Process Mapping

| PDF | Print | Share Process Mapping – An Overview Back to previous page Process Mapping – An Overview What is it and how can it help me? A map of a patient journey is a visual representation – a picture or model – of the relevant procedures and administrative processes. The map shows how things are and what happens, rather than what should happen. This helps anyone involved see other people's views and roles.It can also help you to diagnose problems and identify areas for improvement. There are different approaches to mapping patient journeys, procedures and administrative processes in healthcare services. Which one you select will depend upon: What you need to know Resources and timescales Engagement and interest of staff Each one gives you a slightly different perspective and there is no definitive right or wrong. The key is to reflect how things are – and not how they should be.Examples of process mapping techniques: A guide to mapping patient journeys – process mapping; a conventional model Process mapping – alternatives ways to conventional process mapping Process templates Walkthrough a patient journey Spaghetti diagram Value added steps A picture of time and resources (process templates) required by a single patient Reviewing the patient pathway; mapping your last ten patients – using patient files and records Getting patient perspectives Care pathway analysis When does it work best?Mapping patient journeys is an essential tool to reduce delays and highlight improvements for patients and staff. Each approach reveals a different perspective. All approaches will reveal: Unnecessary delays Unnecessary steps / unnecessary handovers Duplication of effort / waste Things that don't make sense / not logical Likely hotspots, bottlenecks or constraints Depending upon which approach you use, you will be able to: Identify bottlenecks and constraints Identify and understand variations in clinical practice Deve lop a shared understanding of the problem Build teamsIdentify issues to do with quality of care Gain an in-depth understanding of a patient's perspective Identify steps that don't directly contribute to patient care (those that contribute are sometimes called value added steps) Carry out capacity and demand analysis from core information Mapping things out can also produce brilliant ideas; especially from staff who don't normally have the opportunity to contribute to service improvement, but really know how things work. How to use it You don't need to map everything: concentrate on the area where there is a gap in your understanding, or which needs improvement.Ideally, you will know where the bottleneck is before you go into more detailed mapping as the information you need should be slightly different. The information and level of detail you need depends upon your starting point. Consider the views and perspectives of the people you want to work with to identify the problems and so lutions. Where do I start? What do you need to know? How simple can you go? Are you working at a high level along the whole pathway or focusing in more detail? Whose views do you need? What is the best way to engage them? Do you need to meet with / engage people in advance?How could you capture the patient's view (if the mapping exercise includes part of the service they experience)? Wherever possible, use photographs and pictures of places, staff and equipment in mapping exercises. This brings your representation of ‘how things are' to life. Guide to Conventional Process Mapping Potential impact (on patient journeys) This is often used across teams and Reduces unnecessary delays, time lost due organisations (see mapping the whole patient to duplication and work that doesn't make journey across teams and organisations) to sense, right support for constraints. earn about this mapping technique). Strengths Outcome A range of staff's knowledge about their work Different perspecti ves. (what happens and when it happens) mapped Interpretation is shared. along a patient journey. Staff buy-in for potential improvements. Lots of ideas for improvement. Change or improvement ideas. What it is Usually a big meeting of fifteen to twenty- five people lasting around two to three hours. Team building. Everyone understands the issues, so reduces resistance to change proposals.What resources you need Weaknesses Skilled facilitator (not part of the group). A room. Lead-in time to get the right people in the Effort to set up. room. Cost of external facilitation (unless you Time from the people involved, preferably at a time when there is lease opportunity for are able to get someone from another interruption. part of the organisation). Rolls of paper, post-its. Time – delay in getting going. People who aren't in the room don't get engaged. Lots of ideas for improvement overwhelming, so follow-up doesn't meet expectations.Non-Conventional Process Mapping Potential imp act (on patient journeys) This is often used across teams and Reduces unnecessary delays, time lost due organisations (see process mapping – to duplication and work that doesn't make alternative ways). sense or doesn't ‘add value', right support for constraints. Outcome Usually more quickly accessed knowledge Strengths about a procedure / clinic / administrative process. Details could focus on: Can be planned in a shorter timescale. Walk the patient journey yourself. Set up a mini mapping session. Value added steps.Potential for more detailed information to be produced. A good place to start. A picture of the time and resources Weaknesses (process templates) required by a Could still get silos unless links or single patient. interfaces with other teams Staff buy-in for potential considered. improvements. Change or improvement ideas. What it is (eg different approaches) 1. Walking through the patient journey 2. Set up a mini process mapping session. 3. Follow a patient. 4. Be a patient . What resources you need Clipboard and paper (if doing it by yourself) or flipcharts, rolls of paper and post its. onsidered. Just because there is more detail, it does not (and should) not reflect everything. A judgement call needs to made on what actually would be useful and what is possible to undertake in the time that has been allocated. Tracking paperwork, samples, patients Potential impact (on patient journeys) through a system (see tracer studies to Reduces unnecessary delays, time lost due learn about this technique). to duplication and work that doesn't make sense or does not ‘add value'. Outcome A small number of pathways mapped ie 10 Strengths patient records along key steps and/or staff nteractions. Less resource intensive to set up. What it is A form developed to pick up information as something goes through the system. Collate the information and follow-up either through interviews or group discussion. Identifies steps that are hidden. Level of detail in a contained area. Some staff may feel this approach is more scientific as it focuses on what happened and when, adding weight to the findings. What resources you need Planning time and good communication (staff who are involved need to know what they need to do and why). Weaknesses A good form. Analysis time. Analysis time.Follow-up time (meeting or possibly interviews). Ownership of the results or findings less. Some people may say the sample size is too small. Using patient files and records Potential impact (on patient journeys) (see reviewing the patient pathway: mapping Standardises clinical practice / timescales at key stages of clinical pathway, reduces your last ten patients). unnecessary delays and work that doesn't ‘add value'. Outcome 10 records of patient journeys with timescales Strengths from a defined start and end point. What it is A review of patient records and a follow-up meeting to discuss findings.Relatively quick and easy to focus – it gi ves you a good starting point. Focus on clinically important events and when they happen. What resources you need Access to patient records (this isn't always Comparison across consultant. easy). Time to review the patient records. A room and the right people to discuss the Weaknesses results. Misses out the detail. Misses out the ‘why things happen'. People may say the sample size is too small. Walkthrough a patient journey / patient Potential impact (on patient journeys) shadowing (see process mapping – Reduces unnecessary delays, time lost due alternative ways). o duplication and work that doesn't make sense or doesn't ‘add value'. Delays reduced Outcome due to quality issues picked up from patients' Qualitative perspective of the patient's viewpoints. journey and interactions with staff. See also Strengths getting patient perspectives What it is Someone ‘shadows' a patient taking a tour of all of the steps or some steps in a patient's journey. You can al so walk through the journey talking to staff, but you will miss interaction between patients and staff. What resources you need Someone external to the team to carry out the walk through.Identifies issues that staff may be less happy to highlight in a bigger group. Quality focus. Identifies local solutions with staff that they can take forward. Good way for individuals in a team to see how other teams work. Some preparation. Weaknesses Agreement about what to do with the findings. General ownership of the insights Staff who are skilled at observing / gained (it is recommended someone interviewing doing the walk through. Permission from patients. external to the team does the walk Time to write it up. through). Shadowing does not necessarily provide representative views. Workflows (see spaghetti diagram)Outcome A picture of time wasted from walking / movement of things. Strengths What it is A picture of the actual movement of staff, patients or things eg X-rays through a department. Called a spaghetti diagram as that's what it often looks like. Results of improvements Better layout for a department or ward based on observations. Easy and quick to do. Visual picture reveals a lot and triggers much discussion. Weaknesses What resources you need Someone to observe the movement of the Also its strength – a single perspective person, patient or thing. Preparation and discussion time with team. Flipchart and pens.Compare with evidence based pathways Results following improvement Development towards evidence pathways. based Outcome A comparison of your clinical pathways with existing evidence based pathways. Strengths What it is Uses existing pathway work as a source of knowledge and ideas, links to pathway work: Focus on evidence based care and best practice. Simple vision for the future. Map of Medicine May get people ‘on the same page'. Delivering quality and value Cancer Services Collaborative Partnership Department of Health 18 week programme Weaknes ses NHS Library – Protocols and Pathways What resources you need Preparation.Access to the existing pathway. Meeting room and time with the right people. Flipchart. A focus on ‘right patient, right care, right time' (Source local evidence) May not pick up the reality of what is going on in your pathway (especially in support function).. Currently, only main pathways are available. You must know your own pathway to get the most from it. Care Pathway Analysis Tools Results following improvement Care pathway analysis tools allow health Depends upon the focus of the simulation systems to map out the patient journey as a and the changes made as a result. rocess map. You can then modify this to show the potential impact of new ways of Strengths working, or new technology and practice (see care pathway analysis). Displays ideas for improvement and potential impact without need to make What you get from the analysis actual changes on the ground. The anticipated impact prior to change. Done right, it can save significant resources eg you can see bottlenecks and anticipate the impact Helps to visualise benefits of change. of changes in work patterns around the Can prevent decisions that would make things worse rather than better. ottleneck. The discussions around the results usually What it is lead to direct improvement. It is a simulation software tool. A number of Weaknesses tools are now being developed for the NHS, Generally needs a lot of data and some such as the Scenario Generator. The NHS expertise from information and analytical Institute for Innovation and Improvement has departments as well as facilitation. acquired a free license for each SHA and All models represent a view of the world. The PCT. impact the model simulates may not be what happens.What resources you need Currently, free tools only have limited number Access to the simulation software. of pathways Reasonable standard of computer hardware Not available to some regions. to ensure si mulation runs quickly. You must know your own pathway to get the Analytical expertise. most from it. Additional data. Meetings to develop your model. Good understanding about the strengths and limitations of the approach. Examples â€Å"We want the simplest possible picture of how the process works, and simplest is the key word here.The aim of process mapping is to make things clear – to provide us with insight, and the best map is the simplest map that provides that insight. † The East Midlands Improvement Network Originally from Jones & Mitchell, Lean Enterprise Academy  © NHS Confederation. A high level value stream shows the time taken by each main party in an elective care pathway. This type of map can give you context for more detailed mapping exercises. What next? Be clear about your focus. If you are starting out, select an approach that will give you an overview of the whole pathway. Try to get an experienced facilitator on board to help you out.Be clear abo ut your objectives, ie ask what, why, when, where and how? For example, the scope of your project may be to reduce waiting times for radiology. You know mapping will help you. What do you do? A couple of high level maps would be a good place to 1. Describing the workflow of the department, around diagnostic tests 2. Describing the whole pathway for the most common test These would pick up areas for improvement that are straightforward (for example reducing the number of handovers) and may also pick up problem areas for more detailed mapping exercises.You should make improvements before you get to the next stage. The specific tools will guide you a bit more, but you may find it helpful to refer to the service improvement project guide as a checklist. Some tools that may help you Listening – the importance of this skill will help to ensure all participants' views are acknowledged Managing conflict may help with resistance to change Additional resources Websites: Map of Medicine Map of Medicine is linked to Connecting for Health and is currently available to organisations in the english NHS.NHS Scotland's Centre for Change and Innovation covers measurement, analysis, techniques and solutions for service improvement in health, including a section on mapping. Background The techniques described here originate in the main from the manufacturing industry, with a couple from social sciences. For example, the emphasis and term ‘value stream mapping' comes from an approach called Lean.Directly translated to health, this separates and maps out procedures and work processes that: Directly benefit patients (hands on time, decision making) Supports the benefit of patients (eg staff training) Does not benefit patients (eg time spent looking for something that isn't in the right place) Our knowledge about how to apply these approaches to improve health services is developing all the time. The foundation of this guide originates from the NHS Modernisation Agency, the National Clinical Governance Support Team and the learning and experience of work done by NHS organisations.At present, there is a strong influence from Lean and Six Sigma approaches to mapping pathways, procedures and work processes in healthcare. The other strong influence on health services is the development of evidence based clinical pathways. These are being developed as standardised pathways, using evidence developed by organisations like the National Institute for Clinical Excellence (NICE). Mapping has been used to illustrate the world and how things work pretty much since the beginning of time.Humans navigate by maps, as well as using them to illustrate and make sense of the world. Different maps have different perspectives and uses – which all combine to give us a more balanced overview of any given situation. Acknowledgements / sources The foundation of this guide originates from the NHS Modernisation Agency, the National Clinical Governance Support Team and t he learning and experience of work done by NHS organisations.  © Copyright NHS Institute for Innovation and Improvement 2008  © Copyright NHS Institute for Innovation and Improvement 2006-2012

Develop throughout this play? Essay

      The remains calm about the breaking up of her engagement, and this is something that would not have happened an hour earlier. During the time that Mrs Birling was telling her story, and the fact that she thought whoever was responsible should be sorely punished, Sheila and her, unconsciously change places. Sheila becomes the mother, and Mrs Birling, the child. Throughout Mrs Birling’s elucidation, Sheila is trying to stop her from saying something that she will later regret. Mrs Birling just will not listen to Sheila, and she is acting just as a child would – disobediently. Sheila is trying to protect her family. She does not want others to get involved, although she knows that they will, but she also knows that her mother is making things a lot worse for everybody. This is the place in the play, where Sheila’s maturity is most obvious. Near the end of Act 2, they discover that the man who had got Eva Smith pregnant, was there own Eric. Obviously this affected Sheila, firstly because she knows that now every person in her family is partly responsible for someone’s death, and secondly, because she now knows, that that baby would have been her niece of her nephew. Sheila: Mother – I begged you and begged you to stop. (Act 2, page 49) This was the last line of Act 2, and by this point, everyone knows that everyone in the family played a part in killing that girl, and there was no escaping it. By saying the above, Sheila was blaming her mother for part of the situation. Sheila is not trying to take away her guilt, and put it on her mother, but she needs her mother to understand that she has done wrong. After the Inspector has spoken to Eric, and heard his side of the story, Sheila is the one who tells Eric what his mother had done – she had turned her away. At this news, Eric is absolutely furious. Sheila is the grown-up in all of this. She is the one who explains things, who helps people to understand the situation, and to say what has to be said. Inspector: And you can’t even say ‘I’m sorry, Eva Smith’. (Act 3, page 56) Sheila: That’s the worst of it. (Act 3, page 56) Here, this was the first time that I actually saw Sheila as a totally selfless person. She was not talking, or even thinking about herself. The worst part of all of it, was not that her engagement with Gerald had been called off, or that her evening had been spoilt, but the fact that she could not say that she was sorry, and for Sheila, this was a complete transformation from who she was in the beginning. After the Inspector has left, the family continue to talk about it all. Mr and Mrs Birling are blaming Eric, and he is accepting that. However, Sheila seems to be the only one, who actually understands the predicament. Sheila: I behaved badly too. I know I did. I’m ashamed of it. But now you’re beginning to all over again to pretend that nothing much has happened. (Act 3, page 57) This reveals, that Sheila does have strong feelings for Eva Smith, who has died because of what her family has done. She regrets the mistakes that she has made, and she feels very guilty, but she believes that her parents are acting very irresponsibly. As Sheila and Eric listen to what one another have to say, they become one mind, they both feel the same way, and their parents are a complete contrast to that. We also learn here just how intelligent Sheila is. She is the first person to pick up on the fact the Inspector may be a fake. Sheila: Is that when the Inspector came, just after Father had said that? (Act 3, page 58) She soon after this, says, Sheila: It doesn’t much matter now, of course. (Act 3, page 58) She then continues to make a very relevant speech. Her views and opinions were very close to the Inspector’s, as I said earlier, and this is reflected in her speech. This shows that she was listening carefully to what he had been saying that evening, which shows him a lot of respect. Sheila: If all that’s come out of tonight is true, it doesn’t much matter who made us confess. (Act 3, page 59) This illustrates, that Sheila feels that everything her family had done, has still been done, whether the Inspector was real or not. She has now taken over the Inspector’s role, reminding each member of the family, of their role in contributing towards Eva Smith’s death. Once Gerald has confirmed that the Inspector was a fake, Mr and Mrs Birling are so happy, while Eric and Sheila still strongly believe that they have all behaved in an entirely inappropriate manner. Birling copes with the situation through aggressiveness, unlike the calm and composed attitude of the younger generation. Sheila shows her annoyance and infuriation with the older generation, by saying, Sheila: Don’t let’s start dodging and pretending now. Between us we drove that girl to commit suicide. (Act 3, page 66) This shows that Sheila knows that the girl’s death should be priority, and not trying to pass blame. Following this, Gerald then questions the fact that a girl actually committed suicide, by saying, Gerald: I say – there’s no more evidence we did than there was that that chap was a real Police Inspector. (Act 3, page 66) At first, the family members do not see how this could be possible, but as Gerald then explains how it could be true, they begin to listen to him, and start to understand his point. This shows Gerald’s awareness and intelligence at this point in the play. The confirm his beliefs, Gerald then makes the phone call to the Infirmary, and finds out that no girl has died that night from swallowing disinfectant. People react in different ways to this news. Mr and Mrs Birling have learnt nothing throughout his whole experience, Mr Birling: the whole story’s just a lot of moonshine. (Act 3, page 70) Mrs Birling: In the morning they’ll be as amused as we are. (Act 3, page 71) They are still as they were in the beginning. However, Sheila has changed. Sheila: But you’re forgetting one thing I still can’t forget. Everything we said had happened really happened. If it didn’t end tragically, then that’s lucky for us. But it might have done. (Act 3, page 70) Again, this shows maturity and intelligence. Mr Birling and Sheila, both think that the opposite generation is talking nonsense, but the audience know that Sheila is right. She has learnt from her experience – Mr Birling has not. The play ends, with Mr Birling taking a phone call, saying that a girl had just died in the infirmary, from swallowing some disinfectant. In summary, Sheila’s mature attitude was shown throughout the play, and her guilt and willingness to learn from her mistakes was also displayed. She came through, as a caring and thoughtful character, and an intelligent and realistic girl. Sheila did put forward her feelings, but unfortunately, her parents would not listen. If the whole family had acted similarly to Sheila, then maybe the outcome would not have been so tragic. Word Count: 3, 491 Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE J. B. Priestley section.

Luxor Case Answers

Case question 1 Variable manufacturing costs as a percentage of sales and the markup on variable manufacturing cost to establish the selling prices for each of the three product lines in 2008 en 2010: Compared markup 2008 and 2010: The markup is lower in 2010 because Luxor lowered the selling prices for lipstick in 2009 and for nail polish in 2010. They had to do this because the discount chains continued to put pressure on them to reduce the prices for lipstick and nail polish. Case question 2 The calculation that converts the Wholesale selling price of the 12/31/2008 lipstick inventory shown as $11. 5 million to the â€Å"cost† of $9. million: Case question 3 Assuming the variable manufacturing cost per unit stayed the same in 2009 and 2010, did the sales volume of nail polish (in terms of physical units) increase or decrease after the selling price was reduced in 2010? Explain. Conclusion: The variable manufacturing costs per unit stayed the same over 2009 and 2010. The act ual variable manufacturing costs increased, so it’s clear that the firm has sold more units. Case question 4 The calculation of the breakeven revenue in 2011: The contribution margin % is calculated by multiplying the sales mix with the contribution margin. Case question 5Susan’s proposed budget for 2011 includes a substantial repayment of the bank loan. If the repayment occurs, is the firm likely to break even in 2012? Explain. The loan figures of the company have been stable for the last two years. If the company repays $10 million of the loan with an interest rate of 7%, the firm will save $ 700K a year. If you decrease the fixed costs with 700K, you can calculate the new breakeven revenue: Therefore, it is unlikely that the firm will sell more in 2012. The sales will probably decrease. Our advice is to focus marketing & promotion on the product with the highest contribution margin. Case question 6

International marketing Assignment Example | Topics and Well Written Essays - 750 words

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Caf Survey Statistics Project Example | Topics and Well Written Essays - 1500 words

Caf Survey - Statistics Project Example Among the respondents were sixty nine staff members and one hundred and fifty six students. Among the students, 15 are freshman, 25 are sophomore, 43 are Junior, 64 are Senior and 6 are Graduate Students. From the analysis above, we noted that the largest population of the college of technology is dominated by senior students. From the data obtained we can know the group of students and staff that uses the cafà © and this will help in deciding on amount of food staff to prepare and time. From the survey we found that seventy one of the two hundred and twenty five respondents currently use the Executive Express Cafà © in the College of Business. Among those who currently use the cafà © in the college of business, twenty two are staff members and forty nine are students. On how often do respondents who visit the cafà © in the school of business, 57 respondents do use the cafà © 1-2 times a week, 11 uses the cafà © 3-4 times a week and only three use it a week. This is represented below. On analysis of the purchases made by the respondents, 35 do purchase pizza, 10 purchase Chips, 14purchease Muffins/Bagels, 17 purchase Salad Sandwiches, 18 purchase Cookies/Treat Bars, 12 purchase Yogurt/Pudding, 16 purchase Fruit Cups, 42 purchase Coffee/Specialty Drink and 29 purchase Bottled Drinks/Soda. From this data the most purchased is Coffee/Specialty Drink. The table below shows a breakdown of these results. In conclusion we noted that about 32 percent of the college of technology faculty and staff do currently use the cafà © in the college of business. These results give us an approximate of 480 people from college of technology who currently use the cafà © in college of business. Concerning the data collected to determine how often people of college of technology do use the cafà © in the college of business, I do conclude that most people visit the cafà © twice a week. In detail it is 80 percent of those people who use the cafà © in college of business using it 1-2 times a

Private Search and Seizure and the Fourth Amendment Essay

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Chinas Stocks Head for Weekly Gain on Policy Outlook, Europe Article

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History Essay Example | Topics and Well Written Essays - 500 words - 25

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WA3 Assignment Example | Topics and Well Written Essays - 500 words

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A report on how current provision Essay Example for Free

A report on how current provision Essay Each one of the early years educators has played an important role in setting the foundations that is the basis of the main curriculums and foundation frameworks in schools today. Maria Montessori believed in independence in nurseries and that children should be taught to use their senses first rather than just educating their intellect with subjects such as maths and science. These of course came later in the childrens education but the main focus within her nurseries was to develop observational skills through the environment and learning outdoors, and to provide the children with carefully organised preparatory activities rather than repetition as a means of developing competence in skills. Montessori believed children should be encouraged to take responsibility for their own learning, enabling them to become more independent. The teaching practices of Maria Montessori have been highly influential on current practice as many specialised Montessori nurseries are currently running up and down the country. They promote her curriculum of independency and use many of her approaches to practice such as the idea that the childs freedom, dignity and independence are of paramount importance. In a typical Montessori nursery there is a general atmosphere of children doing things for themselves carefully and competently carrying furniture, setting tables, pouring drinks, washing their hands and following activities which absorb and interest them. This is, in some ways, a very different method to the practices used in government run nurseries etc. as they follow a more standard curriculum where reading and writing are encouraged more formally and learning plans set out at an early age. Some of this practice is reflected within my current placement through the childrens play such as tidying away independently at the end of activities and being responsible for making sure toys are put away before a new activity is begun. In my placement, when the children are told it is tidy up time they know they need to put everything away and must help clear up until the room is tidy. The practitioners join in with the tidying but do not do it for the children, so they are leading by example but are still allowing the children to think for themselves and take responsibility for putting away their own play equipment. During snack time I have also witnessed the children carrying their own chairs through if they are a few chairs short in the hall. This gives the children a sense of independence and is also a good way of developing their gross motor skills and co-ordination. In the key stage 1 classes children are encouraged to pour their own drinks and are given small jobs such as handing out the lunchboxes and folders at lunchtime and the end of the day. These are just a few ways that the children are encouraged to be independent within the school day as well as managing their own hygiene and dressing/undressing independently for a physical education activity. Part of the stepping stones within the foundation stage state that children should be encouraged to dress and undress independently and select and use activities and resources independently, which is exactly what I have witnessed in my previous and current placements. The birth to three matters framework has a similar view on independency as the emotional well-being guidelines for a child focuses on developing healthy independence e. g.activities which provide small steps to be achieved will support all children, including those with disabilities, thus reducing frustration and supporting them to become independent. These clear guidelines from the various frameworks and curriculums undoubtedly show the positive effect Maria Montessori has had on current practice, and that her theories have been widely acknowledged within teaching practice today. Rudolf Steiner set up the Waldorf schools where the main consideration is around practical activities that develop the mind and the imagination. The types of activities that Steiner introduced in his schools were things such as knitting, weaving, playing a musical instrument, woodcarving and painting. These are very much practical based activities and many are still carried on in schools today such as learning to play an instrument. This is seen as an important activity for children in the early years and lessons and clubs for this are seen as mainstream activities. Steiner believed that education should be designed to suit the changing needs of a child as they develop mentally, physically and emotionally. This can be seen in the current practices and provisions as there are different levels and stages of which a child can progress through at their own pace, such as the stepping stones in the birth to three matters and foundation stage curriculum. Each individual child is encouraged within their own abilities to progress with their education and onto the next levels of development and learning within todays practices, and Steiners approach has therefore been influential on many areas of the early years education. His ideas on allowing children to be taught by the same teacher for up to seven years have been adopted in some ways by secondary schools as a class is given the same form tutor for up to five years and then another for two years if they progress to higher education. He believed this was an effective way of giving children stability within schools, and the tutors would almost be like main carers for the children until they left school. Friedrich Froebels kindergarten is the modern day nursery, playgroup or parent and toddlers group. He wanted parents to be fully involved with their childrens learning and play an active role in their childs educational development. This was an important feature of Froebels vision and can be seen in current practices through parent/teacher evenings and the various reports and progress write ups that are sent home to parents from early years settings. The placement I am currently with send home termly reports explaining to parents and carers how their child is doing with regards to education and also to their social, emotional and physical well-being. Froebel believed the role of the mother was to recognise their childs capacity for learning and wanted to encourage the parents to support the children with this, and as you can see from the current approaches to this in early years settings his work has helped to develop the understanding of the importance of the role of a childs family in their learning and nurturing. This is now very much reflected in the governments recent every parent matters agenda. He also believed children learn through structured play at their readiness, in an organised and prepared learning environment. This is similar to the guidelines of the curriculums and frameworks we use today as children are taught through structured activities that are carried out in stimulating environments. The fact that activities and play is structured benefits the teachers immensely as they will always have a clear view of what they need to be teaching the children, and when and where they should be learning specific things. They are also able to plan the day effectively and help each child reach their early learning goals. Structured play benefits the children as they need routine so they know what their day will consist of, and are also able to develop their independent learning skills within a structured, focused and supportive environment. If a childs day has routine or structure to it they are able to feel in control of themselves as they will always know what they are going to be doing, and how much time they have for certain activities. The special materials that Froebel developed to assist his activities were things such as shaped wooden bricks and balls, with which he had a linking set of theories. These types of play resources are used throughout early years settings today. The foundation stage framework states that well planned play is a key way in which children learn with enjoyment and challenge. This clearly shows that Froebel and Isaacss theories have been influential towards current practice and benefit children and teachers through the education policies. I have seen these benefits first hand within my placement. The teachers have the opportunity to plan their lessons and the activities ahead and so are able to plan time for their own personal work and preparation for other lessons into the day, and can inform the children exactly what they will be doing that day, thus giving them a clear, structured routine they can easily follow. Children are able to choose freely within play activities yet each play resource is chosen carefully and all of them can relate to either a certain topic they are doing ect.so the childrens learning of a certain subject can be carried on through their play. The foundation stage curriculum states that well planned play, both indoors and outdoors, is a key way in which young children learn with enjoyment and challenge. Froebels theories have, from this example, been the basis of many of the curriculums ideas on play, and making it structured also allows the teachers to plan and resource a challenging environment that will extend the childrens learning. The curriculum also states that practitioners should be supporting childrens learning through planned play activities, extending and supporting childrens spontaneous play and extending and developing childrens language and communication in their play. Many of these requirements would not be possible if play was not planned or structured, as practitioners would not know what resources the children would be using during the day, and so would not be able to make assessments effectively or develop and extend the childrens learning to their full potential. Froebels theories and early years work mean practitioners and children can benefit from play immensely. Children; in all areas of their development, and practitioners; as it enables them to focus their assessments thus informing future planning to better meet the needs of the children. Margaret McMillan was another early years educator who has inspired and influenced many of the current provisions and practices used today. Her main emphasis was on fresh air, exercise and nourishment, and still influences some aspects of current English nursery practice. Many early years settings regard outdoor play as an important aspect of a childs learning, and gardens and play areas are available for the children at either frequent intervals throughout the day, for a substantial amount of time (as can be seen in the placement I am currently at), or constant access is given. McMillan recognised that imagination is good for society as a whole, an idea that is seen in the educational reforms of the 20th century, and can be clearly seen in the practices within her nurseries today. She believed that children are active learners, meaning they learn whilst doing something (usually playing), a concept that has been brought into current practices as practical activities that involve moving about or using some kind of resource, and especially general play, is now much more emphasised in early years settings than it previously was. Rudolph Steiner also believed that practical play activities were a good developer of the imagination. His Waldorf schools concentrated on activities such as wood-work, knitting and playing musical instruments, which are now mainstream subjects in secondary and primary schools e. g. design technology, which covers all creative areas, and music. Children can develop their creativity, imagination and emotional development through music as well as many other areas of personal learning. Teachers are able to apply their own skills in these creative areas and demonstrate to the children how they can achieve what they are aiming for. By seeing their teachers own personal skill first hand the children will be able to respect and learn from practitioners in a more understanding way. Susan Isaacs was also a believer that play is central to learning, and also that parents/carers are seen as partners, working with teachers and their child to develop and support their childs abilities. This is similar to Froebels theories on parent/teacher relationships in the way that he saw parents as the main educators of young children. This concept is still clearly seen in the practices of early years settings as parents are encouraged to be involved in every aspect of a childs learning, and have the opportunity to work with the teacher in developing their childs abilities. This benefits the children and the parents as both can create a bond with each other through the education of the child, and the parent will be able to understand more fully how their child learns best and how to encourage and support them if they are struggling. Play is still seen as central to learning and parents/carers are seen as partners in helping their child progress through the stepping stones. In my current placement children are given ample time throughout the day to have free play and choose to do whatever interests them. The day is structured (as Froebel believed it should be) so they still have time set aside for number work and writing activities, but are not pushed to complete the more intellectual side of the work as play and active learning are the most emphasised activities throughout the childrens day. This benefits the child in the way that they will have a break from concentrating on the more intellectual side of things and be able to relax, whilst still learning through structured play and various activities. Having the ability to choose will keep them interested in learning about writing and reading as they will feel they are not being forced to learn about them. Friedrich Froebel introduced the idea of structured play and fully involving parents with their childrens learning. His work has been extensively influential on current practice in early years settings today as the basic framework and curriculums that guide children through their learning are based around his ideas about how children should be working with their parents and how carers should be involved in all aspects of their childs learning and development through school, and how children should learn at their own pace and be guided instead of pushed towards their learning goals. The national curriculum states that teachers are required to report  annually to parents on pupils progress through their learning goals. Parents also have a say in whether their children are included in religious education classes and sex education, and are given the right to withdraw their children from it or go to the classes with their children to guide them through it. Secondary and primary schools send home letters to parents informing them when classes such as these will be taking place, and permission slips are enclosed so the school know which children can take part in the classes and which cannot. My current placement sends home a daily report on each child so the parents can see their childs routine for the day including what they played with, how long they slept for, what and how much they ate during the day and generally how they got on. This gives the parents a clear understanding of how their child is getting on in the nursery and allows them to give feedback to the practitioners so they can work together to ensure the child is reaching their full potential in all areas of development. This clearly shows that Froebels ideology of parents being involved in childrens learning has been taken into early years settings today and has had a positive effect on current learning and the guidelines in the curriculum. Parent and toddler groups are also a popular class for parents to attend when their children are young. They allow parents to be fully involved with their childs play, and as children learn most substantially through play this gives the parents a better insight as to how their children learn and what stimulates them most effectively. They can then use this knowledge to help progress their childs learning at home. The foundation stage has the same principles as the national curriculum in the way that parents are encouraged to become involved with their childs learning throughout and to work with the practitioners to extend the childrens learning both in the classroom and at home. According to the foundation stage curriculum, when parents and practitioners work together in early years settings the results have a positive impact on the childs development and learning, therefore each setting should seek to develop an effective partnership with parents. This was one of Froebels main theories  within early years and so current practice has clearly been influenced by this and has expanded on his views to make sure parents, practitioners and children can benefit from his work. Practitioners can listen to any concerns parents have over their childs development and then work with them to find an appropriate solution to the problem. Froebel also recognised the importance of specific training for early childhood teachers. He believed that early years teachers needed more focused training as the early stages of a childs development and education formed the basis of their personalities and eagerness to learn in the future. This may have some contribution to the fact that early years practitioners must undergo specific training in order to become qualified to work in early years settings, such as NNEBs, NVQs and BTECs. My opinion of Froebels work and the research I have done on his theories is that his work has been the most influential on current practice due to the fact that most of his work has been combined with, and been the main basis for many of the guidelines in the curriculums and frameworks used in early years today. The emphasis on active learning is well established within early years settings, but combined with the current guidance from central government upon meeting targets, it is indicated by the inspection of early years settings that play-based learning is not a priority, though the training of practitioners, which Froebel believed was essential, has received considerable attention in recent years, and current practice is now trying to catch up with the ideas Froebel proposed. The role of the mother in childrens learning is not as Froebel expounded due to mothers of young children being encouraged to work rather than stay at home. Teaching and nurturing children in the home is regarded as less effective or desirable than education in more formal, out of home settings, though the parents as partners scheme initiated by the government throughout the curriculums gives parents and practitioners a way of communicating and working together to help the child, so in this way I think his ideas on parents being involved in childrens learning has been responsible for this being put into practice. Friedrich Froebels theories have, in my opinion, been the most influential on early years practitioners, and their approach to practice is guided by many of his ideas and concepts on how children should be learning. His work surrounding the kindergarten (the first form of modern day nursery) produced the framework and theories that practitioners work with and expand on in current practice and so in my opinion his work has had the most effective influence on todays early years educators and their practice, and this evidence suggests his work will continue to be explored and expanded on within the curriculums and frameworks for years to come. Bibliography†¢Bruce T learning through play: babies, toddlers and the foundation years, (2201), Hoddler and Stoughton†¢Tassoni P, BTEC early years (2nd edition), (2006) Heinemann†¢Bruce T, Time to play in early childhood education (1991), Hoddler and Stoughton.

The Motion Detector Sensor Engineering Essay

The Motion Detector Sensor Engineering Essay Home automation is a system that uses to help the resident to do the household activity or housework. These housework or household activity can be from pet feeding, plant watering, home entertainment system and so on. It can be operate either automatically or sometime control remotely which all depend to the home resident [2]. The entire system can be controlled by using from remove control, computer, internet until telephone. The home automation covered very wide of hoe system and it is also including home security system. The home security system basically can be separate to five categories [3], there are: Detection of intrusion Simulation of presence Detection of fire, gas and water Medical alert and precise Safe closing of blind For this project, only 2 categories have been discussed. There are detection of intrusion and detection of fire. And there are 4 types of intrusion which are [3]: i) Detection of movement ii) Magnetic contact of door or window iii) Glass breaking and pressure change iv) Pressure change 2.1 Part research and analysis 2.1.1 Motion detector sensor Only detection of movement has been discussed for this project. In here, the detection of movement means the movement that cause by human being and a motion detector sensor being use to detect the motion. A motion detector sensor can separate to active and passive and it can detect motion by using optics or acoustics. An active motion detector sensor is dispersing a constant field to detect motion. The field will remains static until something is enters it then disturbs the reflected pattern. Meanwhile, a passive motion sensor is waiting in standby mode in order to trigger a threshold setting when motion is detected. However, active and passive technique both have similar disadvantage. They only can sense very limited range that may weaken with distance. As the result, combination of both techniques has been used to gain greater effectiveness to detect the motion [4]. There are several types of motion detector sensor being use in the market [5] for example: i) Infrared motion detector sensor Infrared motion sensor is the most reliable and cheapest among the entire motion sensors available in the market. The concept of infrared motion sensor is using the infrared light spectrum to measure the heat of objects that pass in front of it. Then it will compare the heating level to heating level that cause by objects that behind it. The wavelength infrared wave is between 0.7 and 300 micrometers but shorter than the  wavelength  of  visible light  but longer than microwaves that cannot be detected by human senses but can felt as the heat. This infrared motion detector sensor can be fitted with different lenses to get greater distances. Basically the infrared motion detector sensor separate to 2 types only, there are passive and active infrared motion sensor [6]. The passive infrared sensors will detect electromagnetic radiated energy that generate by external sources like thermal energy emitted by people in the infrared range as figure. The thermal energy will reaches to the sensor that comprise more than one individual  sensor which made from pyroelectric materials. This sensor will generate an electrical voltage according it is heated or cooled [7]. Figure 1: The operation of passive motion infrared sensor [8] Meanwhile, the active infrared sensors will generate a multiple beam pattern of modulated infrared energy and react if it has change in the modulation of the frequency or an interruption in the received energy. The active infrared motion basically consist emitter and receiver pairs to generate IR detection zone. However, this emitter and receiver pairs need to adjust probably to achieve the best balancing between reflected IR energy and transmitted IR energy. This balance is called as the threshold level of reflected IR. If the reflected IR energy significantly above the threshold level, IR motion detector sensor will trigger on as figure: Figure 2: The operation of active motion infrared sensor [9] ii) Microwave motion detector sensor Figure 3: The operation of microwave motion sensor [10] The microwave motion detector sensor is type of active sensor that using radar call  Doppler radar to send out microwaves in order to detect and measure the movement of an object. Then it will receive the returning waves that cause by moving object to determine the distance, direction even the speed of the object. Basically the microwave motion detector has 2 types, they called bistatic and monostatic [11]. The bistatic type contains emitter and receiver which operate separately to configure the beam to fit particular situation. It has a larger detection range which up to 1500 linear feet but it cannot define the area of detection and easy to cause the error [12]. Meanwhile, the monostatic type can define detection area based on microwave beam that it emits. The detection range is smaller than bistatic which only 400 linear feet but it more efficient [12]. Although the microwave motion detector sensor cover a larger area than infrared sensor and more reliable over longer distances, but it is least popular because of their vulnerability to electrical interference and expensive cost [11]. iii) Ultrasonic motion detector sensor Figure 4: The operation of ultrasonic motion sensor [13] An ultrasonic  motion detector sensor will detect the movement by generating the sound wave in the ultrasonic frequency range around 30 kHz to 50 kHz within the limited area [14]. It will generate a cone-shaped sound wave and listen to the echoes. . The sound wave generally inaudible to humans and most animals but it does not pass through most objects. So, if no object is moving within the zone of detection, the pattern of sound wave in its environment and the time that reflected back will remain the same. However, if something moves, the microwave detector will detect and analysis the level or phase of returning sound waves then will trigger on the sensor [14]. Basically this ultrasonic motion detector sensor separated to 2 types, there are active and passive. [15] The active ultrasound motion detector sensors emit sound waves from quartz-crystal transducers then the sound wave will cover within the field of detection. The sound wave will not disrupt if there is no any movement detected. However, the sound wave will disrupt when movement detected and reflected back to receiver. The receiver will sent the signal to control unit and trigger on the sensor by analysis its sensitivity and calibration. Although the microwave motion detector sensor very efficiency in performance, but it is weak in very short of the field of detection that only detectable up to forty feet [15]. Meanwhile the passive motion detector sensors operate on the principle of sounds for example breaking glass to trigger on the sensor. These sounds produce sound waves that detected by the sensors which same concept like the active sensors. The signal will sent to control units to determine if the sound wave pattern falls within established normal parameters [15]. Table below is the summary of technologies to detect the motion: Technique Description Advantages Disadvantages 1) Infrared [6] Active: Generate multiple beam of modulated infrared energy and receive any interrupt or change of received energy Passive: detect electromagnetic radiated energy that generate by external sources like thermal energy i) Low cost ii) Easy to maintain i) Cover very small area 2) Microwave [12] Cover area with electronic field and receive any disturb or movement of electronic field i) Cover large area ii) Quick response i)High cost ii)Too sensitive 3) Ultrasonic [15] Generate sound wave and reflect the sound wave if any disturb or movement i) Cover large area ii) Quick response iii) Long lifetime i) Easy affect by environment vibration ii) High cost Table 1: Summary and comparison of 3 technologies to detect the motion 2.1.2 Heat detector sensor For another category which is detection of fire, there also have several techniques to detect it. These techniques are sensing in temperature, humidity and smoke [3] and sensing in temperature will be discussed in this project. There are few technologies in this market to sense the temperature [16] like table: Technologies Description Advantages Disadvantages 1)Thermocouple [17] Consist junction of 2 types of metal that joined together will produce voltage which varies with temperature change i) can used in wide temperature ii)Fast response i) Low accuracy ii) short life time 2) Resistance thermometer (RTD) [18] Electrical resistance of pure metal will increase with rise of temperature i) High accuracy ii) Good stability i)Slow response ii) High cost 3) Thermistor [19] Type of ceramic resistor that resistance will change with temperature changing i) Accuracy in small scale of temperature range ii) Good vibration i) Limit in small temperature range Table 2: Summary and comparison 3 of technologies to sense the temperature in the market 2.1.3 Wireless system application Short range radio application The table below show that the summary of some short range radio application and characteristics that use in the market. Application Frequency Characteristics Security system 300MHz -500MHz,800MHz,900MHZ Simplicity, easy installation Emergency medical alarms 300MHz-500MHz,800MHz Convenient carrying, long battery life, reliable Computer accessories UHF(Ultra High frequency) High data rates, vary short range, low cost RFID (Radio Frequency Identification) 100kHz to 2.4GHz Vary short range, active or passive transponder Wireless microphone and headphone VHF(Very High Frequency), UHF( Ultra High frequency) Analog high fidelity voice modulation, moderate price Keyless entry(gate opener) UHF(Ultra High Frequency) Miniature transmitter, special coding to prevent duplication Wireless bar code readers 900MHz, 2.4GHz Industrial use, spread spectrum Table 3: Short range radio application [20] Figure 5: Radio communication link diagram [21] Figure above is the radio communication link diagram. In transmitter, the source data will send to encoder to create a group of bits then sent the signal to receiver to make sure that no any false occurrences happen. Then the receiver will check and only accept the signals that the same address bits same with it. The signal that sent which also call message frame has 4 fields [21] like figure: Figure 6: Message frame [21] The first field is called preamble that as start bits to tell the receiver the message begins. Next field is called address, it will identify address and notifies the receiver come from which units that message is coming which sent by transmitter. Then the data field will follow on which it may indicate what type of event is being signaled in some protocols. Finally last field is parity which allows the receiver to determine whether the message was received correctly or not [21]. When several transmitters are used with the same receiver, all transmitters need to have the same identification address which set by receiver where receiver need to be set to recognize the identification address of all the transmitters that used in the system. Table below is the summary of advantage and disadvantages of two addressing system [21]: Advantages Disadvantages Unlimited number of transmitter can be used with a receiver Limited number of bits increase false number and interference from adjacent system Can be used with commercially available data encoder and decoders Device must be opened for coding during installation Transmitter and receiver can be easily replaced without recoding the opposite terminal Must be used with a dedicated microcontroller and cannot be used with standard encoders and decoders Each transmitter is individually recognized by receiver Limited number of transmitters can be used with each receiver Large number of code bits reduces possibility of false number Longer code reduces probability of detection Table 4: Advantages and disadvantages of two addressing system [21] 2.2 Review of similar product No Product Specification Cost Reference 1 Motion detector alarm set Detect motion and activates alarm -Build in high output 105dB alarm -Keypad to arm or disarm and security code -120VAC adapter operate US $24.99 [22] 2 Wireless motion system CWA2000 Transmitter can transmit signal to receiver until half mile away -Activates LED and buzzer on base station when detect motion -Expendable up to 8 motion sensor -Can adjust sensitivity of detection -Receiver required AC power and 4 AA batteries for backup mode -Sensor required 4 AA batteries US $99.00 [23] 3 Skylink SC-10 wireless Home security system -Consists 2 door or window sensors and 2 keychain transmitter -Arm or Disarm by using keychain transmitter -Build in high output 110dB siren -Expendable up to 15 sensors operate by AC power and 4 AA batteries for backup mode US $109.95 [24] 4 Powermax + wireless intruder alarm -Support real time viewing from camera -Consist 3 PIR sensor and 2 magnetic door sensor with wireless -External high output siren -Sent message to user by email, SMS or phone when any incident happened -Support latchkey to inform parent when child arrive to home -Remote home management which provide control and status update up to electrical devices -Required AC power to operate  £257.00 [25] 3.7 Hardware description 3.7.1PIC16F874A microcontroller Figure 14: Pin description of PIC16F874A microcontroller [26] The behavior of the Home Security system basically control by three PIC 16F8XX microcontrollers. The PIC16F8XX microcontroller is under Microchip PIC microcontroller device and very commonly being use because of low-cost, low-power consumption but high speed in performance and I/O flexibility if compare to other device and family. The microcontroller emphasizes almost same function as a microprocessor but PIC Microcontroller only operates at very low speed or frequency which only few MHz or even lower if compare to microprocessors that operate with high speed or frequency. Besides, PIC microcontroller consumes very small among of power consumption which only around miliwatts. So, PIC Microcontroller is more suitable for home security system compared to microprocessor in terms of size, cost, power consumption and the memory to control the input/output devices. They are three types of microcontroller also take into consideration, which are PIC 16F84A [27], PIC16F874A [26] and Atmel-AT89C2051 [28].The comparison was made before the final decision make. Below is the table of comparison between 3 microprocessors: Features Microchip (PIC16F84A) Microchip(PIC16F874A) Atmel(ATmega88V) Instruction 35 single word 35 single word 131 single word Operating speed 20MHz 20MHz 20MHz Flash Program Memory 1024 x 14 words 4k x 14 words 8k x 14words Data Memory(RAM) 68 x 8 bytes 192 x 8 bytes 1k bytes internal SRAM EEPROM 64 x 8 bytes 128 x 8 bytes 512 x 8 bytes I/O Port 13 33 23 Counter/timer 1 3 2 Counter bit 8 bits 16 bits 16 bits Series Interface (MSSP) -In-Circuit Serial Programmingâ„ ¢ (ICSPâ„ ¢) via two pins Synchronous Serial Port (SSP) with SPIâ„ ¢ (Master mode) I ²Câ„ ¢ (Master/Slave) Master/Slave SPI Serial Interface Byte-oriented 2-wire Serial Interface (Philips I ²C compatible) Operating Voltage 2.0V-5.5V 2.0V 5.5V 1.8V 5.5V Software MPLAB ® IDE MPLAB ICD2 MPLAB ® IDE MPLAB ICD2 ATAVRISP

Recruiting Nurses in Rural Communities

Recruiting Nurses in Rural Communities B. Trimble Perceptions of nurse practitioner students on clinical rotations in rural health care areas, and the likelihood of practicing in a rural area. With the current primary care provider shortages in rural areas, could the key be the use of nurse practitioners, to ultimately, fill the gap in medical services? How satisfied are patients with a nurse practitioner’s services? How do communities recruit and keep nurse practitioners? What role do rural clinical rotations play in the recruitment of nurse practitioner graduates for practice in rural areas? Rural communities have difficulty recruiting and retaining primary care providers. With the number of aging providers looking at retirement and the lack of medical school graduates interested in primary care, the need will be further increased. The national shortage of primary care providers has many communities searching for help. Meeting the current needs is difficult and the need for services is expected to increase as the rural population ages and the enactment of the patient protection and affordable care act. Advanced practice registered nurses, whom studies show can provide care that is safe and as effective as a physician, are a powerful solution to the problem of the shortage in primary care providers and rising health care costs. There are currently 189,000 nurse practitioners, 35,000 nurse anesthetist, and 18,500 certified nurse-midwives in the United States according to the American Association of Nurse Practitioners (American Association of Nurse Practitioners, 2014). Nurse practitioners play a pivotal role in providing necessary medical care to the underserved of rural communities. A need for studies that examine the experiences of rural health care providers, to assess the barriers and the facilitators for nurse practitioner practice are needed. Offering mentorships, in the rural areas, may be another way to increase interest of the nurse practitioners in rural areas. As the new health care laws become effective, the need will increase. The purpose of this study is to examine how incorporating rural health rotations, in training of nurse practitioner students, may improve on the recruitment of nurse practitioner graduates into the rural healthcare sector. In rural health centers, nurse practitioners fill key leadership positions. In a study on rural health clinic efficiency and the impacts made by nurse practitioners and physician assistants, indicated that rural health centers that used nurse practitioners had a high rate for expertise in quality care and cost effectiveness (Ortiz, Wan, Meemon, Paeth, Agiro, 2010). The purpose of the study was to investigate the impact of nurse practitioners to rural health clinics yield, determine the association of proficiency indicators, and understand specific and organizational factors that affect productivity. The questions posed were as follows: Does rural health clinic’s performance vary contingent on nurse practitioner staffing? To what extent do nurse practitioners influence productivity? What are characteristics of highly productive rural health clinics? (Ortiz, Wan, Meemon, Paeth, Agiro, 2010). . The study suggests that, employments of higher portions of nurse practitioners has a definite stance on productivity, and are able to handle a larger number of patients without adding professional staff. Process efficiency in clinics with a large percent of licensed staff tends to use larger numbers of nurse practitioners. Clinic size is definitely associated with industrial efficiency. The larger the clinic’s professional percentage, the higher the efficiency or production observed. The clinics able to maximize the value of nurse practitioners are the most cost effective in providing health care amenities. The conclusion of the study was that the use of nurse practitioners and physician assistants increased productivity and cost effectiveness in clinics that maximized the use of these medical professionals. There is a need for further studies to determine the contribution of nurse practitioners. Future research would involve risk adjustment factors to assess the effects of patient demographics and socioeconomic aspects. In addition, the evaluation of observational information would provide a better understanding of the nurse practitioner involvments. (Ortiz, Wan, Meemon, Paeth, Agiro, 2010). In a study conducted by Ryan and Rahman in urgent care centers, to determine what factors influence the satisfaction of care provided by nurse practitioners, it was determined that the care provided was scored positive. The scores were higher for those noted to be uninsured as compared to those with insurance. A descriptive study including four urgent care centers using two to four nurse practitioners was used for the study. Two of the four urgent care centers were excluded from the study, due to weather conditions. Patients were asked to complete a post visit review and sealed in an envelope after completion. Participant inclusion was they had to be 18 years of age, be able to read, write and comprehend English. The survey contained five questions on demographics and thirteen items where ten assessed the clarity of the nurse practitioner role. Approval was granted from Shenandoah University IRB and the four participating urgent care centers. No enhancements were offered to participants for participation in the study. Examining factors that affect patient satisfaction, with nurse practitioners in rural urgent care centers studies showed that there was a high rate of patient satisfaction regardless of age, insurance, race, or gender. The clarity of the nurse practitioner role was significantly different between participants that were uninsured as compared to those with insurance. The uninsured rated the experience higher than those with insurance. The overall scores for satisfaction with care were positive. Several of the patients were unaware they were being treated by nurse practitioners until the after treatment survey. This implies that the care was comparable to what had been provided by physicians in the past. The American healthcare system has not been able to meet the demands for accessible, low-cost medical care. Rural areas face a shortage of healthcare providers as family physicians retire and current graduate physicians decide to enter into specialties rather than general practice. Nurs e practitioners can fill the gap in medical providers. The role of the nurse practitioner is on the increase in rural areas that are underserved and are well accepted by colleagues and patients. Nurse practitioners provide competent care; this and previous studies have confirmed that patients are highly satisfied with primary care provided by nurse practitioners (Ryan, 2012). In a qualitative study by Boynton Sharp, to explore the factors related to the recruitment and retaining of nurse practitioners in rural areas, it was determined that nurse practitioners are more likely to accept a position in rural healthcare after having completed at least one clinical practicum in a rural setting (Boynton Sharp, 2010). In this study, the sample size was 29 nurse practitioners from across the United States. The data collection method was semi-structured interviews. Analysis of categories and themes determined that three of the concepts of rural nursing theory were applicable. It was anticipated that the knowledge gained would contribute to understanding nurse practitioner choices to practice in rural areas, to determine the developing rural nurse practitioner educational programs and existing federal agencies involved in recruiting and retainment nurse practitioners, in rural areas. A qualitative study using a focused ethnographic approach was used to explore the cultural construction of rural nurse practitioner roles. A conceptual model analysis from the theory of cultural marginality was developed. The marginality framework was developed to provide a basis for data collection and analysis. Data set used interviews conducted using audio/video tapes of electronic media interviews through web conferencing, except two interviews were conducted by telephone. Data analysis was through transcription of interviews; at the end of the analysis three concepts from the rural nursing theory were identified. Lack of anonymity was subdivided into respect and annoyance. Outsider versus insider status was defined, not as being an insider in the community, but as an outsider in the medical community. Permission to conduct the study was granted by the University of Texas at El Paso’s IRB. Names of participants did not appear anywhere in the report or research. This study identified the three concepts of the rural nursing theory. In the study, the nurse practitioners did not find the lack of anonymity to be an annoyance, but viewed it as a part of being an effective medical care provider. The study indicated that nurse practitioners are well accepted by the community members. However, nurse practitioners are not always accepted by the existing medical community. Self-reliance was indicated by the nurse practitioner’s ability to function alone and make independent decisions related to their clinical practice. Due to differences between urban and rural care needs, it is important that nurse practitioner students be given an appreciation for the uniqueness and benefits of rural practice including a) limited access to healthcare, b) limited resources, and c) distance to specialists. This can be accomplished through changes in didactic and clinical components of nurse practitioner educational programs. Nurse practitioners who accept positions in rural areas most often have a background in rural areas, have participated in a rural training program, or have a desire to serve in a rural community. Completion of a rural program is associated with accepting a position in a rural practice. In this study, 72% of the nurse practitioners completed at least one rural clinical practicum. This supports the importance of rural training as an effective strategy in recruitment of nurse practitioners for rural areas (Boynton Sharp, 2010). In another study published by Purdue University (Richards, 2011) stated that as practitioner students are subjected to underserved populations, they are able to better understand the complicated clinical situation, which also confronts nurse practitioners to provide valuable and professional, high quality safe and cost efficient patient care. The practitioner students rotated through the clinics; this was found to improve the staff role in clinical knowledge, strengthen the evidence of clinically relevant research, and enhance the classroom instructions and assignments. The rotations made class instruction and assignments more meaningful when the students observed the instruction being used in a clinical setting. The experience integrated previous subject matter and allowed practitioner students to develop skills in a supportive and strengthened environment. Allowing students to perform alongside nurse practitioners, help to develop mentoring and educational relationships, regard for others capability, and improves comprehension of the nurse practitioner role. The staff roles shifted from the expert to a mutually supportive learning association (Richards, 2011). The advanced practice nurse can serve to fill the gap in primary health care. Nurse practitioners can provide quality, cost effective care to these communities, offsetting the limited access and rising health care costs. Access to primary health care is essential in maintaining and improving health. Those who have regular primary health care receive more preventative services, are more likely to comply with prescribed treatments, and have lower rates of illness and preventive deaths. To ensure recruitment and retainment of nurse practitioners in these areas, it is important to increase the nurse practitioner student experience with clinical rotations in rural or underserved areas. References American Association of Nurse Practitioners. (2014). NP Fact Sheet. Retrieved from AANP.org: http://www.aanp.org/all-about-nps/np-fact-sheet Boynton Sharp, D. M. (2010). Factors related to the recruitment and retention of nurse practitioners in rural areas. (3409167), 110. Ann Arbor, Mi, United States: ProQuest, LLC. Retrieved March 29, 2014, from http://search.proquest.com.southuniversity.libproxy.edmc.edu/docview/613695577?accountid=87314 Ortiz, J., Wan, T., Meemon, N., Paeth, S., Agiro, A. (2010, July/August). Contextual Correlates of Rural Health Clinics Efficiency: Analysis of Nurse Practitioners Contributions. Journal for Health Care Leaders, 28(4), 237-44. Retrieved March 20, 2014, from http://www.medscape.com/viewarticle/729490_1 Richards, E. (2011). The role of nursing students at two rural nurse managed health clinics. School of Nursing Faculty Publications (paper 4). Purdue University. Doi:10.1080/07370016.2011.539086 Ryan, K. D.-C. (2012, February 1). Examining Factors Influencing Patient Satisfaction With Nurse Practitioners in Rural Urgent Care Centers. Journal of American Academy of Nurse Practitioners, 24(2), 77-81. Doi:10.1111/j.1745.7599.2011.00688.x

A Clockwork Orange Essay: The Future Dystopia -- Clockwork Orange Essa

The Future Dystopia in A Clockwork Orange      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A Clockwork Orange is an anti-utopian novel, describing an imminent future in a stately supervised country. The hero Alex revolts against the state using violence and is therefore locked up. Later he is turned into a harmless subject without free will, incapable of committing any crime.    Burgess paints a future outlook of a land that is still committed to democracy, yet has already adapted radical methods facing youth criminality. There are several indications leading to the supposition that the general form of the government is a socialist one, e.g. the teenage slang called Nadsat which handles chiefly Russian vocabulary, streets named after personalities like Yuri Gagarin and paintings of nude working men in the style of Russian socialist art. So the state is on the say to become totalitarian, after the example of many communist countries.    In addition Alex lives in a society which lacks individualism and opposition. Under the strict governmental rule ordinary citizens are deceived end benumbed by TV and drugs. Moreover books and newspapers are hardly read, theatres and cinemas rarely visited. Everything is done to prevent normal subjects from thinking.    The few people representing an opposition against the government are hooligans like Alex and political reactionaries like Mr. Alexander and his friends. Hooligans are relatively held under control by a strong police force, reactionaries don't have any support from the people. Indeed there is a regular opposition in the country, yet it seems to come into terms with the ruling party.    This leads us back to Burgess' opinion that we should not trust the state. The hero Alex is in fact ... ...tine Books, 1984, (1965), S. 171-177 Hahn, Ronald M. und Volker Jansen. Uhrwerk Orange, in: Hahn, Ronald M. und Volker Jansen. Kultfilme: Von "Metropolis" bis "Rocky Horror Picture Show". 4. Auflage. Mà ¼nchen: Wilhelm Heyne Verlag, 1990, (1985), S. 293-303 Kagan, Norrnan. A Clockwork Orange, in: Kagan, Norman. The Cinema of Stanley Kubrick. New Expanded Edition. New York: The Continuum Publishing Company, 1989, ( 1972), S.167-187 Melchior, Claus. Zeittafel zu Leben und Werk von Anthony Burgess, in: Burgess, Anthony. A Clockwork Orange. 1. Auflage. Stuttgart: Phillip Reclam jun., 1992, S. 247-249 Melchior ,Claus. Nachwort, in: Burgess, Anthony. A Clockwork Orange. 1. Auflage. Stuttgart: Phillip Reclam jun., 1992, S. 251-260 Rabinovitz, Rubin: Ethical Values in Anthony Burgess' A Clockwork Orange, in: Studies in the Novel, 11 (1979) S. 43-50

The Green Mile :: essays research papers

The Green Mile was about a murder of two girls. When the father is told by the mother that the 2 little girls are missing, he gets a whole crowwd together to look for the little girls. They find the girls in the arms of a huge black man (I had to add the about the color of his skin because this part of the story takes place in the 30's and we all know how strong racism was back then). We later find that the man's name us John Coffey. (Just like the drink but not spelled the same.) They take John to jail and everyone is impressed by how large he is. He has huge muscles and he towers over everone. The guard in charge of the green mile goes into the cell that John Coffey is in and removes the cuffs from John's hands. The guard notices that John is very gentle and very kind, and that he has something very special. So for the first couple days The guard watched John carefully, he caused no trouble and John was also quiet. In the first few weeks, they got another prisoner, his name was Wild Bill.Wild Bill was in-fact very wild, he even tried to attack the guards while he was coming in. In the end we all find out that Wild Bill killed (murdered) the two little girls that John Coffey had been convicted of killing. John however, still was sentenced to death. At 11:30 pm the next day John Coffey walked down the green mile. John was placed in the electric chair (ol' sparky) and they placed the mask over his head John told the guard to take off the mask because he was afraid of the dark, and he didnt want to die in the dark. So the guard took off the mask, then placed the wet sponge on his head, they pulled the hood down and put that over top of the wet sponge. The guard yelled "Roll on 2" and they pulled the lever. John Coffey was dead. The guards were so sad they cried, some of them quit just because if that incident. They knew he was innocent but they couldent do anything about it. I think that the books were sad, and very heart pounding.

Inspire to educate Essay

Education is an avenue that enables the production of individuals who knows the proper way to live, learn and work together for the foundation of a strong community. Each and every child deserves the chance to be educated. Such learning must be the kind that involves challenges and stimulates them to achieve their maximum potential. On the Importance of Education The importance of education is quite clear. Education is the knowledge of putting one’s potentials to maximum use. One can safely say that a human being is not in the proper sense till he is educated. This importance of education is basically for two reasons. The first is that the training of a human mind is not complete without education. Education makes man a right thinker. It tells man how to think and how to make decisions. The second reason for the importance of education is that only through the attainment of education, man is enabled to receive information from the external world; to acquaint himself with past history and receive all necessary information regarding the present. Without education, man is as though in a closed room and with education he finds himself in a room with all its windows open towards the outside world (Khan, 2007). Education has an immense impact on the human society. One can safely assume that a person is not in the proper sense till he is educated. It trains the human mind to think the right decisions. In other words, man becomes rational when he is educated. It is through education that knowledge and information is received and spread throughout the world. An educated person cannot read and write and hence he is closed to all the knowledge and wisdom he can gain through books and other mediums. In other words, he is shut off from the outside world. In contrast, an educated man lives in a room with all its windows open towards the outside world. The quality of human resource of a nation is easily judged by the number of literate people living in it. This is to say that education is a must if a nation aspires to achieve growth and development and more importantly sustain it. This may well explain the fact that rich and developed nations of the world have very high literacy rate and productive human resource. In fact these nations have started imparting selective training and education programs so as to meet the new technical and business demands of the 21st century. Keeping the importance of education in mind, the US Department of Education aims to promote student achievement and preparation for global competitiveness by fostering educational excellence and ensuring equal access. It also establishes policies regarding federal financial aid for education, and distributing as well as monitoring those funds. It also continuously strives to focus national attention on key educational issues and providing equal access to education. The importance of education cannot be neglected by any nation. And in today’s world, the role of education has become even more vital. It is an absolute necessity for economic and social development of any nation (Goel, 2007). Inspiring Children to Learn At one of their forums organized by the Walden University entitled â€Å"M. S. In Education: Teaching in Linguistically and Culturally Diverse Classrooms,† the speakers addressed the issue on how to be able to inspire the children to learn, especially the ones who due to their culture are not supported by their family to succeed in their education. This is what they have to say: Set and environment where they choose to become inspired, where the students choose to make the decision. Many families who are from ethnic minorities are not people who have traditionally been successful in school. You need to initiate the phone call to the parents on a consistent basis and let them know how important they are to their children’s education. Do it in ways that are consistent and that show people you care. This is an idea that transcends culture. A mother’s love for a child transcends culture. If you can get through to the mother, that’s what transcends. You can really be proud of knowing that you have changed a life. I have never met a parent who wasn’t interested in his or her child doing well in school. Don’t think you can motivate people. You set an environment where people elect to be motivated and ultimately empowered. It’s a choice that people make and that sets them up for success. Don’t give up on anyone. Understand people’s prior knowledge of schools, where they came from. Give them a message of hope and inclusion. Don’t give up and don’t try to motivate. Set this environment, and you’ll meet with unexpected success (Walden 2006). The need for such environment has never been so great. As educators, we need to trace the path that realizes the many needs of our children. We’ve come to the realization that we cannot do it alone. We need the role of the parents as part of the team. This involvement nonetheless affirms the role of the parents as primary stakeholders in their children’s future, particularly in education. A team whose aim is to be able to provide for our children a great investment that they made be able to reach their true promise. This teamwork is headed to achieve an increased engagement in the advocacy of parents on behalf of their children’s opportunities in learning. We are after molding fully developed citizens who will do good things to their community in return. Academic achievements are only a bonus and not an end in itself. The realization of the importance of education forbids us to deny our children the ability to achieve their fullest promises. Through this light, we cannot deny our society the benefits of our children’s untapped talents. References Alrisala Organization. (2007). The Importance of Education.Retrieved December 8, 2007 from www. alrisala. org/Articles/mailing_list/importance_of_education. html. SearchWarp. com. (2007, July 6). The Importance of Education. Retrieved December 8, 2007 from http://searchwarp. com/swa230219. html. Results for America. (2007). Learn More About Education. Retrieved December 7, 2007 from http://www. resultsforamerica. org/education/learn. php. Walden University. (2006, June 6). M. S. in Education: Teaching in Linguistically and Culturally Diverse Classrooms. Retrieved December 6, 2007 from www. waldenu. edu/c/Files/DocsSOE/Q-a_Ed_DiverseClassrooms. doc.

Helen Essay

1. Helen’s responsibilities to each of the following groups: a. The Accounting   Department and the University –Helen’s responsibility to the Accounting   Department and the University is to uphold honour and pride. Every student is an emissary and a reflection of his or her alma mater. b. Other students in the class and in the department- Helen’s responsibility to the other students in the class and in the department is to encourage truthfulness. Being one of the top students, it is inevitable for the other students and the department to look up to her. c. Big & Apple LLC-Helen’s responsibility to the Big & Apple LLC is to uphold integrity, trust and loyalty. The accounting firm invited her to join them with the intention and hope to hire the best and well-suited person for the job. d. The professor of Accounting 544- Helen’s responsibility to the professor of Accounting 544 is to maintain credibility and respect to his teachings. e. Her bestfriend- Helen’s responsibility to her bestfriend is to promote trustworthiness. Someone who cannot be trusted with little cannot be trusted with much. f. Herself- Helen’s responsibility to herself is to defend her integrity. Cheating is simply a deception of one’s self. 2. From an integrity perspective, Helen should walk away from the opportunity to take a copy of the final exam from the professor’s mailbox.   Because once she gets caught, she might end up not graduating at all aside from totally losing her summa cum laude standing. In other words, she will get expelled. However, if she doesn’t get caught, she might repeat again this mistake and ruining her integrity and somehow degrading her dignity as an accountant. 3. If I were Helen and I have a goal of qualifying for summa cum laude, I would reconsider my priorities and curb time for some things that would not contribute to the attainment of my goal. I would rather consult my professors should I have a hard time dealing with my courses. I would devote more time to studying so as not to compromise the ethics that I stick by. 4. Assuming that the Empire State University provides a $5,000 award to all students who graduate summa cum laude, I will stand by my decision to uphold integrity. Because integrity is not something that you do today and forget tomorrow should the circumstances change. Integrity is the code of value that you stick by. Integrity is who you are no matter what. 5. There should be a consequence for the student who provided the exam to Helen. Because the very act of getting the exam from the professor’s mailbox is stealing and cheating. 6. Should the Empire State University have an honor code my answer would be the same. Because I personally believe in integrity and as I’ve said in my previous answer (number 4) integrity is not something that you do today and forget tomorrow should the circumstances change. 7. As a fellow student in Accounting 544 with Helen, I might feel cheated on and disappointed if I found out about what she did. I might feel that way because I could have been doing things truthfully, looking up to her, and believing that she has done things honestly to get the highest academic honor only to find out that it should not be hers. It would simply be unfair to the class,disrespect to the professor, dishonour to the university, and unethical to accounting.