The Personal Challenge That I Face Essay Example for Free

The Personal Challenge That I Face Essay The personal challenge that I faced mainly dealt with my health. Ever since I was child, I was very sick physically. The doctor recommended that I not play or participate in any type of sports because of my poor health. This led to a lack of confidence in myself to perform my best. I have always thought that there was a barrier somewhere in my life, and I could not pass that barrier because if I did then my life would certainly be in ruins. I was told that no one could perform many tasks at once and be successful. Ever since, I always have an image that if I participated in activities at school then I would do poorly in my school work. I never pushed my limits to the maximum to challenge myself. It was as if there was a wall standing in front of me blocking me from being successful. I was always afraid that the consequences might be permanent and my grades would drop. For years, I have always focused my energy and time into studying and being successful for my future. I never participated in any activities in or outside of school. I would sometimes help my mom take care of the housework because they have to work hard to keep the house financially stable. Maintaining a 3.7 or higher GPA throughout my middle and high school years, I was very happy with my academic accomplishments. In my sophomore year, my vice-principal and counselor encouraged me to join an after-school activity so that I would be qualify to be a member of the National Honor Society during my junior year. I gave a lot of thought to this during sophomore year, and I decided that I should at least try one sport. I joined the softball team, but because of my lack of skills, I was cut from the team. However, I did not give up because my motto is Once you give up, you give up everything including life. I always go by this simple principle and this is what keeps me going on even today. Then I tried outdoor track and found myself struggling and being the slowest person in school. I did not run any race during the meet for that entire year. I was angry at myself for the year. I told myself, If others can do it, then you can too. Throughout my life, I have always tried to challenge myself by trying to succeed. I always have set high standards in myself. I would never let myself be ranked low among others whether it is school work or anything else. At first, I thought that something would have to be  sacrificed because it is natures law to make man not perfect. No one can do well in more than one thing and that is what I believed for the first half of my life. That philosophy however had been shattered by a boy who I met while running for the track team. He was the most perfect boy I have ever met in my life. He was valedictorian of the class of 90 and an outstanding athlete. He opened the gateway to another world for me. I told myself, If He can do it, then I can certainly do it also. From then on, I realized that there is no limit to what a human can do if they put their mind to it. This opened another world to me. I enjoy sports, especially running and swimming. During my junior year, I joined cross country, indoor track, the swim team, and outdoor track. My time in running has improved dramatically, especially during my senior year. I am now captain of the cross country team and co-captain of the swim team. I have improved my time after ever swim meet, track meet, or cross country meet. Even more importantly, I still was able to maintain a very high GPA. This proved to me that I can do anything if I only try. The insight which I have gained from this experience has given me a great boost of self-esteem. I learned that there are no limits to what a human being can do if he or He only does their best. To further prove my theory, I got a job during the summer and kept it during the school year. I am also currently taking four Advanced Placement classes during my senior year along with after school activities. I am doing this to help myself be prepared for college and to further improve my life, because I am spending more time doing other activities such as sports, homework, and going to work. I am hoping to continue being conscientious throughout my college years, as I strive to do my best academically.

Quantitative Research in Patient Safety Literature Review

Quantitative Research in Patient Safety Literature Review Recently, research has occupied a crucial place in nursing that is identified as â€Å"the diagnosis and treatment of human responses to actual or potential health problems† (American Nurses’ Association, 1980 p.9); thus, an appropriate understanding of research literature is a prerequisite for every individual who works in this area (Rees, 2003). Unfortunately, despite the fact that most of nurses acquire specific skills in research, only some of them manage to apply research data or research findings to practice (Bostrum Suter, 1993). This can be explained by the nurses inability to critique a research, evaluating its pros and cons (Krainovich-Miller et al., 2002). The aim of the present essay is to critically analyse two quantitative research literatures in patient safety. The first research is â€Å"Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and noncomplainants following adverse events† by M. Bi smark et al. (2006), while the second research is â€Å"Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals† by P. Michel et al. (2004). Although many nursing studies have been conducted in the last decade (e.g. Johnson Lauver, 1989; Conlon Anderson, 1990; Norman et al., 1991; Brennan et al., 1995; Gross et al., 1995; Fieler et al., 1996; Bennet, 1999), they implicitly dealt with the issues of patient care; however, the studies discussed further directly relate to the quality of medical care in New Zealand and France. The research conducted by Bismark et al. (2006) evaluates the extent of injuries in the patients cured in public hospitals of New Zealand, or more precisely (as the title reveals), a correlation between patients’ complaints and quality of medical care. While the title is clue to the focus, the abstract gives more detailed information, identifying the major aspects of the research (objectives, design, setting, population, main outcome measures, results and conclusion) in a clear scientific style. However, the abstract does not indicate the research questions of the study; they are stated further in the research and are the following: 1) Do complaints track injuries, or are they prompted by more subjective concerns? 2) Are complaints the â€Å"tip of the iceberg’ in terms of quality of care problems and, if so, how representative are they of broader quality problems? (Bismark et al., 2006 p.17). Although the research by Michel et al. (2004) also refers to patient safety, neither the title, nor the abstract uncovers the theme in an explicit way. Actually, the theme is exposed further in the research; in particular, the study analyses rates of unintended injuries (defined by the authors as adverse events and preventable adverse events) in the patients cured in care hospitals of France. Similarly to the first research, the abstract in the second study briefly summarises the research and is divided into the same categories that uncover the essence of the investigation. In this regard, the abstract is an obvious strength of the analysis and it can serve as an example to other researchers who investigate various aspects of nursing. But the research does not specify the research questions either in the abstract or in the introduction section of the paper. Such a lack of specific questions certainly complicates the overall apprehension of the study. The authors could have proposed some research questions, such as 1) What are the major aspects of reliability, acceptability and effectiveness? Or 2) How rates of adverse events and rates of preventable adverse events can be properly assessed with each of three methods? These questions are of primary importance to the research, as adverse events and preventable adverse events can not be rightfully evaluated, if the major criteria of reliability and effectiveness are not properly discussed in the context of the research. However, the authors pay little attention to these aspects of the analysis. Despite the fact that the introduction section in both studies provides a valid explanation of the importance of the problem, neither of the two studies includes an overview of the previous research or specific reports. This neglect decreases the overall presentation and reduces the value of the presented data. However, the problems of statement are formulated in a concise way and reflect that the researchers narrowed the areas of research to the issue of adverse events in the clinical setting in order to get more accurate findings. In fact, this issue is especially relevant today when patient safety has become worse in many countries of the world. The justification for the chosen topic in the research by Bismark et al. (2006) is that the recent accident compensation system in New Zealand does not adequately examine patients’ complaints in all cases of adverse events. Pointing at the fact that â€Å"there is growing international interest in harnessing patient dissatisfaction and complaints to address problems with quality† (Bismark et al., 2006 p.17), the authors concurrently put crucial questions that inspire readers’ interest in the issue of patient safety from the very beginning. In the research of Michel et al. (2004) the underlying reason for initiating an investigation is that the limitations of the employed methods reduce the validity of the received findings in regard to patients’ injures within the hospital setting. However, the lack of appropriate background, theoretical frameworks, hypotheses and definite aims in the introduction section considerably limits the studies. This especially regards the non-inclusion of specific theories that usually back up the presented data. In this respect, both studies are theory-free; unlike theory-testing research and theory-generating research, this kind of research is less popular because it does not analyse any theoretical concepts that constitute the basis of practical nursing. On th e other hand, the studies of Michel et al. (2004) and Bismark et al. (2006) specifically focus on a practical problem-solving framework; that is, the present researches are aimed at identifying practical solutions to the discussed problems rather than discussing theoretical implications. The research of Michel et al. (2004) uses a quantitative research method that â€Å"emphasizes objectivity through statistical analysis† (Santy Kneale, 1998 p.77) and the quasi-experimental design that is considered to be more adequate and less biased than an experimental method, if an investigation is conducted within the clinical setting (Polit Hungler, 1995). Though objectivity is crucial for such kind of research, it would also be appropriate to combine quantitative and qualitative methods, that is, to combine objectivity and subjectivity (Phillips, 1990). The fact is that due to its quantitative method the study appears to be too analytical, too objectively-oriented; thus, there is a necessity to introduce some aspects of the subjective realm into the research. However, Parahoo (1997) supports another viewpoint, exposing the inadequacy of a qualitative method, especially in regard to a nursing research. The author points out that, applying to a quantitative method, rese archers are able to predict the final outcomes, while a qualitative method may generate unpredictable results. The data in the study are collected in care hospitals of Aquitaine with the help of three research techniques – a cross sectional method, a prospective method and a retrospective method. Such triangulation is aimed at â€Å"relat[ing] different sorts of data in such a way as to counteract various possible threats to the validity of analysis† (Hammersely Atkinson, 1983 p.199). In the present study triangulation corresponds with the terms of reference that provide appropriate relevance to the whole research (Shih, 1998). Identifying both advantages and disadvantages of all three methods in Box 2, the researchers contribute much to the reliability of the findings, despite the fact that they have not conducted a pilot study that, according to Carr (2003), intensifies the credibility of the employed research techniques. On the other hand, a pilot study is crucial for the investigations that utilise unchecked tools for research, as is the case with the present study, where the researchers conduct an evaluation of methodology. In this regard, a pilot study â€Å"helps to illuminate some of the problems of the research tool† (Santy and Kneale, 1998 p.80). The research of Bismark et al. (2006) is also quantitative with descriptive design. The baseline data are taken from the medical records of the New Zealand Quality of Healthcare Study (NZQHS) and the Commissioner’s complaints database. Further, multivariate and bivariate analyses are applied to the research to identify certain dissimilarities between complaints and non-complaints. Overall, the explanation of the research techniques and methods is a great strength of this study, as the authors provide a thorough description in regard to data collection and study design. Although the researchers do not define a hypothesis of the analysis, they, nevertheless, use dependent and independent variables to differentiate complainants from non-complainants. However, the limited space of both studies has not allowed the researchers to insert the samples of medical records and questionnaires that served as the basis for the research; thus, the methodology of both investigations can not be fully assessed in terms of the quality. Actually, the research of Bismark et al. (2006) and the research of Michel et al. (2004) employ primary sources (including official records) that explicitly relate to the subjects. But according to Burgess (1991), even primary sources should be critically assessed and â€Å"it is essential to locate them in context† (p.124). But neither the first nor the second study provides a critical evaluation of the utilised sources. In regard to ethical issues, they are not openly addressed in the studies; however, in the research of Bismark et al. (2006) there is a mentioning that the investigation was endorsed by the Wellington Ethics Committee. For Robinson (1996), such ethical approval is a necessary part of a nursing research, as any investigation deals with human beings who may experience certain difficulties during the research. On the other hand, due to its descriptive nature the present study does not necessarily need an informed consent or ethical considerations (Cutcliffe Ward, 2003), while the research of Michel et al. (2004) requires a discussion of certain ethical issues because of its quasi-experimental design. Some of these issues are patients’ confidentiality, defence of their rights and risk control (Pranulis, 1996). In regard to the latter factor, it is necessary for researchers to increase potential benefits and decrease potential risks, especially in such studies that involve a great number of participants, as is just the case with the research of Michel et al. (2004). Thus, it would have been proper for the researchers of the present study to discuss in detail subjects’ conditions and potential harm, particularly in view of the fact that nursing directly relates to patient safety within the clinical setting (DHHS, 1981). However, the ethical rights of samples are implicitly defended in both studies, as no personal details of participants are revealed. But the researchers provide no information of the ways the data were stored and protected before or during the investigation. Similarly, neither of the studies refers to informed consents, while this is a prerequisite for any nursing research (Alt-White, 1995; Berry et al., 1996). As for sampling, the study of Bismark et al. (2006) analyses two groups of patients: the first group includes people who made complaints to the Commissioner and the second group includes people â€Å"identified by the NZQHS as having suffered an adverse event who did not lodge a complaint† (Bismark et al., 2006 p.17). A two stage sampling process is initiated by NZQHS on the example of 6579 medical records. Although inclusion and exclusion criteria are not explicitly identified in the study, the researchers make it clear that they only choose the patients who suffer adverse events. In the process of analysis these patients are divided into two categories – complainants and non-complainants, though both groups are typical representatives of the larger population. In the research of Michel et al. (2004) the sampling includes 778 patients from medical, surgical and obstetric wards. This number of samples is appropriate for a descriptive study. Initially, the researchers chose 786 patients with the help of a two stage cluster stratified process, but excluded 8 persons â€Å"because they were still present on day 30, precluding the review of their medical records† (Michel et al., 2004 p.2). In this respect, the study does not clearly define inclusion and exclusion criteria, but some samples are excluded in the process of investigation. No obvious bias is found in regard to the samples; similar to the previous research, the samples belong to typical representatives of the larger group. In view of this fact, the sampling can be considered as fully reliable. In addition to authors’ comments, the results in the research of Bismark et al. (2006) are presented in figures, tables and boxes that are introduced as additional tools for clarification. This visual information reflects how the data are collected and measured (Figure 1 is especially accurate in revealing the cases of injured complainants and non-complainants). Although the authors do not specifically explain such a choice, they provide a detailed justification for the use of correlation tests that define dependent variables (a distinction between complainants and non-complainants) and independent variables (age, ethnicity, sex and other factors). Besides, the researchers weight the bivariate and multivariate analyses to acquire more accurate findings. The results in the study of Michel et al. (2004) also appear in both textual and graphic forms in order to enhance explanation. But the researchers do not attain the balance between figures and comments, putting too much emphas is on figures. Unlike the previous study, the authors do not use dependent and independent variables in their analysis; however, they employ paired X2 tests for the comparison of retrospective and prospective methods. Discussing their findings, Bismark et al. (2006) draw a parallel between the received results and the findings of the previous studies. Actually, many findings of the prior research are consistent with the present research (e.g. Burstin, et al., 1993; Studdert et al., 2000), while some findings contradict the earlier results (e.g. Tapper et al., 2004). To some extent, such a comparison justifies the lack of literature review at the beginning of the research and provides more validity to the overall outcomes. In general terms, the findings of Bismark et al. (2006) directly relate to the objectives of the study, gradually introducing the evidence that proves the authors’ initial suggestions. In particular, the researchers find out that 79% of all injures can be identified as preventable adverse events. In the case of the Commissioners analysis, 64% of the complaints are made by the patients who suffer adverse events, of which 51% are preventable adverse events. In regard to the NZQHS review, 315 cases of adverse events (out of 850 cases) are preventable, 124 cases are serious and 48 cases are serious and preventable. As for instigators of complaints, 41% of complaints are made by the patients, while 59% by their relatives or friends (13% spouse, 16% parent and 17% child). Evaluating the independent variables, the researchers reveal that the age of complainants is lower than the age of non-complainants; moreover, non-complainants mainly live in the regions with poor economic conditions. The findings in the research of Michel et al. (2004) also relate to the terms of reference, providing evidence that â€Å"the prospective method has several advantages over retrospective and cross sectional methods† (Michel et al., 2004 p.3). In particular, the prospective method better recognises preventable adverse events and is more trustworthy than two other methods. This is clearly seen in Venn diagrams that demonstrate the number of adverse events identified by each of three research methods. Overall, the findings in the present study are not properly discussed; however, the researchers discuss in detail the strengths and limitations of the research in the discussion section. For instance, as the authors reveal, reliability and effectiveness of adverse even ts rates are successfully estimated because the samples are assessed with the help of three methods. On the other hand, the researchers point at the possibility of bias that â€Å"may have been present due to the small number of hospitals and wards† (Michel et al., 2004 p.3) and because of the participation of the care teams in the prospective method. Besides, the reference list that the researchers utilised in the process of investigation might have errors that were not identified. Finally, the aspects of reliability, effectiveness and acceptability are not discussed in detail by the authors, though these are the major assessment criteria of the study. However, there are some obvious strengths of the research; unlike the studies that analyse adverse events either in surgery or medicine (e.g. Mantel et al., 1998; Waterstone et al., 2001), the present study examines various cases of adverse events in three areas – medicine, surgery and obstetrics. Similarly to this research, Bismark et al. (2006) also identify certain limitations of the study; in particular, the analysis of adverse event rates is rather confined, if medical record reviews serve as the basis for the research. The research also lacks definite ethnicity data for all complainants; thus, there is a â€Å"potential for measurement error† (Bismark et al., 2006 p.21). In addition, the authors do not provide any information as to the alternative research methods that can be used for the assessment of the relations between complains and quality of medical care. Drawing a parallel between the employed methods and the alternative methods, it will be possible to enhance the validity of the received findings. The conclusion in the research of Bismark et al. (2006) directly responds to the terms of reference; based on the received results, the conclusion suggests that elderly or economically poor patients rarely initiate complaints processes. The same regards the pati ents who belong to ethnic minorities (in this case – to Pacific ethnicity). The authors recommend to conduct a further study that will profoundly investigate the reasons for people’s refusal to make complaints in the cases of poor medical care. Moreover, the complaints greatly depend on the severity of injures and whether the event is preventable or unpreventable. In this respect, as the researchers conclude, â€Å"complaints offer a valuable portal for observing serious threats to patient safety and may facilitate efforts to improve quality† (Bismark et al., 2006 p.22). Unfortunately, no recommendations for practice are made at the end of the study, thus reducing the relevance of the received findings. On the other hand, as Santy and Kneale (1998) claim, â€Å"all research has some implications for practice even if the results have proven to be inconclusive† (p.82). In the research of Michel et al. (2004) the conclusion summarises the results that, in the authors’ words, â€Å"provide new insights into the epidemiology of adverse events† (p.4). Such a viewpoint is explained by the fact that the findings of the present study reveal the ways to intensify the implementation of prospective assessment in the clinical setting. However, the researchers only suggest the answers to the posed questions, avoiding any insisten ce on specific concepts or notions. Comparing three methods, the researchers recommend to use the prospective method for different purposes that implicitly or explicitly relate to the evaluation of adverse events rates. Finally, Michel et al. (2004) briefly discuss the prior knowledge on the topic and the knowledge acquired in the process of investigation. In regard to the prior knowledge, the assessment of adverse events was conducted in an analytical way that considerably limited the findings. In the present study the researchers receive more feasible results and identify that the causes of adverse events and risk reduction programmes can be successfully evaluated by the prospective method rather than by the retrospective or cross-sectional methods. However, further research is required, if the evidence received in this research is applied to practice (Barron Kenny, 1986; Scott Thompson, 2003). Overall, both researches are well-structured and are written in a scientifically concise style; however, as was stated above, the study of Michel et al. (2004) provides too much technical details, while analysing the results. Therefore, it is slightly difficult to read the research and, consequently, there is a chance that its findings may be ignored by a practitioner on the premise of misunderstanding. Although the research of Michel et al. (2004) is logically constructed, an unqualified person may fail to rightfully apprehend the presented data. On the contrary, the study of Bismark et al. (2006) is easy to understand because it lacks much unexplained jargon. Another strength of the research is the appropriate use of quotes in the discussion section; these quotes are directly related to the analysis and correspond with the ideas expressed by the authors, either refuting or confirming them. Employing this or that quote, the researchers provide a detailed interpretation of a certain concept; and for all that, the number of quotes is reasonable and they are rather short. On the contrary, Michel et al. (2004) do not utilise quotes in the discussion to support their arguments, though they use certain references. Despite the fact that the researchers do not explicitly recommend their studies to nurses, the overall findings can be especially relevant to nursing staff, as well as to the researchers who are involved in health care. Within a complex clinical setting nurses experience various difficulties because of the lack of appropriate practical knowledge (Treacy Hide, 1999; Polit et al., 2001). Thus, the studies of Michel et al. (2004) and Bismark et al. (2006) can inspire nurses’ interest in the ways of patient safety, as, despite their limitations and certain inadequacies, the studies pose vital questions that may increase the quality of medical care not only in France and New Zealand, but in other countries as well. Due to the fact that nowadays nursing staff is usually required to implement various aspects of research into practice (Christman Johnson, 1981; Burnard Morrison, 1990; Street, 1992; McSherry, 1997; Cormack, 2000; Rodgers, 2000; Hek et al., 2002; Cluett Bluff, 2004), the present studies are especially valuable, as they provide useful and valid information that extends the prior knowledge in patient safety. In further studies it will be crucial to discuss the received findings in the context of international implications and to pay more attention to preventable adverse events (Thomas et al., 2000). Moreover, it will be important to give some recommendations for nursing staff and those individuals who deal with patients’ complains (World Health Organisation, 1977; Gordon, 1988; Brink et al., 1989; Lindley Walker, 1993; Ferketich, Mercer, 1995; Northouse, 1995; Roseman Booker, 1995; Duffy et al., 1996; Madge et al., 1997; Vertanen, 2001). Bibliography Alt-White, A. C. (1995) Obtaining ‘informed’ consent from the elderly. Western Journal of Nursing Research, 17, 700-705. American Nurses Association (1980) Nursing: A Social Policy Statement. Kansas City, American Nurses Association. Baron, R.M., Kenny, D.A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. 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A digital test for pelvic muscle strength in older women with urinary incontinence.Nursing Research, 38, 196-199. Burgess, R. G. (1991) In the Field: An Introduction to Field Research. London, Routledge. Burnard, P. Morrison, P. (1990) Nursing Research in Action: Developing Basic Skills. London, Macmillan. Burstin, H. R., Johnson, W.G., Lipsitz, S. R. et al. (1993) Do the poor sue more? A case control study of malpractice claims and socioeconomic status. JAMA, 270, 1697-1701. Carr, J. (2003) Improving questionnaire response rates. Practice Nursing, 14 (4), 171-174. Christman, N. J. Johnson, J. E. (1981) The importance of research in nursing. In: Y. M. Williamson (ed.) Research Methodology and Its Application in Nursing. New York, Wiley. pp.3-24. Cluett, E. R. Bluff, R. (2004) Principles and Practice of Research in Midwifery. London, Bailliere Tindall. Conlon, M., Anderson, G. (1990). Three methods of random assignment: Comparison of balance achieved on potentially confounding variables. Nursing Research, 39, 376-379. Cormack, D. (2000). The Research Process in Nursing. Oxford, Blackwell Science. Cutcliffe, J. R. Ward, M. (2003) Critiquing Nursing Research. Bath, Bath Press. Department of Health and Human Services (DHHS) (January 26, 1981) Final regulations amending basic HHS policy for the protection of human research subjects. Federal Regulations, 46 (16). Duffy, M. E., Rossow, R., Hernandez, M. (1996).Correlates of health-promotion activities in employed Mexican American women.Nursing Research, 45, 18-24. Ferketich, S. L., Mercer, R. T. (1995).Paternal-infant attachment of experienced and inexperienced fathers during infancy. Nursing Research, 44, 31-37. Fieler, V. K., Wlasowicz, G. S., Mitchell, M. L., Jones, L.S., Johnson, J. E. (1996). Information preferences of patients undergoing radiation therapy. Oncology Nursing Forum, 23, 1603-1608. Gordon, D. R (1988) Tenacious assumptions in Western biomedicine. In: Lock M, Gordon D. R (eds) Biomedicine Examined. London, Kluwer Academic Press. pp. 19–56. Gross, D., Conrad, B., Fogg, L., Willis, L., Garvey, C. (1995). A longitudinal study of maternal depression and preschool childrens mental health. Nursing Research, 44, 96-101. Hammersley, M. Atkinson, P. (1983) Ethnography: Principles in Practice. London, Tavistock. Hek G., Judd, M., Moule, P. (2002) Making Sense of Research: An Introduction for Health and Social Care Practitioners. Sage Publications, London. Johnson, J. E. Lauver, D. R. (1989) Alternative explanations of coping with stressful experiences associated with physical illness. Advances in Nursing Science, 11 (2), 39-52. Krainovich-Miller, B., LoBiondo-Wood, G. Haber, J. (2002) Critical reading strategies: Overview of the research process. In: LoBiondo-Wood J. Haber (eds.), Nursing Research: Critical Appraisal, and Utilization. St Louis, MO, Mosby. pp.33-50. Lindley, P., Walker, S. N. (1993).Theoretical and methodological differentiation of moderation and mediation.Nursing Research, 42, 276-279. Madge P, McColl J, Paton J. (1997) Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study. Thorax, 52, 223–228. Mantel, G. D., Biuchmann, E., Rees, H., Pattinson, R. C. (1998) Severe acute maternal morbidity: a pilot study of a definition for a near-miss. British Journal of Obstetrics and Gynaecology, 105, 985-990. McSherry, R. (1997) What do registered nurses and midwives feel and know about research? Journal of Advanced Nursing, 25, 5, 985-998. Michel, P., Quenon, J. L., Sarasqueta, A.M., Scemama, O. (2004). Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. British Medical Journal, 328, 1-5. Norman, E., Gadaleta, D. Griffin, C. C. 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(2003) Introduction to Research for Midwives. London, Books for Midwives. Robinson, J. (1996) It’s only a questionnaire: ethics in social science research. British Journal of Midwifery, 4, 41-46. Rodgers S (2000) A study of the utilisation of research in practice and the influence of education. Nurse Education Today, 20 (4), 279-287. Roseman, C., Booker, J. M. (1995). Workload and environmental factors in hospital medication errors. Nursing Research, 44, 226-230. Santy, J. Kneale, J. (1998) Critiquing quantitative research. Journal of Orthopaedic Nursing, 2, 77-83. Scott, T. J., Thompson D. R. (2003) Assessing the information needs of post-myocardial infarction patients: a systematic review. Patient Education and Counselling. 50 (2), 167-177. Shih, F. J. (1998) Triangulation in nursing research: issues of conceptual clarity and purpose. Journal of Advanced Nursing, 28 (3), 631-641. Street, A. F. (1992) Inside Nursing: A Critical Ethnography of Clinical Nursing Practice. 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The Changeable Nature of Life in The Bean Trees by Barbara Kingsolver E

The Changeable Nature of Life in The Bean Trees by Barbara Kingsolver Life is constantly changing, like clouds in the sky; always shifting and turning. People never really know which way life will turn next, bringing them fortune or failure. When you look at how things change it is best to compare it to something that you can relate it to. The changeable nature of life can be related to the novel 'The Bean Trees.' This is a book written almost entirely on dealing with changes in the characters lives. The Changeable nature of life affects us all somehow. Whether it be moving to a new city, having children, or losing people that we love, it can affect people in many different ways. For example, in the novel, the main character Taylor Greer changes her name from Marietta and moves...

The Power of Discourse in a Political Sex Scandal :: Politics Political Sex Gender Essays

The Power of Discourse in a Political Sex Scandal On August 12th, 2004 New Jersey Governor James McGreevey became this nation's first openly gay state governor. Several moments after he stated, "I am a gay American", he succumbed to intense political and public pressure by announcing his resignation from New Jersey's most powerful position. This announcement and resignation came after a week of intense allegations that McGreevey sexually harassed a male colleague whom he had appointed. While American politics are not foreign to sexual scandal, the political destruction and individual defeat which McGreevey currently faces is poignantly unique. Throughout his career, McGreevey has been formally investigated for unethical political practices on at least 4 occasions. One of the current investigations includes allegations of fraudulent campaign finance practices and nepotism within upper end political appointments. Despite the severity of these allegations, it was the charge of sexual assault from a male employee that forced his resigna tion and retirement from politics. In order to understand the severity of the sexual harassment allegations against McGreevey, it is necessary to look at the situation through the eyes of Rubin and Foucault. Not only did McGreevey's actions reflect the social sexual hierarchy described by Rubin, but through his secrecy and discretion McGreevey disrupted the powerful discourse of his position with political and public realms. In her essay "Thinking Sex", Gayle Rubin strictly outlines the rules of sexual conduct which currently exist in Western society. These rules have created a sexual hierarchy which places heterosexual, monogamous, married, reproductive sex at the top. Anything deterring from this position, is placed below in varying degrees. The allegations of sexual assault made against McGreevey not only announce publicly his sexual preference, but according to Rubin, place him at the very bottom of the sexual hierarchy. First and foremost, McGreevey is a married man. Any act of sexual advance towards anyone besides his wife can be seen as adulterous. Second, these sexual advances were made toward a male colleague while McGreevey remained in a heterosexual marriage. Thus, in the eyes of a bystander, he is eliciting homosexual behavior without claiming full affiliation with the gay community. Most importantly, the allegations of sexual harassment bring into question the consensual nature of his advances. As Rubin explains "A democratic morality should judge sexual acts by the way partners treat one another, the level of mutual consideration, the presence or absence of coercion, and the quantity and quality of the pleasures which they provide.

Orange and Bronze Main Problem

Development of online android application market for Orange and Bronze Main Problem: a. The company has no testing site or centralized point of for their applications software products. Specific Problems: a. Many software products are non-marketable b. Limited number of their software products viewed in the public Causes of the Problems: a. Other countries have different speculations of software products because of their culture b.Almost all of their software products is for their big clients such as accenture, advance, Aeon, Allied Telesis, Technologies so hey don't give the overview of their products because of security purposes and copyrighted. c. Effects of the Problems: a. More software products will be wasted b. Loss of clients. General Subject Area: Application of Mobile Technology in the field of Business II. Specific Topic: The OBAAM is an Philippine android online application that enables the user to download and browse mobile application.It also helps the Application devel oper to publish their own application for testing Ill. Definition of the Topic: A. Importance and Significance The purpose of this study is to have an efficient, reliable, and functioning entralized distributor of software product of the company that can be viewed and download in public. This study aims to present solution to the development ot system that will help the company to upload their apps (made by their Junior programmer) for testing. It also helps other developer's idea not to be wasted.This research project allows us gain information for the development of a system. It also help us for our future career. Through this research, we will already have a peek in what we will do in the future. B. Manageability: (Scope and Limitations) Is the research topic within your capability? What: Descriptions and types The OBAAM is an online Android application that will help the company to test their software products. Feedbacks from the user of the software will help the company for fu rther improvements of the software.Who: users and beneficiaries Through this proposed system, the user could easily find company's android apps even those unusual apps that can only be downloaded in the Philippines. The users will be benefitted by having feedback messages that will be the basis on improving the said system Where: users and applications To use the said system, the user will require android devices. When: historical background The company focuses in providing software services and software products on many big clients so lots of their software products cannot be viewed or download.Why: importance and relevance The system will help the client, user and the company interact providing their different needs. The system will distribute the software products made by the company and benefit both company and user How: process, functions and operations The processes include browsing and downloading of new software apps, uploading apps ,writing suggestions or bugs in forums and C. Availabili y ot Resources: (Sources ot Intormation) Where do you intend to get the information? Primary Data: Thesis and Dissertation Secondary Data: Internet Others: Journals, Articles D.Expected Output/ObJectives A system passed the following evaluation in terms of efficiency, reliability, functionality and maintainability. It will help the company to test their software, user to find unusual mobile android apps and save ideas in terms of marketability. General Objective: A designed and developed system and that will the evaluation in terms of functionality, reliability, and maintainability. The system is a apable of reporting bugs. The report or feedback will come from the users via forums.Specific Objectives: The proposed system will help the company to increase the number of software products viewed in public that will lead to increasing number of their client. The system will be the container of software products in which it will make the unusual software products marketab le so many ideas will not be wasted. University of Makati J. P. Rizal Ext. West Rembo, Makati City College of Computer Science Name: Canizares, Francis Joseph Diamante Garcia, Catherine Echipare Reyes, Edgar Peralta Program: Bachelor ot Science in Intormation Technology Major in Service Management TOPIC PRESENTATION Topic No. l. General Subject Area II. Specific Topic Ill. Specific of Research a. Background of the Study Orange and Bronze was founded in July 2005 by Calen Martin Legaspi and Renato â€Å"Butch† Landingin. Calen Legaspi says that they â€Å"wanted to establish a technology- oriented company that Filipinos can be proud of†¦ we would also want to contribute to global programming standards, create new technologies and be with the same level together with globally-respected companies like Google, Microsoft and BoostPro. The company started as a two-man consulting firm doing software training for local software companies.Their clients eventually hired them as s oftware consultants, before the company ventured into offshore software development projects. This led to partnerships with Google, Springsource and Pentaho. Orange & Bronze Software Labs Inc. (O&B) is a privately-owned computer software development company based in the Philippines. The company delivers software consulting, product engineering, and IT training services with a focus on Java technology. Their mantra is to successfully create software and provide technology olutions that work. b. Research Description i.General Objectives To develop an Application Market that will serve as a centralized contact point and distributor of apps for Android Devices Specitlc O 1 . Evaluate the system in terms of functionality, reliability, efficiency and maintainability 2. Develop the system designed 3. Provision of secure payment mechanisms 4. Avoidance of Downtime ill. Scope and Limitations This study is limited to browsing, downloading of Android apps for user, choosing of application type and publishing of application for Developer The OBAAM will only work whenever there is an internet connection.

Project Estimating Techniques Essay

One of the most important factors to the success of a project is how well the project is estimated, as well as how overall costs are managed during the execution phase by the project manager. Project costs and estimates are vital to the success of any organization to remain competitive in the market. Cost estimating for organizations rely heavily on resources that can sometimes be difficult to obtain. Forecasting and utilizing historical return costs are just a couple of ways that organizations rely on estimating. Experienced planners are often a sought trade within the market; this paper will discuss some often used project cost estimating techniques. Types of Estimating The first type of estimating is analogous. This type of estimating utilizes estimates from a previous project that is similar, and uses them to build estimates for the new project. While this type of estimating is beneficial to the planning process, caution must be used to ensure that estimates carried over from the previous project are fair and reasonable. Parametric estimation takes historical data inputs, makes calculated assumptions based on market and statistical data, and then formulates the estimate. This type of estimating is useful as it does use historical data, coupled with statistical data; however, assumptions made by the planner can be skewed and lead to inaccurate estimates in my opinion. The next type of estimating is bottom-up. Bottom-up estimating utilizes information from individual estimates through the Work Break Down structure. This type of estimating is one of the most common types of estimating because it uses estimates from the floor tasks. These floor tasks are estimated by subject matter experts with years of experience, and can be very beneficial to ensuring that not only the estimate is accurate, but the scope of the task is correct. Another type of estimating is three-point estimating. Three-point estimating takes a look at the best, worst, and most realistic scenario to cost estimating the project. These three options obviously come with a  premium on cost, time, or quality. Dependent on what the project objective is will more than likely determine what route to take in this process. From my work experience with project planning, cost estimating can be a very difficult task. Most organizations have a method or process in how to cost estimate. Some utilize checklists, while others may standard operating procedures as part of an organizational policy. Regardless of what tools are available to a project team during the cost estimating process, knowing the overall goals and objectives of the project are keys to estimating a successful project. The burden of cost estimating is not normally the responsibility of one individual; it often lies within the project team. Multiple estimators from various skills are part of the process, and all types of estimating as discussed earlier are part of the process. Tools that my organization utilizes are bid specification review meetings that go over the material, labor, and rates that apply to the work being conducted during the project. In addition, an independent government estimate (IGE) is utilized to ensure that estimates are filled out thoroughly, and reviewed against the contractor’s estimates upon receipt. There are many other processes that can be used; however, these are the most commonly one’s used within government estimating. Conclusion Cost estimating is a very important part of the project planning process as it often dictates the duration of the project, and how much work can be accomplished during the project against the budget given for the project. Estimates of time and cost together allow the manager to develop a time-phased budget, which is imperative for project control (Larson & Gray, 2014, p. 131). While there are many different ways that estimates are created, there is no sure fire way in stating that one is better than the other. While some may think that historical data is a more accurate way, there is not telling that the estimate and return costs from a previous project were fair and reasonable. If the previous project cost was overestimated, then the current project would continue to be overestimated; therefore not proving to be a cost benefit to the organization. Cost estimating drives the project plan, and organizations need to ensure they utilize all the tools and resources they have available to them to make the  project a success. Reference Larson, E. W., & Gray, C. F. (2014). Project Management: The Managerial Process (6th ed.). McGraw-Hill.

A Resort with a difference

This will be a resort that is customized for Christians though will be open to all as far as they maintain the culture of the place. Different services will be offered including foods and drinks, conference facilities, sports facilities, accommodation, entertainment and spiritual nourishment facilities for Christians.Services will be offered in a serene environment and no alcoholic drinks or other unchristian behaviour will be allowed in the place. Spiritual nourishment facilities will include Christian literature, music and teaching sessions.The Resort will be unique in that besides offering essential services it will maintain an environment that will encourage socialization and at the same time provide spiritual nourishment. All facilities will be provided with great consideration on nurturing good morals and personal developments.The Resort will be a substitute for the local pub or club only that services and facilities will all be geared not only on socialization and entertainmen t but both on spiritual and physical development. There are many people who would like to benefit from facilities offered in pubs, resorts and clubs but their moral values, faiths or public standing prevent them from going to such places due to the nature of provision of services in such places.However, a Resort for Christians will be unique and will provide the modest environment that such people require; they will be able to watch football, popular TV programs or a movie in a place they are comfortable in and with the company of people they would prefer to be with. The churches and other Christian organisations have numerous meetings and visitors and will be easily lured into using this kind of resort because of the perception that it is a Christian place.In the next five weeks the Resort will be in the incubation period. In this period we will be preparing a grand opening of the Resort. We will do in-depth publicity of the up-coming Resort and the grand opening event. Publicity w ill be done through print and electronic media, billboards and direct mail to prominent people.In this period the Resort facilities will be prepared thoroughly and decorated in order to be   The incubation period will end with a grand opening of the Resort which will also mark the entry into the introduction stage. According to NetMBA Business Knowledge Center website (http://www.netmba.com/marketing/productlifecycle) â€Å"during the introduction stage, the primary goals is to establish a market and build primary demand for the product class.†We would do this through intense publishing the resort by the grand opening and continued advertisement. We would invite prominent people in the society, especially those who have a reputation of modesty, to grace the occasion. We will then also adopt a penetration pricing strategy by offering favourable pricing for our products for the first month of our operation.As the business grows we will continually evaluate the service provisi on systems in the facilities and ensure we offer quality services. This is because, as cited in NetMBA Business Knowledge Center website (http://www.netmba.com/marketing/productlifecycle), as a product moves through the different stages of its life cycle, it necessitates change of the marketing strategy thus calling for continuous evaluation and re-adjustment.We will establish a modest and unique culture in order to ensure that our services are different from others. This product differentiation together with continued promotion will ensure that our services are preferred. We will also invest in technology so as to increase efficiency and effectiveness in provision of services.We will maintain a well detailed website and establish links with travel agencies. We would evaluate our business continually and increase or reduce the services we offer and how are they are offered. This will be geared toward maintaining our services as different from those of our competitors and ensuring co st effectiveness. We would also keep on exploring new ways of promoting our services so as to maintain our market share and to compete effectively.ReferencesNetMBA Business Knowledge Center. The Product Life Cycle. Retrieved January 07, 2008 from http://www.netmba.com/marketing/product/lifecycle