunities to benefit patients and may cause significant harm. We are a group of four BSN-RN students, we assigned in this project to evaluate the nursing practice in clinical area if it evidence based or not and to identify the barriers and facilitators to the implementation of EPB into practice using different strategies to overcome the barriers. Bed rest is recommended to patients with a diagnosis of acute myocardial infarction (AMI) upon initial hospitalization. Reasons for immobilization have included reduction in myocardial load, evidence of further malperfusion, and moderation of remodeling process. In last two decade, the influence of bed rest on patient outcomes following AMI has not been thoroughly investigated. In this project we investigate the practice of this issue in cardiac care unit at Salmaniya medical complex and compare it with the evidence based practice by review literatures, meta-analysis and clinical trials. We conclude to the final result and raise our recommendations. (Jacqueline K, 2004). Reason for choosing the topic: From our experience as cardiac staff nurses we had faced a lot of difficulties to convince a patient with uncomplicated MI to be in complete bed rest especially after 12 hrs post hospitalization. [“Patients with uncomplicated MI: patients with ST elevation myocardial infarction who are free of recurrent ischemic discomfort, symptoms of heart failure, or serious disturbances of heart rhythm.”(American Heart Association, 2004). As their chest pain has been relieved, they will try to convince themselves and others that they are in a good health, and can achieve their activities of daily living. Therefore, it is difficult to obligate them to be in complete bed rest. Usually the nurse will face a dilemma whether to mobilize the patient with uncomplicated MI or not as there is no clear protocol for the mobilization. In addition, if the nurse decides to mobilize the patient she/he will be in trouble, questionable, and accountable for any risk that might be happened for the patient. On the other hands, if the nurse doesn’t mobilize the patient, the patient won’t be satisfied and his psychological demands won’t be met. Moreover, the cardiac nurses are aware about the significant impact of the psychological status of the MI patient on the heart workload, health, and efficiency. If the patient hasn’t been satisfied, he would be anxious, nervous, and agitated which in turn will stimulate the sympathetic nervous system to release adrenalin and nor-adrenalin hormones that’s lead to increase the heart rate, and vasoconstriction. Vasoconstriction will increase the venous return which means the increase of the pre load of the heart. In addition, the peripheral resistance will increase as a result of the vasoconstriction and that causes the increase of the after load of the heart. Both, increase of the preload and after load are dangerous as it will expose the MI patient for re-infarction, heart failure, and lethal arrhythmias. Also, we have known that Mohammed Bin Khalifa cardiac center is mobilizing the patient with uncomplicated MI after 24hrs. As we aimed to try our best to standardize our care according to the accredited agencies, we have decided to find an evidence base about the mobilization of the patient with uncomplicated MI, and to apply it in our unit. Title of our Topic: Duration of Bed Rest for Uncomplicated Myocardial Infarction PICO question: Is prolong bed rest safer than early mobilization for uncomplicated MI patient? PICO: Population: Uncomplicated MI patients. Intervention: *To keep a patient with uncomplicated MI at bed rest for more than 48hrs. * To keep a patient with uncomplicated MI at bed rest for 12-24hrs 3. Comparison: comparing whether early mobilization of a patient with uncomplicated MI is safe as a mobilization after prolong bed rest. 4. Outcomes: Early mobilization (2-12 days) doesn’t harm the patient and doesn’t contribute with developing of any complication such as death, re-infarction, and arrhythmias. It is considered to be safe as prolonged bed rest. Protocol used: The used guidelines for mobilization of pts after an acute MI in SMC was stated in the management of acute ST segment elevation myocardial infarction (STEMI) included in ” Evidence- Based Guideline for Management of Cardiac Cases in Secondary Case Settings in the kingdom of Bahrain” Which was developed by Dr. Anwer Jamsheer, Dr. Rashid Al Bannai and Dr. Tayseer Garadah (Consultants Cardiology) and was supervised and final reviewed by Dr. Abdul Hai Al awadi (Assistant Undersecretary for Hospitals). It was mentioned in the above guidelines that “The patient is kept in bed rest until otherwise ordered by the physician” and the nurse should ask on daily bases about the allowed activity privileges for the pts (bed rest, bedside commode, sit out of the bed, walk around the bed, toilet bed side in the first two days and lastly the full mobilizing). It was suggested also that it is the responsibility of the nurse to ensure range of motion exercises (ROM), deep breathing and positioning while the patient is in the bed rest. Moreover, it was declared to explain to the patient the needed rest and to teach him the allowed exercises and help him, if needed. However, it was not mentioned who should do that. Guidelines explained in the “cardiac rehabilitation for patient with STEMI (phase I -in patient care)” the full carried out protocol for the mobilization of pt after an acute MI. This includes: Full bed restrictions in the first 2 days, including bed side wash, shaving and bed pan. Passive form of mobility for arms and foot ruling can be given at frequency of three times per day. In uncomplicated cases the transfer to step down can be arranged on day three. With the mobilization around the bed and allow free toilet access under supervision. On day four and five patient can walk in the corridor and allowed to go one flight or go for symptom limited exercise test. It was noted that the source of information for these guidelines is the last literature review up to date / version 16.1: ACC and AHA, GHA pocket Guidelines and ECS2007, but actually there was no effective date rather than revision date mentioned. This protocol was followed in most of cases but there were some exceptions. Extended bed rest was advised for pts who are unstable or had some complications after MI like lethal arrhythmias, heart failure or recurrent ischemia etc. Such cases were not mentioned specifically in the guidelines although it was mentioned in the original source of information after we have reviewed it. The 1996 ACC/AHA Guidelines for the Management of Patients with Acute MI has found evidence on the continued practice of “coronary precautions” although it was advocated since 1960s that some of theses precautions are no longer applicable in the current practice. In the earlier years patients with STEMI were kept in bed rest for several weeks in order to decrease myocardial oxygen demand but then it was reveled that extended bed rest is more harm than good and it would delay the recovery. 2004 ACC/AHA Guidelines recommended that “Patients with STEMI who are free of recurrent ischemic discomfort, symptoms of heart failure, or serious disturbances of heart rhythm should not be on bed rest for more than 12 to 24 hours” In addition, it is mentioned that patients with hemodynamic instability or continued ischemia to have bedside commode privileges. Both practices are not seen in SMC as Pt with STEMI who described as stable will be in bed rest for 48 hours while unstable pt (complicated MI: patients who have recurrent ischemic discomfort, symptoms of heart failure, or serious rhythm disturbances) will be in bed rest for several days up to one week. Interview: While searching for relevant data and protocol that could answer our PICO question and prove which is the safest and more beneficial for patient post uncomplicated myocardial infarction ,mobilization after 48 hours or less, we interviewed the experts in our institution (Salmaniya Medical Complex – SMC) who are consultant cardiologist in Coronary Care Unit(CCU) ,while interviewing Dr. Hayat Al-Mahroos, she stated that there is no clear protocol is being followed and mobilization depend on the patient condition, how ever the followed and common protocol is 48 hours post uncomplicated myocardial infarction which is not being reviewed long time back, although recent studies encourage early mobilization after 12 ours from bed to chair and after 24 hours pt can walk with the help of cardiac rehabilitation nurse ,in her management she stated still she is mobilizing the patient with in 48 hours because other cardiologist mobilizing the patient with in 48 hours and perhaps mobilizing the patient with in different durations may confuse the nurses ,in addition thrombolytic protocol is for 48 hours and nurses used to mobilize the patient once the protocol is finished ,so that if she asked to mobilize the patient with in 24 hours or to be shifted to step down the nurse will replay ” patient still on protocol and didn’t finish the 48 hours ” she stated we don’t discuses the issue as long there is no harm for the patient and we leave the patient till he finished the protocol to avoid confusion to the nurses ,more ever the setting of CCU doesn’t encourage early mobilization ,the room of the patient has to have comfortable chair so that patient can be early mobilized ,the role of the cardiac rehabilitation should be extended to participate in mobilization of in patient ,early mobilization will definitely improve patient confidence and moral and will help in early discharge that will allow more vacancies for needed patient. On other hand ,Dr. Rashid stated that post uncomplicated myocardial infarction , the patient will be on bed rest for 48 hours and that according to American college of cardiology and guidelines ,he stated that he agree with current protocol and going on line with American guidelines as it is the safest practice because this institution has always consciousness about health practice and has became a reference and source of evidence based practice on international level ,however he stated no enough trial were done on 24 hours bed rest. In contrast, Dr. Tayseer stated that he is following the British guidelines that recommended 48 hour’s protocol; he stated mobilizing the patient in the 24 hours may induce lethal arrhythmias which could be fetal. Literature review: Title Early mobilisation for patients following acute myocardiac infarction: A systematic review and meta-analysis of experimental studies Author Olga L. Cortes, Juan C. Villar, P.J. Devereaux, Alba DiCenso ( 2009 ) Methods Target studies included published and unpublished experimental, controlled studies in any language. Systematic review and meta-analysis. Populations Patients defined as having uncomplicated AMI, except for Abraham et al. (1975), who enrolled patients with both complicated and uncomplicated AMI. Most studies included patients aged 55-65 years, with at least 70% male participants, except for one study that included only male participants (Messin and Demaret, 1982). Interventions The experimental intervention was similar across studies (stand up, move to chair, and walk) with the only difference being how many days post-AMI their EM intervention was initiated. Outcomes Out of 385 potentially relevant studies, 14 met the eligibility criteria (13 published before 1983). There were 149 deaths (9.3% of 1607) and 82 non-fatal reinfarctions (5.2% of 1580) among post-AMI patients receiving EM, compared with 179 deaths (11.6% of 1541) and 80 non-fatal re-infarctions (5.3% of 1518) among AMI patients receiving control treatment (RR = 0.85, 95% CI 0.68, 1.05 and RR = 1.02, 95% CI 0.75, 1.39 respectively). This systematic review of experimental data from studies conducted in the 1970s and 1980s showed a trend towards an increased survival of AMI patients receiving EM relative to those who do not. Notes There is uncertainty about early mobilisation and more research should be developed having into account all kind of differences among patients receiving treatment after AMI worldwide. Title Short versus prolonged bed rest after uncomplicated acute myocardial infarction. Author Methods Systematic review and meta-analysis. Population Hospitalized patients with uncomplicated myocardial infarction . Intervention Early mobilization ( 2- 12 days) Comparing Short versus prolonged bed rest after uncomplicated acute myocardial infarction. Outcomes Early mobilization (2-12 days) doesn’t harm the patient and doesn’t contribute with developing of any complication such as death, reinfarction, and arrhythmias. Its considered to be safe as prolonged bed rest. Title Bed rest for acute uncomplicated myocardial infarction (Review) Author Harald Herkner,Jasmin Arrich, Christof Havel, Marcus Mullner Methods Meta`analysis by: Measuring the incidence of cardiac death Measuring the incidence of reinfarction Incidence of arrythemias Thrmboembolic complication Populations patients post uncomplicated myocardial infarction Interventions Outcomes Incidence of cardiac death , There was no evidence that bed rest duration has link or association with all cause or cardiac death after uncomplicated myocardial infarction (RR 0.85, 95%CI 0.68 to 1.07, and RR 0.81, 95%CI 0.54 to 1.19, respectively). Eleven papers reported on reinfarction ,ut still there was no association between the incidence of reinfarction and the Bed rest duration (RR 1.07, 95%CI 0.79 to 1.44). Arrhythmia was reported in seven studies There was no effect of short or long term duration on arrhythmia rates . Thromboembolic complications were reported in six studies.however the rate was lower in patients with shorter duration of bed rest, but the figure was not significant statistically Notes Share this: Facebook Twitter Reddit LinkedIn WhatsApp