A Reflection On The 12 Brain Rules - 1905 Words

A Reflection on the 12 Brain Rules Faduma B. Khalif Dominion High School A Reflection on the 12 Brain Rules In a modern world so driven by hard-work and productivity, it is essential to not only know how the brain works, but to be able to apply key psychological principles to your daily life in order to capitalize on one’s own brain. The 12 Brain Rules, 12 fundamental concepts that explain how the brain works and how to care for it, show how scientific investigations and experiments have unlocked keys to the brain. Five of the 12 Brain Rules, the ones involving sleep, stress, memory, attention, and vision as the dominant of the five senses, are very clearly supported by events in my life as well as expanded upon by new information in the the book, Brain Rules: 12 Principles for Surviving and Thriving at Work, Home, and School. Sleep is an integral part of live and we cannot function without it. Despite knowing this very well, many people try to anyway. I remember the 3rd quarter of my freshman year, my classmates and I had been given a lot of schoolwork. I remember upperclassmen making jokes to us about how they had gone through phases of ‘not sleeping’ where they would basically live off caffeine and a use a whole slew of other tactics to minimize the amount of sleep they got in order to keep up with their work. During these times my classmates and I would host sessions of â€Å"3 AM club†, where we would stay up till the eponymous time as a class andShow MoreRelatedWhy Gods a Woman1062 Words   |  5 PagesSpecific Purpose: To persuade the audience that God is a woman. Thesis Statement: Since we are supposed to be made in â€Å"his† – meaning God’s- reflection, I am female and therefore God too is female. I. Introduction A. In the bible, Genesis chapter 1, verse 26 – 27, states, â€Å"God said, let us make man in our image, in our likeness, and let them rule over the fish of the sea, and the birds of the air, over the livestock, all over the Earth, and all creatures that move along the ground.† B.Read MoreAnalysis Of Where The Sidewalk Ends A Poem Analysis1275 Words   |  6 Pagescrimson bright, / and there the moon-bird rests from his flight / to cool in the peppermint wind† (1-6). The word choice and descriptive language definitely brought me back to a time when I was younger. Silverstein obviously didn’t follow any set rules, he made it his very own. The place I think he might be talking about is the borderline between night and day, or sun and the moon. It’s the middle of two things that are opposites. The second stanza mostly focuses on explaining that if you followRead MoreOdysseus is Not a Hero for the Modern Age Essay800 Words   |  4 Pages Many would argue that Odysseus is more of a villain nowadays, for every instance of his wiliness or feats of strength there are several of venality, vice, cruelty, or selfishness. The episode of the Sirens,(Book 12), is one example. The only reason Odysseus ties himself up to the mast, when instead he could have simply plugged his ears with wax like the rest of his crew, is that he chooses the jeopardous choice, wanting to go down in the books by being the first man to ever listen to the SirensRead MoreOneness of God1516 Words   |  7 PagesThe Trinity: The Oneness of God Before I try to explain an infinite God with my finite brain, I will bring this verse to mind: Proverbs 3:5-7 states, Trust in the Lord with all your heart and lean not on your own understanding; in all your ways acknowledge Him, and he will make your paths straight. Do not be wise in your own eyes; fear the Lord and shun evil. So, with this in mind, I will attempt to explain the Trinity. The best way to explain the Trinity is not with a statement, but with aRead MoreElectroconvulsive Theory Essay1104 Words   |  5 PagesElectro-Convulsive Therapy will be discussed. It will include rationale for the procedure, an account of the procedure and the student nurses reflection on the experience using Gibbs’ model of reflection (Jasper 2003). Electroconvulsive therapy (ECT) is a medical treatment for severe mental illness in which a small, carefully controlled amount of electricity is introduced into the brain. This electrical stimulation, used in conjunction with anaesthesia and muscle relaxant medications, produces a mild generalisedRead MoreEvaluate the Arguments, Presented in the Course, Supporting Chomsky’s Claim That Humans Are Innately Predisposed to Acquire Language, Discussing Specifically What It Might Mean for Humans to Be ‘Innately Predisposed to1356 Words   |  6 Pagesacquire language, by this it is meant a genetic mechanism that holds w hat he calls the ‘universal grammar’ common to all languages. Noam Chomsky call’s language ‘the human essence’ (1972). He is a discontinuity theorist, this means he believes the human brain appears to have an ‘inborn’ capacity to learn and obtain languages. Chomsky puts forward that many of the attributes adult speakers acquire cannot be answered for by learning mechanisms but ‘‘an innate component of the human mind that yields a particularRead MoreVirtual Child Ages 11-16 Essay1505 Words   |  7 Pagesdevelop the capacity for abstract, systematic, scientific thinking. Whereas concrete operational children can â€Å"operate on reality,† formal operational adolescents can â€Å"operate on operations.† They can come up with new, more general logical rules through reflection, rather than just using concrete things as objects of thought. (p.301). Formal operational thought invokes verbal reasoning about abstract c oncepts. Adolescents doing things such as physics are examples of their operating within this stageRead MoreThe Psychology And Genetics Of An Individual, And Nurture, Or Their Upbringing And Environment Essay1382 Words   |  6 PagesRationale- The human brain works in strange ways, it attaches itself to things and then begins to form a personality based on that. There are two views on this subject, on his article of Theories of Personality, Mcleod describes these two. The first one is called the Idiographic view. It says that each individual had his or her own set of psychological structures, and that among a crowd, some sets are possessed by only one person and that there are times when it is impossible to compare one personRead MoreThe And Out Of The Cradle Endlessly Rocking By Walt Whitman942 Words   |  4 Pagesmeanings in â€Å"When I have fears that I may cease to be† by John Keats and â€Å"Out of the Cradle Endlessly Rocking† by Walt Whitman. Bits and pieces of nature were used to personify mortality. Additional historical context showed that the poems are reflections of their respective authors’ view on mortality. The interpreted meanings of the theme from the poems were greatly different. D espite being written four decades apart, similarities between the poems were rampant. Poets used nature as a colour paletteRead MoreThe New East Bridgewater Junior Senior High School1601 Words   |  7 PagesIn September of 2013, the new East Bridgewater Junior Senior High School opened it’s doors for the very first time welcoming students from grades 7 - 12. After reorganization of the three schools in the district, it was decided that the seventh and eighth grade would move from the middle school into the new building. Although the building was beautiful and filled with the latest technology, a wave of negative thoughts and expectations about how the school and the school district functions engulfed

The Matrix And Descartes Meditations On First Philosophy

If I think, then I exist. Something cannot be thought without there being someone that thinks it. If there is something being doubted, there must be someone doing the doubting. I am the thinker that thinks and the doubter that doubts. I think, therefore I exist. The Matrix and Descartes’ Meditations on First Philosophy tell me that reality is not something I can perceive solely through electrical impulses in the brain. Rather, reality is dominantly at the scrutiny of my mind’s judgment. It follows that reality consists of both a physical reality and a nonphysical reality in which I exist the thinker. All things considered, we can resolve that reality is anything that is truly the case. In order to describe what is real, we must first reduce what we think we know about the world to its most basic foundations. Descartes begins his Meditations by first open-mindedly submitting himself to the â€Å"demolition† of his beliefs. Any belief that he believes true, he asserts the opposite true to establish if in any instance this can be an accurate way of observing reality. Any belief whose opposite can be true is doubtable. He then deliberates that all doubtable beliefs are false. This way of thinking Descartes asserts that by using this â€Å"methodical doubt† of integrating knowledge to the most basic and irrefutable fact, we can find if not only one withstanding truth about the nature of reality. Using only physical means to try and understand what is real leads to doubtable beliefs. InShow MoreRelatedThe Connection Between Senses and Reality in The Matrix, Descartes Meditations on First Philosophy and Plato’s The Republic562 Words   |  2 PagesThe popular movie The Matrix, Descartes Meditations on First Philosophy and Plato’s The Republic have more in common than you would think at quick glance. They all examine the theory that our world is an illusion and question the connection between our senses and reality. The clearest similarity between these works is the doubt of the reality of our world and questioning the reliability of our senses. Descartes proposes that we are dreaming and everything we experience is just an illusion. PlatoRead MoreThe Matrix Is A Clear Demonstration Of Descartes Meditation One855 Words   |  4 PagesThe movie â€Å"The Matrix† is a clear demonstration of Descartes Meditation One, they both question the reality in which they are living, and rather or not if it is real or if it is controlled by something else, questioning the current reality. For Descartes, it is controlled by evil demons, whereas a supercomputer controls the Matrix. Both are in what is perceived as a dream state where the senses cannot be trusted. Descartes works up to his case for universal doubt in Meditation One questioning ourRead MorePlato, Descartes, And The Matrix1150 Words   |  5 PagesSamoria Preston PHIL 201 Dr. Alexander Jech 27 November 2015 Plato, Descartes, and The Matrix Life and human existence give rise to a practically endless list of philosophical questions. Among the plethora of abstract and complexity are found questions regarding the nature of our existence and the world in which surrounds us: â€Å"What can we truly know? How can we accurately depict reality? Can we know absolutely anything for sure?† Such questions lead us down roads that twist and turn remainingRead MoreDescartes And Berkeley s Philosophy958 Words   |  4 Pagesin the first place? Am I trapped in the Matrix and everything I see is an illusion? Philosopher Rene Descartes addressed the question in his meditations. He had distinct ideas concerning reality and illusion. Descartes believed in â€Å"Cartesian Dualism† - a relationship between the body and mind. In his meditations, he goes through the process of discarding all of his previously held beliefs and reevaluating them. However, some philosophers - such as George Berkeley disagreed with Descartes. Be rkeleyRead MoreComparing The Matrix With Readings From Plato And Descartes1023 Words   |  5 Pagescontrasting The Matrix with readings from Plato and Descartes This essay will discuss The Matrix, from synopsis of the following; The Republic by Plato, depicting the famous cave allegory, and Meditations on First Philosophy by Descartes, offering doubt that some senses are accurate. By examining these two readings, and the movie, it will allow the author to show some comparisons, and to show how they are also different as this essay indicates the world is very real. The Matrix In The MatrixRead MoreComparing Plato And Descartes The Matrix, The Allegory Of The Cave889 Words   |  4 PagesThe short stories, written by both authors Plato and Descartes; The Matrix, The Allegory of the Cave, and Meditations on First Philosophy, focuses on what individuals believe to be reality or not within the world. The stories bring on questions of what is in fact illusion. Overall, the stories provide a guide to the truth. According to Wachowski, A, Wachowski, L (1999) in the Matrix, Mr. Anderson questions everything in the world as he knows it. He wonders if what he is involved in a computer programRead MoreWhat do Plato, Descartes, and The Matrix all have in common? All of them study the possibility that600 Words   |  3 PagesWhat do Plato, Descartes, and The Matrix all have in common? All of them study the possibility that our world is just a fantasy. They also demand that we took a good look into the relationship concerning our senses and reality. There is one similarity between all three works that is clear: their writers are skeptical that the real world that surrounds could just be a product of our faulty senses. Can we really rely on them to justify whether or not what we are perceiving is real? â€Å"All that I haveRead MoreComparing Platos The Republic, Rene Descartes Meditations I, and the Film The Matrix667 Words   |  3 PagesRenee Descartes Meditations I, and the 1999 major motion picture The Matrix. The basic tenet that fuels Socrates Allegory of the Cave and the other two previously mentioned works is that reality through the human senses cannot be trusted, may not be true, and cannot necessarily be validated through the human senses. Based on this central premise, there are a number of specific points of comparison existent between this literature and film, particularly between Meditations and The Matrix. The essentialRead MoreThe Matrix the Cave and Meditations Essay1829 Words   |  8 PagesThe Matrix, The Cave And Meditations PHIL 201 John L. Hill II Liberty University John Hill Professor Allyn Kyes Philosophy 201 October 18, 2012 The Matrix, The Cave And Meditations Thesis: There are many similarities in the Matrix ( Wachowski, Andy, and Lana Wachowski 1999 ), The Allegory of the Cave ( Plato ) and Meditation I of The Things of Which We May Doubt ( Decartes, 1641 ). It appears as you take a close look at the Matrix that it is a retelling of â€Å"TheRead MoreInterpreting The Matrix through Descartes’s Philosophy Essay2059 Words   |  9 Pagesvessel for the soul to use, while Descartes provides proof that the body and soul are interconnected (172). One does not simply use the other; though they are separate, the mind affects the body and the body affects the mind. Cartesian dualism tells us that although the whole mind seems to be united to the whole body, I recognize that if a foot or arm or any other part of the body is cut off, nothing has thereby been taken away from the mind (414). However, Descartes also states that nature also teaches

51 Euphemisms for Youre Fired

A euphemism is a seemingly nice or polite way of expressing a harsh or unpleasant truth.  In the  Oxford Dictionary of Euphemisms  (2007), R.W. Holder observes that euphemism is often the language of evasion, hypocrisy, prudery, and deceit. To test that observation, consider these 51 alternative ways of saying Youre fired.   Dan Foreman:  Guys, I feel very terrible about what Im about to say. But Im afraid youre both being let go.Lou:  Let go? What does that mean?Dan Foreman:  It means youre being fired, Louie.(Dennis Quaid and Kevin Chapman in the movie  In Good Company, 2004) Throughout much of the world, unemployment remains a problem. Yet of all those people who have lost their jobs, few were ever told, Youre fired. Apparently, those day-long seminars in workplace sensitivity have paid off: firing is now as outdated as a defined-benefit pension plan. In its place is a brightly colored file folder filled with smiley-faced  euphemisms. True, a few of the terms sound rather dour and legalistic (involuntary separation, for example, and workforce imbalance correction). A few others are simply perplexing (decruit, lateralize, waive). But many sound as cheery as a year-end bonus: constructive discharge, career alternative enhancement, and—no kidding—free up for the future. Youre not losing a job, these expressions seem to be saying. Youre regaining a life. Euphemisms for Job Termination Here, according to management guides and personnel documents found at a host of online human resources sites, are 51 bona fide euphemisms for job termination. career alternative enhancementcareer change opportunitycareer transitionconstructive dischargeconstructive dismissaldecline a contract extensiondecruitdefunddehirede-selectdestaffdischargediscontinuedownscaledownsizeearly retirement opportunityemployee transitionend of a trial periodexcessingfree up for the futureindefinite idlinginvoluntary separationlateralizelet gomake internal efficienciesmake redundantmanage downnegotiate a departureoutplaceoutsourcepersonnel realignmentpersonnel surplus reductionrationalize the workforcereduce headcountreduce in force (or  riffing)re-engineer the staffreleaserelieve of dutiesreorganize (or  re-org)reshufflerestructureretrenchrightsizeselect outseparateskill-mix adjustmentstreamlinesurplusunassignwaiveworkforce imbalance correction Forget those condescending reminders that youre now free to pursue other interests and spend more time with the family. As anyone who has ever lost a job is keenly aware, euphemisms such as these rarely achieve their goal of softening the blow. The terms that  we  use for getting fired tend to be  dysphemisms: sacked, dumped, bounced out, canned, axed, eighty-sixed, and given the old heave-ho. More About Euphemisms and Dysphemisms Why Do We Use Euphemisms?Euphemisms, Dysphemisms, and Distinctio: Soggy Sweats Whiskey SpeechSoft Language

Nurses Shortage Impact Under New ACA Reform The Future...

System Over the years, the nursing profession has become a vital focus to the US health care system with emphasis on nurses’ crisis as being a future challenge with the new ACA reform. The nursing shortage have baffled the experts to recognize the gaps within the Health Care system by addressing the need of more training programs, educational leaders, increase of financial resources, work load of staff-patient ratio distribution and quality of care satisfaction (Sultz Young,2014). A vision of amplified foundations such as â€Å"the Raise Your Voice Campaign†, AARP , RWJF, Macy’s, and Gordon Betty Moore Foundation have contributed towards the educational research programs by amplifying the nurses role as the†¦show more content†¦According to JAMA , a study report describe nurses as being emotionally exhausted and unsatisfied with their time work quality as they work scheduled is overloaded with more patient care; Dr. Linda Aiken found that â€Å"f ailure to retain nurses contributes to avoidable patient deaths†(JAMA,2002). Another impact of the nurse shortage affecting patient’s quality of care is: the high rate of turnover and opening positions. In 2007 AJN, Dr. Kovner found that 37% of the nurses were thinking of alternate jobs positions. A national poll of nurse recruiter found 16.1% of vacancy rate and 13.1% of turnover (Hodes Group, 2005). The nursing shortage have baffled experts to recognize the gaps by addressing the need of more training, increase resources, work load of staff-patient ratio and quality of care (Sultz Young,2014). Although several Health Reform law provisions have been initiated but not completely in full effect, many statewide have implemented their strategies to prevent a nurse’s shortage crisis. Some benefits of the new provisions are: nursing students have more opportunities now to receive federal government loans than ever before by enrolling into a nursing school program and obtain more training skills on their specialty area where they can provide advance care to the aging population with chronic conditions; aspiring students who are not able to afford their school tuition expenses, theShow MoreRelatedWhy Change Is Difficult For The Healthcare Environment2899 Words   |  12 Pagesthe Affordable Care Act. With the new health care system the government mandated U.S. citizens and legal residents to have health insurance that resulted in the rise of insured individuals. Due to the new policy more people have access to health care that means more primary physician needed to accommodate the rise of new patients. Shortages of physicians not only in the primary care area but also in specialty care area are projected between 46,000-90,000 by 2025 (The Physician Shortage, n.d.). TheRead MoreThe Ever Changing Healthcare Environment3006 Words   |  13 Pagesthe Affordable Care Act. With the new health care system the government mandated U.S. citizens and lega l residents to have health insurance that resulted in the rise of insured individuals. Due to the new policy more people have access to health care that means more primary physician needed to accommodate the rise of new patients. Shortages of physicians not only in the primary care area but also in specialty care area are projected between 46,000-90,000 by 2025 (The Physician Shortage, n.d.). TheRead MorePhysician and Nursing Shortages Essay3012 Words   |  13 Pagesï » ¿ Physician Nursing Shortages Impacts they have because the Affordable Care Act and Reform Marquitha Howell 9/28/2013 Healthcare reforms including Obama Care, formally named the Patient Protection and Affordable Care Act greatly impacts physicians and nursing shortages. There are several provisions which could direct impact physicians and nurses through incentives for potential recruitment, grants, training and retention. Through potential initiatives, the act may indirectRead MoreThe Health Care Crisis And An Understanding Of The Reforms2277 Words   |  10 PagesA. The health care crisis and an understanding of the reforms The American Health Care system to say the least is wasteful, bloated, and generally inefficient and therefore in dire need for immediate review. This has largely been as a result of factors such as costs, poor investment return for outlays, inequitably distribution, and being based on anachronistic business model geared at treating diseases more than promoting wellness. The figures are all there to see why a radical surgery of the healthRead MoreHealth Care Problems That Affect The Elderly Essay4215 Words   |  17 Pagesthe health care problems that causes hindrance to fulfilled health care needs for the elderly and to investigate health inequality and the cost of health care that affects the elderly. Most senior citizens in America lack access to health care. Some of the primary hindrances to access are immobilize, inadequate transport system, and poverty. The inaccessible health care results in increased medical effects, mortality rates, increased medical costs, and additional pressure to the future nurses. TheRead MoreNursing Essay41677 Words   |  167 PagesThe Future of Nursing: Leading Change, Advancing Health http://www.nap.edu/catalog/12956.html Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright  © National Academy of Sciences. All rights reserved. The Future of Nursing: Leading Change, Advancing Health http://www.nap.edu/catalog/12956.html THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 Read MoreCurrent and Future Economic Issues Impacting Healthcare Sector2827 Words   |  12 PagesCurrent and Future Economic Issues Impacting Healthcare Sector S. Ruff Dr. Merle Point-Johnson HAS 510 June 15, 2015 Abstract Not unpredictably, the increases in health care spending and the share of GDP dedicated to health care have raised up concerns about the negative influence of health care cost inflation on the U.S. economy. In an era of global economic markets, these concerns are reinforced by the status of the U.S. as a spendingRead MoreHealthcare Essay18323 Words   |  74 PagesChapter 3 The Evolution of Health Services in the United States Learning Objectives To discover historical developments that have shaped the nature of the US health care delivery system To evaluate why the system has been resistant to national health insurance reforms To explore developments associated with the corporatization of health care To speculate on whether the era of socialized medicine has dawned in the United States â€Å"Where’s the market?† 81 26501_CH03_FINAL.indd 81 7/27/11 10:31:29Read MoreEmanuel Medical Center Situational Decision Analysis47698 Words   |  191 PagesSTATE UNIVERSITY OF NEW YORK AT ALBANY Emanuel Medical Center Situational Decision Analysis James T. Onisk 4/29/2012 Table of Contents Situational Analysis Appendices External Analysis Appendix A: S.W.O.T. Analysis Appendix B: External Trend/Issue Analysis Appendix C: Environmental Trends/Issues Plot Appendix D: Stakeholder Map Appendix E: Service Area Profile Appendix F: Service Area Structural Analysis Appendix G: Service Area Competitor Analysis Appendix H: Critical Success Factor AnalysisRead MoreHuman Resources Management150900 Words   |  604 PagesCHAPTER 1 Changing Nature of Human Resource Management After you have read this chapter, you should be able to: ââ€"  Identify four major HR challenges currently facing organizations and managers. List and define each of the seven major categories of HR activities. Identify the three different roles of HR management. Discuss the three dimensions associated with HR management as a strategic business contributor. Explain why HR professionals and operating managers must view HR management as an

Patient Safety Free Essays

string(79) " a corporatized government hospital, still waiting for complete privatization\." â€Å"There is a huge missed opportunity for health care professionals to contribute to hand hygiene as they miss 1 in 2 of all hand cleaning opportunities. † –WHO, 2006 â€Å"What kills women with childbed fever is you doctors who carry deadly microbes from sick women to healthy ones! †Ã¢â‚¬â€Louis Pasteur, 1870 1 . 1. We will write a custom essay sample on Patient Safety or any similar topic only for you Order Now Background of the Study 1. 1. 1. Nosocomial infection burden Nosocomial infections or healthcare acquired infections can truly be a grave toll for hospital management as much as it is for end-beneficiaries, customers, and stakeholders. Mortality reaches 80,000 annually ; 3 patients die per minute ; 10-20% % incidence globally, and figures are expectedly higher in Third World settings. This is not to mention the corollary problem of emerging microorganisms resistant to overuse of prophylactic and anticipatory shotgun antibiotic therapy as empirical solution. The damage wrought is paramount, reaching a cost of one billion pounds per year in Europe alone, resulting from these. 1 excluding priceless, needless mortalities and morbidities 1 1. 1. 2. Role of Hand Hygiene Institute of Medicine has identified nosocomial Infection to be the most common complication for hospital patients and hands are the most common mode of transmission. In 1991, Harvard Practice Study on adverse events in health care indicated that surgical site infections were the second most frequent type of adverse event for inpatients, constituting 13%. One study established an excess mortality caused by NI to as high as 44% in ICU patients. 2 In a local study at Makati Medical Center by Tupasi Littaua, mortality rate was reported to be all NI cases documented 4. 6 % of n the intensive care unit , and authors conclude that risk factors included invasive and manipulative procedures. â€Å"Majority of deaths from NI were associated with the use of respiratory equipment and Foley catheters which were potentially preventable by strict adherence to aseptic techniques†. 3 1. 1. 3 Reality of Poor Compliance Despite it being a seemingly simple practice, and des pite the acknowledged fact that proper hand hygiene is considered the most critical, the most cost-effective measure of adequate infection program, compliance behavior management has been a protracted managerial headache globally. Indeed in our age of ever increasing sophistication, those seemingly simple practices but with grave implications ironically are difficult to address. While the techniques involved in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene behavior makes the study and management of hand hygiene complex. 2 1. 1. 4. Hand Hygiene Compliance : A Managerial Challenge It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behavior and managing the environment. Input from behavioral and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social need4 Speaking for all levels of health care workers , probably the major reason this seemingly simple problem is always taken for granted is the reality that the impact of something not so visible daily to the naked eye will always be swept under the rug amidst more outright demands concerns in patient care. The rest of the justifications like forgetfulness, lack of time, inconvenience, complications, etc. are simply alibis. Given this, the greater burden falls on health care managers to do something so that compliance can be improved, and for health sector in general to come up with more evidence-based materials to convince HCW as well as policy-makers and managers about its importance. 1. 1. 5 Nosocomial Infection Patient Safety Nosocomial infection control is a large part of patient safety, whose importance is currently being highlighted in the light of increasing adverse events which are at most preventable. Prior to this study, the researcher delved into assessing the patient safety culture profile of QMMC, as a general backgrounder, and as part of re-packaging a new approach to an old problem. 3 1. 2. Statement of the Problem Understanding the patient safety culture profile of Quirino Memorial Medical Center gives us the over-all conceptual perspective to the problem at hand. The researcher finds it convenient to discuss it in terms of the Donabedian theme. 1. 2. 1. The Macroenvironment’s Patient Safety Profile 1. 2. 1. 1. The QMMC Patient Safety Structure In alignment with the recent health care thrust, QMMC has revised in 2008 its mission to being â€Å" a tertiary hospital providing a safe, accessible, affordable quality specialized healthcare that is dynamically responsive to the needs of its patients. † Its unwavering commitment is towards delivering health care to all its clients regardless of socio-economic status and to continuously upgrade the services offered in terms of technical expertise, support service, equipment and infrastructure. Patient safety is first and foremost in its goals. Its core values include cleanliness in all aspects including the physical environ, and Its fourth priority is â€Å" to develop and sustain a hospital environment that embraces and practices a culture of safety†. The 7 core values it internalizes include the 7Cs: clean physically, mentally, spiritually, Christ-centered, compassionate, competent, culture-friendly, community-oriented, communicative. At this time, the plus factor is having a medical director who is passionate about the cause, much involved in regular meetings with Department of Health advocates on the matter. â€Å"In QMMC, Dr. Rosalinda Arandia is seen as a charismatic figure in the improvement of health and medical 4 services offered by the hospital and in making recommendations on and implementing the hospital’s quality improvement program. † 5 QMMC is a 350-bed national government hospital that stands in a 42,000-sqm lot between Katipunan Avenue and JP Rizal St, Project 4 Quezon City, Metro Manila. It has in recent years undergone a major upgrading and expansion of its buildings and facilities. Compared to the old infrastructure, the new building and facilities, provide a more sophisticated ambience. Better equipment and architectural upgrading seem to inspire and motivate employees, and the architectural design seems to promote greater staff interaction and communication. Its occupancy rate is 120%. . QMMC is a corporatized government hospital, still waiting for complete privatization. You read "Patient Safety" in category "Papers" When faced with budgetary constraints and too bureaucratic processes they generate their own resources through private solicitations, the biggest of which are donations and affiliation fees from training institutions. As to equipment supplies due to its being a government hospital, only about 60% of its equipment and supplies are provided for and is functioning at any given time. Maintenance and regular checks are being done and complied with as required. It has a total of 564 employees, 35% of whom are contractual. Among the permanent about half have worked for more than 10 years. Among the 549 employees, 159 are doctors (consultants, residents, interns) , 180 are nurses and 225 are administrative personnel. This number does not include those who are fielded from affiliate institutions for training, such as clinical clerks and allied 5 rofessions (nursing, pulmonary therapy, radiologic therapy, medical technology, dental, dietary, midwifery and caregiving). For the consultants and doctors, ratio to patient load is quite acceptable. There are 69 resident physicians and 55 interns. In the wards, roughly the ratio is 1:5 per day; however in the out-patient department, the staff ratio is much higher 1:25 . In the intensive care unit, ratio can be improved to as good as 1:2 depending on the number of rotators from affiliate hospitals , for all professional groups. Attitudes of staff are an important aspects of culture. In QMMC, initial preliminary interviews ith staff revealed that there is some awareness of the concept of patient safety, in all levels of care and even administrative strata. Incident reporting is very minimal such as it is generally perceived that underreporting is rampant. 1. 2. 1. 2 The QMMC Patient Safety Process Profile Teamwork in respective clinical areas is perceived to be good by key administrators, although with the high rate of staff turnover due to training hospital affiliations, this is affected more often than not in a negative fashion. In terms of feedback and communication, there is n o systematic evaluation of staff performance . QMMC has been active in the Patient Safety Task Force of the Department of Health. Underway are devising standardized hospital forms, such as interdepartmental referral forms to enhance communication and lower risks of errors being committed in patient care. 6 In lieu of risk reduction, hand hygiene educational program has been recently revived by the Infectious Disease Team headed by Dr. James Tiu. Educational trainings as well as policy reinforcement are being conducted as the need arises among nursing staff. 1. 2. 1. 3. The QMMC Patient Safety Outcome Profile At the time of study, there were no baseline data available as indicators such as compliance rates, nosocomial infection rates, or patient satisfaction surveys. There are no performance indicators that can be used as feedbacks to improve standards of care. This is a work in progress and hopefull this study becomes a tiny contribution. 1. 2. 2. QMMC’s UncontrolledNosocomial Infection Problem Analyzing the above profile of QMMC, and amidst the track record of physical and service upgrading efforts, the main problem of the hospital regarding patient safety is still nosocomial infection control. Evidences of uncontrolled nosocomial infection are certain occurrences pointing to infection control problems in QMMC in the past 12 months have caused alarm, as follows: (a) Post-surgical wound dehiscence Anecdotal incidents of nosocomial infection getting out of control have been almost part of everyday work in a public hospital like QMMC. However, a situation that occurred last AugustOctober 2008 was particularly notable, wherein dehiscence occurred in a succession of ten postsurgical patients in two wards including the surgical ICU, during Day 5 to Day 11 of their hospital stay. Culture studies revealed the usual notorious nosocomial Proteus microorganisms, E. coli, and 7 Staphylococcus areus , responsive to very expensive intravenous third generation cephalosporins and aminoglycosides, with or without re-suturing of the wounds (Appendix 1) . 6 Aside from the cost of these medications, the prolonged hospital stay with all its accompanying indirect costs to both patient and hospital were staggering. (b) Perennially high incidence of ICU pneumonias and urinary tract infections Based on the latest QMMC Morbidity and Mortality Audit 2008, 7 among ICU patients hooked to ventilators for protracted duration, nosocomial pneumonias are still the leading cause of death. 1. 2. 3. Need for upgrading quality of hand hygiene practice During one root cause analysis done by the management, the Infectious Disease Committee, and the department concerned with the last year’s outbreak of dehiscence, the senior management surmised that the root problem or one of the root problems could be failure for proper andwashing among health staff. The intervention consisted of culture and sensitivity tests followed by proper antibiotic coverage. Policy on handwashing was also tightened up in terms of posting reminders on doors and walls and subsequent refresher educational modules by the Infectious Disease Head were conducted among nursing staff. However, no actual monitoring or evaluation of hand hygiene practices were done . Despite educational training interventions, and despite the presence institutional policies posted on walls and doors, compliance to the practice among QMMC hospital staff has persisted to be unsatisfactory. 8 1. 3. Objectives of the Study GENERAL OBJECTIVE This study aimed to demonstrate the impact of a hand hygiene intervention package to QMMC MICU and SICU, using comparison of intervention. SPECIFIC OBJECTIVES In more detail, this study aimed to : (a) Characterize the current hand hygiene practices in QMMC ICU according to its using structure-process-outcome dimensions; (b) Craft and implement an intervention package addressing manipulable areas of the structure issues identified in the structure-process-outcome dimensions of hand hygiene practices; (c) Measure hand hygiene structure-process-outcome variables as a function of healthcare worker factors and work area factors , pre- and post-intervention, as a way to evaluate impact of above intervention. d) Formulate recommendations to the QMMC management and its stakeholders based on the findings and lessons learned. structure-process-outcome variables pre- and post- 9 1. 4. Significance of the Study The study is valuable in the following general areas of health concern: (a) Infection Control. The study’s advocacy counts very significantly in terms of contributing towards decreasing the grave toll on preventable m orbidity and mortality burden on patients and their families. As we see more systematically the outcome of our efforts towards hand hygiene as it impacts infection control, we learn to rely less on antibiotic use which also lead to emergence of resistant microorganisms that are and will be potentially harder to control eventually. This study will then be part of fulfilling what WHO advocates to be done , i. e. â€Å"for better monitoring of outcomes for hand hygiene studies, reduction of infection rates must be demonstrated, high complexity to evaluate, but high priority requirement. 8 (b) Preventive thrust. Hospitals’ mission is supposedly preventive as much as curative. However, review of literature shows that hospitals, even in the First World settings, tend to so conveniently rely on antibiotic use both prophylactically and empirically in managing and controlling nosocomial infections. Hospital care need not be a double-edged sword nor do we need to stop mitigating phenomena which are in our hands to control, if only we heed the evi dence-based principles put forth. Prevention remains to be the better direction that health care must devote its resources on. (c) Cost savings. According to WHO, â€Å"direct costs of intervention and indirect costs associated with hand hygiene time its promotion corresponds to less than 1% of costs of managing nosocomial infection. Studies on the costs of nosocomial infection caused its toll in terms of protracted hospital stay, expensive drug and antibiotic acquisition in addition to intensive care 10 nit stay, hematological, biochemical, microbiological and radiological tests, extra surgical procedures and working hours. (d) Healthcare management learning. WHO asserts that â€Å"measurement of the compliance of health care workers to hand hygiene measures is a recommended performance indicator of the quality of care†. (e) Compliance behavior management has been a protracted universal problem, as lack of interventional studies to convince policy makers, esp. local, both government and private, predispose health care systems prevalent to sustain awareness and implementation. With the lack of attention given to the problem’s facets and determinants, this study can be a humble contribution. Relevance of this study to the institution and its various stakeholders include the following: (a) Study institution. Often, organizations take action based on some comparison of their measures to a set of benchmark measures. Armed with specific incidents about the organization’s culture, effective action plans flow logically and integrate into existing change processes. QMMC can better select programs and tailor-fit strategies that will be most beneficial to upgrade the attitudes and mindset of the employees, to design the working environment, and to align with its vision-mission pursuit of quality and safety , and better service to patients. It will be helped to see patient and hospital outcomes in a better light. It will eventually have a baseline which will be useful for tracking impact of certain interventions for a sense of comparison. As it uses internationally known research methods, it will provide 1 internal as well as external benchmarking, especially with national government hospitals, both international and local. (b) Leadership. Since QMMC under the present leadership is into the process of advocating patient safety as a goal, this study will help them examine alignments of their policies and systems with their vision-mission statements , goals and core values. Later on when like in international settings and patient safety will be a go vernment regulatory requirement, this hospital can provide benchmarking. (c) Hospital staff. This study provides the staff the much-needed feedback about themselves, the colleagues they work with, and the patients they serve. Feedback is the first step to change. Studies such as this are advantageous in themselves in that it just the simple process of assessment baseline will in itself raise awareness of not only patient safety, specifically, infection control, but of the need for structure (staff attitudes) as well as process variables (teamwork, communication) relevant to safety and other hospital performance. Moreover, they themselves can be target victims of nosocomial infection, so that studies like this could help boost their safety as well. (d) Affiliate training healthcare institutions. The importance of good hand hygiene practice and its observance will be highlighted among the trainees from more than 20 various health care schools, a value that they will most likely carry back to their respected institutions . This is rather crucial and innovative as patient safety, specifically preventive practices to 12 nosocomial control such as hand hygiene are not yet that well-emphasized in the traditional medical and para-medical curricula. (e) Hospital management trainees. The results of this study can be a benchmarking study to compare, study and upgrade other hospitals, both local and international. The study becomes a venue to validate some of the tools that will be used for the first time locally. Results of the study can be utilized by trainees for future research on patient safety and infection control and behavior modification techniques. (f) Healthcare community. This study will help control NI, emergence of resistant organisms for similar government hospitals. It provides significant research for Department of Health which is specific on approaching infection control through Total Quality Management assessment and strategies under their recent thrust on patient safety and quality assurance. Since QMMC could very well be a good prototype of the other government hospitals , the results of this study can largely be of help in implementing the various enabling mechanisms stated in the Philhealth Benchbook. 9 (g) Patients. Above all, since awareness, education , and practice towards patient safety, specifically infection control will be highlighted in this study, the end beneficiary would ultimately be the patients and their families and guests whom this institution is servicing, no matter how indirect and long-term this impact would be. 3 1. 5 . Scope and Limitations of the Study †¢ Being a primarily TQM research project, this study does not attempt to establish cause-and-effect relationship between hand hygiene and nosocomial infection . †¢ This study does not include cost estimates and budgetary implications of intervention if eventually adopted by study institution. †¢ Relative merits of the specific parts of the intervention is beyond the scope of the des ign. †¢ Time and budget constraints were real such that research design were limited in various ways and means. . 6. Definition of Terms and Acronyms TERMS: For purposes of clarity and reference in the discussions all throughout this study, the following definitions and acronyms would be used and referred to: Hand hygiene (HH)- refers to one of the areas in infection control that deals with systems of diminishing pathogenic microbe transmission through evidence-based philosophy and set of practices regarding the hands in relation to direct patient handling during the process of care. 0 14 Hand hygiene practice/practices (HHP) – refer/s to any form of action referable to disinfecting the hands prior to and after patient handling, in the most basic terms defined as â€Å"washing hands with soap/water or (rubbing with) disinfectant, for at least 15 seconds before and after patient contact, after any contact with a source of microorganism, and after removing gloves†. ( Heal thcare Infection Control Practice Advisory ). Hand hygiene event (HHE) – defined as the event involving any of the HH practices (washing, rubbing with disinfectant, donning with gloves) done before or after patient contact; (if both done before and after, they are considered independent events ; if both washing and donning with /removing gloves are done during one instance, it was counted as one event; this regardless of the correctness or adherence to other details as presently prescribed by currently available universal guidelines. 1 Hand hygiene opportunity (HH0) – defined as any event with a high-risk of microbial transmission, executed before and/or immediately after patient contact, regardless of whether gloves. They included all contact with body fluids, or involving manipulative contact with anything in the patient’s body or immediate environment . Over-all hand hygiene compliance – includes all hand hygiene-related behavior in accordance with current institutional , (in this study, QMMC’s ) policy â€Å" to wash hands before and after patient contact† regardless of its alignment with the most currently recommended international standards based on indication, technique, cleansing agent and duration ; this by strict classification based in literature definition, falls under â€Å"incomplete compliance†. 12 15 Complete compliance- refers to all hand hygiene-related practices aligned with the most-updated, most current evidence-based globally recommended guidelines, as required by WHO guidelines 2006 (with QMMC, being a government hospital). Hand hygiene structure-refers to staff factors and work area factors. Staff factors include inherent demographic characteristics, such as professional group, age, sex and duration of service. It also refers to more malleable factors such as staff attitude and training. Work area factors refer to existing policies or specific protocol, logistic infrastructure and supplies, staff volume, patient volume, hospital type, work settings, organizational structure, etc. Hand hygiene process- refers to practice as to how it is done in terms of indication for method, duration, temporal relation to patient contact, cleansing and technique, and how it abides to the currently recommended evidence-based a guideline or protocol . Hand hygiene outcome- refers to measurable events or indicators, for both patients, employees as well as organization; like overall healthcare worker compliance rates, as well as indirect outcomes of good hand hygiene proven in literature, such as nosocomial infection rates, transmission rates, colonization rates. ACRONYMS: For purposes of brevity of certain words and identities mentioned quite repeatedly all throughout the study, the following apply: 6 HCW- Healthcare worker; refers to any staff involved with direct handling of patients in a health facility NI- nosocomial infection; also HAI (healthcare acquired infection); refers to infection developing after 48 hours after admission or confinement in a health care facility. ABHR- alcohol-based hand rub-refers to a hand rub disinfectant with any alcohol of any concentration as the basic ingredient. How to cite Patient Safety, Papers

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The first reason is that the contract contains and covers all the terms which the two parties have come to the agreement. This means that any external document has to be expressly incorporated into the contract. Besides, This is to prevent any ambiguity about the status of any earlier agreements or understandings. Both parties shall only base on the contract to perform their obligations. The last point is to prevent any disagreements and dispute arsing from the difference between the previous drafts and the contract so that the contract can be immediately executed for both parties’ sakes ? A contract normally includes wording the following elements: †¢An entire agreement statement: a statement in the contract that the parties agree that the terms of the contract between them are to be found within the text of the contract document and nowhere else. All entire agreement clauses include this element †¢An exclusion of liability for misrepresentation: most entire agreement clauses include one or more of the following: An acknowledgment by the parties that they have not relied on any representation which is not set out in the contract; A statement excluding liability for misrepresentation