Sunday, January 12, 2020

A Root Cause Analysis Essay

Healthcare facilities that are accredited by Joint Commission are required after a sentinel event to conduct a root cause analysis (RCA). A root cause analysis is conducted to determine the cause or factors that contributed to the sentinel event. A few things must be asked in the RCA such as who, what, where, why and how in order to identify the cause. After the cause of the sentinel event is determined and a corrective action plan has been put in place a failure mode and effects analysis (FMEA) could be conducted to reduce the likelihood that it should happen again. The scenario A 67 year old male (Mr. B) was brought into the emergency room for pain to left leg and left hip. The injury occurred when the patient had a fall due to him losing his balance after tripping over his dog. The hospital is a 60 bed rural hospital located in Mr. B’s hometown. Mr. B was brought in by his son and neighbor. Upon triage Mr. B was complaining of pain 10/10 on the numerical pain scale and his vitals were found to be stable. Mr. B has a history of impaired glucose tolerance, prostate cancer, and chronic pain which he is on oxycodone. The Patient states he had no known allergies or previous falls. Upon the nursing assessment Nurse J. has noticed that the patient has limited range in motion, his left leg has swelling and appears shortened in comparison to the right. Nurse J. has informed the ED physician which he came to his bedside for evaluation. Upon evaluation the physician decided that Mr. B needed to have a reduction of his left hip, due to the dislocation and will require a conscious sedation. Mr. B requires multiple doses of medication to achieve the desired sedation affect for the reduction. Once the reduction was successful Mr. B is left with son in the room where a full set of vitals were not continuously monitored and goes into respiratory failure which lead to the death of Mr. B. Staffing on this day is the day of the event consisted of a secretary, emergency department physician (Dr. T), and two nurses (one RN and one LPN). A respiratory therapist is in house and available as needed in this six bed ED and sixty bed hospital. Events At 3:30pm- Mr. B was taken to ED for left leg and left hip pain from a fall. Pain is a 10/10 vitals include 120/80 blood pressure (BP), 88 heart rate (HR) and regular, 98.6 temperature, (T), 32 respirations (R), 175 lbs.. At 4:05pm- Mr. B was given Diazepam 5mg IVP which had no affect after 5min. At 4:10pm- Dr. T orders 2mg of hydromorphone to be given to Mr. B. At 4:15pm- Mr. B was given 2mg of hydromorphone IVP. At 4:20pm- Dr. T is not satisfied with level of sedation and orders Mr. B to be given 2mg of hydromorphone, and diazepam 5mg IVP. At 4:25pm- Mr. B appears to be sedated and reduction of his (L) hip takes place. The patient remains sedated and appears to have tolerated the procedure. The procedures concludes at 4:30pm. No distress is noted, patient is placed on monitor for blood pressure to be taken every 5 minutes along with pulse oximeter but no supplemental oxygen or ECG leads (monitors cardiac rhythm and respirations) was placed on patient at this time. At 4:30pm- Nurse J allows Mr. B’s son to remain in the room with him as he is being monitor by blood pressure machine only. Nurse J leaves the room. At 4:35pm- Mr. B vitals are BP 110/62, O2 sat is 92% still no oxygen or ECG leads are on patient at this time. EMS is transporting a patient in respiratory distress, lobby is beginning to get congested. LPN and Nurse J. in the process of discharging 2 patients and are checking in the patient that EMS has transported in. LPN enters Mr. B’s room and resets his alarming monitor that was showing a sat of 85% and restarts the B/P to recycle. LPN does not supply oxygen and does not alert Nurse J at this time. Management is not notified that patient acuity and patient load is increasing. Nurse J is now fully engaged with the emergency care of the respiratory distress patient. At 4:43pm- Mr. B’s son comes out of room and informs the nurse that the monitor is alarming with vitas of B/P 58/80 O2 of 79%. The patient has no palpable pulse and is not breathing. A STAT code is called and the son is taken to the waiting room. The code teams arrives places Mr. B on cardiac monitor where he is in ventricular fibrillation and the team begins resuscitative efforts. CPR is started and the patient is intubated. Mr. B is defibrillated and reversal  agents, vasopressors and IV were started. At 5:13pm- After 30 min of interventions the ECG returns to a normal sinus rhythm with Mr. B’s B/P being 110/70. The patient is completely dependent on the ventilator, his pupils are fixed and dilated and there is no spontaneous movements. The family as asked for the patient to be transferred out to a tertiary facility for further advanced care. Outcome Seven Days later Mr. B has died. The family had requested that life-support be removed after brain death had been determined by EEG’s. This is a sentinel event. Investigation of sentinel event should begin with a Team and method of investigation. Interdisciplinary team included in the RCA should include the Director of Nurses, Nursing Supervisor, Risk management, Nursing Coordinator, and Manager of the department. Once the team is put together the RCA should be started. The team should set up interviews with all staff that was involved and present in the department the day the sentinel event happened. A complete chart review should be conducted by team. The policies on conscious sedation, staffing of department, and standardized work should be reviewed. When the cause is identified a corrective action plan should be conducted. The corrective action plan will allow a series of projects can be put in place to help create or change polices if needed. The new or changed polices should be put into education models to teach to current and new staff as needed. The Root Cause Analysis Causative factors- (why it happened) determined cause Individual’s cause factors Nurse J did not follow procedure for conscious sedation. The patient was not placed on continuous B/P, ECG, and pulse oximeter throughout the procedure. Respiratory Therapist was not informed of the conscious sedation. LPN did not address low o2 saturation of 85% between the 4:35pm-4:43pm. Dr. T did not take in account of the patient’s weight and chronic pain medication use. Nurse J did not question the medication that Dr. T ordered. Team’s cause factors Management was not called and informed of staffing needs and acuity of patients. Back up staff was not called in to help when acuity and patient load had increased. Commination between Nurses and Dr. T were not present when the patient began to decompensate. Management /Organizational cause factors Unsafe Staffing at ED. There was not enough staff present to safely manage emergencies in the ED. RCA Findings: Errors and/or Hazards 1. Per protocol the patient was not hooked up to the proper monitoring equipment at the bedside. The facility procedure police called for continuous B/P ECG, and pulse oximetry during and after procedure until patient meet the discharge criteria. The nurse should have remained with patient during the recovery period. Crash cart with defibrillator was not present during the procedure nor was the proper reversal agents that could reverse the medication given for sedation. 2. Nursing staff communication was very poor. LPN did not notify Nurse J or ED physician when the patient’s o2 saturation dropped down to 85%. Oxygen was not placed on patient when O2 saturation dropped which led to respiratory failure causing the patient to code and eventually led to Mr. B’s death. 3. Communication between ED staff and management lacked when staffing needs increased. Patient safety was put at risk when the patient load and acuity increased in the ED and the staffing did not increase. Staffing shortage caused the nurse and nursing support staff to attend to other patients and leave Mr. B unmonitored which led to respiratory distress due to the patient being over medicated for sedation which led to respiratory failure and eventually led to Mr. B’s death. 4. The ED physician did not request the patient be transferred to the nearest trauma center due to lack of recourse’s in the emergency department. Recommended Corrective Action Plan/Change Theory/Improvement Plan 1. Improved patient safety during conscious sedation: Effective immediately all conscious sedation procedures will be conducted per protocol. Within 10 days the conscious sedation procedure should be evaluated by a committee to ensure the best practices are being used. Within 30 days of this RCA all  staff should be educated on conscious sedation protocol. All nursing staff should use review protocols for conscious sedation before a conscious sedation procedure is to take place. 2. Communication within the department should be evaluated immediately by a group of staff members to find out where the miscommunication failure lies. This could be that the nursing support staff is unaware of the parameters that should be reported to nurse or physician. With 10 days of this RCA a policy on documentation of communication should be put in place to ensure that all nursing staff are documenting the communication of a patients change in status has be reported to physician. Effective immediately all nursing support staff should be educated on parameters that should be reported to nursing staff and physicians. This should be put into a policy along with documentation of communication. 3. Improved patient to nurse ratios: Management should put in place a safe nurse to patient ratio for the emergency room. Communication policy between department and management should be put in place effective immediately to ensure that no other patient should be placed in harm’s way due to staffing shortage. The emergency department should be put on diversion if the patient load and acuity places patients at risk for harm in any manner. A copy of the RCA should be given to management and leadership. Management should share the finding with all emergency department staff. Feedback should be done 30 days after corrective action plan or change theory have been put in place to ensure that everything that has been put in place is effective for the department to improve patient safety. Constant reevaluation of patient safety should be conducted and feedback given to improve patient safety by all providers involved. Management will continue to ensure that all staff follow all protocols to ensure that patient care and safety are not compromised. At a 90 days bench mark after the corrective action plan has been put in place management should revisit the any changes made to protocols and polices to ensure compliance and effectiveness is still in place and reevaluate the process to ensure patient safety. Failure Mode and Effects Analysis (FMEA) A Failure Mode and Effects Analysis is proactive versus the RCA which is reactive. A FMEA assesses a process for risks of failures or adverse effects of a process and prevents them by correcting what is wrong proactively  (Institute for Heathcare Improvement, 2004). A Healthcare facility may use FMEA tools on the Institute for Healthcare Improvement website to evaluate a process in the facility. This tool will calculate a risk priority number (RNP) of a process, evaluate the impact of the process and the changes that are being considered, and tract the improvement over time (Institute for Heathcare Improvement, 2004). PRE-FMEA 1. Step one: Select a process to be evaluated with FMEA. The FMEA for this paper will focus on the conscious sedation protocol. 2. Step Two: Recruit a multidisciplinary team and include a member from every department that may be involved or affected. This team for the conscious sedation protocol should will include. Registered Nurse Physician Management Pharmacist Respiratory therapist A member from Legal Laboratory Tech Emergency Department Tech 3. Step Three: Information needs to be gathered by the team. A list of steps in the process being evaluated should be put together or even an outline of steps would be helpful to the team. All internal and external data, clinical practice guidelines, current policies and procedures, current literature and any other information that may pertain to the process that is being evaluated. For the purpose of this paper we would use data on outcomes of conscious sedation protocols, RCA’s on bad outcomes, clinical practice guidelines and any research documentation that would aid in best practices for conscious sedation. Team meetings should be structured with an agenda. A leader or primary person with extensive knowledge of the FMEA knowledge (Department of Defense Patient Safety Center, 2004) 4. Step Four: The Team should list the failure modes and causes. In each process all failure modes should be listed, and then for each failure mode a list of possible causes should be listed as well. In this scenario we will use this as an example Preparing medication Wrong medication prepared Wrong dose prepared 5. Step Five: A Risk Priority Number (RPN) will be assigned to each failure mode for the likelihood of occurrence, for the likelihood of detection, and for the severity. This step is also known as the three steps FMEA. The RPN is a numerical rating. For this scenario here is an example Likelihood of Occurrence: This will measure the likelihood a failure mode is to occur. The score range will be 1-10 with 1 meaning it is very unlikely to occur and 10 meaning very likely to occur. Example- Wrong medication prepared = 5 Likelihood of Detection: This will measure the likelihood a failure mode is to be detected if it should occur. The score range will be 1-10 with 1 meaning it is very likely to be detected and 10 meaning very unlikely to be detected. Example- Wrong medication prepared = 6 Severity of occurrence: This will measure the severity of the failure mode should it occur. The score range will be 1-10 with 1 meaning no effect and 10 will be death should a failure mode occur. Example- Wrong medication prepared= 9 6. Step Six: The team will evaluate the results. For each failure mode the three scores are multiplied with each other. The failure mode with the highest RPN will be the one that will be evaluated by the team to ensure patient safety. The higher the RPN a failure mode has the higher the potential for harm it may cause. The RPN score can be as high as 1,000 and as low at 3. Example- Wrong Medication Prepared Occurrence- 5 Detection- 6 Severity- 9 5x6x9= overall score =270 7. Step Seven: An improvement plan will be made based on the RPN. Likely to Occur. Have a triple check put in place. Have team attempt to eliminate all possible causes. Example-Have medication scanned when pulled from Pyxis to check providers order. Have patient scanned before medication may be prepared to check providers order. Have patient and medication scanned to ensure correct patient with the correct medication and proper providers order. Unlikely to be detected. Look for warning signs that the error may not be detected. Use data from any previous or prior errors. Severity. Use any data available to determine severity of error. Make available any and all resources to prevent further errors and severity of errors. Final Step- The final step in the FMEA is to plan an observation or test. A plan should be clear of its objections and should have some sort of predictions or outcomes. During the test all data should be documented. In this data collection phase all observations including problems or unexpected issues should be documented and later evaluated. After the test is complete and all data collected the team should meet for analysis of the data. A summary of the analysis should be documented. All changes or modifications to the process will be based on the test and analysis of data conducted. Any and all changes should be communicated to all staff members. These changes may or may not show improvement to the process, this is why constant reevaluation of all process should be conducted and any feedback should be given to leadership for the reevaluation of the process. Nurses play a vital role in health care. Nurses have the most contact with a patient. Nurses carry out any orders and or processes. A nurse is the patient advocate, they are the ones who will advocate for patient safety. Nurses are the advocates who will be looking for evidence base practices to improve patient care and patient safety. Improving quality of care for each patient will improve the outcomes for each patient. References Department of Defense Patient Safety Center. (2004, 12 26). Failure Mode and Effects Analysis. Retrieved from FMEA Info Centre: http://www.fmeainfocentre.com/handbooks/FMEA_Guide_V1.pdf Institute for Heathcare Improvement. (2004). Failure Modes and Effects Analysis (FMEA). Retrieved from Institute for Heathcare Improvement: http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx

Saturday, January 4, 2020

Bipolar Disorder The Most Serious Mood Disorders

â€Å"When you are mad, mad like this, you don t know it. Reality is what you see. When what you see shifts, departing from anyone else s reality, it s still reality to you† (Hornbacher, 2008). The purpose of this paper is to educate viewers on bipolar disorder. Bipolar disorder is one of the most serious mood disorders around because of the severe affects it has on a person’s mind, behavior, family and basic daily functioning. â€Å"Approximately 5.7 million† Americans have bipolar disorder (Bipolar Disorder Statistics - Depression and Bipolar Support Alliance, 2013). Bipolar disorder is a manic-depressive illness that causes shifts in behaviors, mood, and energy which in turn then affect one’s social functioning. The term â€Å"ups and downs† is just a glimpse of what someone with bipolar disorder experiences. Basically, people with bipolar disorder experience tsunamis of emotions that bring them down so low they can become suicidal or bring them so high, they can act like the Tasmanian devil from looney tunes (to an extent). Bipolar disorder is divided into two categories – bipolar I and bipolar II. Bipolar I is a more severe than bipolar II. People with bipolar I experience mania accompanied with irritable mood. This type of mania or manic episode involves delusional thinking. The manic episode can only be diagnosed if it is accompanied with three or more symptoms on a daily basis for a minimum of one week. Usually, hospitalization is a necessary if the individual isn’t takingShow MoreRelatedBipolar Disorder ( Bipolar )847 Words   |  4 Pagesâ€Å"Bipolar Disorder† Bipolar Disorder is a mental illness, which involves hypomanic episodes, which are changes in someone’s usual mood. Originally, Bipolar Disorder was called manic depression because it does share similar symptoms with people diagnosed with depression. Bipolar Disorder is a severe condition because it can cause mania, which then causes hallucinations and paranoid rage. (Bipolar Disorder) Bipolar Disorder is classified into two categories, bipolar type 1 and bipolar type 2. BipolarRead MoreBipolar Disorder : Symptoms And Symptoms943 Words   |  4 Pages Bipolar Disorder is a severe mental illness that causes shifts in mood swings by being overly excited or overly depressed, and can have suicidal thoughts. â€Å"All people with bipolar disorder have manic episodes- abnormally elevated or irritable moods that last a week and impair functioning.† (htpp://www.apa.org, 2015) Bipolar disorder is a long-term illness, can be controlled with prescription medication and psychotherapy sessions. Bipolar disorders are broken down into many partsRead MoreBipolar Disorder : A Mental Disorder1321 Words   |  6 PagesBipolar disorder is a very serious mental illness, that can have detrimental effects on a whole family. Bipolar disorder also known as â€Å"manic depression†, is a mental disorder that affects a person’s mood and general outlook on life like most other mental disorders. Bipolar disorder cannot be cured, but treatment can help improve the overall function of a person’s life. Bipolar disorder can affect peop le’s lives greatly. Bipolar disorder can affect a person’s relationship with others. People withRead MoreSymptoms And Symptoms Of Bipolar Disorder1285 Words   |  6 PagesBipolar Disorder This paper will contain information on what bipolar disorder in early and late adolescence is, causes and symptoms, medical along with therapeutic interventions and how important it really is to get treatment. Bipolar disorder is a disease that affects approximately 2.6% Americans in the United States in a given year. There is limited data on the rate of bipolar in adolescents, although, it does tend to affect older teens more often and may be related to substance abuse. A lotRead MoreBipolar Disorder : A Serious Mental Illness980 Words   |  4 PagesBipolar Disorder I decided to do my research paper on Bipolar Disorder. The reason I chose to do my paper on Bipolar disorder is because it is a serious mental illness. Those with bipolar disorder often describe their experience as an emotional roller coaster. Going up and down between strong emotions can keep a person from having anything approaching a normal life. The emotions of a persons’ behavior with bipolar disorder experience as beyond ones control. This condition is exhausting not only forRead MoreAlcoholism : A Common Co Occurring Disorder1628 Words   |  7 PagesAlcoholism Alcohol is the most commonly abused drug in the United States. Alcohol abuse is defined as a pattern of drinking that results in failure to fulfill responsibilities at work, school, or home; drinking in dangerous situations; having recurring alcohol-related legal problems; and continued use despite having medical, social, family, or interpersonal problems caused by or worsened by drinking (APA, 1994). Approximately fourteen percent of people experience alcohol dependence at some pointRead MoreBipolar Disorder And Mental Health1691 Words   |  7 Pagesaffected by bipolar disorder. Bipolar disorder is an illness that occurs with the brain and causes abnormal shifts in mood and energy. An individual with bipolar disorder will experience many ups and downs. These ups and downs are way different from the ups and downs an individual without the disorder will experience. Bipolar disorder is a lifelong condition and if not noticed, or treated properly, the ups and downs can become severe. Many individuals in United States, who have the bipolar disorder, don’tRead MoreSymptoms And Symptoms Of Early Onset Bipolar Disorder1742 Words   |  7 Pages Early-onset bipolar disorder is a chronic mood disturbance that causes dramatic shifts in one’s mood that is uncharacteristic of their normal mood and behavior. This hereditary behavioral disorder causes mood swings from extreme lows, depression, to extreme highs, mania. It usually occurs in mid- to late-adolescence but can appear as early as elementary school. The unique symptoms of this age group are angry and aggressive outbursts followed by periods of remorse and guilt, declining academic performanceRead MoreMental Illness, Schizophrenia, And Eating Disorders1380 Words   |  6 Pagesstatistic most often quoted is that one in four adults and one in five children will have a mental health disorder at some point in their lives. (What is Mental Illness? n.d.). The overall stigma that comes along with a mental disorder is still one of the biggest barriers that prevents those from obtaining treatment or retaining their treatment. â€Å"While there are over 200 classified for ms of mental illness, the five (5) major categories of mental illness are: Anxiety Disorders, Mood Disorders, Schizophrenia/PsychoticRead MoreBipolar Disorder And Major Depression1358 Words   |  6 PagesMood disorders are characterized by unstable emotions, which are not always completely within the individual s control. Mood disorders are one of the most common categories of psychological disorders, and the two most common disorders within this category are bipolar disorder and major depression (also known as clinical depression). These disorders often require a patient to take medications to regulate their mood, which is often paired with psychotherapy or â€Å"talk therapy.† While they are common

Friday, December 27, 2019

The Appeal to (Irrelevant) Authority (Logical Fallacy)

The appeal to (false or irrelevant) authority  is a  fallacy in which a rhetor  (public speaker or writer) seeks to persuade an audience not by giving evidence but by appealing to the respect people have for the famous. Also known as ipse dixit and ad verecundiam, which means he himself said it and argument to modesty or respect respectively, appeals to authority rely entirely upon the trust the audience has as a speakers integrity and expertise on the matter at hand. As W.L. Reese puts it in Dictionary of Philosophy and Religion, though, not every  appeal to authority  commits this fallacy, but every appeal to an authority with respect to matters outside his special province commits the fallacy. Essentially, what he means here is that although not all appeals to authority are fallacies, most are — especially by rhetors with no authority on the topic of discussion. The Art of Deception Manipulation of the general public has been a tool of politicians, religious leaders and marketing experts alike for centuries, utilizing appeal to authority often to support their causes with little to no evidence for doing so. Instead, these figureheads use the art of deception to leverage their fame and recognition as a means to validate their claims.   Have you ever wondered why actors like Luke Wilson endorse ATT as Americas largest wireless phone coverage provider or why Jennifer Aniston appears in Aveeno skincare commercials to say its the best product on the shelves? Marketing firms often hire the most famous A-list celebrities to promote their products for the sole purpose of using their appeal to authority to convince their fans that the product they endorse is worth buying. As Seth Stevenson posits in his 2009 Slate article Indie Sweethearts Pitching Products, Luke Wilsons role in these ATT ads is straight-up spokesman — the [ads] are horribly misleading. The Political Con Game As a result, it is important for audiences and consumers, especially in the political spectrum, to be doubly aware of the logical fallacy of merely trusting someone on their appeal to authority. In order to discern truth in these situations, the first step, then, would be to determine what level of expertise the rhetor has in the field of conversation.   For instance, the 45th President of the United States, Donald Trump, often cites no evidence in his tweets condemning everyone from political opponents and celebrities to supposed illegal voters in the general election. On November 27, 2016, he famously tweeted In addition to winning the Electoral College in a landslide, I won the popular vote if you deduct the millions of people who voted illegally. However, no evidence exists that verify this claim, which only sought to alter public opinion of his opponent Hillary Clintons 3,000,000-vote lead over him in the popular vote count of the 2016 U.S. election, calling her victory illegitimate.   Questioning Expertise This is certainly not unique to Trump — in fact, a large majority of politicians, especially while in public forums and on-the-spot television interviews, use an appeal to authority when facts and evidence are not readily available. Even criminals on trial will use this tactic to attempt to appeal to the empathetic human nature of the jury in order to sway their opinion despite contradictory evidence.   As Joel Rudinow and Vincent E. Barry put it in the 6th edition of Invitation to Critical Thinking, no one is an expert on everything, and therefore no one can be trusted on their appeal to authority every time. The pair comment that whenever an appeal to authority is introduced, it is wise to be aware of the area of expertise of any given authority — and to be mindful of the relevance of that particular area of expertise to the issue under discussion. Essentially, in every case of appeals to authority, be mindful of those tricky appeals to irrelevant authority — just because the speaker is famous, doesnt mean he or she knows anything real about what theyre saying.

Wednesday, December 18, 2019

My Family A Christian Family - 1463 Words

I grew up in Peru in a Christian family, more specifically, an Evangelical one. At first, my family was Catholic however, in the year 2000 we converted to Evangelical. The mom of one of my friends in preschool invited my parents to her church’s anniversary and that is when everything changed for my family. Back then, I was a 6 year old child who did not have an understand of what was happening; all I can remember is my parents taking me and my sisters to the church every Sunday. By seeing old pictures, it is noticeable how my family changed completely after all of this. Before, as Catholics, we did believe in God and my three sisters and I were baptized in water when we were babies; however, we just attended church on special days or†¦show more content†¦In 1529, the â€Å"Protestant† word started being used since they were ‘protesting’ against the Church and its system; before that, these people referred to themselves as â€Å"reformers† because the word â€Å"protestants† sounded aggressive and negative. Therefore, different denomination names started appearing and each of them moved from Europe to different places, like America, where they started establishing themselves. I would only discuss about the Methodists and the Evangelical denominations since these two had been part of my family and my life as I grew up as a Christian. The Methodists were formed in England guided by John Wesley and they finally established themselves properly in America after the American Revolution. Before that, Wesley and other missionaries came to America, however, it wasn’t until around 1760 when they start settling their church successfully in colonies across the South and West (The United Methodist Church, 2016). I learned some of this during middle and high school since I attended a Methodist school and I had to know their history. My parents put me there because they found out that the Methodist and the Evangelical religion share a lot of things since both started from the Protestant movement. Talking about the origins of the Evangelical religion, it also appeared in the 18th century as part of the Protestantism, however, it involves a lot the different denominations that moved here to the United States. What help definingShow MoreRelatedMy Understanding Of Family Life And The Meaning And Content Of Christian Faith955 Words   |  4 Pageslistened to the radio broadcasts provided by the conservative Christian organization, Focus on the Family–both the daily broadcast on family issues and the weekly broadcast of the radio drama for children, Adventures in Odyssey. My understanding of family life and the meaning and content of Christian faith was heavily influenced by these broadcasts. I listened carefully to the dangers of straying beyond the strict confines of conservative Christian morality, and I can still hear the emphatic tone of voiceRead MoreReflection Paper On Structural Family Therapy755 Words   |  4 Pages As I Christian, I hold relationships in high esteem because I believe that relationships have the potential to highlight God’s glory in a unique way. I agree with S. J. Grenz (2002) that â€Å"the image of Cod does not lie in the individual per se, but in the relationality of persons in community† (p. 54). I believe that Satan knows this truth and attacks relationships in order to ruin God’s glory. In my opinion, this is evident by the amount of pain that occurs in relationships. I desire to bring gloryRead MoreAnnotated Bibliography On Family Therapy1629 Words   |  7 Pagesthis paper is to prepare an an notated bibliography on family therapy with emphasis on ethnicity and sociocultural influences on the problems of communication. This research includes twelve resources on authors with the following annotations: Delineation of the main focus or purpose of each author s work; Background and credibility of each author; Intended audience for the work; Any unique feature of the work; Theoretical understandings; Family therapy strategies or techniques; and a Conclusion orRead MoreFamily Ministry : A Comprehensive Guide928 Words   |  4 Pagesthis class with reading what Family Ministry is defined as opened up my view on how Family Ministry can be diverse in a variety of understanding. Diana Garland stated that â€Å"family ministry is any activity that directly or indirectly (1) forms families in the congregation community; (2) increases the Christlikeness of the family relationships of Christians; or (3) equips and supports families for the work to which they are called together.â⠂¬  Earlier in that reading, Family Ministry: A ComprehensiveRead MoreChristian Worldview Essay Paper1121 Words   |  5 PagesChristian Worldview Paper – Second Draft Christine Reiter CWV 101 – Christian World View 11/25/2012 Dr. Jim Uhley My Worldview My worldview is formed by my relationships, challenges and choices I have made, environmental surroundings and my family influence, all which have impressed on me my views of the world. According to Merriam-Webster’s Learners Dictionary, the definition of â€Å"Worldview† is â€Å"The way someone thinks about the world†. Although this simple phrase seems to the point, itRead MoreThe American Suburbs Are A Valuable Community For Families1669 Words   |  7 Pages The American suburbs are a valuable community for families. Some would debate that they are the best place to raise a family. They can provide a safe, loving, and nourishing place for a children but can also be a sheltered place to grow up. Suburbs are places with community and family and are a very important part of today s society and culture. â€Å"For many Americans the word suburb conjures up an image of post-world war II single family tract homes, products of the age of automobiles and superhighways†Read MoreHow do We Say our Last Good Byes in Mexico and in India Essay968 Words   |  4 Pagesthe culture, religion, customs and our own beliefs. However, there are some diffe rences between Indian Hindus and Mexican Christians as well as similarities between both countries and religions. Cooking their favorite meals on their deceased loved ones birthday, and anniversaries, is just one example of similarities they both have. Jumpa Lahiri describes that Gogol and his family prepared Ashoke’s favorite meal (Gogol’s father) on his first death anniversary (Namesake, Chapter 7). First, CustomsRead MoreFamily : Family With Family Essay1444 Words   |  6 PagesFamily Interview Family Therapy is a great way to open up and really get concerns and issues out in the open with families. The assignment was to have a non-clinical family interview, it was not like a therapy session, but it gave great insight of have a family session could go, it was a great experience. It allowed me to be the interviewer and ask questions about a family. It was a really interesting assignment. It consisted of selecting a family, asking questions, observing, and forming my thoughtsRead MoreThe Essence Of Arthur Dorl1184 Words   |  5 PagesDorl My cultural identity is a white, twenty-year old, German American, whose Christian and Republican. I hold true to the Bible and the life of Jesus Christ, Republican values and have high value for friends and family. With family and friends, my level of affection and openness varies slightly. I do not openly show affection towards family, but I would do anything to protect them, their integrity, and would not hesitate to lay down my life for them. Despite my willingness to protect family no matterRead MoreThe Importance Of Being A European American943 Words   |  4 Pagesin my (predominantly) Irish, British, and German heritage. Thanks to ancertory.com, I have been able to trace the clear majority of my family back to native European countries. Also, I have fun attempting to learn my native ancestral languages (impartially German,) dinning on European cuisines, and staying up-to-date on the latest European fashions. Like most Europeans, I too identify myself as being Christian. Unli ke most Europeans however, I take my Christian faith quite seriously. I try my best

Tuesday, December 10, 2019

The economic essential of digital strategy - MyAssignmenthelp.com

Question: Discuss aboutThe economic essential of digital strategy. Answer: Introduction This report depicts the effect of digital disruption in the business organization, Netflix. It is defined that before and after the digital disruption different level of changes might occur that would again make measurable changes in the organizations too. Adoption of new different technologies acts as a catalyst for business success (Bradley and OToole 2016). In order to provide an effective digital future to the business organization the system developers of the organization wills to change the digital platform from the traditional one. The identified issues for which the changes are required are elaborated in this report. In addition to this, the status of the work centered analysis before and after the digital disruption are illustrated in this report. One of the most well known American entertainment companies founded in the year of 1997 had to face digital disruption due to their initial business model (Moller, et al. 2017). The company was specialized in serving streaming media, DVD and also on demand online videos. In 2017, the company had around 109.26 million of consumers throughout the world. Basically their efforts for producing new products with high security and additional content their profit is also ranging from the $16.9 to $21.10 within 2017. Discussion on case details of Netflix Netflix is a streaming service provider that allows the consumers to watch wider variety of different TV shows, movies as well as documentaries. It provides different internet connected devices too (Kramer and Kalka 2017). Moreover, it can be said that, Netflix allows the consumers to enjoy unlimited opportunities to view different contents even without any kind of commercials. Though the company has huge number of viewers throughout but still for getting more competitive advantages they wished to expand their business and during making this change, they faced different issues those are required to be resolved sooner. In order to add more contents such as TV shows and movies as well they must undertook digital disruption in their company (Rosenstand et al. 2017). However, in order to gain measurable revenue from the competitive market including meeting the requirements of the consumers they changes their service platform into a cloud based one. Proper identification of the case Problems of Netflix case In the year of 2016, Netflix company announced that, they are willing expanded their business in around 130 countries within a day only. However, their service will not be available in China International market. Though, the expectation delivered a mixed resultant to their consumers and even to the company. In the initial three months of 2016, the net profit of the company was calculated to be internationally good. On the other hand in the second quarter of 2016, they failed to reach their expectation (Davis and Zboralska 2017). However, after the forecast of the company, it is found that the growth of the way for the company was below the street target measured by the company. The reasons for which they faced trouble in the international market are as follows: Local content limitation: There is a different company who serves effective service throughout. This particular limited amount is extremely related due to the religion competitors in the developed marketplace such as France, Germany etc (Riemer et al. 2015). It is found that the contents offered by Netflix are limited and the other competitors of the company offers more localized content to their consumers. This is a major trouble to the company which is needed to be resolved. Barriers in language: Netflix mostly offers English contents to their consumers that might hamper many counties like Russia, Portugal demand. According to the census of 2010, only 5% of the country could speak English. Therefore, language barrier is referred to as main issues for Netflix that hampered the revenue of the company. High expense: Many companies are there which offers similar kinds of services to the consumers. In order to develop the market of the competition level, significant changes are needed to be considered by the company. The initial requirement of any consumer is to adopt affordable subscription services (Flew 2017). However, in case of Netflix the monthly subscription charge was found to be very high than the others. This is the reason for which the number of consumers for the company is reducing day by day. Goals of the case The goal of Netflix is to deliver successful, on-time and affordable services to the consumers throughout the world avoiding expense issues and language barriers as well. It is expected that as soon as the company would start delivering affordable services to the consumers it would be able to gain competitive advantages and measurable revenue from the market as well. Moreover, the goal of the company is to resolve all the identified issues including few of the flaws. Other current ethical issues that have been identified by Netflix is that they lied to the public about their services openly. Therefore collective it is determined that the goal of the company is to deliver data caps those are restricted to avoid ethical dilemma. Apart from this, the communication team of Netflix also wills to offer good streaming experiences for the consumers for avoiding unexpected fines from the mobiles service providers. Challenges associated to digital disruption Different challenges might occur after the digital disruption. It is define that if digital disruption took place in the companies then the operational and functional ability of the company would be affected automatically (Kramer and Kalka 2017). The challenges associated to digital disruption are as follows: Security: During the digital disruption due to lack of security most of the information could be hijacked with unauthenticated external assaults. Data loss: In order to avoid the issues with services, delivery and price the company is willing to transfer their digital platform to a cloud based one. It is expected that it would help the business organization to resolve the issues accordingly (Valentine 2016). While changing the platform information might get lost from the server. If proper backup and disaster recovery plans are not added to the services then, data would surely get lost and cannot b ever retrieved again by the service providers. Recommendation to the company Different alternative solutions are there that helps to ensure the improvement of the Netflix services. The recommendation for the company is as follows: Development of modern streaming to make sure that Netflix has reached the growth of the operators To avoid the poor streaming issues throughout the world is facing Consumers should get on-time and secured services Implementation plan based on the recommendations In order to avoid the issues of security, communication, lack of availability of local contents Netflix is focused to bring digital disruption in their marketplace. The goal of the company is to deliver on time, accurate secured and enough content to the consumers throughout the world. In order to deliver services avoiding these issues, the company has changed their business model concept entirely. Netflix has developed a web based catalog service to their consumers which are able to rent movies of older time in the DVD format. They could deliver this service through mails also. Through this cloud based online website the consumers could develop their movies wish list (Flew 2017). According to the currently implemented service they would be allowed to deliver three movies from the consumers wish list with a minimal subscription charge which is $19.96 in each month. The profit of this service implies that there would be no such return deadline and late charges for the DVDs sent throug h emails. Even Netflix could also introduce a service for delivering movies and other television shows directly to the consumers PCs. It is expected that with the service quality Netflix could compete apple, Amazon etc. The other reasons for which it is determined that Netflix would reach success are as follows: They could make deals with Disney, CBS and Epix for the TV content This could introduce easy watch services as little as $8.98 per month It would introduce limitless TV and movies streaming services It could separate the online streaming videos and mail services for delivering DVDs to the consumers Conclusion From the overall discussion it can be concluded that, digital disruption is referred to as one of the important steps that has to be taken by different business organizations to minimize the rate of digital errors. Netflix a well-known entertainment service provider company serves their services throughout the world. The classic management textbox theory has predicted that the company should have failed now. While providing services to the company, it has been found that due to lack of security agenda the rate of competition was increasing and the service of this company is lagging behind. Instead of getting competitive advantages the company was facing tough competition from the other companies. Beyond the DVD distribution second act had also been created by the Netflix stock. Due to the knock of innovation at the doorstep, the company wills to change their platform from the previous one to the cloud based one. After identifying the problem, the different changes those have been nee ded and the changes occurred after the digital disruptions are also elaborated in this report. References Bradley, C. and OToole, C., 2016. An incumbents guide to digital disruption.McKinsey Quarterly, May. Davis, C. and Zboralska, E., 2017. Transnational over-the-top media distribution as a business and policy disruptor: The case of Netflix in Canada.The Journal of Media Innovations,4(1), pp.4-25. Dawson, A., Hirt, M. and Scanlan, J., 2016. The economic essentials of digital strategy.McKinsey Quarterly. Evans, P. and Forth, P., 2016. Navigating a world of digital disruption.IEEE Engineering Management Review,43(3), pp.89-97. Flew, T., 2017. Social media and the cultural and creative industries. InSAGE Handbook of Social Media(pp. 512-526). SAGE Publications Inc. Kramer, A. and Kalka, R., 2017. How digital disruption changes pricing strategies and price models. InPhantom Ex Machina(pp. 87-103). Springer International Publishing. Moller, L., Gertsen, F., Johansen, S.S. and Rosenstand, C., 2017, June. Characterizing digital disruption in the general theory of disruptive innovation. InISPIM Innovation Symposium(p. 1). The International Society for Professional Innovation Management (ISPIM). Reddy, S. and Reinartz, W., 2017. Digital transformation and value creation: Sea change ahead.GfK Marketing Intelligence Review,9(1), p.10. Riemer, K., Gal, U., Hamann, J., Gilchriest, B. and Teixeira, M., 2015.Digital Disruptive Intermediaries: Finding new digital opportunities by disrupting existing business models. University of Sydney, Business School and Capgemini. Rosenstand, C.A.F., Johansen, S.S., Tollestrup, C., Haase, L.M., Nielsen, K. and Gertsen, F., 2017, June. Interdisciplinary Digital Disruption Research Framework. InISPIM Innovation Symposium(p. 1). The International Society for Professional Innovation Management (ISPIM). Selwyn, N., 2016. Minding our language: why education and technology is full of bullshit and what might be done about it. Valentine, E., 2016. Governance of enterprise Information and Technology: A new core competency for boards of directors.

Tuesday, December 3, 2019

Structure of the UN Essay Example For Students

Structure of the UN Essay The League of Nations was a world organization established in 1920 to promote international cooperation and peace. It was first proposed in 1918 by President Woodrow Wilson, although the United States never joined the League. The league was essentially powerless and it was officially dissolved in 1946. This former international organization was formed after World War I to promote international peace and security. The basis of the League, the Covenant, was written into the Treaty of Versailles and other peace treaties and provided for an assembly, a council, and a secretariat. A system of colonial mandates was also set up. The U.S., which failed to ratify the Treaty of Versailles, never became a member. Based in Geneva, the League proved useful in settling minor international disputes, but was unable to stop aggression by major powers. For example Japans occupation of Manchuria (1931), Italys conquest of Ethiopia (1935-36), and Germanys seizure of Austria (1938). It collapsed early in World War II and dissolved itself in 1946. The League established the first pattern of permanent international organization and served as a model for its successor, the United Nations. The UN an international organization composed of most of the countries of the world was founded in 1945 to promote peace, security, and economic development. This international organization was established immediately after World War II to maintain international peace and security and to achieve cooperation in solving international economic, social, cultural, and humanitarian problems. It replaced the League of Nations. The name was coined by President Franklin Delano Roosevelt in 1941 to describe the countries fighting against the Axis powers in World War II.It was first used officially on January 1, 1942 when 26 states joined in the Declaration by the United Nations, pledging to continue their joint war effort and to make peace. The UN Charter, the organizations governing treaty, was drawn up in 19 45 at a conference held in San Francisco. The principal organs, as specified in the Charter, are the General Assembly, the Security Council, the Economic and Social Council, the Trusteeship Council, the International Court of Justice, and the Secretariat. The Secretariat, with the secretary general at its head, handles all administrative functions. Trygve Lie, the UNs first secretary general, was succeeded by Dag Hammarskjld, U Thant, Kurt Waldheim, Javier Prez de Cullar, and Boutros Boutros-Ghali. In 1945 there were 51 members; there are now 185. We will write a custom essay on Structure of the UN specifically for you for only $16.38 $13.9/page Order now The UN has been very effective in keeping peace. Some early UN peacekeeping efforts included the establishment of armed forces to repel (1950) the North Korean attack on South Korea, the mobilization of troops and peacekeeping forces for the Congo, Cyprus, and the Middle East. The UN has prospered as a forum for debate intended to defuse international conflict, and it has worked to aid economic and technological development in developing nations.With the end of the cold war, the UN has become increasingly important to preserving and restoring international peace, most notably in Kuwait, with the authorization of the use of force against Iraq after its invasion, and Mozambique but less successfully in Cambodia, Bosnia, and Somalia. As the demand for peacekeeping forces has increased, however, the funds to pay for them have become harder to raise, and nations have not always been willing to contribute troops, particularly if the risks are high. The UN has been generally effective in keeping peace worldwide but it could be more effective. The UN would need to make changes in its constitution and in structure.A former problem with the UN was the abuse of the veto power by the former Soviet Republic. Another problem with the UN is countries look to better themselves rather than the worldwide community, and this causes countries to vote in blocks. There are three main blocks. The first is the communist block, the second is the western block, and the third is the third World or the Afro-Asian block. A third problem is member nations boycotting the UN. This is where a member nation pulls it ambassador from the general assembly in protest to a resolution. .u45391b6e1e0bfe2240b27f83842924da , .u45391b6e1e0bfe2240b27f83842924da .postImageUrl , .u45391b6e1e0bfe2240b27f83842924da .centered-text-area { min-height: 80px; position: relative; } .u45391b6e1e0bfe2240b27f83842924da , .u45391b6e1e0bfe2240b27f83842924da:hover , .u45391b6e1e0bfe2240b27f83842924da:visited , .u45391b6e1e0bfe2240b27f83842924da:active { border:0!important; } .u45391b6e1e0bfe2240b27f83842924da .clearfix:after { content: ""; display: table; clear: both; } .u45391b6e1e0bfe2240b27f83842924da { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u45391b6e1e0bfe2240b27f83842924da:active , .u45391b6e1e0bfe2240b27f83842924da:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u45391b6e1e0bfe2240b27f83842924da .centered-text-area { width: 100%; position: relative ; } .u45391b6e1e0bfe2240b27f83842924da .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u45391b6e1e0bfe2240b27f83842924da .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u45391b6e1e0bfe2240b27f83842924da .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u45391b6e1e0bfe2240b27f83842924da:hover .ctaButton { background-color: #34495E!important; } .u45391b6e1e0bfe2240b27f83842924da .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u45391b6e1e0bfe2240b27f83842924da .u45391b6e1e0bfe2240b27f83842924da-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u45391b6e1e0bfe2240b27f83842924da:after { content: ""; display: block; clear: both; } READ: Film Production (1681 words) EssayThe problem of veto abuse is no longer a major issue for the UN because the have a veto over-ride when a proposal that

Wednesday, November 27, 2019

Create a Magic Genie in a Bottle Effect

Create a Magic Genie in a Bottle Effect Drop a chemical into a flask to produce a cloud of water vapor and oxygen, resembling a magic genie emerging from its bottle. This chemistry demonstration can be used to introduce the concepts of decomposition reactions, exothermic reactions, and catalysts. Magic Genie Safety Wear rubber gloves and safety goggles. The 30% hydrogen peroxide used in this demonstration is a strong oxidizing agent which should be handled with care. It is extremely corrosive and reactive. Sodium iodide should not be ingested. The chemical reaction evolves heat so it is important to use borosilicate glass and to take care that the mouth of the flask is directed away from people. Magic Genie Demonstration Materials 50 ml of 30% hydrogen peroxide (H2O2)4 g of sodium iodide, NaI [may substitute manganese(IV) oxide]1-liter borosilicate (Pyrex or Kimax) volumetric flaskFilter paper or tissue paper The peroxide solution is considerably more concentrated than ordinary household peroxide (3%), so youll either need to obtain it from a beauty supply store, chemical supply ​store or online. Sodium iodide or manganese oxide are best obtained from chemical suppliers. Magic Genie Procedure Wrap the sodium iodide or manganese oxide in a piece of filter paper or tissue paper. Staple the paper so none of the solid can spill out.Carefully pour 50 ml of 30% hydrogen peroxide solution into the volumetric flask.Set the flask a counter and cover it with a towel to protect your hands from the heat of the reaction. When you are ready, drop the packet of solid reactant into the flask. Be sure the flask is pointed away from yourself and students. The magic water vapor genie will appear!After the demonstration is complete, the liquid may be washed down the drain with excess water. Rinse the flask and dilute any spills with water before cleanup. Magic Genie Reaction Hydrogen peroxide decomposes into water vapor and oxygen gas. The sodium iodide or manganese oxide catalyzes the exothermic reaction. The reaction is: 2H2O2 (aq) → 2H2O (g) O2 (g) heat Helpful Tips for the Magic Genie Experiment Use of Pyrex, Kimax, or another type of borosilicate glass minimizes the risk of breakage.Rather than dropping the packet of sodium iodide or manganese oxide, you can hang it inside the flask by a string taped to the outside of the flask or secured (loosely) with a stopper. Do not tightly seal the flask! A stopper with a hole or two is safest.  Use a large volume flask, even though youre only using a small volume of liquid. This is because brown liquid can splash up near the conclusion of the reaction. This liquid is free iodine released from the oxidizing effect of the strong peroxide solution.Make sure you dont seal or tightly stopper the flask, as pressure buildup from a premature reaction can shatter the flask violently.Excess sodium iodide may be thrown away in the trash receptacle.Are you artistic? You can wrap the flask in foil to make it look like a magic genie bottle or lamp. While you have the 30% peroxide out, why not try the elephant toothpaste demonstration? Another interesting demonstration to try involves making violet smoke. Reference: Stone, Charles, H. J. Chem. Ed., 1944, 21, 300.