Tuesday, December 10, 2019
Drying the infant quickly and placing her under a radiant warmer reduces heat loss through evaporation and radiation. C)Ã Newborns in an incubator are more difficult to access than those in a radiant warmer. INCORRECT Although a radiant warmer allows healthcare personnel easy access to the infant, that is not the reason for its use in this situation. D)Ã Bonding is promoted by enhancing the infants appearance. INCORRECT Drying and warming do not necessarily enhance the infants appearance or promote bonding. 2. Which action should the nurse take prior to drying the infants back? A)Ã Note if the infant has passed any meconium stool. INCORRECT Although this observation is important, it is not related to drying the back. B)Ã Observe the sacral area for possible Mongolian spots. INCORRECT Mongolian spots are normal variations in the pigment of the skin, and they do not hinder drying the back. C)Ã Assess the amount and location of vernix caseosa. INCORRECT The amount of vernix caseosa is related to gestation age, but is not related to drying the back. D)Ã Inspect the back for possible neurological defects. CORRECT To prevent harm while drying the newborn, the back should always be inspected for possible neurological defects, like spinal bifida. At 1 minute of age, the infant is crying and has a heart rate of 160 and a respiratory rate of 58. Both of the infants arms and legs are flexed, and her hands and feet are cyanotic. 3. Which APGAR score should the nurse assign? A)Ã 10. INCORRECT Review the findings again. B)Ã 9. CORRECT One point is deducted for acrocyanosis. C)Ã 8. INCORRECT Review the findings again. D)Ã 7. INCORRECT Review the findings again. The nurse conducts a physical assessment of the infant looking for normal as well as abnormal findings. 4. Upon inspection of theÃ umbilical cord, which finding should the nurse report to the healthcare provider? A)Ã The cord is covered with Whartons jelly. INCORRECT This is a normal finding. B)Ã Pulsations are felt at the base of the cord. INCORRECT This is a normal finding. C)Ã One artery and one vein are present. CORRECT Two arteries and one vein should be present. D)Ã The cord is glistening with a pearl-like coloring. INCORRECT This is a normal finding. The Carson babys head is molded from the vaginal delivery. Upon seeing the baby, Ms. Carson says, Oh, she is so beautiful, but something is wrong with her head. 5. How should the nurse respond? A)Ã No nothing is wrong with her head. She really is a beautiful baby. INCORRECT This response does not fully address the mothers concern. B)Ã Yes, it is misshaped, but we will show you how to change it over time. INCORRECT Parents can be taught to change an infants sleeping positions to correct a misshaped head, but this is not the best response. C)Ã Her head has been molded from delivery through the birth canal, which is normal. CORRECT Molding commonly occurs in babies delivered vaginally, and the head will become more symmetrical over time. D)Ã I know you are concerned. Would you like to talk further with the midwife? INCORRECT Acknowledging Ms. Carsons feelings is a thoughtful response, but referral to the midwife is not necessary. Ms. Carson is offered the opportunity toÃ breastfeed. After securing a comfortable position for herself and the baby, Ms. Carson puts the infant to her breast. The baby latches onto the nipple, and with some encouragement, she begins to nurse. After a time of family interaction, Ms. Carson is taken to the postpartum unit, and the infant is transferred to the transition care nursery. Transition Care TheÃ nurse checksÃ the identification bands for both the baby and the mother uponÃ admissionÃ to the nursery. One ID number is incorrect. 6. Which action should the nurse take to solve this problem? A)Ã Document the presence of the incorrect number on the charts for the baby and the mother. INCORRECT Although the nurse should probably document the discrepancy, it does not solve the problem. B)Ã Explain to the mother that there is an incorrect number on one of the bands. INCORRECT Although an explanation should be given to the mother, that will not solve the problem. C)Ã Redo the identification bands with another nurse witnessing the process. CORRECT Identification bands must be correct to ensure the safety and security of all hospitalized clients, especially newborns. D)Ã Mark the incorrect numbers in red to denote the correction made to the bands. INCORRECT This is not the proper action for the nurse to take to solve this problem. Upon admission to the transition care nursery, the Carson babys axillary temperature is 97. 4Ã ° F. 7. Which action should the nurse take? A)Ã Continue monitoring and document this finding in the record. INCORRECT Another action should be taken in this situation. B)Ã Place the infant in a radiant warmer and monitor her temperature. CORRECT The babys temperature is not within normal range (97. 5Ã °-99Ã ° F). The infant should remain in the radiant heat warmer until her temperature has stabilized. C)Ã Remove a blanket from the infant and check the temperature again. INCORRECT This action will make the situation worse, not improve it. D)Ã Notify the healthcare provider immediately about the temperature. INCORRECT The nurse is capable of providing care to remedy this situation. It is not necessary to notify the healthcare provider. Newborn Assessment While examining the infants head, the nurse notes soft swelling of the scalp that extends across the suture lines of the fetal skull. 8. Which action should the nurse take in response to this finding? A)Ã Document the finding in the record. CORRECT This finding indicates caput succedaneum, which commonly occurs after a vaginal birth. B)Ã Monitor the tension of the anterior fontanel. INCORRECT Although the anterior fontanel should be monitored, it is not related to this finding. C)Ã Report the finding to the healthcare provider. INCORRECT It is not necessary to report this finding to the healthcare provider. D)Ã Apply cool compresses to prevent more swelling. INCORRECT Applying cool compresses is not the proper action for the nurse to take. The nurse notes a bluish discoloration of the skin across the infants sacral area. 9. Which should the nurse do in response to this finding? A)Ã Assess the infant for cold stress. INCORRECT An overall mottled appearance is usually more indicative of cold stress. B)Ã Refer the parent to the care of a pediatric specialist. INCORRECT A referral to a pediatric specialist is not necessary as a result of this assessment. C)Ã Document this finding in the record. CORRECT This bluish discoloration of the skin is a birthmark, commonly referred to as Mongolian spots. They are merely a dense collection of normal skin cells deep in the skin. This is a common finding, which should simply be noted in the babys record. D)Ã Evaluate the infants neurological status. INCORRECT It is not necessary to further evaluate the infants neurological status based on this finding. However, tufts of hair or dimples in the sacral area might indicate a need for a more in-depth neurological evaluation. 10. Which physical finding, if present, should the nurse report to theÃ healthcareÃ provider? A)Ã Presence of unopened sebaceous glands. INCORRECT These pinhead-size whiteheads on the newborn are referred to as milia, and they usually disappear without treatment. Their presence does not need to be reported. B)Ã Loose natal teeth that are not covered by the gums. CORRECT Natal teeth present at birth is an unusual occurrence that should be reported to the healthcare provider. Loose natal teeth are frequently removed to prevent aspiration. C)Ã White, cream cheese-like substance on skin. INCORRECT This substance is vernix caseosa, which covers and protects the fetus from the amniotic fluid in utero. Because its presence on the infant at birth is normal, this finding does not need to be reported. D)Ã Enlarged breasts secreting a thin, watery discharge. INCORRECT This temporary condition in the newborn is caused by the influence of the mothers hormones on the fetus prior to birth. The secretion is often referred to as witchs milk. This is a normal finding that does not need to be reported. 11. When examining the babys extremities, which finding would warrant additional assessment by the nurse? A)Ã Toenails blanch with pressure and quickly refill. INCORRECT This is a normal response that does not require additional assessment. B)Ã Feet that turn in, but can be manipulated to midline. INCORRECT This is a normal finding that does not require additional assessment. C)Ã Hands are plump and clenched into fists. INCORRECT This is a normal finding and does not require additional assessment. D)Ã Limited hip abduction in the supine position. CORRECT Because this finding could indicate developmental dysplasia of the hip, formerly known as congenital hip dislocation, additional assessment is warranted. 12. Which finding by the nurse is consistent with an infant born at 39 weeks gestation? A)Ã Presence of abundant lanugo hair across face and back. INCORRECT A baby born at 39 weeks gestation has minimal lanugo hair, which is the soft prenatal hair that is shed during the last few weeks of pregnancy. B)Ã Plantar creases covering the entire sole of foot. CORRECT This finding is consistent with a baby born at 39 weeks gestation. C)Ã Slightly soft, curved pinna with slow recoil. INCORRECT The ear of a baby born at 39 weeks gestation should be well formed and firm with instant recall. D)Ã Skin is smooth and pink with visible veins. INCORRECT This finding is more consistent for an infant with an earlier gestational age. Continued Transition Care A nursing student is assisting the RN in caring for the infants in the nursery. The RN questions the studentÃ about vitaminÃ K (Aqua MEPHYTON) as preparations are made for administration. 13. Which response by the student indicates an understanding of the purpose for administering this drug? A)Ã The purpose of this drug is to prevent hyperbilirubinemia in the newborn. INCORRECT Further teaching is needed because vitamin K does not prevent hyperbilirubinemia. B)Ã Vitamin K is a fat-soluble vitamin and promotes a positive nutritional status. INCORRECT This is not the primary reason for giving vitamin K. C)Ã This drug is given to the newborn to prevent and/or treat hemorrhagic disease. CORRECT Because this vitamin does not cross the placenta and there is very little in breast milk, supplemental vitamin K should be given to newborns at birth to help clot the blood. Therefore, this is an accurate response by the student and no further client teaching is needed. D)Ã Vitamin K is produced and stored in the liver, which is immature in the infant. INCORRECT Vitamin K is produced in the gut, but stored in the liver. The nurse is preparing to give the baby her first bath. 14. Which assessment data indicates that it is safe for the baby to be given her bath at this time? A)Ã Respiratory rate of 46. INCORRECT This respiratory rate is high-normal and will rise with the activity of bathing. B)Ã Axillary temperature of 98Ã ° F. CORRECT A bath may potentially lower the temperature, which will not be harmful because the core temperature is near 99Ã ° F. C)Ã Apical heart rate of 160. INCORRECT This heart rate is high-normal and will rise further with the activity of bathing. D)Ã Pulse oximeter of 90%. INCORRECT This value is below normal and could become lower with the activity of bathing. At 2400 hours the infant is crying, her skin is mottled, and her hands are shaking. 15. Which action should the nurse take first? A)Ã Assess the infants respiratory efforts. INCORRECT Assessing the respiratory efforts of the infant is unnecessary since the infant is crying, and crying is a good indicator of respiratory effort. B)Ã Monitor the blood glucose level. CORRECT Since it has been 2 hours since delivery, the infant may be experiencing hypoglycemia. C)Ã Give the infant some formula. INCORRECT Because this infant is breastfeeding, an attempt should be made to let her nurse before offering the formula. D)Ã Evaluate for possible seizures. INCORRECT The infant is not exhibiting any signs associated with seizures. Rooming-In The babys vital signs have stabilized by 0100 hours. Upon completion of assessment and documentation, the nurse takes the baby to Ms. Carson who wants to breastfeed and room-in with the baby. After checking the ID bands, the infant is positioned for breastfeeding. The nurse checks on Ms. Carson and the baby at 0200 hours. Both are asleep in the bed, with the baby lying beside Ms. Carson. 16. What should the nurse do next? A)Ã Pick up the baby and return her to the crib while letting Ms. Carson sleep. INCORRECT Although returning the baby to her crib is the proper response, this action is incomplete. B)Ã Wake Ms. Carson and remind her that keeping the baby in the bed is unsafe. INCORRECT Although waking Ms. Carson is the proper response, this action is incomplete. C)Ã Tell Ms. Carson that the baby must be returned to the nursery for safety reasons. INCORRECT Although the baby can be returned to the nursery if Ms. Carson is too tired to care for her, there is a better response in this situation. D)Ã Remind Ms. Carson about infant safety and assist her to place the infant in the crib. CORRECT This action protects the baby while reinforcing teaching to the mother. When returning the baby to the crib, the nurse notices that the blanket covering the baby is loose, and the cap is off her head. The nurse takes the babys temperature, which is 97. 6Ã ° F. 17. Which should the nurse do next? A)Ã Bundle the baby and place the cap on her head. INCORRECT Although this would help the baby, another action is more effective. B)Ã Cover the baby with a blanket, but leave the cap off. INCORRECT This action is incomplete. C)Ã Show Ms. Carson how to wrap the baby for warmth and apply the cap to her head. CORRECT This action not only protects the baby, but also involves and teaches the mother. D)Ã Immediately take the baby and place her under a heat source. INCORRECT Other actions should be done first. The nurse checks on Ms. Carson and her baby every 2 hours throughout the night. The baby is breastfed at 0300 and 0600 hours without difficulty. After the change of shift report at 0700 hours, the day nurse assesses the mother and baby. Ms. Carson states that the baby had a bowel movement after breastfeeding. She tells the nurse that she attempted to change the diaper, but had difficulty doing so. 8. What action should the nurse implement? A)Ã Reassure Ms. Carson that she will get plenty of practice. INCORRECT Ms. Carsons statement implied a need that should be addressed by the nurse. B)Ã Observe Ms. Carson as she performs a diaper change. CORRECT This approach helps the nurse evaluate the problems Ms. Carson is experiencing so the most effective teaching can be provided. C)Ã Pl ace the baby on the bed and demonstrate how to change a diaper. INCORRECT Another action is more effective to meet the clients needs. D)Ã Tell Ms. Carson that the nurses can change the diapers until they go home. INCORRECT Although the nurses may assist with diaper changing, the mothers involvement in the care of her baby is essential. When Ms. Carson removes the diaper, the nurse notices that the baby has caked powder in the inguinal leg folds and vulva areas. 19. What action should the nurse take? A)Ã Show Ms. Carson how to remove the caked-on powder. INCORRECT This should be done, but further instruction is needed. B)Ã Explore with Ms. Carson why powder was used. INCORRECT This may provide some information, but does not correct the problem. C)Ã Praise Ms. Carson for wanting to keep her baby dry. INCORRECT This response does not teach Ms. Carson about the proper use of powder on her baby. D)Ã Instruct Ms. Carson to use plain water instead of powder. CORRECT Until the baby is 4 days old, only plain warm water is recommended (after the initial bath) because soaps, ointments, powders, lotions, and baby wipes can disrupt the acid mantle on the skin and provide a medium for bacterial growth. Ointments are prescribed only if a rash develops in the first few days of life. Use of powder also places the infant at risk for fine particle aspiration. While changing the diaper, Ms. Carson notices blood-tinged mucous in the vulva area and asks the nurse what is causing this with her baby. 20. Which explanation should the nurse provide? A)Ã Your baby probably has the beginning of a urinary tract infection. INCORRECT This finding is not consistent with a urinary tract infection. B)Ã Apparently your baby had some trauma at birth to cause this. INCORRECT There is usually a much more reasonable explanation for this finding. This response could cause the mother unnecessary anxiety. C)Ã Withdrawal of maternal hormones is the usual cause of this occurrence. CORRECT This is called pseudomenstruation, which is due to the effects of maternal hormones. D)Ã This is unusual, and I will notify the pediatrician about the mucous. INCORRECT This is not an unusual occurrence. Preparation for Discharge At two days post birth, Ms. Carson and her baby are doing well and preparing for discharge. The babys weight at birth was 7 lb 15 oz (3600 gms), and today she weighs 7 lb 3 oz (3300 gms). Ms. Carson expresses her concern to the nurse when she realizes that her baby has lost almost a pound since birth. 21. How should the nurse respond? A)Ã I can tell you are concerned. Would you like to talk with the pediatrician? INCORRECT She can certainly talk with the pediatrician, but the nurse can and should respond to this mothers concern. B)Ã Yes, this is a concern. The pediatrician may want to keep the baby here for another day. INCORRECT Based on the data regarding the babys weight loss, it would not be necessary to keep the baby another day. C)Ã Dont worry. Your baby will gain weight in a few days when your milk comes in. INCORRECT This response offers false reassurance. In addition, it may lead the mother to believe that her breast milk is not adequate at this time, which is incorrect. D)Ã Dont be concerned. Your babys weight loss is in the typical range for all babies. CORRECT Babies may lose up to approximately 10% of their birth weight. Ms. Carson is told that a neonatal screening test needs to be done before they are discharged. 22. When asked the reason for including the PKU test in the screening, which information should the nurse provide? A)Ã An error in metabolism of the amino acids leucine, isoleucine, and valine can cause death if not detected and treated early. INCORRECT This describes another error in metabolism. B)Ã A problem converting the protein, phenylalanine, may be present, which can lead to mental retardation if not found and treated early. CORRECT PKU testing is done to detect the level of phenylalanine in the babys blood. C)Ã Screening for an error in metabolism of the sugars galactose and lactose can prevent liver and brain damage in the newborn. INCORRECT This describes a different error in metabolism. D)Ã This test detects the level of thyroxin produced by the thyroid. If too little is produced or if treatment is not started early, mental retardation can result. INCORRECT This describes another metabolic disorder, not PKU. 3. How should the nurse collect the blood needed for PKU screening? A)Ã Clean the heel with alcohol swap, dry with gauze, and collect blood in a capillary tube. INCORRECT A capillary tube is used to collect blood for hemoglobin, not PKU screening. B)Ã Puncture the lateral heel after warming and collect blood samples on the designated lab form. CORRECT The heel should be warmed, cleaned with alcohol, and dried with gauze. After puncturing the heel with a microlancet, blood is collected on a special neonatal screening form. C)Ã Collect heel blood using a transfer pipette and place a drop of blood on a reflectance meter. INCORRECT This is the usual technique to collect blood for glucose analysis, not PKU screening. D)Ã After grasping the babys lower leg and foot, use a microlancet to puncture the middle portion of the heel. INCORRECT The middle portion of the heel should not be used. Case Outcome After discharge teaching is complete and the nurse removes one ID band from the baby to keep with the record, follow-up appointments are made for both mother and baby. Ms. Carson thanks the nurses for their support, care, and teaching. Ms. Carson and baby are taken by wheelchair to a private car, where the baby is secured in a car seat for the drive home.
Tuesday, December 3, 2019
Rivethead; Social Issues Of Work Introduction Ben Hampers book Rivethead; Tales From The Assembly Line is a gritty in your face account of a factory workers struggles against his factory, his co-workers, and the time clock. Hamper makes no apologies for any of his actions, many of which were unorthodox or illegal. Instead he justifies them in a way that makes the factory workers strife apparent to those who have never set foot on an assembly line and wouldn't have the vaguest idea how much blood, sweat and tears go into the products we take for granted everyday. Rivethead is an account of the entire life of Author Ben Hamper, from his long family lineage of ?shoprats? and his catholic school upbringing to his numerous different positions on the General Motors assembly line and his equally numerous lay-offs from the GM Truck & Bus Division. Unfortunately the many years of back breaking labor combined with Hampers own personal demons led him to check into an outpatient mental facility (at the time of the completion of this book) where he learns daily to cope with his many years of mental anguish. Rivethead is a social commentary on industrial America, assembly line work , and the auto industry. This essay, however, will focus on the more specific aspects Hamper considers, such as the monotony required on a (then) modern assembly line, the relationship and hierarchy among workers and their interaction with management as well as both collective and individual responses to work and job satisfaction (or lack there of). Analysis When Henry Ford first developed the idea of the assembly line he was heralded as one of the most forward thinking men of his time, and without the assembly line we would no doubt not be as powerful a nation as we are today. The assembly line principle as it matured in industrial society however, proved to destroy workers creativity and stifle the very essence of human life. Growth and change. On an assembly line workers are degraded to automatons, performing the same tasks over and over and over. Day in day out, without ever having any knowledge or input into any of the other tasks related to completion of the project. This monotony in the workplace spills over into the daily life of many factory workers and affects how they live their life outside of the factory after the whistle blows as much as it does while they're on the assembly line. This spillover was observed by Hamper of his Grandfather. ?Straight home from work, dinner, the evening news and immediately into bed at 7:00 p.m. He arose each weekday at 3:30 a.m., fixed himself some black coffee, turned on the kitchen radio, smoked a handful of Lucky Strikes and waited to leave for work at a quarter to five. This regimen never varied one iota in the forty years he worked for GM? (Hamper pg.6). It is fairly clear that the monotony of the assembly line has a way of setting personal routines for it's workers that eventually work their way out of the factory and into the home. One interesting question that is raised, is whether people who like their life to be routinized eventually find their way to an assembly line or if the assembly line monotony brings the propensity to routinize out in people who previously did not live by many routines. The relationships Hamper discusses between the workers on the assembly line are unique to say the least and sometimes comical or dangerous. After reading this book I would surmise that most factory workers build friendships with other factory workers almost exclusively. This could be due to their similarity of interests, similarity of jobs, the fact that they are in contact daily, or just by virtue of the timing of their shifts (as was Hampers case). I think one thing that helped to bind the workers together was the fact that they saw it as workers against management and by their solidarity they could turn the balance of power in their favor. This solidarity was visible when a new supervisor was hired who wasn't cutting the workers any slack, so the workers resorted to sabotage. ?We simply had no other recourse. Sometimes these power-gods had to be reminded that it was we, the workers, who kept this place runnin'? (Hamper pg.206). Relationships between workers were generally very good, although there was a hierarchy among the workers between the new guys and the experienced guys. ?Franklin...made a career out of intimidating rookies? (Hamper pg.51) because until a worker had put in 90 days he could be fired for any reason. Not all of Hamper's co-workers saw eye to
Wednesday, November 27, 2019
Future Role of Hospitals Essay Example Future Role of Hospitals Essay Future Role of Hospitals Essay Universal health care is on the way for all Americans. President Obamas Health Care Reform will mandate that all Americans have medical insurance by 2014. (Jackson Nolen, 2010) Either the employers will provide the medical insurance or the individual will have to purchased the medical insurance themselves. Who is responsible for purchasing the medical insurance depends on several factors but those details are not the scope of this paper. The key point of the health care reform law is that every American will be mandated to have medical insurance. Universal health care coverage will have a major impact on all aspects of health care. We will focus on the impact of universal health care on hospitals. There is no doubt, that all hospitals will have to make major changes in their day to day operations. As the new law takes effect, the hospitals will have to evolve to meet the new requirements. A transformation will need to take place in order to adjust to the new volume of patients that can be expected after the mandate is put in place. The role the hospitals will play in the future will depend on many different factors. : We will investigate these evolving roles as we examine what the future role of hospitals will be in America. Today there are 5,815 registered hospitals in the United States. Of the 5,815 registered hospitals, 5,010 are community based hospitals. There are 2,923 Not-for-Profit community hospitals, 982 For-Profit community hospitals and 1,105 state and local government community hospitals. The remainder of the hospitals are comprised of Federal Government hospitals, Nonfederal Psychiatric Hospitals, Nonfederal Long Term Care Hospitals and a number of Hospital Units of Institutions. (Fast Facts, 2010) Each year over 35 million people are admitted to the hospital. More than 118 million people are treated in the emergency department and 481 million people are treated as outpatients. Hospitals also deliver over 4 million babies each year. In 2006, hospitals provided care to people in need at a cost of over $31 billion of care for which no payment was received. (Hospital Facts, 2008) The Emergency Medical Treatment and Active Labor Act (EMTALA) require all hospitals to screen each patient that comes through the Emergency Department. (Emtala. com, n. d.) If an emergent condition is found, they must stabilize the patient. Many times these emergent patients do not have insurance or a means to pay for their care. In the future, hospitals will be asked to do more while keeping cost down. A major role hospitals will have to play in the future is that of cost containment. Today, one third of hospitals lose money on operations. They have a meager operating margin of only 4% on average. It will be very difficult for many hospitals to keep their doors open in the future if they continue to lose money. Hit the hardest are the rural hospitals. It has become more and more difficult for rural hospitals to stay in business. During the decade of the 1990s, 186 hospitals closed their doors and went out of business. (Cracks in the Foundation, 2002) One major reason hospitals have a hard time with their operating cost is because of payment shortfalls from Medicare and Medicaid. Roughly 54% of gross revenues come from the charges to Medicare and Medicaid. In 2003, Medicare accounted for 40. 4% percent of the hospitals gross revenues and Medicaid accounted for 14. 4% of the hospitals gross revenues. The hospitals financial performance is based on these government payments because they cover the majority of the patients seen. In fact, the majority of hospitals lose money in treating Medicare and Medicaid patients. In 2003, 59% of the hospitals were losing money treating Medicare patients and 61% of the hospitals were losing money treating Medicaid patients. (Fragile State of Hospitals, n. d. ). This is important information because in the future, hospitals will not only have to manage cost of treating Medicare and Medicaid patients but also be responsible for managing the cost of treatingÃ patients under the new universal health care coverage. In order for the hospitals to maintain their doors open, they will have to do better at collecting payments of the newly insured patients. A concern hospitals will have to contend with is the reality that not all individuals will opt to buy into a universal health care plan. This individuals may opt to pay the small penalty of not carrying insurance. Not buying medical insurance will be an option for some individuals. (Jackson Nolen, 2010) This will present a problem to the hospitals. A lot of these patients bills will go on the books as bad debt. With hospitals already losing money by treating Medicare and Medicaid patients, they will not be able to tolerate additional loses in operating cost by treating non-insured patients. Hospitals make enormous economic contributions to our society. Hospital care is the largest component of the health care sector and represented 16. 2 percent of the Gross Domestic Product. The hospital care sector accounted for $2. 3 Trillion of which hospitals accounted for $718 billion of that total. In addition, community hospitals created over $2 trillion of economic activity. The goods and services hospitals purchase from other businesses create additional economic value for the community. With these ripple effects included, each hospital job supports about two more jobs and every dollar spent by a hospital supports roughly $2. 30 of additional business activity. (Economic Contribution of Hospitals, 2010) Hospitals play a major role today and in the future in the creation of jobs for both themselves and for the surrounding communities. In 2008, hospitals employed over 5. 3 million people and were the second largest source of private sector jobs. Hospitals support nearly one of 9 jobs in the U. S. Nursing jobs are the foundation of every hospitals. They must have enough nursing staff to take care of the patients that are admitted on a daily basis. In the future hospitals will have to partner with universities and technical and vocational schools that produce the supply of nurses. Nurses of different skill levels will be needed to take care of the hospitalized patients. The hospital will need Register Nurses (RNs), Licensed Vocational Nurses (LVNs), Certified Nursing Assistants (CNAs), and other specialized medical technicians. Most important are the RNs. Depending on the services offered by the hospitals, RNs with various skills sets will be required. Some hospitals will require Critical Care RNs, Emergency Care RNs, Pediatric Care RNs, etc. As more and more hospital services are being utilized, the number of RNs required will increase. For the past decade, the demand of RNs has increase but the supply has decreased. It is estimated that there will be a shortage of 800,000 RNs by the year 2020. (Fragile State of Hospital Finances, n. d. ) In the future, the demand for hospital services will continue to increase. Breakthroughs in medicine has contributed to the increase in the average life of expectancy. Medical advances have greatly improved the health and longevity of Americans. A person born in 2000 can expect to live 3. 3 years longer than a person born in 1980. New treatments have led to sharp reductions in mortality for heart disease, cancer, stroke and many other diseases. (Lutz Rodgers, 2003) The increase in the growth of the population combined with the increased number of people aged over 65 will create a demand for more hospital services. A sharp increase in the population aged 65 and over is expected to increase because of the large number of Baby Boomers reaching this milestone. In coming decades, the sheer number of aging baby boomers will swell the number of elderly with disabilities and the need for services. (Walker, 2002) There were 34. 8 million people aged 65 or older in 2000 which accounted for 12. 7 percent of the countrys total population. It is estimated, that by 2020, the percentage of Americans age 65 or older will reach 16. 5 percent. By 2020, one in six Americans will be 65 years old or older representing close to 20 million people. The General Accounting Office estimates that by 2040, the number of people aged 85 years and older will triple and reach 14 million. (Walker, 2002) Hospitals in the future will need to plan to for the care of advanced age patients. This age group tends to use more resources and have longer lengths of stay. Often times, they require specialty care and more nursing care. These patients also tend to be more critically ill with several co-morbid chronic conditions. Hospitals will need an infrastructure capable of handling an increase in these types of patients. Critical Care beds will need to be increased and the nursing staff will need to be trained to care for these complicated patients. In addition to the elderly, people 65 and older, the hospitals will play a vital role in taking care of a new group of patients, the obese. Obesity has become a major problem in the United States. Obesity in America has dramatically increased in recent years and become an urgent health concern. Approximately 22 percent of adult Americans are obese defined as having a body mass index (BMI) of 30 or more. Among children, 13 percent are considered overweight defined as having a BMI of 25 or more. (Lutz Rodgers, 2003) This is a great concern for hospitals. There is a strong correlation between obesity and numerous chronic medical conditions. If the prevalence of obesity continues, the hospitals in the future can expect to treat a larger amount of obese patients with multiple chronic condition. Obese people tend to have a higher risk of hypertension, coronary heart disease, type 2 diabetes, stroke, and various forms of cancer. Overweight and obesity, and their associated health problems, have a considerable economic impact on hospitals and the health care system. An estimated $177 billion is spent annually as a result of overweight and obesity. Recent estimates suggest that obesity accounts for about 5. 7 percent of total U. S. direct health care costs, excluding costs related to increased mortality among obese and overweight individuals. Recent research also suggests that compared to patients who are obese, patients with a BMI of 20-24. 9 have approximately 51 percent lower prescription drug costs, 28 percent lower hospital inpatient costs, and 12 percent lower hospital outpatient costs. (Lutz Rodgers, 2003) If these trends continue, the hospitals will have to make more accommodations for the obese patients. The hospitals will not only have to invest more on nursing care for these patients but always make some capital investments. The hospital would require wheel chairs large enough to handle the size and weight of these patients. Larger operating tables would be required. Special surgical equipment would be needed. Extra large beds for the inpatient rooms would have to be available. These are some of the considerations hospitals will have to make in the future role of obese patient care. In recent years, hospitals have been treating more and more sicker patients than in the past. This trend is expected to increase as the population ages and as the number of elderly increases. The complexity and acuity of these patients is due to the greater presence of complex co-morbidities. These acutely ill patients utilize a lot more hospital resources. Treating these patients creates a financial burden for the hospital because in most cases the re-imbursements are less than the cost of the patient care. Between 2000-2002, hospitals saw a 15 percent rise in extremely ill patients that were treated in their facility. (Lutz Rodgers, 2003). In the future, hospitals will have to adjust to an increase in the demand of hospital utilization. Hospitals are already seeing an increase in outpatient and inpatient visits today and they can expect it to increase in the future as more and more people will demand the services of the hospital. It is already anticipated that more Americans will use the hospital services as universal health care plans are initiated. Millions of Americans who otherwise would not go to the hospital will now have medical and hospital insurance. These people would typically avoid a trip to the hospital because of the exurbanite out of pocket cost. These people will demand more hospital services and will drive over all hospitalization up. A concern hospitals will have is the over utilization of the Emergency Department (ED). Americans have become accustomed to the availability of 24-hour care. Approximately a third of hospital care begins in the ED. Hospitals have seen a 25 percent increase in ED volume over the past decade. In 2004, there were 112. 6 million ED visits. The majority of these visits required immediate care and more than half of the ED care takes place outside of normal business hours. (Prepare to Care, n. d. ). Hospitals today and in the future need to provide an extensive array of resource in order to meet the many different and often unpredictable needs of emergency care for the patients. Patient volume can vary dramatically; therefore, hospitals must have medical staff, both physicians and nurses, on standby in order to meet the demand of patient volume. In addition, hospitals providing 24/7 emergency care have to have other support staffing available to support the ED. Hospital EDs require services from the laboratory, radiology, pharmacy, surgical services, general and intensive care units, labor and delivery, plus on-call physicians. It is not uncommon for hospital EDs to see more than 1,500 unique patient conditions. A problem most hospitals face is the use of the ED as a patients safety net. Often lacking a medical home, Medicaid beneficiaries and people without health care coverage together, 103 million individuals disproportionately look to the hospital ED as their access point for care. (Prepare to Care, n. d. ) Acting as the safety net for these patients is very costly to hospitals. As discussed earlier, most hospitals lose money taking care of Medicaid patients. Also, most uninsured patients rarely have the means to pay for their ED visit. This problem continues to persist as evident by the 22 percent increase in ED utilization by Medicaid and uninsured patients during the years of 1998-2003. A current problem and a problem that will have to be addressed in the future by hospitals is the care of the behaviorally ill. Declining reimbursements from payers and the erosion of public support have resulted in reductions and/or eliminations of inpatient psychiatric units and/or beds in hospitals as well as in private, free-standing and state behavioral health facilities. Many outpatient centers also have closed and some behavioral health specialist are limiting their practices to fee-for-service patients only. As a result, individuals suffering from mental health and substance abuse (MHSA) conditions increasingly turn to EDs for care. (Prepare to Care, n. d. ) With limited resources and a thin profit margin, most hospitals will continue to lack the ability to take care of this patient population. Hospitals have a challenge today and they will be challenged in the future when it comes to providing 24/7 emergency care. A concern hospitals will have is covering the cost of the uninsured. Even as the new insurance mandate is implemented, there will still be people who will risk not having coverage and opt to pay the penalty for not having an insurance premium. The hospitals also take a risk in absorbing the cost of these individuals without the means of paying for their services. The majority of hospitals already lose money on the Medicaid and Medicare patients, they cannot afford to add another category of non-paying patients. The future role of hospitals will definitely involve new technology and medical advances. The government has already mandated that every provider will transition to electronic medical records by the year 2014. Information technology (IT) has been identified as an essential tool in improving the quality of clinical care and reducing health care costs. Hospitals and health systems currently leading the field in IT adoption report that they generally begin by improving the safety of medication administration, both by automating the ordering process and matching medications electronically to patients at the time of administration. (Lutz Rodgers, 2003) The one drawback to IT is the cost of implementation. Over the next few years all medical records will be transitioned into electronic medical records. The hospitals will be the leaders in the medical community in the adoption of the new requirements. They will play a vital role in recruiting the physicians into adopting the use of electronic medical records. Hospitals will also take the lead in the interoperability between hospital electronic medical records and physician electronic medical records. New biomedical and technology advancements has vastly improve the quality of life of people and has extended the life expectancy. Because of the advancements of less invasive procedures, patient demand has increased. Advancement in imaging has been a huge breakthrough in patient care. Newer high tech imaging devices such as magnetic resonance imaging (MRI) and computed tomography (CT) functional imaging with positron emission tomography (PET) has lead to early detection of diseases and early treatment. Research indicates advances in medical care are contributing to longer, healthier lives. Disability and mortality rates have consistently declined since the 1970s. (Lutz Rodgers, 2003). The downside to all the advancements in health care is the cost. As with all health care, paying for the new technologies and advancements will be the major obstacle. The majority of hospitals today are losing money year over year. In the future, hospitals will have to develop more cost effective ways to implement new medical advancements and field new technology. One thing is for sure, hospitals will play a major role in health care in the future. Hospitals are the foundation of this countrys health care system. They are major contributors to the economy of the U. S. Hospitals will always play a lead in the care of Americans. Reference Page Jackson, Jill and Nolen, John. Health Care Reform Bill Summary: A Look At Whats in the Bill. (2010, March 23). Retrieved from CBSNews. com. cbsnews. com/8301- 503544_162-20000846-503544. html Fast Facts on U. S. Hospitals. (2010, June 24). Retrieved from AHA. com. aha. org/aha/resource-center/Statistics-and-Studies/fast-facts. html Hospital Facts to Know. (2008, March). Retrieved from AHA. com. aha. org/aha/resource-center/Statistics-and-Studies/studies. html Frequently Asked Questions About the Emergency Medical Treatment and Active Labor Act (EMTALA). (no date). Retrieved from Emtala. com. emtala. com/faq. htm Cracks in the Foundation: Averting a Crisis in Americas Hospitals. (2002, August). Retrieved from AHA. Com. aha. org/aha/resource-center/Statistics-and- Studies/studies. html The Fragile State of Hospital Finances. (no date). Retrieved from AHA. com. aha. org/aha/resource-center/Statistics-and-Studies/studies. html The Economic Contribution of Hospitals. (2010). Retrieved from AHA. com. aha. org/aha/resource-center/Statistics-and-Studies/studies. html Lutz, Sandy and Rodgers, Jack. Cost of Caring: Key Drivers of Growth in Spending onÃ Hospital Care. (2003, February 19) Retrieved from Retrieved from AHA. com. aha. org/aha/resource-center/Statistics-and-Studies/studies. html Walker, David M. Long-Term Care: Aging Baby Boom Generation Will Increase Demand and Burden on Federal and State Budgets. (2002, March 21). Retrieved from GAO. gov. gao. gov/new. items/d10468sp. pdf Prepared to Care: the 24/7 Role of Americas Full-Service Hospitals. (no date). Retrieved from AHA. com. aha. org/aha/resource-center/Statistics-and-Studies/studies. html Rural Hospital Closures 1990-1999.
Saturday, November 23, 2019
Major Problems In US to 18 Chapter 1 Review essays Although many people believe that the Americas were discovered by Christopher Columbus, there were many people here before his arrival. These people were native Indian tribes such as the Aztecs and the Anasazi. These native people were very civilized. When the Europeans did arrive the interactions between them and the Indians were very difficult. They were very different people. They had different religion, appearances, work roles between men and women, notions of private property, and governmental structures. Eventually the Europeans will lead to the death of all the natives. They brought warfare and disease, which the natives had never dealt with prior to their arrival. In the documents, the Europeans and the Indians speak many different views. In the first document by Christopher Columbus, he tells of the land and people. He describes the land as beautiful and rich. He realizes the value of this land for building and farming. He also says that the land contains great mines of gold. He describes the natives appearances as naked. He also thinks that they are somewhat unintelligent because they do not know the value of trade. They trade not for value but for use. An example that he uses is that they value a broken useless piece of glass as a jewel. They also trade with him a broken strap for two and a half castellanos of gold. Columbus also does not understand the religion of the Indians. They have no one god like he does. They worship many gods from the sky. In Document 2 the conquest of the Aztecs is discussed. The warfare was brutal. The stabbing, beating and killing of the Indians left the Indians in terror. They had never seen this violence nor had they seen the warfare before. They had no iron or steel like the Spanish had. The Spanish stole all valuables, killed many through famine and murder, and left them without a leader who died of the small pox disease that the Spanish spread. In d...
Thursday, November 21, 2019
Little italy - Research Paper Example However, Italian Harlem is currently composing of more Spanish Americans as compared to those from Italian origin. In this regard, Little Italy in lower Manhattan serves as a perfect representation of Italian populations in modern America. Currently, Little Italy in New York is characterized by numerous restaurants selling Italian cuisine. In addition, streets along this region are laced with several convenience stores selling products preferred by Italian consumers. History of Little Italy Historically, Little Italy in Manhattan was founded in the late 19th Century during immigration of Europeans into the US. Supposedly, Europeans from different countries including Spain, Italy and Britain were moving in mass numbers into the US. During the movement, thousands of Italians entered into the United StateÃ¢â¬â¢s west coast. Since Europeans preferred urban settlements, most Italians moved from the cost and settled in areas around New York metropolitan. In 1910, population of Americans from Italian ancestry living in the region was approximately 10000. This does not mean that the entire population of Little Italy was ten thousand. Other people, especially Chinese immigrants were living with Italians within the city. As of 2011, demographic statistics shows that Little Italy comprised of approximately 1200 Americans from Italian ancestry. Vincenza (2008) says that through the ages, residents in this region continually move from Little Italy to places like Texas and California in search of greener pastures. This is because Little Italy is known for being a residential area with poorest Italian American in United States. Economic Segregation Based on immigration history, Italians were of lower economic and social status compared to their European counterparts like Spanish and Irish immigrants. Italians worked as farmers and laborers while British and Spanish immigrants owned farms and industries. Currently, economic segregation that existed during the immigration per iod is still conspicuous in Little Italy. Businesses owned by Italian Americans within the town are small and medium in sizes compared to those owned by people from other ethnic background. In terms of social status, Italian Americans in Little Italy live in cheap and affordable homesteads similar to those of Indian and Chinese Americans. This means that residents of Italian origin living in Little Italy still demonstrate a humble and economical living style. According to Vincenza (2008), there is a general notion that Italians were aware of their low economic power when compared to other European immigrants. In this case, their main intention of immigrating into the US was to work hard, accumulate wealth and return back to Italy. This explains why Italians in Little Italy does not prefer permanent homes and engage in casual occupation as a means of earning a living. Demographics As acknowledged earlier, Little Italy currently comprise of approximately 1200 Italian Americans. This i s contrary to the townÃ¢â¬â¢s population in 1910 when it reached a peak of approximately 10000 people from Italian ancestry. The reason for decline in population can be attributed to the fact that residents shift from one American state to another in search of better economic environments. In this case, Italian Americans who previously lived in Little Italy of lower Manhattan have moved to other places, leaving a
Wednesday, November 20, 2019
Promotional Strategies - Essay Example Then, the next most important element of promotion is the targeting factor, which pertains to the way the business would communicate with its customers. Thus, an airline would cope up with the rivals by marketing and promoting itself in the form of both, print and television channels. In order to secure a successful position and share in the market, the organization would try to be extremely cost- efficient and avoid the excess expenditures. Besides this, most of the advertisement in the airline industry is undertaken through the word of mouth advertisements (Anon, n.d.). One of the major success factors for the positioning of the airline company is to be considerate regarding its market positioning. The termÃ¢â¬â¢ positioningÃ¢â¬â¢ refers to the unique image and the distinguishing position that the business makes of itself in the minds of the consumers. Since, airline is a service industry; it needs to put in extra efforts to provide superior quality services to its customers in order to give rise to a better word of mouth advertisement (Goizueta & Roberto C., 1990). Thus, the company needs to have with it a well-defined and sophisticated model of the business which utilizes the short hauls and single aircraft type for the purpose of positioning itself while keeping its costs low. The lowest possible fares, more routes to be flown, timely flights, excellent services in the plane, and getting the passengers to their destinations quicker are all the services which shall be helpful.... One of the major success factors for the positioning of the airline company is to be considerate regarding its market positioning. The termÃ¢â¬â¢ positioningÃ¢â¬â¢ refers to the unique image and the distinguishing position that the business makes of itself in the minds of the consumers. Since, airline is a service industry; it needs to put in extra efforts to provide superior quality services to its customers in order to give rise to a better word of mouth advertisement (Goizueta & Roberto C., 1990). Thus, the company needs to have with it a well-defined and sophisticated model of the business which utilizes the short hauls and single aircraft type for the purpose of positioning itself while keeping its costs low. The lowest possible fares, more routes to be flown, timely flights, excellent services in the plane, and getting the passengers to their destinations quicker are all the services which shall be helpful in creating the companyÃ¢â¬â¢s positioning in front of its competi tors. Moreover, the communication of messages for the purpose of advertisement and publicity of the airline company can easily be delivered through its quality services. The provision of quick services, comfortable environment and the reasonable costs is all what forms the unique image of the company. This strategy, furthermore, assists the company build a positively reinforced image in the minds of the customers (Benady & Simonian, 2005). One of the companies following the above mentioned promotional strategies include Southwest Airlines, which has been able to generate quicker revenues at relatively lower costs. Breakfast Cereals Breakfast cereal is one of the consumer goods which is bought and
Sunday, November 17, 2019
Books Vs. Movies Essay Why are audiences so upset with the way the movie turned out after reading the book? Ã¢â¬ Ask any reader who has seen the movie version of a favorite book, and the answer will usually be, the book was better.Ã¢â¬ (Corliss, 2005, p. 1)They are frequently disappointed because the movie versions are not sticking to their all-time favorite book. Growing up with books like Harry Potter, as readers or having someone reading to us our minds wonder off to this mystical land, picturing how our heroes and villains would look and act. As they take in the words, the reader can almost smell the trees and here the wind blow through the castles. Reading a book compared to watching the movie brings up controversy; with books readers use their minds while watching a movie people sit back and enjoy. It all starts with the book and how the readerÃ¢â¬â¢s mind starts to imagine what it will look like; the smell, taste, and feel. Then they bring the movie with the directorÃ¢â¬â¢s view on the story. LetÃ¢â¬â¢s start with how people view the story that they are reading. The reader will take the story from the book and make it their own personal story, internalize from their own perspective and imagination. Each reader will see and interact with the story in their way. With Harry Potter readers, some say they feel closer to the main characters because it easier to see whatÃ¢â¬â¢s going on in their minds. The directors have read the same books too and have challenges to overcome. Bringing Harry Potter to life on the big Screen, and appease all the children that have read the books. His job is to make the movie exciting; some books have some narrative that can just drag on. Sometimes what you read may not work in the movies. Some directors like to change things up so the viewers will be surprised and not be bored because they know everything that was going to happen. Now, back to how the audience sees the main character in a different light concerning reading, then on the big screen. The book builds this character that they grow to like; readers may see themselves as the leading actor. Some readers will picture their favorite actor playing the part. Characters are what keeps the readers coming back every time or make it impossible to put the book down because they want to find out what happens next. As a reader, you feel closer to whatÃ¢â¬â¢s happening; you feel all the emotion that the characters are going through. Concerning the big screen, the character usually gets a brief back ground. The director determines the character for you; he will pick the actor for the spot. Sometimes they will pick a different gender to play the part. The director has to take a book like Harry Potter and cut some of the characters out so that the main character gets more time. They also cut out scenes. LetÃ¢â¬â¢s take for example, the Dursleys family that was to keep Harry safe when not in school. After the third film they cut them out most of the other films. In book 4 they were to meet the Weasleys and that was cut out for the movie. (Bibbiani (2011)), Ã¢â¬Å"The audience spent way too much time with the Dursley family over the course of the franchise to deny them their only redeeming moment.Ã¢â¬ The director will put his own insights and how he pictures the characters to be and what scenes he wants. The story line people see in our mind from reading may change on the big screen. With reading, they get the whole story from beginning to the end, the readers will know everything about their character; including where they live and what time period theyÃ¢â¬â¢re from. It all goes back to how they imagine it will be like. In every story it starts out slow so it can build you up to the main event. It may take up to 100 pages to explain a character. After reading the book, must readers feel that they lived another life, unless itÃ¢â¬â¢s a series, the reader will feel completed. However, with the movie there are time constraints to think about and they need to achieve the right rating for the movie. In the books the writers has more freedom with the story line, when it comes to the movie they need to make sure it targets the right audience. The Harry Potter movies always have been geared toward children and teens, so they cut things out to achieve that goal. The Goblet of Fire was a 734- page book that would be a 10 hour movie. The screen writer Steve Kloves said Ã¢â¬ it took him two years to figure out how to make the movie and deciding what parts to cut outÃ¢â¬ (Corliss, 2005, pp. 3-3). They took the first hundred pages and put it into a thrilling 20 minutes. They need to make the movie exciting by cutting out some of the narrative and zipping through some of it. There are some movie critics that love the movies because they cut out the boring narration of the books. Readers interact with the book and use their minds to imagine the story while movie-audiences are more passively enjoying the movie. We see how and why things change from reading books and how the movie may have a different concept. When reading books, a person is creating their own movie in a sense. You know how the character speaks, what they look like. Where the director is showing how he perceived the story and characters. Can we as readers see books and movies as different entities? Not all movie versions might be considered worse than the books. Books require your imagination to run wild with in the story. Movies are an in-depth perspective toward the story. In some people opinion they need to change some of the details from the book to make the movie more enjoyable. Think about how dull that movie may be if you put everything from the book into the movie. Next time you are out watching a movie and you have already read the book try to remember that it is not going to be how you imagined it, itÃ¢â¬â¢s someone elseÃ¢â¬â¢s story and how they perceived it. Ã¢â¬Å"If we were more naÃ ¯ve, new to the plot and characters, things might be different, but since weÃ¢â¬â¢ve read the books, and read them emphatically, possibly more than once we canÃ¢â¬â¢t know that for sure. We can only compare to what we know, and already loveÃ¢â¬ (Mario Mario, 2012, pp. 3-2). References: Bibbiani, W. (2011). Crave Online. Retrieved from http://www.craveonline.com/film/articles/171155-the-top-ten-things-the-harry-potter-movies-left-out Corliss, R. (2005, Nov.). Books Vs. Movies. Time, (),. Retrieved from http://www.time.com/time/magazine/article/0,9171,1134742,00.html Mario, A., Mario, R. (2012, may). The Trouble with Making Books We Love into Movies. The Atlantic Wire, (), 5. Retrieved from http://www.theatlanticwire.com/entertainment/2012/03/trouble-making-books-we-love-movies/50220/