“The Road Not Taken” by Robert Frost is one of his most famous, inspirational and well-analyzed poems. It is autobiographical in nature and talks about making choices in life – choices that can affect one’s entire future. It seems to encourage unconventional thinking, bold decisions to tread a path not many people have taken. To experiment with new ideas and new thoughts and explore the real world like it has not been done before. It seems to preach self-reliance and not just following where others have led. It does not moralize about choice, simply portrays that choice is inevitable. But it also illustrates how one never knows what the choice will mean until one has actually lived it. In this poem, Robert Frost talks about the dilemma he faces when he’s taking an important decision of his life. He can either go the usual, conventional way or follow the path not many may have used or think is acceptable. While largely it may be interpreted as inspiring, there are multiple ways of ascribing what he says. In the beginning we are introduced to the two roads as diverging options- “Two roads diverged in a yellow wood.” The poet while understands that he can only take one of the two roads, is regretful that he cannot explore both “And sorry I could not travel both”. He is alone and hence must make a choice – a choice that could define his future. Thereafter he says that he “looked down one as far as I could”. This is his attempt to see as far as he could to help him make the decision. But surely there is only so much one can predict and thereafter one needs to decide if he is a follower or a leader. (“and looked down oneâ€¦.bent in undergrowth”). He then decides to take the other road for ‘it looks grassy and wants wear, symbolizing how the path he wishes to take is not only the one that fewer people take (hence grassy) but also one that should be given a chance. It is clear that fewer people have walked that road and hence appears more difficult than the path many people have taken. Following this however, he speaks of how both the roads are in fact, similar (“worn them really about the same”, “both that morning equally lay”). This shows the difficulty of making the choice as at that stage all one can go by is that fewer people have walked a path than the other, but there is no way to tell which might be a better option as you cannot really see much further. He then continues by saying that while he is desirous of returning and taking the other road someday and seeing where it takes him, he knows that, life being what it is, he shall almost certainly not get that chance -“I kept the first for another day!” One knows that one does not get many chances in life, that your decisions take you along one way and it is so difficult to return or follow another path later. But such is life that one has to choose and live with the choice forever. The poet then finishes with saying that he took the road less travelled i.e the path that fewer people take and that made a great deal of difference in life – “I took the one less travelled by, And that has made all the difference.”. This clearly reflects the success he achieves in life, choosing not to walk the trodden path and looking for newer pastures, ideas and thoughts. It demonstrates the power of taking your chances and choosing boldly to live a more meaningful and successful life. While the risks may be greater but so will be the rewards. Thus one can interpret the poem as an inspiring one that speaks of being an individual and taking a radical approach to life. It also emphasizes on the choice that one makes and not the path itself as being of paramount importance. However, the poem is open to another inference. The poet may be employing irony to show how people often delude themselves into believing that their choices matter when in reality they do not. There is only so much one can look in the future and thereafter the choice is a matter for gut and instinct. Where one reaches after making the choice depends on many other factors and what lies on the way. This is indicated by the poet’s sigh in the last stanza, as well as his admitting that the two roads may not be so different after all (stanzas two and three) and so the ending lines are ironical. Which interpretation one wishes to follow is one’s own CHOICE. The title “THE ROAD NOT TAKEN” is very open ended .It creates suspense as to what or how our lives would have been had we taken the other path. It speaks not only about what one chooses to do but also what one could have chosen to do. The poem’s theme is evergreen making it one of the most quotable poems in history. It is apt and relevant for all age groups, be it a child, a teenager or an adult. Personally after reading I feel, life is all about making choices, taking the right decisions at the right time. One cannot escape the various dilemmas life throws at us. We all have to make choices, small or big to move ahead in life. It is these decisions, these choices that shape our life. The impacts of these can be seen in our career, social and love lives.
Share this: Facebook Twitter Reddit LinkedIn WhatsApp Case Scenario Part 1: Case Scenario A typical patient in my practice usually presents after we have already met in the hospital setting. Often times, their first ‘office visit’ is a post operative contact, which typically 10-14 days post-op. My ortho practice is focused on trauma, but with some degree of regularity, we also perform general orthopaedic procedures which may involve most any bone. One of the more common procedures that we perform is the fixation of hip fractures, whether they are femoral neck/sub-capital, or involving the trochanter. For my case scenario, I have chosen to focus on hip fractures, as trauma can be too complicated when trying to describe or accurately follow. These particular injuries often do not read the textbooks, and can have untoward affects. My typical post-operative patient is within the age ranges of 50-90, with the most common procedure being the cephalo-medually nail, which might be an intertan or sliding hip screw. They often are just beginning to ambulate with the aid of a walker, and are still in a fair amount of tenderness. I am foremost concerned with their x-rays to ensure that they have not begun to cut out, and to verify that the implant has not changed in position. Secondly, during my physical exam, I will look to ensure that there are no post opertitive complications such as dvt’s or site infection. Thirdly, I will want to know if they are getting up and walking or at least attempting to. This can be somewhat prognostic in that if they are not walking at all, then the likelihood of them making a full recovery is questionable. Our practice uses the SF-36 for patient self assessment at each visit, from their initial post op, to their yearly anniversary. Several studies have shown the SF-36 to especially helpful in quantifying subjective information (Kalantar-Zadeh, Kopple, Block, 2004). What makes it almost imperative in using a standardized form in relation to a patients outcomes, is that much of what is reported can be subjective. Pain is a notorious problem in quantifying as it can be different in each individual, as we all have varying degrees of pain tolerance. Case Scenario Part 2: Application to Disablement Models When comparing my case scenario of hip fractures against the components of the disablement model, I feel that most if not all are met. There is a continuous flow of research that is related to hip fractures, in how to prevent them, what adjuncts to use in the treatment, and how best to approach them after the fact. Many of these findings have been incorporated into health policy, since we know that the effects of a hip fracture are often life altering. The authors of one article were able to quantify the loss of life as it results to those who have sustained a hip fracture. They were are to show that there is direct correlation with the loss of overall life expectancy and that at certain stages, it can result in a reduction of 81% of years remaining (Neilsen, 2008). This is important in to not only the potential dire consequences of this injury, but as it relates to the patients disabilities. Over the past 20 years, the overall life expectancy has increased as the direct result of better orthopaedic practice and rehab. It was only two decades ago that 3 out of four hip fractures would not make it past one year (Lesinon, Schmidt, Wener, 1979). Despite our best intentions though, today, one out of every four patinets who presetns with a hip fractures, will perish within one year (Paulson, Yearingly, Miller, Heverty, 2009). I think that there is a role for disablement models in relation to this partculcar injury. By following the paradigm that the disablements models shows, we can continue to identify and define the problems that wil continue to exists. With all of our knowledge to date, we still have a great deal to learn in not only the best approach to prevent this tragedy, but what are the best ways to handle them once they do present. 27 Case Scenario Part 3: Application to HRQOL Concepts As a clinician, unfortunately I cannot say that I actively monitor HRQOL. After thinking a great deal, about why exactly I do not, I realized that I judge success by overall outcomes. Our first goal is to get them out of the 30 mark, which has shown to be a time period where some patients might not make it. Much after that, I view a patient’s HRQOL by their ability to return to their previous lifestyle. What this means, is that if they were independent and walked to the store every day, then if they are able to return to that lifestyle without impairment, then it is a success. Even if they digress in their ability to care for themselves, as long as they are happy with their relative way of life, then that too is a success albeit to a varying degree. I might be jaded in the notion that this is an immediate life threatening event, and not a benign condition that can be successfully monitored remotely. I certainly see many of the dimension of HRQOL in the way that we treat our patient population. We too take the big picture with respect to the physical, physiological, social, and even the economic perspective. Yet I think with many of my patients, it is the psychological facet that takes the largest hit; and understandably. Almost everyone of these patients were productive, independent, citizens that had an identity. This in part is taken from them, as they become increasingly reliant on those around them in ways that are unknown to them up until now. This can take its toll quicker than many of the other dimensions, aside from the physical attributes. The roles of clinicians and patients are one that is symbiotic. One cannot survive without the other, even from a very basic business sense. In light of this relationship, I find myself more interested in the HRQOL of patients than of providers. At the very crux of why we are here, is to help people; plain and simple. Independent of what we think or feel about any given treatment, we are all taught to error on the side of the patient, and to remain objective. Case Scenario Part 4: Generic and Specific Outcomes Instruments For my case scenario, I find that reliability, validity, precision, and feasibility, are the most important instruments in measuring outcomes. We all must follow a standard of practice, and this is dictated by literature and evidence based medicine, especially in the surgical community. Of course there are certain treatments that are provided on an off-label basis, but they are in direct line with the respective authors intentions, and do not vary to any real degree. My instruments incorporate a little of both when it comes to measurements’. The only ideal that is not in parallel with the others is feasibility, and that is due in part to the overall cost of orthopaedic care in the United States. Very often, these instruments are implemented on the initial contact, which is either in the er/trauma bay, or on the floor as a general consult. All of the implants used are obviously FDA approved and on average have 5-10 years of data, if not more. There are implants that we use that have 20 year follow up (Waker, Neim, Rozni, 2008). Each case is different with respect to the patient, the fracture, and the overall outcome. The surgery performed could very well be differnet in a hospice patient versus in an active 50 year old. One has to do with palliative care, and the other is about qualtiy of life. Case Scenario Part 5: Critiquing Your Outcomes Instrument? I can honestly say that I read the vast majority of the student seminars, and could not really find one that is any more appropriate than the one I have. I realize also that I am the only provider who is involved with ortho trauma, so I am sure that has a lot to do with it. I think many of the scenarios follow the same overall premise, and that they are equal to mine. It appears to be more closely related to the respective topic than to the general approach. My scenario looked into the potential benefits of low intensity pulsed ultra sound in the treatment of non-unions. The most important thought in my seminar was to critically appraise the literature to see if this particular treatment worked well enough to implement it sooner in the treatment modality; which it did not. Many of the other seminars seem to look more into critical thinking, than anything else. Case Scenario Part 6: Measuring Change that is Important to Your Patient I have read this article repeatedly, and cannot find the MCD or the MCID values for this study. I have p values, I have average time from fracture to clinically healed, and even the cumulative percentage of healed. The most applicable measurement provided was the time interval of healing when compared to placebo. After 70 days of treatment, about 70% of the fractures healed compared to 19% in the placebo group (Rubin, Bolander, Rybay, Hadjiargryou, 2004). This inconjunciton with the fact that there are no known contraindications to its use, including cigarrets and alcohol, makes it an interesting choice. The problem with not knowing the particular instrument used is that I cannot fully appreciate the exact precision of the measuring agent. I can understand the study design, and I see its relative application, but the matter in between is lost. This makes it very difficult to know what it actual change and what was not mere circumstance. Case Scenario Part 7: Creating a Clinical Question Does the placement of demineralized bone matrix in the presence of open tibia fractures, reduce the rate of non-union Patient- Open fracture Intervention- placement of demineralized bone matrix Comparison- non-placement Outcome- decrease the rate of non-union in tibia fractures Case Scenario Part 8: Important Considerations for Your Case Scenario One of the biggest matters to take into consideration is infection. Open fractures are notorious for two things; non-union and infection. These are often in the presence of each other, which makes the matter that much more difficult to study. There have been countless studies over the years that have shown open tibia fractures have an overall infection rate of about 9% (Leong, Low, Smeietz, 2005). Many in the orthopaedic community argue that placing a biological agent such as demineralized bone matrix (DBX), is not only a waste of money, but a potential nidus for infection. This is primarily due to the fact that DBX does not have the ability to fight off an infectious agent, such as staph aureaus or staph epidermidus. Since DBX is essentially the foundation for bone matrix, my contention is that with the inflammatory process that is associate with healing, so too comes the interleukins which do have the ability to fight infection. I think that my scenario can be performed in a healthcare setting, but I do not think it is likely. There is absolutely no literature that supports this theory, and on the contrary, there is one study that alludes to this idea being a potential problem (Finkmeier, 2002). Also, in this medically litigious society, if you are not following the standard of care, then you are opening yourself to a lawsuit; even in the presence of an IRB sanctioned study. Case Scenario Part 9: Applying Concepts of Clinical Outcomes to Your Clinical Practice and/or Research Experience. Is there a component of the course that speaks to you as a member of the healthcare community? There are no wrong answers for this portion of the assignment and if you have questions about the role of outcomes in your particular healthcare setting, feel free to post a discussion board question or to contact me personally. After this course, I have learned to not only be a better journal/study reader, but also a much more critical one. I realized that much of the material that is presented in journals is superficial and really lacks much substance. This has had a direct influence my patient population, as I really only recommend practices that have shown the data and the manner in which it was obtained. Thankfully, we use outcome assessments everyday in my practice, which makes it not only convenient but also useful. There are have been only a handful of times that I had researched a patients SF-36 from their initial encounter, prior to entering this course. Since entering, I have pulled no less than a dozen, and actively compared them with a more recent survey, to determine the overall course. These particular studies had been implemented prior to my arrival, so I have had the luxury of entering into a practice that actively solicits this information. Despite the begrudgingly contempt from many patients about its overall vagueness, I try my best to assure them that it does affect their overall care, as its from this feedback that we can post market survey what works and what doesn’t. Share this: Facebook Twitter Reddit LinkedIn WhatsApp
Drama, Film, and Mass Communication homework help. ANOVA Article CritiqueRead the article “Cognitive Effects of Risperidone in Children with Autism and Irritable Behavior”, and identify the research questions and/or hypotheses as they are stated. Consider the following questions: What are the variables (sample sizes, population, treatments, etc.)? How was the analysis of variance used in this article (and what type of ANOVA was used)?Write a two- to three-page paper presenting the information listed below.ÿ In addition, provide a title page and reference page in APA style.ÿ Cite any references made to the article within the body of the paper in APA style. Your paper should begin with an introductory paragraph (including a thesis statement) and end with a concluding paragraph summarizing the major points made in the body of the paper and reaffirming the thesis.The body of your paper must:Determine what question(s) the authors are trying to answer by doing this research.Determine the hypothesis being tested and the concepts that were applied in this process.Evaluate the article and critique the statistical analysis employed in the study.ÿ Would you have included more and/or different variables?ÿ Explain your answer.Examine the assumptions and limitations of the statistical study.ÿ What would you have done differently in this case?ÿ Explain your answer.Identify how the authors applied statistical testing to the problem.Interpret the findings of the author(s) using statistical concepts.Access the Critical Thinking Community website for tips on how to formulate your thoughts and discussion of these questions in a logical and meaningful manner.Writing the Article Critique The Assignment:Must be two to three double-spaced pages in length (excluding title and reference pages), and formatted according to APA style as outlined in the Ashford Writing Center.Must include a title page with the following:Title of paperStudent?s nameCourse name and numberInstructor?s nameDate submittedMust document all sources in APA style as outlined in the Ashford Writing Center.Must include a separate reference page formatted according to APA style as outlined in the Ashford Writing Center.Drama, Film, and Mass Communication homework help
Cross Cultural Awareness For The International Manager Successful Cross Cultural Management And The Anticipated Characteristics Of France And Brazil Introduction It has been commented that to minimise or resolve conflicts between different cultures they should first be grouped or categorized to measure their differences (Trompenaar, 2006). The UK scores fairly low in the uncertainty avoidance index, suggesting that people in these cultures are less risk averse and feel relatively secure (French, 2008). In terms of the workplace, this can be reflected in a high employee turnover and managers encouraging risk taking and to expect change (Overby, 2005). When taking Trompenaar’s dimensions of universal or particular (the extent to which rules are followed regardless of the situation and people involved) into consideration, it may help to explain further where this behaviour or reasoning comes from. Products and services are being offered on a global scale, posing a serious problem when a universalist culture engages in business with a particularist society, where the importance of relationship is ignored. Trans-cultural effectiveness is not only measured by the way one culture values another but also by the ability to reconcile the dilemmas, resolving them promptly, and the extent to which both values are synergised as one (Hemple, 2001). Hemple emphasises upon the importance of such an understanding in the current globalisation era. At present, when companies become global, there is predominantly an inevitable move towards the universalist view (Hemple, 2001). In order to go about such a task, Trompenaar’s dimension of universal v particular is a helpful tool to signify the importance placed upon relationships and people compared to individual needs (Trompenaars F. H.-T., 1998). Trompenaar’s Neutral V Affective Trompenaar’s dimension of neutral v affective describes the extent to which a culture displays emotion, either openly (affective) or in a restrained manner (neutral) (Gooderham, 2003). A cross cultural venture will involve communication between a variety of groups and people. The way in which people communicate is diverse and consequently the manner in which behaviours and actions are inter-operated also differs, leaving room for miscommunication. For example, people from a neutral culture may perceive displays of emotion in the workplace as unprofessional behaviour whilst the lack of emotions displayed by those from a neutral culture may be perceived as deceitful behaviour from the affective cultures’ point of view (Snodgrass, 2002). With the display of emotions in affective cultures, it maybe that communication is not just seen as a verbal exchange, rather, value is placed upon gestures. Although, minimal or indirect speech is made; facial expressions, actions, and body language may prove to be more influential than words. Without the knowledge of such cultures and their practices, there is a possibility of miscommunication. People from a neutral culture may interpret the lack of verbal communication to be impolite, rather than picking up on the meaning behind gestures such as body language. Hall’s description of high and low context cultures is reminiscent of neutral v affective, but primarily focuses on the communication styles of such cultures, specifically, on how they communicate (French, 2008). Trompenaar’s Specific V Diffuse This aspect is useful in providing an insight into how employees perceive their position in the workplace. Those from the diffuse culture value their work and do not separate their responsibility in the workplace from their personal life. In fact, both facets of their life are integrated and are an essential element of who they are. Whereas, those from the specific culture clearly separate their work life from their personal life. They deem their work to be a means of acquiring a valuable objective, such as earning an income in order to achieve a better quality of life. The insights obtained from this dimension may explain any variations in commitment over time amongst employees. Although, neither culture is inaccurate in their thinking, it may still present differences that lead to conflict. For example, those of the diffuse culture may feel obligated to stay behind outside their contractual working hours or work during their lunch break in order to complete a task, as opposed to those of the specific culture who may take their full lunch break and sign off at the end of the day upon completion of their contractual working hours. In turn, those of the diffuse culture may feel unappreciated as they might consider themselves to be earnest whilst viewing their colleagues as insincere. As well as giving an insight into employee behaviour, the specific v diffuse dimension can also elaborate on how employees work and how their interaction with colleagues translates into their personal life (Binder, 2007). France France scores highly on Hofstede’s uncertainty avoidance index which is reflected in the emphasis placed upon rules in the workplace with managers endorsing rules, regulations and control of employees. Employees in return seek job security and significant benefits such as health insurance and extended holidays (Overby, 2005). This has an impact on the internal work culture in that managers closely supervise and guide their employees and as a result employees often have little autonomy in their job role. This brings about the issue of HRM practices in a cross cultural venture; whereas performance related pay, individual appraisals etc. are common practice in UK organisations they may not be as successful in French organisations where guidance and control are valued as being a sense of security due to low uncertainty avoidance. French employees’ value team work and to stand out or receive individual recognition from the rest of the team may be seen to demean or show up others in contrast to being seen as individual achievement. This is also related to the customers’ perception of an organization when buying products/services; they would prefer to build up relationships carefully and to maintain them as opposed to a quick sale (Trompenaars F. H.-T., 1998). However, similarities are apparent between the UK and France in the use of goal setting (in a HRM context) but with an emphasis on joint goal setting as opposed to individual. This demonstrates the indirect effects of uncertainty avoidance, initially it may be thought of as a resistance to change and enhanced caution towards new people and new procedures. However, the way in which work is organised needs to be adjusted in order to get the most out of employees in a mutual context. For example, (Trompenaars F. W., 2001) research highlights an example of the French nature when change is to be implemented into an organisation: “…..The French, in turn, were so much worried about the unions and how to keep their people motivated…..When I came back some three months later to check how the implementation was going, I noticed in France and Germany nothing had started yet (Trompenaars F. W., 2001).” This should therefore be something to consider when UK managers communicate, organise and develop people and organisations from different cultures. Not only for a smooth transition but also for the impact it can have on achieving corporate objectives. Inter-Relational Dimensions BIRTISH TENDENCIES FRENCH TENDENCIES Universalism: rules Middle – Universalism / Particularism: rules, relationships Individualism: focus on individual Collectivism: focus on group Neutral: reserved with emotions Affective: demonstrative with emotions Specific: distance in relationships Specific: distance in relationships Achievement: doing/merit Middle – Ascription / Achievement: being/status, doing/merit (Parsons, 1951) Trompenaar’s Neutral V Affective Research shows that France has an implicit culture in which communication is often indirect as opposed to being concise and clear as of the explicit culture and communication methods of the UK. The French manner of communication and importance resulting from an affective culture can impact their approach to analysis. It is often the case that these implicit societies will “think more diffusively or holistically, making decisions more on intuition than on facts and figures. They can often seem indirect and ambiguous (Overby, 2005).” Therefore in the workplace it may be apparent that a high concern is given to the needs of people in and around the organisation and ensuring those needs are being met as a priority over getting the job done and spending time discussing factual impersonal information (Overby, 2005). As a result when UK and French employees and managers are together it will be important to address the issue of emotions; taking into consideration the French’s attitude towards uncertainty as well. Suspicion, doubts and caution maybe demonstrated in a highly effective way rather than the culture often found in western organizations such as the UK, where suspicion, doubts and a sense of unease is often only apparent amongst small groups as opposed to sharing these feelings or making them known in a more outward manner. Trompenaar’s Specific V Diffuse For those in specific cultures such as the UK, clear differences and separation is given in terms of their status and persona portrayed between work and social lives. In contrast diffuse cultures like France withhold the same persona in work and outside of work and believe that their work status plays a significant role in their perceived status in society. This can bring differences in how colleagues interact with each other (if at all) without the confinement of the workplace. Workplace social events or gatherings are commonly viewed in the UK as being an opportunity to really get to know and speak to the real person without the confinements of position, status or duties to influence a person’s behaviour or actions. However, in a diffuse culture such an occasion may not be perceived in the same way; such people may find it difficult to speak with or associate with others without giving respect to the status or position they have in the workplace. In this instance diffuse cultures look to the status or position of an individual as a way of dictating who the individual is and thus how others should interact with them. This dimension closely relates to the significance and importance given to status across cultures. As mentioned previously, the UK can distinguish between work and social life and thus a manager in the workplace regardless of achievements, experience and qualifications will not necessarily be given the same respect and admiration outside the workplace. In contrast France (diffuse culture) maintains the same respect and status of that person which can often bring privileges and favours outside the workplace purely from the respect given to their status. For example, those who have graduated from Grande Ecoles (the French elite of universities) go on to hold top positions within organizations and government (Earley, 2002). However, the respect and status awarded to them holds the expectation amongst society that they will ensure the well-being of the community within the organization. Brazil Brazil scores quite high on the uncertainty avoidance index which is indicative of its culture where structural order is sought to reduce uncertainty (Hofstede, 2009). Strict procedures are implemented in order to reduce ambiguity and avoid conflict (Hofstede, 2009). Alternatively, the culture in U.K embraces ambiguity and thrives on conflict. There are flexible structures in place and risks are endorsed without fear of failure. For the British, failure is another step in the way towards success whereas the Brazilian, perceive it negatively. Both perceptions are a reflection of their respective flexible and structured hierarchical societies. Therefore, it is important in Brazil, to avoid confronting one about an issue concerning others and putting them on the spot about an opinion (Trompenaars F. W., 2001). The Brazilian tendency to avoid risk may affect how business is conducted with U.K as both differ severely in this regard and it will be important to consider this as it might affect future joint business ventures or trade partnerships. Inter-Relational Dimensions BIRTISH TENDENCIES BRAZILIAN TENDENCIES Universalism: rules Particularism: relationships Individualism: focus on individual Collectivism: focus on group Neutral: reserved with emotions Affective: demonstrative with emotions Specific: distance in relationships Diffuse: involvement in relationships Achievement: doing/merit Ascription: being/status (Parsons, 1951) Trompenaar’s Neutral V Affective People from affective cultures like Brazil tend to show their emotions, whereas someone from a neutral one like the U.K will appear more reserved and refrain from demonstrating emotions (Trompenaars F. H.-T., 1998). The style of interrelating is different in Brazil as compared to the UK as eye contact, touching, and personal spaces are important to them. Therefore, it is important to consider these interpersonal elements of interaction when engaging in business with the Brazilian since they can build or deter trust, understanding, and likeability of clients. Awareness of these subtle differences can help in avoiding embarrassing situations or offending someone. The Brazilian, have transparency and expressiveness in release of tensions and may seem dramatic in delivery of statements as emotions flow vehemently and without inhibition (Earley, 2002). It’s different from the British culture where emotions are concealed and there is a lack of physical contact, gestures, or strong facial expressions along with a monotone style of oral delivery. Trompenaar’s Specific V Diffuse In a diffuse society like Brazil, closeness and confidence between those working together will be more important than a fancy sales presentation of a product or service as might be the case in the U.K. The final decision of signing a deal will reflect the relationship building that has taken place during the negotiation process. This concept of diffuse is exemplified in the treatment of clients arriving in Brazil. According to the video series “Doing Business in Brazil” (Boulder, 1977), visiting business people are usually picked up in person by a driver or some representative from the company for all appointments and are invited to meals and social events. In the case of the specific relational category reflected in the U.K., clients basically must fend for themselves by taxi and relationships are kept strictly to business. The main point in this video is that in Brazil, the key to doing business is building personal relationships and integrating oneself into the local network. The idea of private versus public space also correlates with the diffuse versus specific context. Trompenaar (Trompenaars F. H.-T., 1998) cites the example of a situation where if a manager or director were to encounter a subordinate in a social context completely separate from work. In a specific-oriented culture like the U.K., the two individuals would be on equal ground, the levels of professional hierarchy less significant. However, in a diffuse- oriented society like Brazil, the hierarchical space and the superiority of the higher rank would permeate more noticeably into every situation, work-related or not (Trompenaar, 2006). Therefore, even in an encounter outside of work, the subordinate must still defer to the authority. Caution must be taken to heed the local system of hierarchy in Brazil when dealing with the social levels and status even though it is less egalitarian than the U.K. It could be offensive to a Brazilian to not respect the social distance between oneself and an inferior. Appendices Power Distance Index (PDI) that is the extent to which the less powerful members of organizations and institutions (like the family) accept and expect that power is distributed unequally. This represents inequality (more versus less), but defined from below, not from above. It suggests that a society’s level of inequality is endorsed by the followers as much as by the leaders. Power and inequality, of course, are extremely fundamental facts of any society and anybody with some international experience will be aware that ‘all societies are unequal, but some are more unequal than others’. Individualism (IDV) on the one side versus its opposite, collectivism, that is the degree to which individuals are integrated into groups. On the individualist side we find societies in which the ties between individuals are loose: everyone is expected to look after him/herself and his/her immediate family. On the collectivist side, we find societies in which people from birth onwards are integrated into strong, cohesive in-groups, often extended families (with uncles, aunts and grandparents) which continue protecting them in exchange for unquestioning loyalty. The word ‘collectivism’ in this sense has no political meaning: it refers to the group, not to the state. Again, the issue addressed by this dimension is an extremely fundamental one, regarding all societies in the world. Masculinity (MAS) versus its opposite, femininity refers to the distribution of roles between the genders which is another fundamental issue for any society to which a range of solutions are found. The IBM studies revealed that (a) women’s values differ less among societies than men’s values; (b) men’s values from one country to another contain a dimension from very assertive and competitive and maximally different from women’s values on the one side, to modest and caring and similar to women’s values on the other. The assertive pole has been called ‘masculine’ and the modest, caring pole ‘feminine’. The women in feminine countries have the same modest, caring values as the men; in the masculine countries they are somewhat assertive and competitive, but not as much as the men, so that these countries show a gap between men’s values and women’s values. Uncertainty Avoidance Index (UAI) deals with a society’s tolerance for uncertainty and ambiguity; it ultimately refers to man’s search for Truth. It indicates to what extent a culture programs its members to feel either uncomfortable or comfortable in unstructured situations. Unstructured situations are novel, unknown, surprising, and different from usual. Uncertainty avoiding cultures try to minimize the possibility of such situations by strict laws and rules, safety and security measures, and on the philosophical and religious level by a belief in absolute Truth; ‘there can only be one Truth and we have it’. People in uncertainty avoiding countries are also more emotional, and motivated by inner nervous energy. The opposite type, uncertainty accepting cultures, are more tolerant of opinions different from what they are used to; they try to have as few rules as possible, and on the philosophical and religious level they are relativist and allow many currents to flow side by side. People within these cultures are more phlegmatic and contemplative, and not expected by their environment to express emotions. Long-Term Orientation (LTO) versus short-term orientation: this fifth dimension was found in a study among students in 23 countries around the world, using a questionnaire designed by Chinese scholars It can be said to deal with Virtue regardless of Truth. Values associated with Long Term Orientation are thrift and perseverance; values associated with Short Term Orientation are respect for tradition, fulfilling social obligations, and protecting one’s ‘face’. Both the positively and the negatively rated values of this dimension are found in the teachings of Confucius, the most influential Chinese philosopher who lived around 500 B.C.; however, the dimension also applies to countries without a Confucian heritage. Bibliography 1. Binder, J. (2007). Trompenaars’ dimensions. Retrieved December 16, 2009, from Global Project Management: http://www.globalprojectmanagement.org/index.php?option=com_content
Ana G Mendez University Significant Healthcare Acts in United States Powerpoint
Ana G Mendez University Significant Healthcare Acts in United States Powerpoint.
Assignment 7.2 – Discussion Board Instructions: (Please, read carefully) In a PowerPoint presentation (PPT), describe at least three (3) acts of legislation that have had a significant impact on health in America.Your PPT must be “at least” three (3) slides, and “no more than” eight (8) slides of content (not counting your title slide and references slide).Upload in the Discussion Board to share with classmates, and evaluate.Please, respond to “at least” one of your classmate’s posts.Upload your slides here for grading here, as well as in the “Discussion Board” area to share with your classmates.Come prepared to class to discuss it with your classmates.
Ana G Mendez University Significant Healthcare Acts in United States Powerpoint
Memo for Presentation: Social Media Research Paper
help me with my homework The main idea of the discussion is to present the social media and its connection with the business. Many business people believe that social media is very helpful in business and they are right. It is important to use social medial appropriate and do not believe the myths which exist around social media in general. One of the main organizational objectives is to make sure that more and more people are aware of the company and are familiarized with the company products. Therefore, the main idea of using the social media is to advertise the company and its products. Body Social media has become an essential part of human life. This is not a secret that the use of social media in business may increase customers’ awareness about the company and as a result increase the income from sales. The world is changing, people receive the information from other sources and those who want to be successful in business should make sure that they are able to satisfy the needs of the audience. Four steps should be followed with the purpose to meet the requirements and make sure that the social network strategy is applied successfully and may b realized in the nearest future. First of all, we are going to define audience our social network ingoing to be divided to. Then, it is important to set clear goals as pursuing various purposes which are not connected to each other may lead to low interest of the visitors to the company social media. It is important to create an action plan according to which the company is going to develop. Finally, tools, techniques and tactics are to be developed as without these important for strategy aspects any blog or forum will die in a week. Information blogs, twitters, and forums should be used as the feedback platforms. People should know that they can leave their comments which will be answered. Thus, we take care of our customers. At the same time, it is inadmissible to believe that all people are socially network active and the information presented at the forums is going to be delivered to each customer. The social networks are created for particular audience, mostly students and youth who spends much time on the Internet. Recommendations One of the main recommendations which is really urgent for those who have decided to refer to social media as the advertising and informing aspect is the updating of the information. Having created a blog, forum, twitter or another specific social media, one should update the information there to attract more and more new visitors as well as continue to make other be interested. Additionally, people should feel responsiveness and it is important to answer to some comments o comment some posts. Get your 100% original paper on any topic done in as little as 3 hours Learn More Conclusion Therefore, it may be concluded that social media is really important for business if it is used appropriately. Having created the blog, forum and twitter devoted to the company news and products, the business may increase its purchases by means of customers’ awareness of the company news and innovations. There is no need to pay too much attention to the social media and spend hours online. Several minutes a day may be enough to make sure that the social media issues are supported.
Reaction Paper #3
Reaction Paper #3. I’m trying to learn for my History class and I’m stuck. Can you help?
Type of service: Essay
Spacing: Double spacing
Paper format: Not applicable
Number of pages: 1 page
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Rose Director Friedman, 1910-2009, was for many years a professor at the University of Chicago Law School. She was married to Milton Friedman, 1912-2006, an economist who spent most of his career at the University of Chicago and who won the Nobel Memorial Prize in Econmic Sciences in 1976. Robert Nozick 1938-2002, was an American philosopher who spent much of his career at Harvard. Friedrick Hayek, 1899-1992, was an Austrian-born British economist and philsopher, who taught at the London School of Economics and at the University of Chicago. With Gunnar Myrdal, he received the Nobel Memorial Prize in Economic Sciences in 1974. Read the excerpts from the works of these authors in Justice: A Reader, Chapter III. Together these excerpts provide an introduction to Libertarianism. Analyze these excerpts about Libertarianism. Before writing up your analysis, consider all the standard questions we will ask of all the texts we read this semester. What is the genre of the text? Who wrote it? For whom was it written? When was it written? Does the text seem to be based on other source material, such as previous documents or eyewitness testimony, or not? What seems to be the purpose of the text? What is its structure? What are its parts? How do the parts relate to the purpose of the whole? What historical inferences can you make from the text? What is claimed? What isn’t claimed? What is assumed or left unspoken? What key terms are used in the text? What seems to be the special meaning of these key terms in context? What can you infer about the social world that made the text? What can you infer about the events, individuals, or groups described in the text? In addition, for these texts in particular, consider the following. How would you state succinctly the underlying principle of Libertarianism? What are the implications of that underlying principle for the nature of government and the state? Consider also the questions raised by Sandel in his preface to the chapter, “If you accept the idea that we own ourselves, must you also accept the conclusion that all paternalist and redistributive laws are unjust? If, on the other hand, you believe that the government should tax the rich to help the poor, how do you answer the Libertarian argument that such laws are a form of coerced charity that makes every person the property (perhaps even the slave) of the majority?”
Reaction Paper #3
COMPETENCIES 734.3.1 : Principles of Leadership The graduate applies principles of leadership to promote high-quality healthcare in a variety
COMPETENCIES 734.3.1 : Principles of Leadership The graduate applies principles of leadership to promote high-quality healthcare in a variety of settings through the application of sound leadership principles. 734.3.2 : Interdisciplinary Collaboration The graduate applies theoretical principles necessary for effective participation in an interdisciplinary team. 734.3.3 : Quality and Patient Safety The graduate applies quality improvement processes intended to achieve optimal healthcare outcomes, contributing to and supporting a culture of safety. INTRODUCTION Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. SCENARIO It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B. Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders. After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B. Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored. Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading. Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc. At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected. A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care. Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died. Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day. REQUIREMENTS Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide. You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. A. Explain the general purpose of conducting a root cause analysis (RCA). 1. Explain each of the six steps used to conduct an RCA, as defined by IHI. 2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome. B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome. 1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan. C. Explain the general purpose of the failure mode and effects analysis (FMEA) process. 1. Describe the steps of the FMEA process as defined by IHI. 2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. Note: You are not expected to carry out the full FMEA. D. Explain how you would test the interventions from the process improvement plan from part B to improve care. E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas: • promoting quality care • improving patient outcomes • influencing quality improvement activities 1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities. F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized. G. Demonstrate professional communication in the content and presentation of your submission. File Restrictions File name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( ) File size limit: 200 MB File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z