Nursing Interventions For Critically Ill Brain Injury Patients

Nursing Interventions For Critically Ill Brain Injury Patients A key priority when caring for a patient with an altered level of consciousness is giving the patient a chance, in which interventions are focused on learning about the patient, protecting and monitoring patient status, talking to the patient and working with the family (Villanueva, 1999). Neuroscience intensive care unit nurses carry numerous interventions when caring for a critically ill traumatic brain injured patient. In this study, their specific interventions, that they routinely perform, are identified. Quantitatively and qualitatively, nurses regularly monitor hemodynamic considerations such as O2 saturation, BP and temperature and other physiological parameters, monitor intracranial pressure and cerebral perfusion, and providing emotional support. While qualitative analyses solely showed that the other nursing interventions that they do could be classified as neurophysiological interventions, psychosocial interventions, injury prevention interventions, and interventions that maintains therapeutic environment. This study would present proofs of the comprehensive role of the neuroscience intensive care unit nurses caring for Traumatic Brain Injured patients and can be used in future researchers that would like to investigate the contribution of neuroscience inte nsive care unit nurses interventions to the progression of the patients condition. After gaining an approval from the institutional review boards and nursing administration, a survey was done to 67 nurses who work in 3 different ICUs from two level-I trauma centers who regularly care for critically ill TBI patients. Those two trauma centers were chosen because they were both comparable in terms of delivery and organization of nursing care, employment ratios, and nurse characteristics so as to not have bias on the study. The respondents were registered nurses that worked for at least 3 months as a full-time or part-time clinical bedside nurse in an ICU that handles critically ill Traumatic Brain Injured patients. They were approached during their unit staff meetings and change-of-shift report times and invited to take part in the study. They were then given a questionnaire which was comprised of 3 parts: Part A was comprised of series of questions about their previously handled TBI patient, part B contained case scenarios wherein they used nursing judgments, and par t C gathered demographic information about the nurse respondents. For the quantitative data, all neuroscience intensive care unit nurses indicated that they were responsible for the monitoring of the patients blood pressure, oxygen saturation, and temperature. And approximately 50% of the nurses indicated that they were also responsible for the monitoring of the ICP and CPP. For the qualitative data, there were 4 categories where in the nurses interventions were grouped. The first one is the Neurophysiological Interventions. It is comprised of monitoring and maintaining the physiological parameters to guarantee neurological stability in TBI patients. In addition to that parameter, they also monitored pulmonary artery and central venous pressure reading, cerebral spinal fluid drainage, serial laboratory values, and carbon dioxide parameters. Keeping these values within the normal range, nurses help TBI patient to prevent secondary brain injury and to uphold neurological stability. The second one is the Psychosocial Interventions. In this category, n urses make meetings between the family member and various members of the healthcare team. Meetings between the family members are held to provide education and background of the plan of care being rendered to the patients and also to give information about the possible patient outcomes and rationales for the therapies. The third one is the Injury Prevention Interventions. This category aims to prevent additional complications to the patient and to ensure patients safety. The primary interventions for this category are maintenance of spine precautions and frequent reorientation of the patient. Other interventions like prevention of skin breakdown and ventilator-associated pneumonia, prevention of falls and evaluation for the need of restraints to prevent disruption of medical devices are considered usual care for any vitally ill patient. The fourth and the last category is Maintaining Therapeutic Milieu. In this category, nurses give suitable environment for the patient and provide t heir special needs. Limiting visitors, decreasing lighting, minimizing noise, avoiding disruption of the patients sleep-wake cycle are the interventions done in this group. All of which are carried out to provide optimal care and rest periods to the patient thus limits further increase in ICP. Neuroscience nurses indeed have an essential part in the care of the critically ill traumatic brain injured patients. Their interventions address the prevention of secondary brain injury and complications and provide significant support and guidance for the family members. Therefore, they have a big contribution to the patients positive outcomes, but there is still no research documenting their multifaceted role on the patients progression. These data are needed to recognize the exceptional contribution of neuroscience ICU nurses as part of the interdisciplinary team caring for TBI patients and as a foundation for future research investigating how ICU nurses impact patient and family recovery from TBI during the acute stage of injury.

Canada At War :: essays research papers

Any war is a horrific event that may last years. Wars leave a legacy of death and destruction. They aren’t just for soldiers and battlefields but for new weapons that make destruction possible on our lands, beneath our seas, and in our air. They bring suffering and death to all families, races and nationalities. No matter where you live during the wars, they can effect you; seeing families destroyed, lives taken and children screaming in horror. In each World War Canada took apart defending their parent country, helping the countries that needed their help. We, as Canadians, should feel proud because many men from our Canadian Troops gave up their families, their friends even their lives to give the countries that needed them the freedom that Canadians had.   Ã‚  Ã‚  Ã‚  Ã‚  The Black Watches were a famous Scottish army command known as the Royal Highland Regiment. The troop was founded when there were threats of local trouble in Scotland. So eight leaders each raised a company of soldiers designed to keep peace. The first duties included controlling the uprising clans in the Scottish Highlands.   Ã‚  Ã‚  Ã‚  Ã‚  The Battalion’s worth as a military was proven on many occasions. The troops were called out to serve for many months on the Canadian border of the Niagara Peninsula and the Eastern Townships during the Fenian Raids of 1886 and 1870. The Canadian Troops also set out in aid of the civil power in 1877 during the Orange Riots, the Quebec riots which were a year later and served at the smallpox Riot of 1885. Due to Canada’s service over seas in Africa, the Royal Highlanders were awarded the battle honour, South Africa 1889-1900.   Ã‚  Ã‚  Ã‚  Ã‚  1905 was the year that the Royal Highlanders Regiment was formally allied with the Black Watch Troops in Scotland, and in 1906 that army was ordered to form a second army. It was the only two-army command stationed in one city for years. On August 1st, 1914 Sir Robert Borden, the Prime Minister of Canada, offered the Black Watch’s of Canada to help Great Britain in a war against Germany, Great Britain accepted the offer. 300 of the men volunteered. During World War I, three more Black Watch armies were formed. By the end of the month the Black Watch has over 1,000 men. Over 60% of the original soldiers were of British origin. During the first acts of war, the Canadian army lost over a hundred officers, and nearly 460 other ranks.

Ethical Counseling Essay

The code of ethics was created to assist and benefit members of the American Counseling Association. The code of ethics mission statement discusses what counselors should aspire to do in an ethical manner and also explains how they can be responsible counselors who protect themselves against complaints. The code of ethics is sometimes revised because individuals of the ACA develop useful material that will protect counselors. The code of ethics focuses on examining benefits of interactions with clients, students, and supervisees within and outside the clinical setting. (Herlihy&Corey, 2006) Similarities in Code of Ethics When comparing the ACA and the AMHCA code of ethics, one will notice they both provide guidance, training and direction toward making ethic decisions for their members. They both explain a variety of professional situations to a practicing counselor. The two codes also share relation due to their commitment of students, employee, and supervisory relationships. When employees become involved with clients this could cause issues and end horribly for all parties involved including companies. Differences in the Code of Ethics One huge difference in the ACA and the AMHAC code of ethics is how violations of the code of ethics are addressed by the organizations and codes. The ACA code of ethics mentions a process for processing ethical violations. The AMHAC does not adjudicate, investigate or mention ethical complaints but it does say actions may be taken regarding a member’s membership based upon their licensure. Record keeping is also different between these two codes. The AMHAC code of ethics has certain guidelines regarding communication, record keeping, use of assessment tools and retention. The ACA code of ethics does not specify such requirements. Future Code of Ethics and Counseling Code of Ethics for counselors was created in order to guide and protect counselors from making unethical decisions and avoiding legal issues. Once I become a counselor I will always refer to the code of ethics, lawyers, mentors, and colleagues for advice with troubling cases. The ethical standards casebook presents different case studies that will allow me to analyze and manage cases of my own. When counseling my clients I will refer to the code of ethics for assurance of unethical choices. The code of ethics will also provide me with guidance and information that will protect me from complaining and dissatisfied clients. Being a counselor involves making ethical decisions and I know decisions will be challenging to arrive at during times. I plan to look at all of my cases in an ethical and professional way. I will take multicultural and diversity values and beliefs into consideration when counseling clients from different cultures. I fully understand that being bias and influencing clients is not ethical performance. (Herlihy&Corey,2006) (page 14) Code of Ethics This course explains the code of ethics and introduces certain dilemmas counselors could very well face while practicing. Referring to the code of ethics may still leave a counselor puzzled as to how to handle a special case if it has not been addressed before. Members of the ACA make revisions to the code of ethics because times are changing and new events occur. I look forward to learning more about ethics, legal and professional issues in this course so I can be an excellent counselor.

Yves Saint Laurent

After a thorough study of your company and a meticulous analysis the information you have given me, I have concluded that if Yves Saint Laurent changes from a differentiation strategy to a differentiation focus strategy, it is possible for YSL to double its profit within three years. The upsides of the change are a 150-percent increase in profit and strong brand awareness in a niche segment whose profile will be described in details hereafter. On the other hand, there are downside risks, including high possibility that Louis Vuitton, Tods and Bulgari will attempt to replicate YSL products since they are close to the targeted positioning as well (See Appendix A). The specific goals for YSL in the next 3 years include focusing on a specific segment of the fashion industry. YSL’s current operations and net sales of $145 million are small, compared to Gucci and even YSL Beaute but they make differentiation focus strategy a suitable and viable option. Furthermore, the prospect of targeting a niche market also arises from YSL’s prominent image as sophisticated sexy and European-chic. Hence, I recommend that YSL develops a focus on men and women who are â€Å"thirty and thriving†. These clienteles are those who are beautiful and sophisticated with a promising career. They are quite successful for their age and seem to â€Å"have, but still want it all† such as young successful entrepreneurs or middle-management investment bankers. The benefits of focusing on clientele who are in their 30s are the solidity of their earnings which will drive stable sales and their tendency toward elegance and departing from pure chic and hip. The other goals that coupled with a targeted niche segment are improving operating margin and sales. With the declining trend in royalties, I recommend that YSL should discount them and focus mainly on operating margin excluding royalties. The milestones are 20% in the 2004, 24% in 2008 and 28% in 2005 which will bring YSL’s operating margin to Vuitton’s vicinity. However, increasing volume in sales should increase as in well in order to gain a more critical mass. The milestones are set as followed: at least $200, 300 and $400 in the first, second and third year respectively. These targets will uniquely reposition YSL since it has a higher operating margin than Hermes and its sales target is much lower than Vuitton which signifies its exclusivity (See Appendix B). Product: There are two products offering options that I would consider: ready-to-wear clothes or leather bags. Both products are desirable in the chosen niche market. Louis Vuitton has a leather-dominant product mix while Hermes would be a more appropriate competitor for read-to-make apparel. It is important that YSL only choose one product on which it can focus because a diverse product mix when implement a differentiation-focus strategy runs a dilution risk. The durability of leather is an advantage with lower product line turnover than apparel. Bags are often viewed as more versatile as a fashionable statement compared to the constantly changing trends in apparel. However, the habit of buying clothes when new season comes around can drive higher sales. In the case that clothing is chosen, it is recommended that the sizes should range from 0-2 and the fit should enunciate our clienteles’ confident figures. These factors contribute to the exclusivity. Also, there are a lot of opportunities for synergies in production. YSL can have production in Italy with the help of Gucci’s excellent suppliers relationship and expertise as well as its own factories in Paris. Price: In order to meet the targeted sales of $400 million after 3 years, if each item is has a premium price of $3000, YSL is aiming to sell 134,000 items in 2005. It is a reasonable estimate considering that after the acquisition of Mendes, YSL will have the capacity to produce and sell at such volume. However, it is recommended that YSL open additional stores (See Place/Distribution Channel). When buying raw materials from suppliers, YSL and Gucci need to collaborate to ask for better discounts. YSL should also sell off any unnecessary factories bought from Mendes in France if it is more economical to produce in Italy with Gucci. Place/Distribution Channels: Gucci and YSl can also share facilities including warehouses in Italy and factories in France. Another recommendation is that YSL should purchase all its licensees, sever contracts with other distributors and wholesale businesses even if they are bringing in earnings. YSL needs an exclusive distribution channel to match the nature of its products. YSL should only sell its products through directly operated stores. YSL need to work with Gucci’s recent revamp team in order to change their store layouts to have a lounge ambience, fitting with the sophisticated 30s. YSL also needs to ask Gucci to pick 15 new locations in Italy for additional stores. There should only be stores in Italy and France to preserve the European charm which is a big part of its brand image and identity. It must close down the distributor in Japan so it can have a complete control over what the stores look like, how the sales representatives dress and behave. Another distribution channel that YSL should explore is the budding e-commerce culture but YSL should retain exclusivity by restricting access unless existing customers have a code authorized by YSL to log in. Promotion: â€Å"A luxurious brand for the most fortunately beautiful people on earth† The phrase should be the tagline for any YSL advertisement and a benchmark to assessing the brand performance. Also, it is important to reiterate the â€Å"fortunately beautiful† in marketing campaign as to reinforcing the exclusivity of the clientele and to anchoring the brand with such clientele. Even the buying experience is unique. It is a negotiation between the salesperson and the customers to determine each other’s fit. Salespeople should be told not to rush a sale and customers are encouraged to make multiple visits to the store before purchasing. In addition, if Gucci has Tom Ford, YSL needs to use Yves’s revered figure in marketing. An image of the young Yves will add to the mystique of the brand and a linkage to a rich history. I hope these recommendations are helpful and I am looking forward to working with you.

Meterology essays

Meterology essays Humankinds ability to predict the weather has come a long way over the past century. It doesnt seem like to long ago that the only way we could forecast weather events as to look at nature. Farmers would look at things such as when the birds migrated, and if there were a ring around the moon to determine if the winter would arrive early, or if it would rain. Today meteorologists have sophisticated radar, computers, and satellites that help them analyze weather patterns and events. With this high-tech equipment, mankinds ability to predict the weather has greatly improved. Oklahoma has one of the best weather forecasting systems in the world. The University of Oklahoma (OU) has one of the best meteorology schools in the entire nation, if not the world. Here young meteorologist wannabes can take part in some of the most cutting edge research. OU has the most powerful weather radar in the entire world, and is home to the NEXRAD. (Nexrad) It also played a rather integral part in demonstrating that Doppler weather radar can be a useful tool in the detection of tornadoes, hail, and other severe weather events. (Weather Center) Its really no surprise that Oklahoma is home to such a prestigious meteorology school. Where else in the world is there a better location for the study of weather than here? Oklahomas weather system is unique. We get more tornadoes per square mile, per year, than any other part of the globe. Hot fronts from the south, cold fronts from the north, and weather systems from across the continent all converge in Oklahoma, making the weather rather volatile. What Meteorologist could resist the lure of studyin g the weather here? With the tornados we constantly receive, theres a constant need for the populace to be warned when bad weather is headed their way. (The Weather Center) Meteorology has helped to shape the technology that we use. ...

Why do good people suffer Research Paper Example | Topics and Well Written Essays - 2250 words

Why do good people suffer - Research Paper Example Do we then simply have to accept things and tell ourselves, â€Å"The Lord gave and the Lord has taken away; may the name of the Lord be praised† (Job 1:21)? Not exactly, for in every human being, there is a natural curiosity to know why things happen, and especially why bad things happen to good people. We may feel angry and bitter at the suffering that good people experience and at all the injustice around us, but the Book of Job and the Scriptures somehow shed light on the idea that these sufferings, especially those of good people, indeed have a spiritual basis. The reasons why good people suffer are mostly implied in the Book of Job in the Hebrew Bible. One of the essential points that the book is trying to emphasize is that God’s will transcends innocence. In simple terms, it means that God will not spare someone from suffering simply because one claims to be innocent. This further means that despite one’s goodness and obedience to God and to His laws, bad things may still happen to him. Job himself actually claims innocence when he states that he has not committed sins like lust, lies, idolatry and adultery. Job also reiterates that he has not failed to help the needy and the poor and his slaves, and that he has not even treated his enemies in an unfair way (Job 31:1-40, New International Version Holy Bible). Nevertheless, Job experiences extreme suffering. All these imply one thing – that God’s will is above man’s innocence. In fact, because of this, Job assumes that God is cruel, where such assumption is evident in the lines â€Å"I cry out to you, God, but you do not answer† (Job 30:20), and, â€Å"You turn on me ruthlessly; with the might of your hand you attack me† (Job 30:21). Indeed, anyone who does not show compassion to the weak and innocent is viewed as cruel. Nevertheless, God remains above man’s innocence and man’s concept of sparing the innocent from suffering. The concept of innocence is actually one which is mostly misunderstood by the layman. Perhaps one reason for this is that man usually equates moral innocence with legal innocence. It is in this respect that man is mistaken. Good people suffer because â€Å"technically speaking there are no good [or innocent] people† (Slick). The apostle Paul echoes this in his Epistle to the Romans, where he says, â€Å"For all have sinned and fall short of the glory of God† (Rom. 3:23). This means that no one is spared from sin. Paul even calls himself â€Å"chief of sinners† (1 Tim. 1:15). Moreover, even Jesus Himself says, â€Å"Why do you call Me good?...No one is good except God alone† (Lk. 18:18). Furthermore, Job’s defense of himself by claiming that he has been a good man all along is actually not even plausible for everyone simply is a sinner, regardless of the good or the bad he has done. It is true that in terms of the law of the country or in terms of rules, it is clear who obeys it and who violates it. However, when it comes to the Scriptures, there are really no good people and that bad things just simply happen to them. What then is the effect of this sin? The apostle Paul describes the effects of sin on the Ephesians: â€Å"Having lost all sensitivity, they have given themselves over to sensuality so as to indulge in every kind of impurity, and they are full of greed† (Eph. 4:19). Thus, sin, according to Paul, leads to more sin. Moreover, sin can lead to various physiological problems such as â€Å"liver problems, diabetes, heart disease† as well as emotional problems like â€Å"guilt, low self-esteem [and] loss of self-respect† (Vandermark). Thus, sin leads to both emotional and physical suffering. Lastly, perhaps the worst effect of sin is stated by the apostle Paul in

Book Assignment Part 5 Essay Example | Topics and Well Written Essays - 1250 words

Book Assignment Part 5 - Essay Example Actors on a historical stage do not just exist; they act, and they act out of the conditions of their character and circumstances. Human life is biographical as well as biological, and it is clear that memory has sense from both of these perspectives. Following Martnez (1994), Wilson and Donnan state that: "transnationalism is the process whereby borderlanders are influenced by, and sometimes share the values, ideas, customs and traditions of, their counterparts across the boundary line" (Wilson and Donnan 1999, p. 5). Unlike the stage actor, whose assumed identity is not taken seriously to represent the self within, the spy must convince skeptical and suspicious others of the reality of an assumed identity, when that assumed identity is in fact false. Thus, the spy poses an interesting case for a psychology of self and identity, especially when the possibilities of double agents or counterspies are considered. In contrast to other borders, the uniqueness of the U.S.-Mexican border is explained by historical relations between the nations and political struggle. The war between the United States and Mexico (1846-48) ended with the defeat of Mexico and its resultant loss of Texas, New Mexico, Arizona, and California. For the first time the Spanish Americans realized that the "Colossus of the North" was a threat to them. Although Mexico has had to accept the loss of half the territory it claimed, that loss is still a source of bitterness. In South America after the wars of independence there were no developments of international importance comparable to those in Mexico. Though for some purposes and in some contexts the 'native' population was treated as homogeneous, there was in colonialism, an ideology and practice of classification' which usually divided that population into further, hierarchically ordered and stereotyped, categories. Sometimes these were very broad: Spaniards in Mexico referred to the 'wild' Indians. This kind of transformation often emerged through an 'ethnic dialectic'. In the colonial classification of indigenous populations there was a dialectical relationship between existing ethnic categories, often those of the locally dominant group with which the colonizers first established contact, or with which they had their most enduring relationship, and the categories of the colonizers' own language and culture. They did not impose or operate solely with a preformed system of classification, nor did they adopt existing systems wholesale. In the shaping and reshaping of indigenous ethnic and cultural pluralism there was a complex i nterplay between colonizers' systems of classification and those of the colonized (which in any case were not timeless or unchanging). The transformation of ethnic space involved various forms of social and political incorporation. "The exploration of Mexican and Mexican-American political values and actions at the border is an early example of ethnicity as a factor which gives character to the borderlands, binds communities to each other across the borderline" (Wilson and Donnan Wilson and Donnan 1999, p. 54) . The relations between the U.S. and Mexico were based on unique cultural values and traditions shaped by both cultures. The historical and sociological process we have