Firefighter Paper Essay Example for Free

Firefighter Paper Essay In this cynical age, firefighting remains a heroic and noble profession. The images of fire professionals we see on television and in film are often romanticized versions of day-to-day life on the job. What is the life of a firefighter really like? The Job According to a 1993 survey, annual starting salaries for firefighters in major cities fall in the range of $28,000 to $46,000 with overtime pay. Firefighters receive health, disability and retirement benefits, and many consider the work schedule beneficial as well (rotating 24-hour shifts). No two days are alike, and the work is as varied as it is unpredictable. Responding to Calls Gender and Race in the Urban Fire Service reveals what its like to enter a burning building. those entering a building are often confronted with such intense heat and heavy smoke that it is impossible for them to walk upright or to make out their surroundings. They wear face masks and air tanks to allow them to breathe, but the tanks are heavy, the time limited and the breathing process awkward. The location is almost always completely unfamiliar, filled with obstacles and unknown hazards. While the engine crew works on the ground with water to put the fire out, a truck crew ventilates the building, opening a sufficiently large hole in the roof to allow heat, smoke and gasses to escape so that the ground crew can do its work. Roof work is not only dangerous, but generally requires a high level of strength, skill and coordination. If there are possible victims, either crew may become involved in search and rescue (or body recovery), which means working ones way through this foreign environment in darkness and heat, unsure what you may find, taking care not to become trapped or disoriented. In many municipal fire departments, an increasing emphasis is placed on emergency medical services (EMS). Currently at the Oakland Fire Department, 80 percent of calls are EMS calls. In many cases a fire crew is nearer to an emergency than an ambulance or paramedic unit. Most new firefighters are also trained as emergency medical technicians, and candidates with previous paramedic experience are desirable. Not all of a firefighters workday is spent responding to calls, however, and not all calls require significant activity. Many times calls involve false alarms or situations where no emergency exists. Firefighters spend a high proportion of their time taking care of nonemergency calls, including activities such as fire inspections, practice drills, physical training, housekeeping and maintenance chores station maintenance as well as shopping and cooking. Unless youre a firefighter, no one can really understand what we do. We have a special relationship. We have to live for 24 hours together. Its not like an eight-hour day where you can put on a fake thing for eight hours and then you go home. Here, this is our home. Firehouse as Home In most urban departments, firefighters work 24-hour shifts. The schedule involves a rotation of three shifts, so that two of every three days are free. Since firefighters literally live together for 24 hours, the firehouse becomes a combination of work and home, and coworkers constitute a sort of second family. Firefighters often spend more time with crew members than with their own families. The station is fashioned like home, placed in a work setting. There are officers quarters, a dormitory-type sleeping area, a communal bathroom with showers and toilets, a big kitchen and a lounge or TV room. In most stations, meals are eaten at a large table in the kitchen. Outdoor areas may also include a barbecue, a patio or a deck. Firefighters share personal living space and eat meals together while on duty. To make things work, crewmembers must be trustworthy and participate in household chores. a good firefighter is someone who can perform not only on the fireground or at a medical emergency, but also as a good roommate or family member. Challenges Although the life of a firefighter may seem exciting and glamorous, it has many challenges. Camaraderie and strong bonds between coworkers, along with respect from grateful members of the community is extremely rewarding. However, firefighting is a physically demanding and dangerous occupation. Meeting such hazards requires certain kinds of personal and social qualities, the physical capacity to do the work, the stamina to continue strenuous activity for hours with little rest. But the work requires firefighters to think on their feet, rapidly assess the problem at hand, plan a course of action and then quickly react when conditions change. Throughout an emergency, a firefighter must maintain a constant and heightened awareness, never losing sight of the broader picture while attending to a specific task. Other challenges include a work schedule that requires nights and weekends away from home, sleep deprivation due to work schedule and anxiety and a high level of stress due to exposure to trauma and tragedy. Adventure, challenge, variety, teamwork, service, skill and satisfaction are all aspects of a firefighters life. Most firefighters claim that its the best job in the world. YOU CAN DO ANYTHING IN LIFE YOU WANT TO DO YOU JUST NEED TO HAVE THE DETERMINATION AND DRIVE TO WANT TO DO IT!!! P.S. It is the best and most rewarding job I think anyone could have. All you need is a little heart and drive to be in shape and willingness to learn the ropes of fire fighting and you would do fine. Start applying at different locations and stay out of trouble with drugs and alcohol and you won’t have a problem. Good luck with your future!

Impact of transformational leadership on organizational learning Essay

Organizational Learning (OL) Literature reveals that OL improves the development by introducing new expertise, output or commercialism. Nonaka & Takuchi (1995) argued that learning is vital for product innovation which means that it is not limited to only acquisition and retention of knowledge but it is used to get the required outcomes. Knowledge oriented view of the organizations argue that knowledge and learning capacity influence the organizational performance and also direct the firm to achieve sustainable and continuous competitive advantage (Zhang, 2008). In last thirty years extensive research have been conducted on the OL and it has contributed a lot in the organizational development and change management, but still there is a little agreement on what is meant by the term OL and its nature. (Crossan, Lane & White, R.E, 1999; Huber, 1999 and Kim, 1993). The reason for this problem is that the OL has been studied by many disciplines and perspectives (Lopez, et al, 2006). According to (Argyris, 1995),† Learning occurs whenever errors are detected and corrected or when a match between intentions and consequences is produced for the first time.† (p.20). According to Huber (1991), when knowledge is acquired, information is spread, correctly analyzed, and recalled, organization learning eventually takes place. He further assumed that learning occurs in the organization if any of its unit acquires information useful to the organization. This is also supported by DeNisi & Griffin (2008) that â€Å"OL is the process by which the organization â€Å"learns† from past mistakes and adapts to its environment.† From these definitions, it is concluded that OL is a process whereby organization gets knowledge and removes the problem and adapts ... ...pply knowledge, then OL will be damaged, so organizations should have such compensation systems that motivate the employee to get, share, and apply knowledge in the organization (Wong, 2005). The findings of the study conducted by Dechawatanapaisal (2005) demonstrated that the pay for performance and recognition are the contributing factors in the organizational learning. Especially recognition that is easy to implement and does not require large investment, can increase the employee morale that support their learning. Khandekar & Sharma (2006) pointed out that improved reward system plays an important role in strengthening the learning capabilities of the organization which leads us to propose that the selective compensation and reward system that create a powerful motive for the employees to get, apply and share knowledge has a positive impact on OL.

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

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. 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