(Love you mother and father in Romanian) many individuals here today most likely didn't comprehend what I just said in light of the fact...
Wednesday, August 26, 2020
(Love you mother and father in Romanian) many individuals here today most likely didn't comprehend what I just said in light of the fact that I am Romanian, yet in the event that you investigate my folks face they realize I love them. I am Romanian and my folks went to the U.S. also, could have picked any state however they picked Washington. For all the individuals who don't acknowledge Washington as much as me let me set out certain vibes. After I went to Arizona and California and some different states I came to understand that everything here is so a lot greener. Washington has the best-tasting faucet water and truly, there is a distinction in taste of water. Did you realize Washington has a wonderful kelp backwoods? Individuals from all around the globe come here to make a plunge our sea to see our kelp woods. On the off chance that you need some speculation tips put resources into kelp cause there will be a major blast in that industry. The city of Seattle is one of the best. I t is so aesthetic and everybody here is so pleasant. I just felt I should call attention to that we have perhaps the best state in the United States. The magnificence of doing a graduation discourse is you get the opportunity to state what ever you need. I felt that would have been simple however, as I think back through the four years of secondary school the main time I composed something was the point at which I was relegated it. So you would think such a youthful flourishing psyche would exploit this and hold nothing back out. So I composed and composed and well, I continued wasting time. I viewed other initiation speakers from the HBN chronicle talk about our future and understood that they had some truly extravagant expressions of exhortation. Presently I realize I can't offer you guidance on the future since I don't have the experience. What I will give you individuals here today is some evaluation An information about a spot that you all may not of ev... ...iday collection. That is the excellence of The Simpsons, it doesn't make a difference how stupid you are everybody has their place in the city. They keep consistent with them selves and in the long run there snapshot of popularity will come. Everybody, know your Simpsons! Presently I need to leave as much as all you individuals, it just appears as if the most recent day will never end. So I simply need to state regard one another and never abandon any you had always wanted in light of the fact that you get one life and you should make it a great one. So as we leave I need all of you to realize that I have the all the best for every one of you and if any of you see my comic book, Stickmen Revolution, available to be purchased feel free to get me out a piece. I leave you with a joke, (Romanian Joke) I know some of you may experience considerable difficulties getting that however on the off chance that you investigate my folks' faces that was, that was an extremely amusing joke. For The Revolution!
Posted by Evette Correia at 10:12 AM
Saturday, August 22, 2020
In the book Bless Me, Ultima, Ultima is an elderly person who was welcome to remain at our hero house, Antonio, to live the rest of her existence with the Marez family. Yet, there is a contention to who is Ultima, a witch or curandera? Ultima considers herself a curandera, somebody who utilizes herbs and old traditions to recuperate another person, however a few people in the book consider her a bruja, which is Spanish for witch. Ultima is known as a witch ordinarily in the novel yet neither denies nor acknowledges the allegation. The Author of the book, Anaya Rudolfo leaves us with the topic of who truly was Ultima, a witch or curandera? As I would see it I accept that Ultima is a witch. All through the novel Ultima shows numerous attributes of being a witch and in this paper I will give you how Ultima is a witch. First is the connection among Ultima and the owl. In the book when Ultima moves in with the Marez family, an owl follows. The owl can be an image of witch and is even said so in the novel, Ã¢â¬Å"In numerous cuentos I had heard the owl was one of the camouflages a bruja tookÃ¢â¬ ¦Ã¢â¬ (pg13). Ultima has an exceptionally solid association with the owl and is even said that the owl was UltimaÃ¢â¬â¢s soul or life power. A case of Ultima and the owl being a similar individual is toward the finish of the novel when Antonio covers the owl, Ã¢â¬Å"Ã¢â¬ ¦ and after mass we would take her body [Ultima] to the function in las Pasturas for internment. In any case, that would just be recommended by custom. Ultima was truly covered here. TonightÃ¢â¬ (pg262). That citation implies that when Antonio covered the owl he was likewise covering Ultima since they shared spirits. In the event that Ultima has the spirit of witch, at that point she herself must be abhorrent. Another underhanded association among Ultima and the owl is when in page 134 of the book UltimaÃ¢â¬â¢s owl tears out TenorioÃ¢â¬â¢s eye. On the off chance that Ultima was actually a curandera would she truly harmed a man, when her obligation of a curandera was to help and help individuals? Next are the demonstrations of Ultima. Ultima shows many witch like character when she was relieving Lucas. First was that she had dolls of the three witches and she had utilized them like voodoo dolls, Ã¢â¬Å"Ã¢â¬ ¦and when he inhaled on them they appeared to wriggle in her grasp. I shivered to see those earth dolls take life. At that point she took pinsÃ¢â¬ ¦she stuck a pin into each dollÃ¢â¬ (pg101). Here Ultima seems to do some malicious voodoo custom. A curandera depends on herbs and nature to mend individuals and not insidious voodoo. Second is the way that she reviled somebody, Ã¢â¬Å"Ã¢â¬ ¦ and what you looked to do will fix youÃ¢â¬ (pg101). Here is the place Ultima was evacuating the revile that was put on Lucas, AntonioÃ¢â¬â¢s uncle. Ultima doesn't just expel the revile yet sends it back to witches that reviled Lucas. On the off chance that she was a curandera shouldnÃ¢â¬â¢t she have the aims to just mend Lucas rather than likewise reviling the witches as well? Last is the statement Ã¢â¬Å"You must comprehend that when anyone, bruja or curandera, cleric r miscreant, alters the destiny of a man that occasionally a chain of occasions is sent into movement over which nobody will have extreme control. Ã¢â¬ This occurs and it prompts passing of TenorioÃ¢â¬â¢s girl, angering him, to execute Narciso. Ultima knew this and it wound up murdering a man. Could this have been a malicious plot by Ultima? Last is the wellspring of UltimaÃ¢â¬â¢s powers. The possibility of UltimaÃ¢â¬â¢s powers are raised in page 93, Ã¢â¬Å"Toma, Tenorio yelled. He crossed his fingers and held the indication of the cross before UltimaÃ¢â¬â¢s face. She didn't budgeÃ¢â¬ ¦Either she was not a bruja, or their perspective, she had powers that had a place with the fiend himself. Ã¢â¬ It is workable for Ultima to have the forces of the fallen angel on the grounds that off all the past reasons recorded. She has done malevolence for the reasons appear previously and now since she can take the cross you can see that she has powers more grounded than a witch, or even powers Ã¢â¬Å"from the fallen angel himselfÃ¢â¬ . To additional confirmation of her fallen angel skilled forces you can see from this statement, Ã¢â¬Å"Would the enchantment of Ultima be more grounded than all the forces of the holy people and the blessed mother churchÃ¢â¬ ¦Ã¢â¬ (pg97). Here you can see that UltimaÃ¢â¬â¢s powers are not of the congregation and are more grounded. Last is a definitive test that was made in the book. Ultima was given the test to stroll through an entryway that had the characteristic of a cross made by two favored needles. She effectively experiences the entryway however with a special case. Everybody returns home reasoning she isn't a witch, yet Antonio finds the needles on the ground. In the event that the needles were on the ground, at that point Ultima could have strolled through the entryway easily. Ultima could have disrupted the needles when the possibility of the test was first welcomed on. Her thumping down the needles can demonstrate her dread of God and everything sacred, saying she is a witch. Taking everything into account you can see that Ultima is a witch. She has a profound association with a creature that is supposed to be a witch, which is her owl. Ultima additionally has the spirit of a witch. Ultima has drilled voodoo in the book alongside reviling others. At long last her forces are from the villain himself. Due to all the reasons expressed I accept that Ultima is a witch in the story Bless Me, Ultima.
Posted by Evette Correia at 7:50 AM
Monday, August 17, 2020
Phenibut Withdrawal Symptoms, Timeline & Treatment Addiction Coping and Recovery Overcoming Addiction Print How Long Does Withdrawal From Phenibut Last? By Corinne OâKeefe Osborn linkedin Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Learn about our editorial policy Corinne OâKeefe Osborn Updated on August 07, 2019 Verywell / Gary Ferster More in Addiction Coping and Recovery Overcoming Addiction Methods and Support Personal Stories Alcohol Use Addictive Behaviors Drug Use Nicotine Use In This Article Table of Contents Expand Overview Signs & Symptoms Coping & Relief Warnings Long-Term Treatment Resources View All Back To Top Phenibut (Ã-phenyl-?-aminobutyric acid) is a psychoactive medication developed in Russia during the nineteen-sixties. It was, and remains, approved there to treat a variety of disorders, including insomnia, anxiety, and depression. Because phenibut was never approved by the FDA, it remains unavailable here as a prescription medication. Although it is still unknown to most Americans, phenibut use has grown in recent years due to its widespread availability on the internet. Phenibut can now be easily purchased online as a âdietary supplement.â Phenibut is used and abused for a variety of purposes. As a central nervous system depressant, it can relieve anxiety and induce euphoria. This makes it an appealing alternative to people struggling with alcohol or opioid dependence. It is less sedating than some other anti-anxiety medications because it also contains stimulating and nootropic properties. Nootropics, also known as smart drugs, help to increase focus. Due to these combined effects, phenibut is often used to reduce social anxiety, become more sociable, and get work or studying done. Unfortunately, phenibut tolerance can develop within weeks of occasional use. This leads people to take higher and higher doses, increasing the likelihood of a difficult withdrawal experience. Overview Phenibut is a synthetic, designer drug, but its chemical structure is very similar to that of a naturally occurring amino acid known as GABA. Because GABA and other amino acids are proteins, according to the FDA, GABA is technically a âfoodâ and not a drug. It is through this loophole that phenibut, a GABA lookalike, can be legally bought and sold in the U.S.?? People often assume that legal nutritional supplements are safer than illegal drugs, even when taken daily in large doses. Unfortunately, this is not the case. There are many risks to taking unregulated nutritional supplements like phenibut, and chief among them is the potential for dependence and withdrawal. Reports have begun surfacing of phenibut withdrawal symptoms so severe that people require hospitalization.?? These symptoms are usually both physical and psychological. Symptoms can include severe anxiety and agitation along with tremors, nausea, and vomiting. There have been reports of serious psychotic symptoms such as auditory and visual hallucinations, delusions, and paranoia.?? Withdrawal symptoms may appear anywhere from several hours to several days after your last dose. Symptoms may be combined with an intense desire to use more phenibut. If you experience intense cravings, then your phenibut abuse may have evolved into an addiction. Signs Symptoms Phenibut withdrawal is different for everyone. Some people take large daily doses for a year but donât experience withdrawal, or see only mild effects. Other people take moderate doses two to three times a week for a few months and end up suffering severe symptoms when they try to stop. Still, others take high doses for only a few consecutive days and end up in the hospital. Doctors and researchers in this part of the world have little understanding of phenibut withdrawal. It is not easily recognized in clinical settings and there are no standard treatment protocols. What little we do know about phenibut withdrawal syndrome comes from case reports published in medical journals and self-reported descriptions in online forums. Phenibut withdrawal can begin in as little as three to four hours after your last dose. Acute symptoms can last for several days and are sometimes followed by a period of protracted withdrawal lasting weeks or months.?? The physical symptoms can be very distressing, but it is usually the psychological symptoms that drive people to seek medical attention. Psychological hallucinations delusions dissociation suicidal thoughts anxiety depression panic attacks Physical tremors muscle rigidity sweating nausea vomiting fast heart rate seizures fatigue There have been several reported cases of extreme psychotic symptoms stemming from phenibut intoxication and withdrawal. People have come to the emergency room after experiencing visual and auditory hallucinations.?? One person described seeing dragons, flashes of color, and disturbing sexual images.?? Others have described a sense of dissociation or a feeling of unreality. Delusions, psychosis, and suicidal thoughts or acts have also been reported.?? Many people experience extreme agitation and anxiety. In several of the reported cases of intoxication and withdrawal, both physical and chemical restraints were necessary for the safety of both the patient and medical staff. Three patients required IV sedation so intense that they needed breathing tubes.?? While these examples are worst-case scenario, milder psychological symptoms are not uncommon. In online message boards, many people describe feeling like they are âgoing insaneâ or âstuck in hell.â People describe panic attacks, depression, suicidal thoughts, and severe insomnia. Physical symptoms like tremors, muscle rigidity, and sweating all contribute to intense insomnia. Some people even experience âbrain zapsâ when they try to sleep. Depression and fatigue cause problems for many people, who find it difficult to fulfill their normal responsibility at home, work, or school. Depression and rebound anxiety may continue for several weeks after the acute symptoms of withdrawal resolve. How Do You Know If Youre Having Hallucinations? Coping Relief First of all, if you experience hallucinations, suicidal thoughts, or extreme agitation, seek emergency medical attention right away. Phenibut withdrawal can be severe, so many people opt for medication-assisted detox. While there is no standard treatment protocol, there are several medications that can help treat your acute symptoms and increase your chances of quitting phenibut successfully. Trying to treat your withdrawal symptoms at home with prescription drugs or supplements is not a good idea. Treating phenibut withdrawal is difficult and people respond differently to the medications available. Medications that work for some people may make your symptoms worse. Inpatient treatment at your local emergency room or detox clinic ensures access to a variety of prescription medications. Medications that have been used to treat severe acute symptoms of phenibut withdrawal in inpatient settings include the following sedatives and anti-psychotics:?? Dexmedetomidine PhenobarbitalPropofolHaloperidolBenzodiazepines For people without severe psychological symptoms like hallucinations, delirium, or agitation, the following prescription medications may be taken at home. It is important to work with a doctor to gradually taper these medications. BaclofenGabapentinBenzodiazepines (diazepam, lorazepam, others)ClonidinePregabalinPhenobarbitalZolpidem, Benadryl, or other sleep medsAnti-depressants In anecdotal reports, most people respond to either a baclofen or gabapentin taper. These two medications are structurally similar to phenibut, so they act as a substitute to prevent withdrawal. However, you may need to reduce your phenibut dose before you make the switch. In one case study of an individual taking high doses of phenibut, doctors found that 8 to 10mg of baclofen could be substituted for one gram of phenibut.?? Their treatment protocol involved reducing daily phenibut intake by about 0.5 to 3g each week. For example, 8g daily during week one, 5g daily during week three, and down to 1g by week six. During this taper, doctors simultaneously prescribed gradually larger doses of baclofen, peaking at 60mg during week six, then tapering down.?? This was one of the only reported case studies that included a phenibut taper, but according to anecdotal reports, a gradual taper is one of the most common self-directed withdrawal treatments. The members of the subreddit r/quittingphenibut recommend reducing your dose by about 10-100mg per day. During your taper, the short-term use of benzodiazepines and sleep meds can help you manage acute anxiety and insomnia. Go to a primary care doctor or psychiatrist for help. They can help you develop a plan. Discussions in online forums also include a variety of supplements that may help ease withdrawal in some people. Frequently mentioned supplements include: L-theanineMagnesiumKavaAshwagandha Warnings Phenibut withdrawal can be very dangerous. More dangerous than most other withdrawal syndromes. Attempting to quit cold turkey very bad idea and could increase your risk of seizures, insomnia, and psychosis. Your best bet is to make a plan to quit phenibut. Inpatient detox is hands down the safest way to quit. At an inpatient detox facility, hospital, or addiction clinic, you will be met with a team of specialists who can help get you through withdrawal with the least amount of discomfort possible. Many insurance plans cover detox and addiction treatment. If you canât or wonât do inpatient treatment, then at least see a doctor before you quit. That way you are prepared with a tapering plan and prescription medications to treat your symptoms. Arrange to take the first three or four days off of work. Make sure you have someone to help monitor you for signs of danger and assist with at-home responsibilities like childcare. Be prepared to meet with some resistance at the hospital or doctorâs office. Most doctors in the U.S. have very little experience with phenibut dependence and withdrawal. Even addiction specialists may be unaware of the severity of phenibut withdrawal. You may need to educate your doctor about phenibut, so make sure to have an article or case report keyed up on your phone. Even better, print one out. Long-Term Treatment Many people with phenibut dependence require a long-term treatment plan. Long-term addiction treatment focuses on preventing relapse. Relapses are common among phenibut users who may go months without the drug then decide they are âreadyâ to handle it again in small doses, or for occasional use only. This type of thinking typically leads straight back to dependence and addiction. Your long-term treatment plan will need to address any current or prior dependence on other drugs or alcohol. If you started using phenibut to help you quit drinking, then quitting phenibut increases your risk of relapsing with alcohol. Research shows that people addicted to drugs require at least three months of treatment to quit successfully. If you have a co-occurring alcohol use disorder, treatment will be an ongoing process that you will have to deal with for many years to come, especially during times of high stress.?? There is another group of people who may require more specialized care. If you began using phenibut to treat anxiety, depression, or post-traumatic stress disorder, these symptoms are likely to reemerge after withdrawal. It is imperative that you seek treatment for these underlying disorders. Otherwise, you are at risk of relapsing with phenibut or other non-therapeutic drugs. Evidence-based treatments for single or multi-substance abuse include varying combinations of behavioral therapy and medications.?? The same is true for people with co-occurring substance abuse and mental health issues. Behavioral therapy can take several forms. You may work with a therapist, psychologist, or a prescribing psychiatrist. Many people benefit from residential treatment programs, which provide an opportunity to stay in a healing environment for several weeks after your withdrawal. Other people prefer to seek treatment on an outpatient basis. Often supplementing behavioral therapy with peer-based support groups like Narcotics Anonymous or Alcoholics Anonymous. Resources Phenibut dependence is not widely understood or recognized, but that doesnât mean it isnât real. Check out this message board full of people going through the same thing as you: r/quittingphenibut. When you are ready to get serious about quitting, start by making an appointment with your primary care doctor, psychiatrist, or local health clinic. Your doctor can help refer you to the best place for treatment. Look for someplace that accepts your insurance. To find a doctor who specializes in addiction treatment, use this searchable directory from the Substance Abuse and Mental Health Services Administration (SAMHSA). You can also call SAMHSAâs national helpline at 1-800-662-HELP (4357). A Word From Verywell When you first sought out phenibut, you were not looking to pick up another addiction. Maybe you used to help you get off alcohol, kratom, or benzos. Maybe you have severe anxiety. Whatever your reasons, expect those issues to arise again during and after your phenibut withdrawal. It is going to be hard, and symptoms may linger for weeks, but you will get through it. Once the brain fog is lifted, and the vicious withdrawal cycles are over, you will be free to live your life. How Long Should You Expect Withdrawal Symptoms to Last?
Posted by Evette Correia at 11:54 PM
Sunday, May 24, 2020
Using Animals Symbolically by Using Poetic Devices I will be discussing the ways in which the poets use animals symbolically by using poetic devices. The three poems that I have chosen are Ã¢â¬Å"The TygerÃ¢â¬ by William Blake, Ã¢â¬Å"The EagleÃ¢â¬ by Alfred, Lord Tennyson. Lastly, Pied Beauty by Gerard Manley Hopkins. Alfred Lord Tennyson has used an image of an eagle to give the reader an image of a man standing on a cliff top waiting for his world to fall around him. He is in a desolate area; there is no society near him Ã¢â¬Å"ringed with the azure world. He standsÃ¢â¬ . He watches the sea pass lower than him his world collapses beneath him n he falls. Ã¢â¬Å"And like a thunderbolt he fallsÃ¢â¬ The sun has symbolized God. And his closeness to the eagle.Ã¢â¬ ¦show more contentÃ¢â¬ ¦However, the poem is trying to tell us that the eagle is standing Ã¢â¬Å"close to the sun in lonely landsÃ¢â¬ and that the enormous sea is beneath him. These are the ways that the poet has used the eagle symbolically and to illustrate his strength and power standing high in the sky. Ã¢â¬Å"Tyger! Tyger! Burning brightÃ¢â¬ This is an example from Ã¢â¬Å"The TygerÃ¢â¬ Metaphors of fire and blazing are emphasize by duplication of the Ã¢â¬Å"BÃ¢â¬ sound. The Ã¢â¬Å"BÃ¢â¬ sound makes it stronger and powerful to use. My second choice is Ã¢â¬Å"Pied BeautyÃ¢â¬ . Gerard Manley Hopkins who was born in 1844 wrote this poem. The poem is tells us about all the different creatures that God has shaped. Explaining how for many belongings in nature there is a contradictory. He is also telling the reader that we should be thankful towards it and the entire God gifted. In the poem, there are uses of some oxymoronÃ¢â¬â¢s by using them it shows the different extremes that exist within nature. This is similar to the Tyger. In addition, that shows the readers that to keep the balance on the planet God has created an opposite. Ã¢â¬Å"Adazzle, dimÃ¢â¬ . Ã¢â¬Å"With swift, slow; sweet, sourÃ¢â¬ He uses animals as one of GodÃ¢â¬â¢s gift for our nature and used them symbolically for the exquisiteness of the planet. My third choice of poem is Ã¢â¬Å"The TygerÃ¢â¬ written by William Blake. This poem shows the evilness of theShow MoreRelatedHow Does Randall Jarrell Use the Imagery in DurerÃ¢â¬Å¡ÃâÃ ´s Engraving of the Knight, the Devil and Death to Symbolically Convey a Philosophy of Life Using Powerful Poetic Devices?1131 Words Ã |Ã 5 PagesHow does Randall Jarrell use the imagery in DurerÃ¢â¬â¢s engraving of the knight, the devil and death to symbolically convey a philosophy of life using powerful poetic devices? Ã¢â¬ËThe knight, Death and the DevilÃ¢â¬â¢ poem written by Randall Jarrell, based on the engraving by German artist Ã¢â¬ËAlbert DurerÃ¢â¬â¢ depicting a valiant knight, on horseback treading along the path of life. A path beset on all sides by many obstacles, and the dark forces ranged against the knight in his journey. Created in 1513, DurerÃ¢â¬â¢sRead MoreEssay on Sacrifice to the Signifier, in Comic Praise of the Logos1345 Words Ã |Ã 6 Pageswhich composes a prominent pattern of response to the words of others. I see what you mean, I see it clearly now, IÃ¢â¬â¢ve seen the light, etc.Ã¢â¬âsuch a pattern of response pins abstract cognition to sensual particularity. Furthermore, the rhetorical/poetic category of imagery suggests similar principles of anchorage. Vividness, clarity, scope, proportionality, elegance, and other criteria for rhetorical excellence all imply firm grounding in the utilities and pleasures of sight. The prominence ofRead MoreAmerican Literature11652 Words Ã |Ã 47 Pagesis poetry ? Poetry goes beyond the rhyming of words. The object of writing a poem is usually to make a very complicated statement using as few words as possible; as Laurence Perrine says, poetry may be defined as a kind of language that says more and says it more intensely than does ordinary language (517). 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The following line from Robert Frosts poem Acquainted with the Night provides us with an example of alliteration,: I have stood still and stopped the sound of feet. The repetition of the s sound creates a sense of quiet, reinforcing the meaning of the line 3. allegory Ã¢â¬â Where every aspect of a story is representative, usually symbolicRead MoreAn Analysis of Sacrifice in Arthur Millers All My Sons4310 Words Ã |Ã 18 Pageshairline crackÃ¢â¬ is a reminder of the seriousness of the consequences of JoeÃ¢â¬â¢s actions: something similar to some major elements in the plot is only revealed after close inspection. This symbolism, although minor in the theme of sacrifice, is a linkage device between the small and the large: between the microscopic hairline crack and the macroscopic outcome: the family sacrifice and the humanity sacrifice. 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Those incidents that are the most significant will be emphasized and expanded into full-fledged dramatic scenes by using such devices as description, dialogue and action. Other incidents will be given relatively less emphasis through deliberate subordination. In the latter case, the author may shorten the dramatic elements of the scene or eliminate them altogether in favourRead MoreEssay on Silent Spring - Rachel Carson30092 Words Ã |Ã 121 Pagesher older brother and sister enjoyed a compara tively stimulating childhood. A great reader and passionate naturalist, Maria Carson left an especially deep imprint on her youngest child. While still quite young, Rachel began writing stories about animals, and by age ten, she had published a prize-winning magazine piece. In 1925, Carson earned a scholarship for Pennsylvania Womens College where she hoped to prepare herself for a literary career by majoring in English. As had always been her habitRead MoreMetz Film Language a Semiotics of the Cinema PDF100902 Words Ã |Ã 316 Pagesmovie). They spontaneously appeal to his sense of beliefÃ¢â¬ânever, of course, entirely, but more intensely than do the other arts, and occasionally films are, even in the absolute, very convincing. They speak to us with the accents of true evidence, using the argument that It is so. With ease they make the kind of statements a linguist would call fully assertive and which, moreover, are usually taken at face value. There is a filmic mode, which is the mode of presence, and to a great extent it is
Posted by Evette Correia at 8:16 AM
Wednesday, May 13, 2020
The Uncertainty of Minority Identity in Claude McKay s America Claude McKay was simultaneously a central and a peripheral figure in the Harlem Renaissance. McKay s name is inextricably linked with this poetic movement; his work was included in Alain Locke s seminal anthology The New Negro: An Interpretation (1925), cementing not only his success as a contemporary poet but also his significance as a black poet in America. However, McKay is an unusual case in that, unlike other notable Harlem poets like Langston Hughes or Gwendolyn Bennett, he was not born in America. McKay moved from his native Jamaica to America when he was 22, he was already a grown man and an established poet by the time he experienced life in a racially dividedÃ¢â¬ ¦show more contentÃ¢â¬ ¦McKay inserts himself into the canonical literary history of the sonnet, exploiting this mainstream, traditional form to discuss the issue of unstable identities experienced by marginalised groups in America. Robert Smith argues that the sonnet form s rise and fall seemed quite the thing for the thought [McKay] wished to convey to his readers (Smith 273). The oscillation of sonnets between contradictory ideas allows McKay to riddle America with contesting descriptions of America, all of which destabilise the speaker s feelings towards this country, as the love which he explicitly claims to feel is undercut by consistent qualifications and mitigations. The unconventionality of McKay s type of rise and fall (Smith 273) lies in the continual nature of this oscillation; there is not just one turning point in America, it is perpetually twisting and turning as it navigates the experience of the speaker as a member of an oppressed group. Although the poem starts with ostensibly negative images of a feminised America feeding the speaker bread of bitterness (2) as she sinks into my throat her tiger s tooth (2). The plosives in the tight-knit phrase bread of bitterness create forceful, heavy sounds , sitting on the tongue uncomfortably, just like the unpalatable bread itself. The inversion of syntax in the following line is also awkward, foregrounding the act of violence being
Posted by Evette Correia at 11:51 AM
Wednesday, May 6, 2020
CombÃ¢â¬â¢s are not high margin companies individually, and the internet is a great way to cut down on the sales cost and time to close for deals. As mentioned above, SAP offers two Ã¢â¬Å"solutionsÃ¢â¬ for CombÃ¢â¬â¢s: SAP Business One ND mynas All-in-One. SAP even discloses that 60% of their implementations fit into the SMB category (a large number considering it was earlier stated that 15% of revenue comes from such clients). We will write a custom essay sample on Smb Company or any similar topic only for you Order Now The category is defined in a related article sponsored by SAP done by DC (a global market intelligence and advisory firm) the SMB category is made up of businesses with fewer than 1,000 employees. SAP Business One SAP Business One is targeted at companies from 10 to several hundred employees. It includes the basic CRM, manufacturing and finance components of the ERP software, the so-called Ã¢â¬Å"criticalÃ¢â¬ functions. It is billed as an ass to implement, understand and upgrade solution that integrates with Microsoft Office applications. ItÃ¢â¬â¢s repeatedly referred to as an affordable solution which solves the problems of multiple systems for multiple uses (what ERP does for any business). The following is an outline of the capabilities of SAP Business One, which is implemented through business partners. Most companies have some form of application or software system that handles financial, inventory and customer data, intelligence and reporting. 9 www. Sap. Com Looking through the demos available through SAPÃ¢â¬â¢s website, the interfaces appear to e straightforward and robust, but not an open-the-box solution such as Microsoft Office. There would still need to be some kind of training to get an organization up to speed on the software. Case in Point: Annexation Federal One organization that successfully used this approach is Annexation Federal, a systems integrator to U. S. Federal government agencies. The company, which designs, sources, and installs voice and data telecommunications systems, struggled with a variety of legacy systems from prior mergers. The company needed a single, integrated solution that could handle the omelet demands of managing high-end telecommunications projects while providing greater flexibility, better reporting, and enhanced data visibility throughout the organization. Annexation Federal saw a demonstration of the product, which proved to its financial team that SAP Business One could support the companyÃ¢â¬â¢s current and future accounting and financial systems needs. The organization recognized that the SAP Business One features were precisely what was needed to help manage the order- to- cash process accurately tracking order and sales from multiple vendors, billing contracts in a timely manner, monitoring work in progress, ND accurately calculating contract profitability. Implementing SAP Business One in less than six weeks, the company was able to create a seamless path from initial quote to purchase order through 7 invoices. With SAP Business One, we were able to streamline multiple solutions down to Just one and simultaneously achieve much wider functionality than we had previously, says Duane Taylor, vice president of finance for Annexation Federal. Today, the company is able to more effectively get the information it needs from its system, creating dramatic benefits. For example, the reconciliation of financial data at he end of each fiscal period once took as much as three weeks with employees working overtime. With SAP Business One, the company generates the needed department were redirected, saving more than $300,000 annually. Accounts receivable collections improved as a result of the availability of information, saving $1. 5 million. In addition, soft benefits such as improved communications, better visibility, and enhanced customer responsiveness have also been noted. The net result: Annexation Federal received payback on its investment in Just four months. (from SAP. Com) mynas All-in-One mynas All-in-One consists of solutions which are re-packaged and industry specific. They are versions of the mynas Business Suite engineered for turn-key application. These solutions are created to enable companies in the SMB range to purchase the capabilities of SAP software without any of the implementation issues associated with modifying the system. These are implemented through business partners such as Barrington and MM. In addition to these solutions, SAP also describes on their website the success stories through press releases, news articles, examples and case studies for particular industries. Qualified mynas All-in-One solutions are under development worldwide. And several of these vertical and cross- industry solutions are currently available in North America. Examples include industries such as high tech manufacturing, semiconductor manufacturing, ISP businesses, pharmaceuticals, and beverages. A recent press release outlined the partnership with SAP and Citric: 8 Both software vendors traditionally have focused on the enterprise market but now have Joined forces to make inroads into the SMB market. The solution will allow small and midsized customers to securely access their ERP applications from the road or from their home offices, the companies said. Citric will adopt SAPÃ¢â¬â¢s licensing model ND has priced the Material solution at $139 per named user. Business One costs $3,700 per named user. 10 10 Rooney, Paula. Citric, SAP Join Forces To Target SMB Market Joint solution to be Material Presentation Server For Business One. CRY. January 17, 2005 9 SMB ERP oracle protect it. Headquartered in Redwood Shores California, Oracle has operated for over three decades and is currently the worldÃ¢â¬â¢s largest enterprise software company with over ten billion dollars in annual revenue. The company has grown in part through organic growth and in part through acquisitions, including Peoples/JDK Edwards 2004), Retake (2005), and Entrance (2002). Oracle currently offers SMB solutions through both its Oracle and Peoples/JDK Edwards brand names with a vision to merge the solutions into a central Ã¢â¬ËFusionÃ¢â¬â¢ platform. 11 Their company vision places an emphasis on three principles of the Inoperativeness Enterprise; to simplify, standardize, and automate. Oracle has integrated these principles into their own operations and focuses to incorporate them into the design of their software to better serve businesses worldwide. In June 2004, Oracle concluded that the enterprise segment was highly penetrated and the mid-market segments are large ND growing. In FYI 02/03 over 50% of application new license revenue came from companies under $1 billion. OracleÃ¢â¬â¢s market assessment concluded that they would move to target the US mid-market segment as they believe it to hold the greatest potential for incremental growth. 12 Their mid-market messaging will surround the idea of Ã¢â¬Ësimply business. Ã¢â¬Ë More specifically, Oracle looks to emphasize their affordability, simplicity, competitive, and growth aspects. 11 Presentation by Hide Kindle of Oracle in Seattle on Thursday, May 12 and www. Oracle. Com/solutions/mid/index. HTML 12 Oracle Presentation, June 2004 Ã¢â¬â Mid Market Special Edition Campaign Plan: HI IFFY SMB ERP oracle E-justness suite Ã¢â¬Ëspecial EditionÃ¢â¬â¢ The current Oracle solution emphasizes their E-Business Suite. The suite specifically focuses on core business applications to streamline key business processes (financial, purchasing, inventory management, order management, manufacturing, and sales forc e automation). 13 To target businesses less than $100 million, Oracle offers a Ã¢â¬ËSpecial EditionÃ¢â¬â¢ package which is basically a scaled down version of their full- business suite. It claims to be affordable, easy to install, and simple to implement for a rapid and measurable return on investment. Oracle has chosen to sell this package through regional partners rather than directly through their sales representatives. 14 The differentiating factor that Oracle focuses on is that they are the only package with comprehensive, built-in business intelligence. What this meaner to SMB is that they will be able to manage, access, and analyze their business data very rapidly. This ability to synchronize information can give a company the ability to quickly Enterprise The current Peoples/JDK Edwards SMB solution is targeted at companies that have begun to outgrow their current systems. It is positioned as footwear to meet a companyÃ¢â¬â¢s current needs with the flexibility and adaptability to also meet needs in the future. The product line is branded under JDK Edwards (Enterprise Solutions, Rapid Start, and World Express). Emphasis is placed on the comprehensive industry-specific functionality, affordability of the package, and flexibility to fit into a current and changing business. 314 Conversation with Keith Gosling of Hitachi Consulting in Seattle on Monday, May 16 Presentation by Hide Kindle of Oracle in Seattle on Thursday, May 12 The package is a pre-integrated set of modular applications with built-in, underspecified functionality. At this point the JDK Edwards sales force continues to sell the JDK Edwards product. They continue to promote the pr oduct but at some point in the next 2-3 years I predict that the sales forces of JDK Edwards and Oracle will converge in anticipation of the Fusion release. Oracle Fusion Hide Kindle, Oracle SMB Manager, noted that there are three primary Ã¢â¬Ëhot topicsÃ¢â¬â¢ currently facing Oracle. 1 5 These include business intelligence (81), corporate governance (SOX), and budgeting/planning. Over the next several years Oracle aspires to focus on these hot topics in conjunction with taking the best pieces of each of their three primary footwear packages (Oracle, Peoples, JDK Edwards) to integrate into a complete Ã¢â¬ËFusionÃ¢â¬â¢ package. Oracle plans to roll-out individual fusion applications by 2007 and a complete Fusion Application Suite by 2008. OracleÃ¢â¬â¢s primary sales point surrounds this idea of Ã¢â¬Ëhow you packageÃ¢â¬â¢ the product. They see the advantages of Oracle Fusion in four general categories. The first is scalability. Here they argue that with the package you will be able to implement the package and it will have the ability to grow alongside your business. Price is the second advantage. Oracle plans to package the cost of software, services, and licensing to make the option an attractive and affordable one. A third advantage is functionality. By taking the best pieces of the current software packages, Oracle argues that functionality will be a distinct advantage. By using partners on a regional level, Oracle sees the ease and effectiveness of implementation as a fourth advantage of Fusion. 15 This rapid transition from stand-alone products to an integrated suite does not come without issues. Two primary disadvantages of OracleÃ¢â¬â¢s Fusion Suite are integration and support. More specifically, Oracle is going to face some major challenges over hose next few years as they look to roll-out a new package while supporting current customers. 3 SMB ERP Microsoft Microsoft Business Solutions offers a variety of ERP solutions for medium sized business entities. These solutions cover most industries and can be scaled down to any size business. Several of the software solutions are a complete ERP solution. All of the solutions offer an accounting and finance core. Many of the solutions integrate with Microsoft Office software so it is easy for new users to manage and leverage the data. In addition, Microsoft offers several solutions for certain aspects of business footwear solutions. 6 These additional solutions include: Business Network which allows streamlining collaboration through the use of XML templates, CRM to support marketing and customer service, Enterprise Reporting or Small Business Financial which are accounting applications, Retail Management System for point of sale and retail applications, Small Business Products for e-business, and Business Contact Manager for managing customer data. Microsoft Kappa Microsoft Kappa is an ERP solution with a price range from $kick to $kick. Currently, about 4,500 firms are using this software. Microsoft provides local partners to assist with implementation of this software and ongoing support. The benefits of Kappa is its unique design Ã¢â¬â one database, one toolbox, one business logic, one source code Ã¢â¬â meaner customizations and upgrades are easy to make. In addition, maintenance costs are low. 17 1617 www. Microsoft. Com/BoisterousnessÃ¢â¬â¢s/Default. Asps www. Software re. Com 14 Nucleus Research, a global provider of research focused on IT return on investment conducted a study on Microsoft Kappa. 8 It found the following: 75 percent of customers had achieved a positive ROI from their Microsoft Kappa deployment with n average payback period of 23 months. 56 percent of Microsoft Kappa customers were able to reduce staffing costs as a result of their Microsoft Kappa deployment. 44 percent of Microsoft Kappa customers were able to reduce IT costs as a result of their Microsoft Kappa deployment. 75 percent of Microsoft Kappa customers reported improved operations and visibility as a result of their Microsoft Kappa deployment. Kappa is a multi-language, multi-currency ERP solution with core strengths in manufacturing and e-business together with strong functionality for the wholesale distribution and business services industries. By providing integrated, adaptable functionality within one open, scalable platform, Microsoft Kappa helps mid-market and companies across the globe seize opportunity and gain competitive advantage Extra is designed to help scale your business by providing internet functionality. This internet functionality can be used to collaborate with customers, partners, suppliers, and employees. Microsoft Kappa supports the entire business with functionality spanning manufacturing, distribution, supply chain management, reject management, financial management, customer relationship management, human resource management and business analysis. It also tailors itself to local legal and accounting requirements while supporting multiple languages and currencies. 18 www. Microsoft. Com/BoisterousnessÃ¢â¬â¢s/Kappa/kappa_ROI_report. SSP Microsoft Kappa Case Study:19 The vision of North Atlantic Industries (ANA) is to become the preeminent global supplier of innovative military and commercial off- the-shelf (COTS) solutions that fulfill the requirements of companies in the aerospace, industrial, and defense markets. ANA achieved a positive return on its investment in Microsoft BoisterousnessÃ¢â¬â¢s Kappa software by reducing inventory costs, realizing direct savings in perso nnel costs, and increasing the productivity of employees through reduced downtime. Annual return on investment (ROI) 128% Payback period (years) 0. 60 Net present value (NP) 499,888 Average yearly cost of ownership 146,626 Microsoft Great Plains Microsoft Great Plains is an ERP solution with a price range from $ask to $kick. With a lower price range than Kappa, Great Plains is positioned to support lower midwicket firms. It provides functionality for How to cite Smb Company, Papers
Posted by Evette Correia at 1:47 PM
Monday, May 4, 2020
Some key information missing in introduction conclusion. 3-5 Detailed and focused introduction conclusion. 6-8 Well developed introduction conclusion. 9-10 Very well developed comprehensive introduction conclusion. BODY0-2 Description of event lacked some major detail. 3-5 Descriptions of event mostly clear, but some detail lacking. -8 Clear description of event. 9-10 Very clear and succinct description of event. 0-4 Relevant legal and/ or ethical issues only briefly / not described. Critical analyses of issues poorly / not attempted. Arguments not/ inadequately supported by appropriate literature. 6-10 Relevant legal and/ or ethical issues described. Critical analyses of issues attempted. Arguments supported by appropriate literature. 12-16 Relevant legal and/ or ethical issues well described. Sound critical analyses of issues evident. Arguments well supported by appropriate literature. 18-20 Relevant legal and/ or ethical issues comprehensively described. In-depth critical analyses of issues evident Arguments well developed and thoroughly supported strengthened by appropriate literature. 0-4 Relevant ANMC or ACORN Competencies or standards only briefly / not described. Critical analyses poorly / not attempted. Arguments not/ inadequately supported by appropriate literature. 6-10 Relevant ANMC or ACORN Competencies or standards described. Critical analyses attempted. Arguments supported by appropriate literature. 12-16 Relevant ANMC or ACORN Competencies or standards well described. Sound critical analyses evident. Arguments well supported by appropriate literature. 18-20 Relevant ANMC or ACORN Competencies or standards comprehensively described. In-depth critical analyses evident. Arguments well developed and thoroughly supported strengthened by appropriate literature. 0-4 Recommendations not included/ only briefly described/not supported. 6-10 Recommendations included however more support or description needed. 12-16 Sound, relevant recommendations described. 18-20 Very clear description well argued support of relevant recommendations. Some (5-6) grammatical spelling errors. 6-8 Followed academic presentation requirements. Few (2-4) grammatical spelling errors. 9-10 Good structure and adherence of academic presentation requirements. No grammatical or spelling errors. Total: /100 /30% INTRODUCTION. In this assignment on critical analysis I will present a clinical incident and discuss and analyse a critical incident in detail utilising a critical incident tool (CIT). This incident I have chosen occurred during an operative procedure. I will discuss the incident as I proceed through the steps outlined in the critical analysis tool. I will present a brief overview of the incident before commencing my analysis. I will discuss the importance of a critical analysis and why they are important to nursing practice. I will also discuss the incident in terms of standards, guidelines and legislation. I will outline 4 recommendations for improvement to my practice. I will finish with a conclusion and a look forward to the future of pressure injury care in Australia. Incident The patient was a 12 year old male child undergoing and emergency open reduction and internal fixation of a right wrist fracture. The child was positioned in the supine position. The procedure was a difficult fixation and done by a registrar so was somewhat longer that the usual time taken to undertake this procedure. No names will be used to protect patient confidentiality. Due to the positioning the patient sustained a near miss pressure injury. The near miss and resultant tissue injury was not discovered until the procedure was completed. I will discuss this incident in full as I proceed through the critical analysis. Critical Analysis The purpose of undertaking this assignment is to look at this incident in more detail, and delve into the nursing obligations and duties owed to our patients. It has encouraged me to think more globally and think the issue through in depth. I have found I have had to consider the foundations that underpin my nursing practice. Critical analysis utilises a framework or a methodology to formally process and incident or significant event. The event does not have to be Ã¢â¬Å"criticalÃ¢â¬ or even have a significant adverse outcome to be viewed as a critical incident. I have included the following definitions in relation to performing a critical analysis and what it hopes to achieve for the practitioner. Schluter, 2007), Ã¢â¬Å"The CIT is a practical methodology that allows researchers to understand complexities of the nursing role and function, and the interactions between nurses and other clinicians. Ã¢â¬ (p113). This is expanded in definition by (McClure ND) who defined reflective practice learning experience as follows, Ã¢â¬Å"To maximise learning through critical reflection we need to contextually locate ourselves within the experienc e and explore available theory, knowledge and experience to understand the experience in different ways. Ã¢â¬ (para 7). A critical incident is an event that is usually remembered by the participant as important or used as a learning tool for the purpose of reflection. (Daly, Speedman, Jackson,. 2010). The Australia Nursing Midwifery Council (ANMC) states the following about critical thinking and analysis, Ã¢â¬Å"This relates to self Ã¢â¬â appraisal, professional development, and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/groups is an important professional benchmark. Ã¢â¬ (p. 2). Also under the ANMC competencies nurses have a duty of care to their patients to that complies within the current legislation governing nursing practice. I am using the following incident analysis from (Services, 2009) which is heavily based on work by Crisp, Green Lister and Dutton (2005) . 1. Account of the incident The incident I am going to discuss did not get discovered until we were taking down the drapes and getting ready to transfer the patient onto the bed. During the procedure I was the scout nurse in the theatre. Once the drapes were removed, I noticed the childÃ¢â¬â¢s left foot was crossed on top of his right foot. This resulted in the calcaneal part of his heel came to rest on the top part of the bony section of his right foot. I could immediately see a round red area on the top of his right foot that resulted from pressure from his heel. This was a direct result of the pressure of his foot over the duration of the procedure. The procedure was a difficult fixation and done by a registrar so was somewhat longer that the usual time taken to undertake this procedure. Once I discovered the incident my focus was to assess the injury and treat it appropriately. I pressed the skin involved and the red area from the pressure was blanchable, but slow to respond. I think had the pressure from his upper foot had been applied any longer this would have developed into a stage one pressure area. I rubbed the affected area to help restore circulation and checked the heel of the foot that was resting on the top of the right foot. I gave the patient a warm blanket to help achieve normothermia, reported and documented the injury. I also completed a prime incident report. 2. Initial responses to the incident When I discovered the incident, I felt a sense of failure that I had not noticed the crossed leg under the drape. I felt I had let our patient down whilst caring for him in the operating room. I also felt my colleague was unmindful of the ramifications of what a pressure injury that develops into a stage one pressure ulcer would involve for this patient. I felt we owed a duty of care to the patient to administer appropriate treatment, timely intervention and report the injury to the surgeons. I had assumed everyone would be of the same mind in relation to this incident. 3. Issues and dilemmas highlighted by this incident Under the ANMC competencies there is an ethical nursing framework that exists to govern ethical nursing practice. One area of ethical consideration during this incident was when I pointed out the scrub nurse this injury to the patient. She stated to me that the positioning was correct at the beginning of the case, so there was nothing that we could do about the injury occurring. Under the ANMC framework to Ã¢â¬Å"maintain an effective process of care when confronted by differing values, beliefs and biases. Ã¢â¬ I myself did not witness the patient position prior the draping, so I canÃ¢â¬â¢t say I noted the patientÃ¢â¬â¢s position. The staff member was very senior to me and have a forceful personality. I felt quite uncomfortable during the time that we discussed the patient injury. I felt the person who was with me felt as if there was blame being allocated, which for me was not the case at all. I wanted to notify her of the patientÃ¢â¬â¢s injury as I would like to be if I were in the same position. I also felt she was being dismissive of the patientÃ¢â¬â¢s injury. I notified the surgeon and documented this in the nursing notes. I also communicated the injury with the recovery staff. Under civil legislation we owe the client a duty of care in all aspects of the care we provide. 4. Outcome The patient was very fortunate not to develop a stage one pressure injury. Due to the state of the tissues when I found them I have no doubt that another 20 minutes or less would have resulted in a pressure injury for this patient. This is why I have used it as a critical incident. It was such a close call for a patient who was so young with no other co morbidities. Had he not been well nourished and in good health, I am certain this would have resulted in a pressure injury. Due to this incident I have changed how I practice in the surgical setting in regard to monitoring and correcting patients positioning. I feel I am more vigilant in regard to positioning. As I have processed this incident through critical analysis and reflective practice I think I have come to terms with the incident a little better. I have gained a better understanding of my role in this incident, and have developed as a practitioner to help other patients so they are better positioned to decrease the likelihood of developing a pressure injury. I have also increased my knowledge base about pressure injuries significantly, and continue to learn about them in the peri-operative environment. I think this incident served as an excellent learning experience to help prevent similar injuries in others. 5. Learning A recent survey has been collected and published by AORN, (Steelman, Grayling Perkhounkova 2013) found during a survey of peri-operative nurses that preventing pressure injuries was the 5th most important priority safety issue they were concerned about. When they divided it into settings, hospital based nurses rated it as the third most important safety issue. They also found there was no purpose built valid tool to conduct risk assessments on patients in the peri-operative environment. They also found limited resources to help nurses prevent pressure injuries. (Mahan, P. 2006) defines a pressure ulcer (now known as pressure injury) as Ã¢â¬Å"any lesion caused by unrelieved pressure resulting in damage of underlying tissue. Pressure ulcers are usually located over bony prominences and are graded or staged to classify the degree of tissue damage observed. Ã¢â¬ (p. . ). (Mahan, P 2006) stated in relation to pressure injuries, that Ã¢â¬Å"prompt and effective treatment can minimise the deleterious effects and speed recovery. Ã¢â¬ (p. 6) (Baron McFarlane 2009) identified that staff felt that pressure injuries were uncommon in the operative setting. However due to surgical techniques improving and becoming increasingly complex, op erating times were lengthening. They found that injuries could occur in a one to four hour time frame dependent of the patientÃ¢â¬â¢s condition. They also found due to specific environmental reasons the operative environment contributed to this risk. This was due to general anaesthesia, anaesthetic agents that decreased perfusional status and body temperature. When relaying incidents and other issues found postoperatively I will continue to maintain a calm, non judgmental response. I will be more forward when a staff members seems to find this confronting and discuss the issue with them at and appropriate time and find out why they reacted the way they did. I have found 4 recommendations for improvement that I can undertake to help prevent pressure injuries. 1)Educate staff on what a pressure injury is and how to prevent them. This would also highlight patient risk factors, important co morbidities and the importance of patient positioning. There are two online options for this education. These had the added benefit of accruing CDE points, and all staff can undertake the education when they are able. https://members. nursingquality. org/NDNQIPressureUlcerTraining/https://members. nursingquality. org/NDNQIPressureUlcerTraining/ http://www. health. vic. gov. au/pressureulcers/education. htm 2) Use a patient positioning time out prior to draping involving all team members. This does not have to be formal, and is a quick and easy check prior to draping to ensure the patient is correctly positioned prior to draping. It is important to involve other staff members from all disciplines as pressure injuries occurs both in the anesthetic and surgical arena. This also incorporates all elements of the ACORN standard on peri-operative positioning. Advocate for the use of pressure relieving devices on all patients, regardless of age, co morbidities or skin condition. Even young well people are at risk of pressure injures. Conduct and document a baseline skin assessment, and continue to monitor the status of the patients skin, documenting any issues. The Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury suggest a number of tools for the use in children, and there is good evidence to support the use of three of the tools 3)Ensure patient is warm and all warming devices are used appropriately. Pressure injuries can result from heavy blankets. So I would ensure the patient has one warm blanket and a forced air warmer insitu. There is good evidence to link pressure injury prevention and normothermia. If the patient is normothermic the risk of pressure injury is decreased. (Fred, Ford, Wagner VanBrackle, 2012) As a result of this incident I am more aware of the Australian College of Operating Room Nurses Standard (ACORN) on Patient Positioning. (ACORN 2012-2013) states, Ã¢â¬Å"Safe positioning for, and during, surgery and in the immediate postoperative period minimizes the risk and prevents unnecessary surgical complications. Ã¢â¬ and also Ã¢â¬Å"The positioning shall not compromise the patients respiratory and cardiovascular function, or cause damage to the nervous, muscular and integumentary systems. Future learning needs. I believe I need to educate myself on patient positioning for all types of surgery. I also need to maintain currency in the latest evidence based practice on pressure injuries and pressure relieving devices. Due to the governments policy on pressure injuries and the financial penalties health care facilities face, I think all nursed will need to make this a priority learning goal. I also need to learn more about anaesthetic agents in greater detail. It was not until I undertook this assignment that I realised the uge impact they have on a patient and there risk of a pressure injury. (Walton-Greer, P. 2009) discusses the impact anaesthesia has on the patient in relation to pressure injury. Due to pain receptors being blocked, depression of the autonomic nervous system and the vasodilatory effect of the anaesthetic agents the all have a cumulative affect on the risk of developing a pressure injury. She also found that patients having a spinal or epidural anaesthetic were more at risk. I am also going to complete the pressure injury education components as per recommendation one in this assignment. As a department we need to explore a risk assessment tool for use in the theatre for patients who do not have one already completed. The health care facility uses the Waterlow scoring system. It is part of the ACORN standard S12 criteria 1. 3. This standard also states that nurses Ã¢â¬Å"demonstrate a competent knowledge of the aetiology of pressure soresÃ¢â¬â¢ and (ACORN) statement 3, states that nurses Ã¢â¬Å"appropriately use a risk assessment tool and preventive screening positioning techniques based on evidenced based researchÃ¢â¬ (p. 3). CONCLUSION In conclusion I think that pressure injuries are a priority area for nursing care and active preventative measure should be instituted in all surgical patients. Nursing staff should work as a team to ensure the patient is positioned well, and given appropriate follow up care. It should become standard practice to conduct a skin assessment on admission to a hospital facility, and if one has not been done, it should be conducted if practicable by the theatre nurse. At the end of my conclusion I will include a look forward for what in will mean to hospitals if patients acquire a pressure injury in their care. I personally will conduct a patient positioning time out prior to draping to ensure the patient is correctly positioned and had the correct pressure relieving devices in place. I will also explore my future learning needs as outlined in my assignment. All issues surrounding patients need to be communicated clearly and in a calm and non judgmental way, they also need to be documented as per hospital policy. Looking Forward. The Australian government has instituted a policy where Health Care Facilities will be fined under a punitive system on each pressure injury that occurs in a facility. This money will be taken from the operative budget of the ward/ unit in which the pressure injury occurred. I personally think this will have a detrimental affect on health care. There are other models in which you a financially rewarded for preventing pressure injuries. Injuries need to be documented within 6 hours of admission or otherwise a financial penalty will result whether the injury occurred within the facility or not. This will be important to theatre nursing staff who are treating trauma patients and critically ill patients who are admitted to their unit after presentation to the hospital.
Posted by Evette Correia at 8:41 PM