Expose Article Example | Topics and Well Written Essays - 500 words

Expose - Article Example However, the electrician did nothing and said he would come to fix it later. Many residents believe that short circuit catalysed the occurrence of the fire. After the fire, the casualties were moved to another labour camp In AlShahaniya. Also, the employees were promised 200 riyals above their April salaries as compensation for the damage. Many volunteers have been appealing for food and clothe donations for the displaced men. Firstly, the article highlighted the troubling facts about the living conditions of the employees in the labour camps. Kovessy (2015) indicates that over eight men live in one room and there are no fire safety measures in the labour camps such as fire extinguishers and emergency exits despite the overcrowding of the rooms. Questions have been raised about Qatar’s commitment to safeguarding the welfare of their labour force despite the enormous wealth of the country. The evident negligence of the camp supervisors should have been questioned in courts since it was the major cause of the fire. The majority of the Sri Lankan employees are opting to go home despite the Sri Lankan embassy encouraging them to go back to work. They claim that they still don’t trust the safety standards of the labour camp. It is not understandable why the Sri Lankan government is not doing enough to cater for the rights of their nationals. A spokesman for the Sri Lankan embassy stated that no one was killed in the disaster; however, unconfirmed reports indicated that two Bangladesh nationals were killed in the fire. The statement exposed how the Sri Lankan Government is trying to cover up Qatar despite the fact that their nationals are suffering. Despite the fact that, the spokesperson was indicating the fire was evidence for the substandard housing conditions for the labourers, they agreed to settle for only 200 Riyal per employee. The displaced employees only escaped with the clothes on their bodies and 200 riyals could not possibly compensate for

Quality Improvement Project for Patient Prescription Record

Quality Improvement Project for Patient Prescription Record The aim of this quality improvement project is to ensure that nurses record in the designated box on patients Prescription and administration record (to be referred to as: Kardex) if High Dose Antipsychotics Monitoring is Applicable YES or NO (to be referred as: applicable Y/N) and subsequently if yes, that the High Dose Antipsychotic Therapy monitoring form (to be referred to as: Monitoring form and the Early Warning Signs (EWS) Form have been activated for completion. The purpose of this is to secure patient safety from the side effects of the medication. There is widespread evidence which clearly links antipsychotic medication contributing to physical health problems such as cardiovascular problems, weight gain, endocrine problems, metabolic syndrome and sudden death (Gumber et al, 2010; Churchword et al, 2009; Tyson et al, 1999). Many premature deaths of people with serious mental illness are due to poor medical care that fails to monitor risk factors which may be due to side effects of medication (Cohen Hove, 2001). A council report by the Royal College of Psychiatrists (2006) revealed that past audits of high dose antipsychotic prescribing for in- patients showed poor adherence to monitoring recommendations. All patients on high dose antipsychotic treatment must be monitored. These guidelines attempt to clarify the identification of patients on high dose antipsychotics, factors to be taken into account before such prescribing and the documentation required when antipsychotics are prescribed in high dose; furthermore it is a polic y requirement of Forth Valley that this documentation is completed for these patients (Forth Valley, 2011). The charge nurse highlighted a concern when evaluating the patients Kardex audit, it showed 100% non-compliance for the completion of the Yes/No response for high dose antipsychotics monitoring. Subsequently when the patients are receiving high dose antipsychotics, there was inconsistency of the completion of the Therapy monitoring form and EWS form. A recent audit of patient Kardexes confirmed the charges nurse finding (see Pareto chart, Appendix B). To begin the process of the quality improvement project, a general ward meeting was held and attended by all staff in the ward that was on shift. During the meeting the charge nurse highlighted the recent findings of the Kardex audit. Concerns were raised that many areas on the Kardex were not being completed, and reminded staff nurses that this is not acceptable and needs to be improved. As a nurse it is extremely important to keep accurate documentation, good record keeping is an fundamental part of nursing practice, and is necessary to the delivery of safe and effective care (Nursing and Midwifery Council, (NMC) 2010). As an attempt to focus the quality improvement project more specifically the results of the audit were presented using a Pareto chart (Appendix B). The data confirmed the areas on the Kardex which were not being completed however, high dose antipsychotic monitoring Yes/No was the highest at 100% non-completion, therefore it was agreed that a new strategy would be implemented to improve this. McLaughlin and Kaluzny (2006) state that the defect focused on does not necessarily need to be the greatest frequency to be improved first, but attention should be given to that defect that may have a devastating result, such as an adverse event or even death. However the defect in this instance was the highest and potentially could cause an adverse event. Following the meeting a questionnaire (Appendix C) was devised and completed anonymously by the pharmacists, consultants and staff nurses to identify the root causes of why this area on the Kardex was not completed. A fishbone diagram was used to illustrate the findings (Appendix D). When populating the fishbone diagram with the data, it was clear to see that there were many reasons that each member of the multidisciplinary team had not completed the applicable area on the Kardex. Role confusion was a common theme from each member of the team. Hill-Smith et al (2012) claims that this is not unusual within multi-disciplinary teams and that respectful communication and clear instructions is of high importance in the delivery of high quality clinical care. Therefore based on these findings PDSA one was developed (Appendix G1). This tested whether the nurse attending the MDT meeting completes the Applicable Y/N on the patients’ Kardex following an email reminder and a verbal promp t from charge nurse before attending the meeting. The test confirmed there was a breakdown in communication, the nurse did not receive the email or a verbal reminder from the charge nurse prior to attending the MDT meeting therefore they were not aware of the procedure that had been discussed and as a consequence the applicable area on the form was not completed, this was confirmed by an audit of the Kardex (Appendix H). This informed the decision for PDSA two (Appendix G2). The nurse coordinating the shift should use the visual prompt situated on the shift coordinating sheet to remind the nurse attending the MDT meeting, to update applicable Y/N on the patients Kardex. The small change of a visual reminder on the shift coordinating sheet proved to be success. It reminded the coordinating nurse to verbally prompt the nurse attending the MDT meeting to complete the patient’s Kardex in the applicable area, which was shown by the Kardex audit after the shift; all patientsâ€℠¢ Kardexes were completed and as a consequently the Therapy form and EWS from were also initiated for completion. These findings are consistent with Simpson (2007) research, where teams have clear operating procedures in place, care coordinating is enhanced. The assumption was that the email and verbally prompt from the charge nurse would result in nurses completing the Applicable Y/N on all patients Kardexes, following the MDT meeting by 23rd February 2014 by 100%. Furthermore, if yes the Therapy form and the EWS form activated for completion. Audits were carried out on the dates shown to give a snapshot of the completion of Applicable Y/N on all patients Kardexes in the IPCU ward at that time. Initial findings of the first audit by the charge nurse on 01/02/2014 revealed that Applicable Y/N was completed 0%. The second audit carried out to confirm the previous results on 08/02/2014 which confirmed the charge nurses findings of 0% compliance of Applicable Y/N. PDSA one was carried out on 10/2/2014 the change revealed 0% improvement in the completion of Applicable Y/N. PDSA two was implemented on 21/2/2014 the change was successful, the results of the audit revealed that Applicable Y/N was completed on all patients Kardexes by 100% this in turn activated the completion of the Therapy form and EWS Form. Comparison of questions, predictions, and analysis of data: Engaging with the quality improvement (QI) project has required me to learn and apply new skills in practice. The process of plan, do, study, act (PDSA) cycles were a new technical skill which I had to not only learn myself, but teach fellow staff nurses on the ward, as this was also, a new process to them. I learnt that PDSA cycles provisionally test an idea by testing a change and assessing its impact. After implementing the first cycle, I learnt that it does not always get the results expected when making changes to your process; it taught me that it was better, and more effective to trial a small change to see if it made a difference, before implementing the change permanently. This also gave staff the opportunity to be involved and offer suggestions and see if the proposed changes would work. I also learnt that communication is an essential and fundamental process during the course of the QI. According to Adams (1999), to persuade others to make an improvement or change, the negotiator must be influential. The Charge nurse in this instance was the influential position to lead change. Unfortunately they were not able to fulfil their obligation in PDSA one, but they carried out the ward meeting and used this as a platform to discuss the Kardex audits with the staff which informed them of the need to make an improvement in practice. Once the need for the new process was established and its principles by the email from the charge nurse, informing the reasoning for a change in practice, this was used as a base for PDSA two. I learnt that it is just as important to define the risk of not making a change (Plummer, 2000) and in this circumstance, changing practice would not only enhance quality of care to patients, but it would promote the involvement between staff nurses and the MDT, building trust and confidence to make the change, whereas the risk of not making the change, could potentially cause an adverse event A final learning point I would like to include was how staff nurses initially were resistant to change. In my opinion from observing, the nurses were quite defensive as though they were being blamed for not doing their job correctly. The questionnaire used was an effective communication tool and successful resource for managing this resistance. It give staff the opportunity to anonymously feedback their reasons for not completing the applicable area on the Kardex, it also let them express their opinion without being condemned. Also, I feel that during this time, they were able to adjust and prepare for the change which minimised resistance (Bernhard and Walsh, 1995). I felt it was essential to take note of all their views as individuals and as team members, which provided further explanation of their reasoning for non-completion. Accountability was a consistent reason used by nurses for their reason for non-completion, as they felt it was a doctor or the pharmacist role and they did not want to be accountable for making the decision. When it was clarified that it was a team decision, by email from the charge nurse, the nursing staff felt supported. Mitchell (2001) states that accountability in nursing is a complex issue and acknowledged the importance of team support in the identification of roles and responsibilities. Frequent ideas and conversations with staff were held over the ten days, in advance of the change in PDSA two which I feel made the improvement successful and run smoother as nursing staff were aware of the new change. I have learnt that within nursing it is important to continually improve the way we work. Working at every level developing the knowledge, technical skills, including leadership, are vital for long-term improvement. Continually learning may be important not only to ensure that we have the skills needed to improve the quality of healthcare, but also to enhance the motivation to do so. Discuss the project’s significance on the local system and any findings that may be generalizable to other systems: Relocation to a new site change what been good practice and now a gap had appeared in the process of monitoring patient. The outcome of this project was a success. It was predicted that by 23rd February 2014 applicable Y/N would be completed by 100%. By establishing the success of the visual prompt in PDSA two on the co-ordinating sheet, was a very small but effective change. As a consequence, at the following staff meeting it was decided that the visual prompt would be a permanent fixture on the coordinating sheet, as it was a sustainable reminder to future shift coordinators, thus improving the initiation of therapy monitoring and EWS forms, and overall patient safety outcomes. Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your reflections on the role of the team? The factors which promoted success in the project were support and leadership from the charge nurse at the beginning of my placement. They helped identify areas in the ward which they felt needed improvement. Furthermore, as a student who had never been in a mental health ward, I felt overwhelmed with the task and this support and guidance helped me through the project. The use of the tools were a great way to involve staff on the ward to feel part of the project and broke down the barriers of pointing blame and focussed their attention in a systematic way, and explored the potential causes of the non-completions. I was amazed as how such a small change help facilitate and test change in a manageable way. I now understand that Quality improvement as a way of approaching change in healthcare that focuses on self-reflection, assessing needs and gaps, and considering how to improve in a multifaceted manner. I feel I have gained an enormous understanding in about quality improvement in that it aims to create an ethos of continuous reflection and a commitment to ongoing improvement. It provides nurses to gain an the skills and knowledge needed to assess the performance of healthcare and individual and population needs, to understand the gaps between current activities and best practice and to have the tools and confidence to develop activities to reduce these gaps Thus, the scan did not focus only on narrowly defined quality improvement models such as ‘plan, do, study, act’ (PDSA) cycles.

Lord of the Flies :: Character Analysis, Jack and Ralph

One’s personality changes over time when it is necessary to adapt to one’s environment or when one suffers or even thrives from another’s actions. In the Lord of the Flies, both Jack and Ralph underwent changes in their personalities, which also affected their relationship. It was obvious in the beginning that Jack would not get along easily with Ralph and Piggy because he ridiculed Piggy for his weight and awkwardness. However, Jack felt threatened because Ralph was voted chief. By saying â€Å"I ought to be chief†¦ because I’m chapter chorister and head boy,† Jack’s overconfidence was shown (Golding 22). On the other hand, there was Ralph, who was taller and more attractive than Jack was, and after being elected leader, he gave part of his power to Jack, displaying his generosity. This was when â€Å"Jack and Ralph smiled at each other with shy liking,† showing the beginning of their friendship (Golding 23). Ralph, starting off as a strong, demanding leader, was most adult-like out of everyone else; he was very concerned about the younger children, shown when he says â€Å"‘We need shelters as a sort of—’ ‘Home’† (Golding 52). Also in the beginning, while they were exploring the island, their â€Å"eyes shining, mouths open, triumphant, they savored the right of domination. They were lifted up; were friends† (Golding 29). Their friendship was already growing at this point. A little later, Jack had made a pathetic attempt to stick a pig, but he let the pig go free. He made an excuse that he â€Å"was choosing a place†¦ just waiting for a moment to decide where to stab him;† however, â€Å"they knew very well why he hadn’t: because of the enormity of the knife descending and cutting into living flesh; because of the unbearable blood† (Golding 31). Then he â€Å"snatched his knife out of the sheath and slammed it into a tree trunk... [a nd] looked around fiercely, daring them to contradict,† expressing not only his violent nature, but also his inability to kill (Golding 31). This also foreshadowed his savage hunting. In chapter two, Ralph calls a second meeting, when he makes up the rule that whoever is holding the conch gets to speak. This demonstrated that he was trying to establish order in some way; however, he was also shown to be a bit irresponsible, when he said that they â€Å"want to have fun† (Golding 37). When they were all making a fire by bringing up wood, â€Å"Ralph found himself alone on a limb with Jack and they grinned at each other, sharing this burden† (Golding 39).

The Importance of Securing equipmen Essay

The ability to be accountable of army equipment is a task given to all Service members. It starts when we first enter basic training. We receive our first issued items from CIF in order to complete all of our task during basic training. We are responsible to inventory and maintain our gear until we are finished with basic training. It is expected that we turn in item that were received in a clean and serviceable condition. After Basic training we move on to AIT and later to our first Unit. As we progress with our military career we become responsible for more gear. Our Platoon leaders and commanders entrust us with more sensitive as we sign not just for our personal gear. We sign for radios, vehicle, Blue Force Trackers and many other items that cannot fall into the hands of the enemy. The loss of any equipment is costly, not only does it cost money but it take time away from the mission while you are waiting for much needed gear. The inability to maintain your equipment potential causes a mission failure or missing a movement. The best method to keep equipment secure is to always have it on your person. The problem with this method is it’s not always possible. Caring around everything would be a very tedious and inefficient process. The next best method is to keep your equipment under lock and key. Keeping that in mind the equipment should be left in a place where security is in place to guard those items. Of course some item will need different levels of security such as weapons. The loss of any equipment can lead to a loss in operational security. You don’t want information much less equipment to fall into enemy hands. This could potentially lead to a loss of life.

Effects of the Black Death Essay

Imagine one half of the world’s population by wiped out in a space of less than a ten years. You probably cannot imagine such an event occurring; it seems unreal. Yet, this very thing happened in the between the years 1347 and 1351 in Europe. This massive destruction of human life was known as the Black Death. This Black Death was an ecological disaster on a global scale. The effects of the plague on human and certain animal populations from East Asia to as far west as Greenland were catastrophic. All facets of society, from peasant to king were affected; no one was safe. All of society was affected; nothing would ever be the same. Thus, there were many economic, social, and political effects of the Black Death. Before one can understand the effects of the Black Death, one must understand precisely what is and what it did. The Black Death was the common name for what is now known today to be three different diseases. The first, and most common of these was Bubonic Plague. The Bubonic Plague lasts for approximately six days. The early symptoms include hemorrhaging and splotches on the skin. Later on, various neurological and psychological disorders can occur. Bubonic Plague is fatal fifty to sixty percent of the time. The other two forms of the Plague, Septicaemic and Pneumonic were both much more rare, but much deadly, killing ninety-five a hundred percent of the time. The Black Death did not originate in Europe, however. It originated in Central Asia, far away from Europe. So how did it get to Europe, and why during the Late Middle Ages? Before the time of the Late Middle Ages, infrastructure was vastly underdeveloped. Thus, diseases spread by humans could not possibly spread far, as most humans did not move too far from their homeland. By the time of the Late Middle Ages, trade and infrastructure had evolved into an advanced state. Trade routes connected all the main cities of Europe to the far away lands of Asia. Now, as the Black Death epidemic began in Asia, it began to slaughter and spread immediately. By the 1350s, two-thirds of China’s population lay dead, but this was just the beginning. The Black Death quickly spread across Central Asia, following the route of the Silk Road. Soon it reached the Middle East, where Italian merchants proceeded to spread it to Europe via their trading  ships. At the time the Black Death reached Europe, the population was in full swing. Population numbers, due to new agricultural methods and other means, were at all time highs. The Black Death would quickly change that. The Black Death, traveling quickly across trading routes covered Europe in the brief span between the years 1347 and 1351. Everywhere from Ireland to Scandinavia to Spain was hit. Once the Black Death hit a town only some were spared. Anywhere from twenty-five to seventy-five percent of a town’s population would perish. And once a town would begin to recover, the Black Death would strike again and again, relentlessly slaughtering thousands. For an event as destructive as the Black Death, the economic effects are vast. After the plague had swept through Europe and reduced the population by a third, a sudden surplus of all items and food drove prices down drastically. In reply to this people began to wildly overspend what was not worth that much. However, after the excess amount of food had been used up, the insufficiency of labor began to make an impact. Prices rapidly shot up, way beyond pre-plague rates. In addition, those laborers who remained soon were in high demand. They realized that their services were rare, and thus they could charge any rate they wanted. In response to this, governments created laws limiting wages. This in turn would later cause peasant revolts in the later 14th Century. However, Some places experienced economic prosperity as a long term consequence of the plague. In addition to the effects on wages, there were other economic effects as well. Towns in the Late Middle Ages were slowly becoming important centers of trade. Towns were the center of commerce, and places were markets were. The Black Death struck these very towns the hardest. Towns, being crowded and infested by rats, were more susceptible to the plague than rural areas. Thus, people abandoned many towns for the safety of the countryside. This heavily stunted trade, as now towns were abandoned, and there was no central location for people to meet and trade. Furthermore, there were many social effects as well. Middle Age culture  became a culture of death and decay. Life became cheap. The stench of death became unavoidable when entering towns and cities. Everywhere there were the dead and the dying. Bodies were literally piled up outside in wheelbarrows, waiting to be dumped. The dead were not treated with respect or dignity. Fear was so great of infection that bodies were simply piled up and dumped in mass graves. People, ignorant of what was causing this terrible catastrophe, blamed those on the margins of society. Others questioned the Church. Why would God inflict such suffering? The Church had no answers, so people began to question it more and more. Some took matters into their own hands. Groups of people, known as flagellants began to go through towns and cities, wiping themselves to appease God. They believed that if they caused enough pain to themselves, then perhaps God would ease their suffering. In addition, the new devaluing of life and questioning of the Church, the fabric that held society together society was ripped. The plague affected everyone from kings to peasants. Soldiers who once protected peasants were no longer there, and survivors were vulnerable to looters and highwaymen. Nobility who once guided society were now deceased, and people could no longer count on them to run manors and provide for general protection against enemies. Nobles could no longer rely on peasants, as they quickly became scarce. In short, the Black Death caused a violent upheaval on society as death became common, and nothing could be trusted. In addition to the many social and economic effects, there were also many political effects of the Black Plague. As stated before, the Black Plague affected virtually all facets of society, including the nobility. The nobility’s ability to effectively assert their power became extremely limited due to the rapid decline of feudalism that occurred due to the plague. The main source of the power of the nobility came from their feudal powers, and once these powers became limited, the ability of the nobles to effect political change also became limited. Before the Black Plague, kings had to take into account the nobles and their ideas. Following the Black Plague, nobles became helpless, unless they agreed to further the kings’ claims and demands. This in turn further centralized power, which was a trend of the 14th Century. The main political effect of the Black Death was  the further loss of power of the nobles in government. The Black Death was the terror of the Middle Ages. Serf and king alike feared it. And where the plague struck, nothing could be the same. Overpopulated towns suddenly became deserted. Flourishing commerce suddenly became dead and empty. Whereas the dead were once respected and taken care of, now they were devalued and thrown in piles. The kings continued to gain in power, due to the weakening of the feudal system. In retrospect, the Black Death was, perhaps, one of the most transforming events in human history. The economy, society, and politics of the time were transformed forever.