Explain how the Tourism Destination is served by Transportation Links Essay

Explain how the Tourism Destination is served by Transportation Links. Identify Key issues of best practice and limiting factors - Essay Example The paper will also include various theories of tourism and models and will analyze the type, options, range, volume, seasonality, availability and accessibility, and the relative costs of transportation in Hong Kong. Another key area will be examining the various key issues around the best factors as well as the limitations of the transport service in Hong Kong. Hong Kong Transport, Volume and Seasonality Hong Kong is one of the two administrative regions of the People’s Republic of China, working under the one government two systems arrangement (WTO., 2001). It is located on the South Coast of China and is in between the South China Sea and the Pearl River Delta (Beirman, 2003). Hong Kong is extensively known for its open skyline as well as the deep natural harbors. The city center is regarded for its modern architecture that has led to the city being branded as the most vertical city in the world. Despite being only 1104 km2, Honk Kong manages to attract huge numbers of tou rists per annum, making tourism one of the most notable sources of revenue for the region. Tourism in Hong Kong is managed by the Hong Kong Tourism Board (HKTB). Hong Kong has numerous tourist attraction facilities and each of its districts can almost be considered as viable tourist destination sites. Among the most visited locations in Hong Kong, include the Victoria peak, Victoria Harbor, and Ocean Park Hong Kong in the Island; the Hong Kong Art Museum, Clock Tower, and Avenue of Stars in New Kowloon among others (Ghai, 2000). According to statistics from the Hong Kong Tourism Management Board (HKTMB), Hong Kong receives about 20 million tourists per annum. A majority of the visitors to the city are mainly from The Mainland in China with a good percentage also coming from the neighboring countries in the Middle East and other parts of the world. Appendix A contains statistical graphs and charts showing an analysis of the visitors to Hong Kong from various parts of the world (Beirm an, 2003). The statistics show that Hong Kong is a major tourist destination in the world attracting lots of tourists in the past few years. In as much as Hong Kong is a major tourist destination, it also emerging as a major business hub on the global scene (Ghai, 2000). It is one of the primary global financial centers acknowledged for its capitalist economy renowned for its lower tax regimes and free trade. The Hong Kong dollar, the currency used in Hong Kong is also the eighth most traded currency in international trade. The Hong Kong government has put a lot of measures to manage the transport networks in the city in order to enable visitors to access the city and visit the various tourist attractions sites. The city has a wide range of transportation links ranging from air, water, road and rail transport (Ghai, 2000). Visitors can move around the city via light rail, minibuses, buses, trains, trams, ferries, and taxis. Each of these means of transport have their own systems of paying fares and often require one to buy tickets each time they travel to various destinations (Cooper, 2005). One can also buy the Octopus card, which is an electronic system of paying fare in public transport. The road transport consists of various options such as public

Homeostasis Essay Example | Topics and Well Written Essays - 1000 words - 1

Homeostasis - Essay Example The failure of the organs to excrete waste products is very detrimental to the health of a person and could possibly lead to death. Diseases are likewise outcomes of this failure. There are natural bodily processes like Osmoregulation which creates balance thus preventing the occurrence of diseases relating to the excretory organs. There are also man-made treatments to combat the negative effects of the malfunction of the excretory systems like Dialysis for severe kidney diseases. We shall concentrate on the two excretory organs: the kidneys as a component of the urinary system and the skin as a regulator of temperature. In the course of the discussion of the structures and functions of the urinary system and the skin, the effects of the failure of these systems will be tackled. The terms Osmoregulation and Dialysis will likewise be elaborated and explained. The urinary system has four major components: the kidneys, the ureters, the urinary bladder and the urethra. The main organs of the urinary system are the kidneys. The kidneys with its functional components called nephrons, form the urine. The process begins during blood circulation. Blood contains Urea, which is produced when protein-rich foods are broken down. Blood through the bloodstream travels through the kidneys and deposits the urea there along with water and other waste matters. This results to the formation of urine. The ureters are small tubes where urine passes through going to the bladder. Urine is then stored in the urinary bladder. The bladder sends information if there is a need for urination when the bladder is filled up. The contractions of the muscles in the bladder release the urine into a tube called urethra. The urethra is the last passageway which allows the body to release urine or to undergo the process of urination. The primary function of the urinary system is to get rid of waste products in the body resulting from cellular metabolism. This function preserves the normal composition and volume of body fluids. Aside from maintaining the appropriate amount of water in the body, the urinary system also has other functions. It sustains the normal pH of the blood and helps in managing the proper production of red blood cells by secreting the erythropoietin hormone. By producing the renin enzyme, the urinary system likewise helps in the maintenance of normal blood pressure. What will happen if the major components of the urinary system fail It will lead to major health problems. Diseases or disorders resulting from the urinary system failure include Kidney Stones which vary in size and may cause little or great pain, and Renal Failure of the kidneys which is a result of the kidneys not being able to properly and completely remove waste products from the blood. In this case, the kidneys are also not able to regulate the chemicals and water in the body. Other disorders are the Urinary Tract Infections which are caused by urinary tract bacteria, Urinary Incontinence, or the inability to control the bladder in releasing urine, and Urinary Retention, or problems in emptying the bladder (Your Urinary System and How It

Examples Of Acute Injuries Health And Social Care Essay

Examples Of Acute Injuries Health And Social Care Essay To be fit and healthy it is important that you exercise, however, exercise too much and you could injure yourself. This can be caused by; An accident while training Insufficient equipment Pushing yourself too hard Not warming up properly Sports injuries can be classed into two categories; Acute injury Overuse injury An acute injury is on in which there is rapid onset of pain is resulting from an incident that has been traumatic for example, an injury. It is normally impact on a specific part of the body. Examples of acute injuries are; Sprains are injuries to ligaments by stretching them too far or by being torn. Ligaments are fibrous tissue which holds bones together as well as to keep your body in position preventing any unwanted movements. Examples of ligaments are; the calcaneoifbular ligament in the ankle which is the damaged ligament in the picture on the right. A sprain is an injury to a muscle or to a tendon. Muscles move your skeleton and this in turn pulls on a tendon which is connected to a bone. Both can be stretched but if they are stretched to far it can cause a tear in it. A contusion or bruise in common terms, is one of the most common sports injuries. These occur when a blood vessel underneath the skin ruptures due to compressive force to a muscle. Blood then leaks into the dermis layer of the skin, causing discoloration. This can also occur to organs. Dislocation is the separation of two bones at their meeting joint due to sudden force to the joint; this is clearly shown by the picture on the left. Therefore, the bone is no longer in its normal position. Dislocation can cause damage to the tissues surrounding the bone as well as any ligaments attached to the bone. Damage can also be done to the blood vessels and nerves. A fracture is a condition where the bone has broken or when there is a crack present in the bone. These occur due to high force or stress on the bone. Fractures can occur in any bone in the human body, however, bones can normally withstand most impacts and it is only if the force is too much it fractures. There are several different classes which fractures can be classed into; all are identified on the right. Closed/Simple fracture is when the bone is only damaged and there has been no damage done to the tissue or skin surrounding the bone. Compound/Open fracture is when the skin or tissue surrounding the fracture has been damaged. There is a higher risk of infection with this type due to the damage to the skin. Overuse injuries are those that are caused by recurring actions which damage tendons, ligaments, muscles and tissues in the same place over a period of time. Common overuse injuries are; Tennis elbow is due to injury of both the muscle and tendon on the outside of the radius and ulna, or more specifically the lateral epicondyle. It is caused my overuse of the forearm muscles resulting in pain. It is most common in tennis players; however, you do not need to be a tennis play to get this. Golfers elbow is a similar condition to tennis elbow, only this condition affects the muscle and tendons on the inside of the arm. Iliotibial band syndrome (ITBS) is caused by repetitive trauma to the Iliotibial band which is present in legs and runs along the outside of the thigh which keeps the knee in place as it flexes and extends. ITBS is the overuse of this band resulting in pain specifically during running and inflammation of the iliotibial band. A Shin splint occur when there is a recurring and a large amount of exercise being done. This puts large amounts of pressure onto the leg which can cause injury to the bone and tissue that surrounds it. Shin splints can also be where small tears develop in the interosseous membrane in the leg or tiny fractures develop on the surface of the tibia. Sports injuries are very common. One of which is a broken leg, this happened to American football wide receiver Tyrone Prothro who played for the University of Alabama between 2003 and 2005. On 1st October 2005, during a game versus the Florida Gators, Prothro went for a touchdown pass and got hit in the air and the way he landed on the ground he fractured both the tibia and fibula. Since the leg is deformed, this would be classed as a severe tibia and fibula fracture resulting in the inability to stand and walk as well as weakness in both the leg and foot. Damage was more than likely done to the surrounding tissue, nerves and blood vessels. First aid First aid is very important when it comes to an injured person. There are a number of rules in which you can follow; DR ABC is a mnemonic which is used soon after someone got injured; Danger Check the area and make sure you and the people around you are safe, especially the injured person. Response Can the injured person hear you? Can they open and close their eyes? Any movements? Response to touch? Airway Is there a blockage in the throat or have they swallowed their tongue? Is the head in a suitable position to allow breathing? Care should be taken not to make anything worse but the airway must be cleared if it is blocked. Breathing Can the injured person breathe clearly? Circulation Is there a pulse? Is the pulse weak / strong / racing R.I.C.E is another mnemonic that is used for tissue injuries; Rest This is important for repairing the body as without it more strain would be placed on the injured area leading to more injury. Ice Ice is perfect for reducing inflammation and any pain caused. It is recommended that you ice for 20 minutes and then no ice for 20 minutes. This can reduce the chance of getting frostbite, as well as wrapping the ice in a towel before placing it on the injured area. If you use the ice for too long, this can prolong the repairing time as it will restrict the blood flow to the area, which can reduce the nutrients getting the tissues of the injured area. Compression Compression is used to reduce the swelling that is from inflammation but everyone does get some swelling. For this an elastic bandage is better as it does not restrict the blood flow as is not to be too tight. Elevation ­ Elevation is good at reducing swelling by the higher amount of blood which returns to the systemic circulation. This break is easy to diagnose by the use of modern imaging techniques; X-rays CT scan MRI scan Bone scan Extremity ultrasound However, in Tyrone Prothro circumstances, he was given an X-ray as this was the fastest technique to use and is the least expensive. X-rays are high photon energy electromagnetic radiation which can be used in both diagnosis and therapy. As the rays pass thought the body, the photons present in your body are absorbed at different rates; this is what produces the image. The materials in your body which are dense, like bone, show up as white areas on the image. The parts of your body which are made of softer material, like muscles and organs, show up as darker areas. X-rays can be dangerous if the does given is too much for the body, however, medical x-rays are normally are a very small dose level, meaning the chance of radiation damage to your body is small. Due to the way in which Tyrone Prothro fractured his tibia and fibula, surgery had to be the option due to being the quickest option as without it, it would take years to heal or might never heal and will constantly be in pain. He had to get three separate surgeries due to the damage done to the tissue, nerve and blood vessel damage. The doctors put an intramedullary rod in his leg which will align the leg and help to fix the fracture. The IM rod was inserted into the interior of the bones, where the bone marrow is present. This is the best way to help heal the broken tibia and fibula as it does not support the bone; instead it shares the load with the bone. Rehabilitation of the broken tibia and fibula would be used to restore the function of the limb, as best as possible and to reduce the discomfort the patient is in. The patient may need the use of crutches, depending on the weight bearing position. The doctor may also decide if Tyrone would need the use of an orthopaedic cast, which means the leg would be covered by plaster to create a shell type casing. This is to reduce the movement the injured limb to do which will decrease the healing time. Once the cast has been removed, the patient will have to visit a physiotherapist to regain strength and range of motion in the leg. However, it will never be the same as what he had before the injury. Both the tibia and fibula may start to heal within 6 to 16 weeks of the injury, but the capability of the bone to sustain a heavy load could take up to a year, meaning the injured may be is some sort of discomfort until then. REHABILITATION VISITS Non-surgical Specialist Fracture, Tibia or Fibula Physical Therapist Up to 20 visits within 8 weeks Surgical Specialist Fracture, Tibia or Fibula Physical Therapist Up to 16 visits within 8 weeks http://www.mdguidelines.com/fracture-tibia-or-fibula/rehabilitation The table is how often you would have to visit a physiotherapist if you had a broken tibia and fibula. Or Tyrone Prothro, surgery was the option, meaning once he was released from hospital and ready, he would have to visit the physiotherapist 16 times within the space of 8 weeks, means 2 times a week. Due to the damage that was done and his leg never fully recovering, meaning he was advised never to play football again, his career finished. Prevention of sports injuries There are six steps that are highly important to reduce the risk of sports injuries; Warm up Do not over do it Stay hydrated Using the right technique Use of the proper equipment Cool down Sports occupation The sports profession that I have chosen to examine in this unit is physiotherapy. Physiotherapy helps to restore the function and movement in any part of the body where the human has been effect by a disability, illness or injury. This is normally done through movement, exercise and education. The American Board of Physical Therapy Specialties (ABPTS), state that there are 8 credible types of physiotherapy; Sports This has to be the most common type of physiotherapy, being used every day. It is the management of injuries for all types of athletes, amateur to Olympian. It involves the treatment and healing of injuries. Orthopedic This type helps to identify and care for injuries or disorders of the musculoskeletal system. Pediatric This type is all about improving coordination and balance within a human as well as their motor skills. It can also be used to focus on strength and endurance. Humans with conditions such as, spina bifida and cerebral palsy. Normally this is used on children and adolescents. Cardiovascular and Pulmonary This is for the treatment of humans with cardiovascular and pulmonary disorders, as well as those who have had cardiac or pulmonary surgery such as, bypass surgery. This is used in humans with the following disorders; pulmonary fibrosis, CORD (Chronic Obstructive Respiratory Disease), heart attacks. Geriatric This type of physiotherapy is for the vast amount of conditions that affect humans as they grow old and therefore would only be practiced on the elderly. A few examples of the conditions are as follows; Alzheimers disease, cancer, arthritis and osteoporosis. Neurological This type is practiced on those with a neurological disorder such as, Alzheimers disease, cerebral palsy, Parkinsons disease and motor neurone disease Clinical electrophysiology This type normally is used with electrophysiological evaluation where an EMG (electromyography) is used. Integumentary This is used as a treatment for skin and organ conditions like burns and wounds. University level Physiotherapy is degree based career, meaning you have to go through university if you wish to become a physiotherapist. University of Ulster is the only university in Northern Ireland to offer a degree, specifically, a BSc Hons in physiotherapy. The university states that applicants must; Hold a GCSE pass in English Language at Grade C or above (or equivalent).   You must also have obtained a GCSE pass in Mathematics at grade C or above (or equivalent). A level Grades BBB to include one science subject from Biology, Chemistry, Maths, Physics or Double Award Applied Science  (with a BB in Double Award Applied Science). Irish Leaving Certificate B2B2B3B3B3 at higher level to include two subjects from Maths, Physics, Biology or Chemistry. English and Maths Grade D at Higher Level or Grade C at Ordinary Level. BTEC National Diploma Successful completion of a science related BTEC National Diploma with a DDM profile.   Pass with overall average of 70 71% to include 70% in each final year module. Final year modules must include 2 from the following:- Maths (with maths to be presented at level 3), Biology, Physics, Chemistry. Applicants must also sit the Health Professions Admissions Test results in a satisfactory performance in the HPAT. As well as testing all candidates are required to undergo a medical examination and criminal records check (AccessNI). http://prospectus.ulster.ac.uk/course/?id=9773 BSc Hons in Physiotherapy is a three year course results in peoples meeting the demand of physiotherapists in the current health care system, the NHS or via private practices. In each of the three years you study; Year 1 Development of professional identity and professionalism Knowledge and Skills for Professional Practice, and Communication and Psychology for the Health Sciences. An understanding of core subjects: Physiology and, Structure, Function and Assessment of the Human Body. Specific skills are taught with regard to cardio-respiratory, electrotherapy, walking rehabilitation and therapeutic exercise. Students undertake a one week orientation and a six week clinical placement. Year 2 Neurological rehabilitation. Spinal dysfunction and rehabilitation. Musculoskeletal. Pediatrics. Oncology. Amputation rehabilitation. Students undertake two six week clinical placements. Year 3 Cardio-respiratory and professional issues develop awareness of the role of the physiotherapist within the multidisciplinary team and in a changing clinical environment. Students undertake an investigative project or dissertation Students undertake two six week clinical placements. http://prospectus.ulster.ac.uk/course/?id=9773 Professional Organisations Once you have completed the course, you leave with a BSc (Bachelor of Science) in Physiotherapy and are therefore eligible for registration with the Health and Care Professions Council (HCPC), this was set up with the Health Service reform 2002 and membership of the Chartered Society of Physiotherapy (CSP). As a physiotherapy student at the University of Ulster, they recommend that you join CSP as soon as possible with membership being a one off payment. Personal Qualities As a physiotherapist it is important that they are fit and healthy, to set an example to your clients. Good communication and social skills are key to ensure a good relationship between the therapist and the patient. Tolerance and patience is an important quality, due to this being a very hand on career. Careers Beyond obtaining the BSc in physiotherapy, you can either go into a career or do a postgraduate degree, MSc which is a Master of Science. The University of Ulster offers Physiotherapy at MSc level. If one does not want to go on to do a postgraduate degree then it is possible to go into the world of work, the possibilities are endless with physiotherapy due to the vast amounts of sports played in the world or any other types of physiotherapy (ABPTS) are needed on a daily basis. NHS vs. Private Care There are various jobs available on the NHS (National Health Service) and private practitioners, both of which are highly regarded. With the NHS based jobs, they would be working in a hospital environment and are needed in most of the departments; Outpatients Intensive care Womens health Care of the elderly Stroke patients Orthopedics Mental illness Learning difficulties Occupational health Terminally ill Pediatrics This means that they will constantly be on the clocked and needed for various things. Physiotherapists do not just work in the hospital surrounding; they would work in various environments; Industry Special schools The private sector (for example, private practice) Education Leisure sport For physiotherapists that are in the private sector would work in the same principles as those on the NHS, however, the private section physios will have to be paid for. There are three bands for physiotherapists on the NHS, all have a different salary;  £21,176  £27,534 (band 5)  £25,472  £34,189 for specialist physiotherapists (band 6)  £30,460  £40,157 for advanced physiotherapists (band 7) The physiotherapists that work in the private sector will generally have the same salary as those on the NHS. Medical Physics Roger Muncaster http://www.nhs.uk/conditions/sports-injuries/Pages/Introduction.aspx http://www.sportsmd.com/sportsmd_articles/id/347.aspx http://sportsmedicine.about.com/od/glossary/g/acute_def.htm http://orthopedics.about.com/cs/sprainsstrains/a/sprain.htm http://www.howtotreatasprainedankle.org/wp-content/uploads/2011/11/sprained-ankle-pic.jpg http://www.examples10.com/e/ligaments/ http://www.umm.edu/graphics/images/en/19618.jpg http://emedicine.medscape.com/article/88153-overview http://www.emedicinehealth.com/script/main/art.asp?articlekey=135557ref=132720 http://images.emedicinehealth.com/images/healthwise/medical/hw/n5550698.jpg http://www.empowher.com/files/ebsco/images/si55550720.jpg http://www.chanorthopaedics.com.sg/wp-content/uploads/2011/09/type-of-fracture.gif http://www.medicalnewstoday.com/articles/173312.php http://www.nsmi.org.uk/articles/overuse-injuries.html http://img.webmd.boots.com/dtmcms/live/webmd_uk/consumer_assets/site_images/articles/health_and_medical_reference/joints_bones_and_muscles/arthritis_tennis_elbow.jpg http://www.webmd.boots.com/osteoarthritis/guide/tennis-elbow http://davidrobertsphysio.co.uk/wp-content/uploads/golferselbow.gif http://www.sdri.net/wp-content/uploads/2010/02/ITBS1-201300.jpg http://www.medicinenet.com/iliotibial_band_syndrome/article.htm http://0.tqn.com/f/p/440/graphics/images/en/19482.jpg http://sportsmedicine.about.com/b/2007/08/21/shin-splints.htm http://www.nhs.uk/conditions/shin-splints/Pages/Introduction.aspx http://blog.al.com/rapsheet/2009/04/medium_t1_proth_si.jpg http://www.manlyweb.com/sports/injuries/prothro.htm http://medical.cdn.patient.co.uk/images/i77_l.jpg http://www.freemd.com/tibia-fracture/overview.htm http://image.sciencesource.com/photos/preview/7w/7w2937.jpg http://www.teachpe.com/multi/dr_abc.htm http://www.freemd.com/tibia-fracture/evaluation.htm http://sportsmedicine.about.com/cs/rehab/a/rice.htm http://www.body-dynamics.co.uk/rice.html http://www.nhs.uk/conditions/x-ray/pages/introduction.aspx http://www.tyroneprothro.com/news.htm http://orthoinfo.aaos.org/figures/A00525F02.jpg http://orthopedics.about.com/cs/brokenbones/g/imrod.htm http://www.mdguidelines.com/fracture-tibia-or-fibula/rehabilitation http://www.louisbarnett.com/leg-cast.jpg http://sportsmedicine.about.com/cs/injuryprevention/a/aa101801a.htm http://www.nhs.uk/Conditions/Sports-injuries/Pages/Prevention.aspx

The Jacksonian Era Essay -- American History, Politics

Three specific ways in which American expansion shaped the Jacksonian period was through the advancement of technology, by way of slavery, and the Indian Removal Act. Jackson used any political and economic means necessary in order to see American frontier regions expand across the nation. Jackson’s Indian Removal policy had some of the most important consequences and paved the way toward American expansion. In the beginning of the Jacksonian era, colonial Americans’ settlements had not yet extended far beyond the Atlantic seaboard, partly because bad roads and primitive technology limited their ability to expand, and because both hostile Indians and British imperial policy discouraged migration beyond Appalachian Mountains. However, all of this changed after Jackson was in office and American expansion was well underway. One of the ways in which American expansion shaped the Jacksonian period was through technology. The economic and political growth as well as American settlement can only be described in detail as a side effect of the advancement in technology. First the rising dominance of trade, commerce, and growth would not have been possible without the development of the first canals and then the railroads. (C-108) For example, Western New York had not yet been settled by white Americans. It was not until the impact of the Erie Canal that things began to change. The Erie Canal was one of the most significant and largest transportation projects of the era. Even before the project was completed, production of wheat began to take off and was shipped to eastern customers. Toll revenues on the canal grew so large that the project became self-financing. The expansion of westward trade turned New York into an urban powerhouse. ... ...The Indian Removal Act was all a part of Jackson’s expansion process, and he would stop at nothing until America made the most of its land. American expansion shaped the Jacksonian period in a number of ways which included the advancement of technology, by way of slavery, and most importantly through the Indian Removal Act. Although, very diverse, these three aspects are similar in that they all made their mark during the Jacksonian period. Technology and new developments had connected this vast expansion of land being acquired. Slavery had helped acquire these lands because of the labor needed for production. And most importantly, the Indian Removal Act had made a clear statement that American’s were taking over what was rightfully theirs. American expansion would not have been possible if not for these three ideas which greatly affected the Jacksonian period.

Arts

One of these checks recently preformed was of a 67 year old patient who presented for a hysterectomy. She ended up with complications and subsequent treatment for these complications, all care was provided by Nightingale Community Hospital. Mistakes were made with this patients care and corrective actions will be taken. It is cases like these we strive to correct, in order to become â€Å"the hospital of choice for patients, employees, physicians, volunteers, and the community. † (Nightingale Community Hospital, p. ) In order to learn and grow from the mistakes made with our tracer patient, we must identify specific mistakes made and develop a corrective action plan to address the improvements we are going to make. According to the information provided by our tracer patient's worksheet, it was determined the patient presented for â€Å"librarianship hysterectomy that was converted to an open procedure due to excessive bleeding approximately five weeks prior to hospitalizing. † After examining our patient's worksheet, or fact sheet, a few items throughout their care with us was not up to standards.First mistake found was our tracer patient did not have an admissions assessment thin the 24-hour window, starting with the time of admissions. The tracer patient's physical was done over 72 hours after admission. Second, the staff reported completing a functional assessment but there was no documentation supporting this claim in her chart. Third, the nurse evaluated the need for an advance directive, found none to be present, and requested the family bring one with them. The family never followed through and did not provide it.Fourth, the nurses did not update the tracer patient's plan of care since the surgery, and this assessment was done 5 weeks after surgery upon re-admittance. Fifth, a pain assessment is supposed to be done within an hour after pain medications are given. The night before this assessment, the follow up was done over an hour after th e pain medication was distributed 4 times. Sixth, the tracer patient's oxygen tanks were not secured properly and her room's air vents were dirty. Seventh, the nurse was not able to explain range order or give a proper range in milliards.Eighth, hand off communication is poor when patient transfers units and or providers. The SD, OR nurse and PACIFIC nurses employed all evaluation tasks properly. As you can see, many steps required for safety were either incomplete or overlooked. In order to bring this tracer patient up to the standards of the Joint commission a corrective action plan needs to be made. For this assessment I am going to concentrate on the issues of medication range orders and communication during the hand off process.Medication range orders are very important because they can prevent over fusing and under dosing. Over dosing has obvious consequences or poisoning and even death, under dosing can lead to the patient Ewing in unnecessary pain. The hand – off proc ess is very important and was addressed in prior assessments. This is where most mistakes within a hospital take place. A hand-off can include when a patient goes from one department from another or even when there is Just a shift change.In our previous case, the disorientation or the hand off lead to one of Nightingale Community Hospital's patient's Tina, to be discharged to a parent who did not have custody of her, resulting in a sentinel event. 2. 1 . Nightingale Community Hospital needs to repeat the steps taken to evaluate the racer patient on a wider range of patients. They need to re-evaluate the care of at least 100 patients receiving general anesthesia and inpatient surgery within the last 60 days.This is an important step to take to make sure these mistakes were not made as an isolated incident and more as an over all hospital wide issue. Assuming these mistakes are typical to Nightingale Community Hospital, it should proceed with the following steps. 2. Nightingale Commun ity Hospital will concentrate on two specific failures: medication range orders and communication during hand off process. These areas need to be a priority because they have the greatest consequences. Poor communication leads to almost all patient issues and medication dosage can quickly lead to fatalities. . In regards to hand offs and transferring, the Joint commission requires â€Å"The hospital's process for hand-off communication provides for the opportunity for discussion between the giver and receiver of patient information. Note: Such information may include the patient's condition, care, treatment, medications, services, and any recent or anticipated changes to any of these. Anoint Commission, 2014, p. 1) As described in the tracer patients information, the hand-off preformed was â€Å"Disjointed hand-off process, inconsistent use of handcuff form. To correct this staff, specifically all nurses and transport staff, will be re-trained how to transfer patients. Executives and unit super visors will collaborate on making a check off list, including such items as patient condition review, care treatment, medications and services (as recommended by the Joint Commission), which the two providers who are handing off the patient will both initial and review. . After the executives and unit supervisors develop the check off lists for all departments, an online training session will be mandatory for all employees.It will followed with a brief in person review of all employees by their unit super visors within 30 days of the implementation and the results will be kept in all employee files. The people responsible for this issues are the nurses and the transport staff. A measure of success is going to be a check off list, which has specific questions both the send off person and the receiving staff will have to fill out. Both of the questionnaires will be filed in the patients chart and their will be a set for each hand off the patient encores throughout the d ay.The question air protocol will start in two weeks from today. This will go on for one week throughout the entire hospital. Each of the lead super visors for each division or floor will then compile these questionnaires, compile a report for each staff member and review the findings with the staff member within 20 days following the one week assessment. They will discuss what can be improved generally and what the employee needs to specifically irking, if anything. C. Similar actions will be taken for range order re-training.Range orders are â€Å"medications in which the medication does may vary over a prescribed range, depending on the patient status. † (, 2009, p. 2) The important of training for range orders is clear. If over dosed, a patient can be killed, and if under dosed, the patient is in pain. Again, the executives and department super visors will collaborate to create range order guidelines and a re-training program. Rather then having this training be an all st aff and employee requirement, range order training ill only be implemented with employees who distribute medications.Training should spread further then physicians and nurses, but also to Urn's aids and certified nursing staff. It is important for them to have this basic training, even through they are not changing the distribution amounts, but they will be better able to spot a mistake if they have further training. The people responsible for this action are all staff members who distribute the medications. The measurement of success is going to be an audit, done by the nursing lead for the day. The lead will audit all charts for he last two hours of each persons shift.The staff will not be informed of this audit. The lead will look over any medications passed to the patient. Calculate what the text book dosage range is, make sure what was given to the patient was within this range. The lead will have on week from tomorrow to start these audits. They will go on for one 24 hours per iod throughout the hospital. The leads will have one week to compile the data, and one week following to have the reviews with the staff. During the review and nurse will distribute a pamphlet overgrowing orange order dosing.

Barbara Norris: Leading Change in the General Surgery Unit Essay

Barbara Norris facing many difficulties. The GSU which she lead is currently short-staffed and does not perform as she expected. Her staffs have low morale and low motivation to do their daily job. On top of that, there is a cultural issue where confrontation, blaming, and favoritism are typical in her unit. She also facing a budget problem where overtime has been eliminated due to cost cutting measure implemented on the hospital. The budget cut make it difficult to Barbara to allocate a right personnel in case of some staff take a personal or vacation leave. In many cases, she has to rely on nurses from general float pool to cover the staff on leave, but this often lead to negative effect to her staff dynamics because the substitute nurses is not familiar with the GSU. There are three broad problem Barbara has to solve: lack of collaboration and teamwork, staff conflict either within her unit or within the hospital, and lack of transparent performance appraisal procedures. All of this three issues need to be address simultaneously to ensure that the unit perform as Barbara expected. It is evident that there is conflict between junior nurses, senior nurses, and PCAS’s which lead to ineffective collaboration among them. Junior nurses feels like the don’t belong to the team and they don’t get positive feedback from senior nurses. On the other hand, senior nurses feels that many junior nurses and PCA’s are incompetent and feel overwhelmed to support them. To solve this issues, Barbara need to redefine a clear role among the nurses and make sure that the role is properly understood by all her staff. In redefining the role, she must include advice from her staff to ensure that the role definition fit within her unit. She also need to develop a transparent communication mechanism to solve any role discrepancy within her unit. To address the performance appraisal issues, Barbara needs to start creating a transparent review process. Although she still facing a budget constraint, she can utilize non-monetary approach to reward her staff. This can be in form of formal recognition in staff meeting or announcement of monthly best-staff. Although it would not directly impacted to her staff salary, it can be a great motivational tools for the junior staff to feel recognized. Barbara should also make a system where senior nurses can have a positive feedback in performance review by helping a junior nurses. Whenever possible, Barbara should persuade the hospital director to increase her unit budget.If approved, she could make a proper  adjustment to the staff salary and position based on their previous performance.