A memorable day Essay Example

A memorable day Essay A memorable day it was today. That Bassanio fellow approached me and claimed he was there to borrow money from me. Me, a Jew? Bassanio had to be desperate and I could read his face, so much tension and worry. In my head I figured it could not be a large sum as Bassanio was known for his extravagant spending habits, however, as he mentioned that the sum would be 3000 ducats but in Antonios name, my face seemed to light up. Antonio, that Christian scoundrel, the same man that spat on me. He humiliated me in public and he resents my religion. Antonio had called me a dog, a sinner and now he chooses to come to me in his time of need. I took advantage of this situation and placed Antonio at my mercy.At first I simply mocked Bassanio and repeatedly stated the details of the bond: 3000 ducats for 3 months and the fawning publican Antonio bound, over and over again I stated it in a manner that grew more condescending each time. I thought out loud and put emphasis on the dangers that ships en tail such as the treacherous winds and the pirates, after all it would not be the first time that a merchants ships and fortunes were lost to the all too brutal seas. As imagined, Bassanio did not take kindly to my words of fret.As the bond had been discussed Antonio was summoned to confirm it. We were to settle a rate of interest. Christians, those self-righteous fools who refuse to charge interest on loans yet offer interest to those borrowed from, Antonio is this kind of typical Christian. I confronted his hypocritical ways to which his anger fuelled, it was quite humorous to watch him rile up in such a way.I forced him to listen to the teachings of the Torah, I preached to him in a way that he could not ignore. Words from the religion he had spoken ill of. It is his turn to be pushed around and mocked; I would make sure of it. I would retaliate against his harsh words, brutal actions and his criticism of my values, I would make him pay.I saw right through him, the weakness in hi s heart for his trusted friend, Bassanio, the desperation he feels to fulfil the needs of his friend, the presence of this predilection makes revenge so much easier for me. To make Antonio feel the pain he has induced upon me all these years would be the ultimate comeuppance.Finally I announced the terms of the bond. If for some reason Antonio was not able to pay Shylock back with the full amount loaned, then I would be entitled to be paid back in kind, a pound of Antonios fair Christian flesh. The expression on Bassanios face dropped and he became hesitant. He told Antonio that he would rather live without his need than have Antonio pay this outrageous price. This proved to boost Antonios self confidence making him seem arrogant and obnoxious, not that that was far from his general attitude. This attitude irritated me and to feign a nonchalant attitude I simply compared his human flesh to the worth of common meat, this I knew would enrage him further which turned out to be quite en tertaining.I have no guarantee that anything will happen to Antonios ships, yet the risk or peril is greater than the chance of safe return, if he pays me on time then that is where I will be compelled to leave it, however if there is a glitch with his income then I will carry out the bonds terms and conditions. Thisis bad blood between two religions, if I am not to carry out this task of cutting a pound of flesh from his body then I will understand that a greater force has not allowed me to do so.Now, some may say Im evil or that I am in fact a person without feelings, but how wrong they are. I am spit upon in public because of the religion I was born to. Did I have any part to play in this decision of nature? From being the victim I must prove myself to be worth more whether it be a hero or a villain. In a sense, I would be both, villain to the Christians and hero to the Jews from my sacred nation, Israel. For this ancient grudge my people have been enslaved and abused. This is wh ere I take my stand.

Battle of Waxhaws in the American Revolution

Battle of Waxhaws in the American Revolution The Battle of Waxhaws was fought May 29, 1780, during the American Revolution (1775-1783) and was one of several American defeats in the South that summer. In late 1778, with the fighting in the northern colonies increasingly becoming a stalemate, the British began to expand their operations to the south. This saw troops under Lieutenant Colonel Archibald Campbell land and capture Savannah, GA on December 29. Reinforced, the garrison withstood a combined Franco-American attack led by Major General Benjamin Lincoln and  Vice Admiral Comte dEstaing the following year. Seeking to expand this foothold, the British commander-in-chief in North America,  Lieutenant General Sir Henry Clinton, mounted a large expedition in 1780 to capture Charleston, SC. The Fall of Charleston Though Charleston had defeated an earlier British attack in 1776, Clintons forces were able to capture the city and Lincolns garrison on May 12, 1780 after a seven-week siege. The defeat marked the largest surrender of American troops during the war and left the Continental Army without a sizable force in the South. Following the American capitulation, British forces under Clinton occupied the city. Escaping North Six days later, Clinton dispatched Lieutenant General Lord Charles Cornwallis with 2,500 men to subdue the South Carolina back country. Advancing from the city, his force crossed the Santee River and moved towards Camden. En route, he learned from local Loyalists that South Carolina Governor John Rutledge was attempting to escape to North Carolina with a force of 350 men. This contingent was led by Colonel Abraham Buford and consisted of the 7th Virginia Regiment, two companies of the 2nd Virginia, 40 light dragoons, and two 6-pdr guns. Though his command included several veteran officers, the majority of Bufords men were untested recruits. Buford had originally been ordered south to aid in the Siege of Charleston, but when the city was invested by the British he received new directions from Lincoln to assume a position at Lenuds Ferry on the Santee River. Reaching the ferry, Buford soon learned of the citys fall and commenced withdrawing from the area. Retreating back toward North Carolina, he had a large lead on Cornwallis. Understanding that his column was too slow to catch the fleeing Americans, Cornwallis detached a mobile force under Lieutenant Colonel Banastre Tarleton on May 27 to run down Bufords men. Departing Camden late on May 28, Tarleton continued his pursuit of the fleeing Americans. Armies Commanders Americans Colonel Abraham Buford420 men British Lieutenant Colonel Banastre Tarleton270 men The Chase Tarletons command consisted of 270 men drawn from the 17th Dragoons, Loyalist British Legion, and a 3-pdr gun. Riding hard, Tarletons men covered over 100 miles in 54 hours. Warned of Tarletons rapid approach, Buford sent Rutledge ahead towards Hillsborough, NC with a small escort. Reaching Rugeleys Mill mid-morning on May 29, Tarleton learned that the Americans had camped there the previous night and were around 20 miles ahead. Pressing forward, the British column caught up with Buford around 3:00 PM at a location six miles south of the border near Waxhaws. The Battle of Waxhaws Defeating the American rearguard, Tarleton sent a messenger to Buford. Inflating his numbers to scare the American commander, he demanded Bufords surrender. Buford delayed responding while his men reached a more favorable position before replying, Sir, I reject your proposals, and shall defend myself to the last extremity. To meet Tarletons attack, he deployed his infantry into a single line with a small reserve to the rear. Opposite, Tarleton moved directly to assault the American position without waiting for his entire command to arrive. Forming his men on a small rise opposite the American line, he divided his men into three groups with one assigned to strike the enemy right, another the center, and the third the left. Moving forward, they began their charge approximately 300 yards from the Americans. As the British approached, Buford ordered his men to hold their fire until they were 10-30 yards away. While an appropriate tactic against infantry, it proved disastrous against cavalry. The Americans were able to fire one volley before Tarletons men shattered their line. With the British dragoons hacking with their sabers, the Americans began surrender while others fled the field. What happened next is a subject of controversy. One Patriot witness, Dr. Robert Brownfield, claimed that Buford waved a white flag to surrender. As he called for quarter, Tarletons horse was shot, throwing the British commander the ground. Believing their commander to have been attacked under a flag of truce, the Loyalists renewed their attack, slaughtering the remaining Americans, including wounded. Brownfield insinuates that this continuation of hostilities was encouraged by Tarleton (Brownfield Letter). Other Patriot sources claim that Tarleton ordered the renewed attack as he did not wish to be encumbered with prisoners. Regardless, the butchery continued with American troops, including wounded, being struck down. In his report after the battle, Tarleton stated that his men, believing him struck down, continued the fight with a vindictive asperity not easily restrained. After approximately fifteen minutes of fighting the battle concluded. Only around 100 Americans, including Buford, succeeded in escaping the field. Aftermath The defeat at Waxhaws cost Buford 113 killed, 150 wounded, and 53 captured. British losses were a light 5 killed and 12 wounded. The action at Waxhaws quickly earned Tarleton nicknames such as Bloody Ban and Ban the Butcher. In addition, the term Tarletons Quarter quickly came to mean that no mercy would be given. The defeat became a rallying cry in the region and led many to flock to the Patriot cause. Among those were numerous local militias, particularly those from over the Appalachian Mountains, which would play a key role at the Battle of Kings Mountain that October. Vilified by the Americans, Tarleton was decisively defeated by Brigadier General Daniel Morgan at the Battle of Cowpens in January 1781. Remaining with Cornwallis army, he was captured at the Battle of Yorktown. In negotiating the British surrender, special arrangements had to be made to protect Tarleton due to his unsavory reputation. After the surrender, the American officers invited all of their British counterparts to dine with them but specifically forbade Tarleton from attending.

Case Study of MGM Example | Topics and Well Written Essays - 500 words

Of MGM - Case Study Example The highly competitive nature of the hospitality and gaming industry is considered one of the biggest threats for MGM. The competitors vary considerably in terms of their size, quality of services, financial potency and capabilities, level of facilities and the diversity that exists in terms of geographic location. MGM faces competition from several public and private companies that operate in the hotel, gaming and resort business. In just the short period, that MGM has been in the market, its portfolio has vastly increased. MGM is actively in pursuit of development opportunities in the main regions that show some form of opportunity, both domestically and internationally. However, now MGM seems to be highly reliant on Las Vegas to generate the larger part of its revenue. Secondly, MGM has taken up several initiatives in order to set it apart from its competitors. Building themed hotels came outdated and a clichà © over time, which in turn necessitated the need for MGM to take up on something different and unique. This is relevant in ensuring that the hotel can offer to its customers what the other hotels in the hospitality and gaming industry do not have to offer. Furthermore, in order to get a head start in the changing era of the competitive industry, MGM has collaborated with the digital entertainment party known, as bwin party waiting for the time when gambling shall be made legal. The world is vastly changing to be a digital and customers are everyday hoping to do everything online. Offering online poker is likely to give MGM competitive advantage in the gaming industry. The resource-based model is ideal when venturing into international markets as a way of maintaining competitive advantage and attaining above average returns. Furthermore, MGM should focus on training the employees in order to deliver consistent excellent customer service across all of its

Stress response Outline Example | Topics and Well Written Essays - 500 words

Stress response - Outline Example Stress as it is widely known and is linked to negative effects (Pond 2004). According to Braun and Anderson (2007), communication between cells is a stress response. The authors explain that a disturbance of homeostasis by harmful forces lead to stress. Additionally, stressors cause stress and can be either endogenous or exogenous. Coping with stress depends on various factors. Some of the factors that can determine ways of perceiving or coping stress are health, age, genetic factors and social support. Homeostasis reliability is a stress response. However, destruction of body tissues can occur with time in case there is an excess in response to stress. Neuroendocrine response and hormones are initiated when there is an excess to stress response. Stressors activate different patterns of response which in turn initiate different neuroendocrine pathways and neural. Stress is common to the human body because of its capability and its adaption to experience stress. Stress is regarded as negative if it persists due to challenges met by humans. Psychological impacts of stress vary depending on stressors. Study of stressors common on children or teenagers such as abuse, violence, marital problems and other stressing events in the family provide a clear view of psychological impacts of stressor. Child abuse is the most common problem in the society and has severe implications. For example, a child can view education negatively or perform poorly in school. Marital problems or divorce renders a child anti-social. The child remains depressed, anxious and less social than the peers. In adulthood stage, the child from divorced, or family with conflicts shows more stress and less friend support than a person from a family with no marital problems. Unrelieved stress causes depression, post traumatic stress disorders, panic attack conditions and drug or alc oholism addiction. Research shows that a child develops post traumatic stress disorder later in life when exposed to

Sample Quality Article Example | Topics and Well Written Essays - 500 words

Sample Quality - Article Example It lowers the cost of carrying out a research, enables faster collection of data, improves the quality of the data, and ensures homogeneity and accuracy of results. This paper will analyze sample quality in the listed articles. In doing this, paper will seek to define the population in each case and quote the sampling method used. It will also explain the choice of the sample and state who participated in the study. It will equally seek to qualify the research to other populations. In deducing, the sampling method used, it will be necessary to define the various sampling methods that we have. Random sampling involves the random selection of sample from the population. In cluster sampling, selection of samples is in clusters close to each other like households in the same estate. Quota sampling involves selection of samples nonrandom according to a fixed quota. Snowball sampling involves the identifying of samples that meet the criteria for inclusion in a study. Purposive sampling involves sampling with a  purpose  in mind.  Availability sampling involves using just the available samples (Trochim Web). In the article by Scott et.al, the population was all Canadian elderly patients with anxiety disorders and clinically significant anxiety symptoms. Quota sampling method selected a sample of 36,984 adults aged 55 years and above who participated in the Canadian Community Health Survey in 2008. The selection of the people in the sample was because they suitably represented the target population.  The actual participants in the study were 12,792 individuals, living in Canada (Scott et.al 792). The researchers cannot generalize it to other populations because the analysis focused on adults aged 55 years and above which are usually the minority in any society. In the Yang et.al study, population was all adolescents 6 months after the 2008 Wenchuan earthquake in China. Quota sampling selected a sample of 2,463 middle schools and grade 10 students. Their selection was

Effects Of Climate Change On Vietnamese Agriculture Environmental Sciences Essay

Effects Of Climate Change On Vietnamese Agriculture Environmental Sciences Essay In the last decade, an overwhelming consensus has emerged among the worlds most reputable climate scientists that the world has entered a period of rapid global climate change, much of which is accountable to anthropogenic greenhouse gas (GHG) emissions (NSAC 2009). The agreement is demonstrated in the 1996 report of the Intergovernmental Panel on Climate Change (IPCC), an international body of leading natural and social scientists sponsored by the United Nations Environment Programme and the World Meteorological Organization. According to the panels report, an equivalent doubling of atmospheric carbon dioxide (CO2) concentration will force a rise in global average surface temperature of 1.0 to 3.5 degrees Celsius by 2100. It will result in an increase of sea level by 19 to 59 cm. Because a warmer atmosphere holds more water vapor, average precipitation also will go up as much 10 to 15 percent (IPCC 2007). Agriculture is highly sensitive to climate variability and weather extremes, such as droughts, floods and severe storms. Even warmer climate may give positive effects on food production, the increased potential for droughts, floods and heat waves will pose challenges for farmers. Global climate change is also expected to impact agriculture by causing shifts in precipitation, soil quality, pest regimes, and seasonal growth patterns (NSAC 2009). The exact nature and degree of these changes for any given region will be difficult to predict. CASE OF VIETNAM Situated in South East Asia in the Indochinese Peninsula, Vietnam territory is lasting from 8Â °15 to 23Â °22 latitude and between 102Â °8 to 109Â °30 longitude (ADPC 2003). It has 329,314 sq. km of natural area, in which 7,348.5 thousand hectares (22.2 percent) is arable land, with population about 83 millions (WHO). Viet Nam lies in the region of tropical monsoon climate with a high temperature. The average temperature varies between 21Â °C and 27Â °C, rainfall volume of 1800-2000 mm/year and is not evenly distributed among the months of the year (Tran 2009). Versatile and various climates of the regions create a variety of vegetation and domestic animals which originated in the temperate, sub-tropical and tropical regions. Being an agricultural country, 75 percent of Vietnamese labor-force is engaged in agriculture, forestry, and fisheries. This sector contributes roughly 20 percent to the GDP. The output value structure of agriculture, forestry and fisheries was 77 percent, 4 percent and 19 percent, respectively (Tran 2009). Vietnam is likely one of the most vulnerable countries in the world to climate change, because of its geographical location (Oxfam 2008). During the last 50 years, Viet Nams annual average surface temperature has increased by approximately 0.50 0.70 C, while the sea level along its coastline has risen by approximately 20 cm (ISPONRE 2009). The El-Nino and La-Nina phenomena have caused increasingly adverse impacts to Viet Nam. Changes in climate can have serious implications for economic development, especially in the agricultural sector, due to its direct exposure to and dependence on weather and other natural conditions. Studies for the Southeast Asian region show that climate change could lower agricultural productivity 2-15 percent in Vietnam (Bingxin et al. 2009). It is very likely that global warming is leading to an increase in weather extremes like heat waves and heavy rainfall. Droughts will occur more often, and that tropical cyclones (typhoons and hurricanes) will become more intense. Vietnam has always been suffering from extreme weather events and is struck by typhoons annually. Strong winds and sea surges cause death and destruction along the narrow and low-lying coastal area, while heavy rains hit the mountainous hinterland and river deltas with floods and landslides (Vietnam Red Cross 2007). For example, the river flood in Mekong Delta in 2000 killed 548 people; it flooded and damaged 401,342 ha of rice fields. An estimated loss of this flood is about 250 million USD (Chaudhry Ruysschaert 2007). The peak occurrence for typhoon landfalls has been during the month of October in the Central region and November in the South. A partial explanation of this lies in the sea surface temperatures (SSTs), which decrease later in the season. T yphoons are generated where SSTs are 26 Â °C or above, and by September, this is only found in those ocean areas further south where the SST remains around 25-28 Â °C throughout the year (ADPC 2003). Climate change may lead to an increase in sea surface temperatures in higher latitudes and a resulting increase of typhoon activity in North Vietnam. An increase of extreme events, both in intensity and duration, will be the most catastrophic preventing the agriculture development. Flood damage is expected to be aggravated because of a predicted increase in daily rainfall of 12 19% by 2070. In other times of the year, an increase in evaporation and the variation in rainfall will intensify drought problems about 3 percent in coastal zones and 8 percent in inland areas by 2070 (Chaudhry Ruysschaert 2007). Climate change impacts on agriculture are also channeled through changes in temperature. According to the third assessment report of IPCC, the temperature in this century will increase by 4-50 C. The International Rice Research Institute (IRRI) modeler determined that, as a general rule, yield of rice will decrease by 0.5 ton per hectare for every 10C increase in growing seasonal minimum temperature (Javellana 2007). According to the medium emissions scenario, the average temperature is expected to increase by nearly 2Â °C in the southern regions of Viet Nam and up to 2.8Â °C in the northern regions by 2100. However, in the high emissions scenario this could be as much as 3.6Â °C in the North Central Coast region (United Nation 2009). So, it is predicted that yields of summer rice will decrease by 3 6% by 2070 when compared to the 1960-1998 period. The impact on spring rice may be more serious, especially in the north where yields are expected to decrease by 17% (Chaudhry Ruyssc haert 2007). The evapotranspiration rate will also increase due to increasing temperature, depicted in figure 1 2. Rainfall in the dry season will decrease by 2070 in Central parts of Viet Nam and droughts would occur more frequently, because rainfall would be concentrated in the rainy season (WHO). Figure 1: The projected change of mean daily maximum temperature since 1980s to 2070s (Le 2010) Figure 2: The projected change of mean daily minimum temperature since 1980s to 2070s (Le 2010) Climate also creates a shift in amount and pattern of precipitation. It will affect hydrology and runoff, which will alter the availability of water for irrigation and other uses. The projected runoff changes for the two major rivers from three organizations show different trends. In the Red River, the IPSL scenarios show decreased wet-season flow. GISS and MONRE projections show increased dry season flow. In Mekong River, major flow reduces under IPSL projection, depicted in figure 3 (Ringler 2010). Significant rice yield decline is observed in all scenarios, ranging from 4.2 percent in MONRE-2030 to 12.5 percent in IPSL-2030. The impact is especially large in the Central Highlands and the northern zones, highlighting the enlarged gaps in food supply in these regions. Although the impact of climate change is relatively moderate in the major rice-producing region of the Mekong River Delta, the average rice yield is projected to drop by 1.4-8.3 percent by 2030 (Bingxin et al. 2010). Figure 3: Percentage of Basin Runoff Changes (Ringler 2010) Besides increasing average temperature, global warming also raises the sea water level which has resulted in salt-water-invasion and land loss. A recent study on the potential impacts of sea level rise in 84 developing countries suggested that Vietnam would rank among the top 5 affected countries. About 43 million Vietnamese or about 55% of the countrys population are living in vulnerable low elevation coastal zones (LECZ) (38 % of Vietnams urban population) (Waibel 2008). In Vietnam, the sea level has risen between 2.5 to 3.0 cm per decade in the last 50 years, but with regional variations (Oxfam 2008). According to ADPC report, sea levels may increase by 9 cm in 2010, 33 cm in 2050, 45 cm in 2070, and 1 meter in 2100 (ADPC 2003). If sea level rises 1 meter, a national potential land loss is predicted of 12% which will expose about 17.1 million people or 23.1 % of the population (Schaefer 2002). The Mekong River Delta will be the most affected region with 1.77 million ha of saline l and, accounting for 45 percent of the land (Chaudhry Ruysschaert 2007). Land loss and sea water invasion in the Mekong River Delta and parts of the Red River Delta, which are the most important agricultural areas in Vietnam, will cause serious risks to farmers as well as agricultural exports, and possibly to national food security. In summary, climate change is a very real threat to Vietnamese socio-economical development. Higher temperatures, the rising of sea water level and extreme weather events will all have significant impacts across the nation. However, the concept of climate change and its effects are just well known by experts and management agencies. Dealing with the serious implications of climate change will be a major challenge for Vietnam in the next decades.

Review of an Ecological Science Research Article from a Primary Scientific Source :: essays research papers

Powell, K., 2005. Fish farming, Eat your Veg, Nature, 426, 378-379.   Ã‚  Ã‚  Ã‚  Ã‚  The article that I chose to review discussed the possibility of maintaining and sustaining aquaculture by changing the diets of the farmed fish. The idea of carnivorous fish turning into vegetarians would help for future sustentation of aquaculture. There were pros and cons to either side of vegetarianism and the maintaining of carnivores. There are issues that would require research and analysis to which the author points out to the reader.   Ã‚  Ã‚  Ã‚  Ã‚  Aquaculture has increased by 5% over the past 10 years. The wild stock of fish that is caught to feed the fish farms has numbered 11 million tons, which is 12 % of the total fish hauled from the sea each year. Carp and tilapia are the most farmed fish in the industry that already are consisting of a vegetarian type diet. Salmon and trout are the next largest farmed fish. The difference is that the salmon and trout are carnivores. The author reports that the carnivorous fish are more expensive to cultivate and more resources are needed to maintain these types of farmed fish.   Ã‚  Ã‚  Ã‚  Ã‚  Most farmed fish are fed on a diet that consists greatly of fish oil and fishmeal. Fishmeal is made from a protein rich powder of ground up cheap fish as a source of nutrients and proteins. The problem with using these within the farm diet is that the demand for the fish oil will overpower the supply as aquaculture expands and booms. The author states that the â€Å"demand will outstrip supply of oil by 2010.† (Powell).   Ã‚  Ã‚  Ã‚  Ã‚  Feed companies which supply the fish farms with fishmeal and fish oil as a staple to the diet of the carnivorous fish will seek different sources of protein. This protein could possibly come from larger fish such as mackerel, herring, and blue whiting. If this happens it would put more pressure on the natural stock already being harvested for other purposes. Some companies are traveling to the Antarctic to collect krill, which has repercussions for the bottom of the food chain in that the ocean itself is a primordial web of life.   Ã‚  Ã‚  Ã‚  Ã‚  The author boosts that the fish will be able to eat Soya beans, corn, rapeseed, sunflower seeds, flaxseeds, and wheat gluten if converted to a vegetarian diet. The author also reports that some salmon farms already use these foods as staples in their fish farm diets.

Economic Background – Greece

Greece has a mixed capitalistic economy with a large public sector that accounts about half of GDP. Besides, Greece is a major beneficiary of European Union aid, which equal to about 3. 3% of annual GDP. In addition, Greece is an agricultural country and one of the poorest countries of the European Union with the second to lowest average income, after Portugal. In January 2002, Greece adopted the euro as its currency. The adoption provided Greece, formerly a high inflation risk country under drachma, with access to competitive loan rates and also to low rates of the Eurobond market which led to a dramatic increase in consumer spending and gave a momentous boost to economic growth. Between 2003 and 2007, Greece economy grew by nearly 4. 0% per year. The preparation for the Athens Olympic Games during 2004 gave an impulse to the Greece economy. However, the financial crisis had slowed down the Greece’s economic growth to 2.0 % in 2008. As a result of the world financial crisis and its impact on access to credit, world trade and domestic consumption, the economy went into recession in 2009 and contracted by 2. 0%. In late 2009, eroding public finances, misreported statistics, and inadequate follow-through on reforms prompted major credit rating agencies to downgrade Greece’s international debt rating, which has led to increased financial instability and a debt crisis. Greek government has approved a three-year reform program that includes cutting government spending, reducing the size of public sector, tackling tax evasion, reforming the health care and pension systems, and improving competitiveness through structural reforms to the labour and product market under the intense pressure by the EU and international lenders. The Greek Government projects that its reform program will achieve a reduction of Greece’s deficit by 4% of GDP in 2010 and allow Greece to decrease the deficit to below 3% by 2012. Greece requested activation of a joint European Union-International Monetary Fund support mechanism designed to assist Greece in financing its public debt in April 2010.

Concept Analysis on Acuity Nursing Essay Sample

Concept Analysis on Acuity Nursing Essay Sample Concept Analysis on Acuity Nursing Essay Example Concept Analysis on Acuity Nursing Essay Example The focus of this concept analysis paper is acuity. On the surface, â€Å"acuity† appears to be a precisely defined concept because of its prevalent use in health sciences-related literature. For instance, many authors have acknowledged the rising patient acuity in the course of the last three decades. Moreover, numerous tools have been developed to quantitatively measure patient acuity. Some of these tools include the Revised Easley-Storfjell Patient Classification Instrument, the Can Slyck and Associated Acuity System, the Injury Severity Score, the National Therapeutic Intervention Scoring System, the Acute Physiology, Age, Chronic Health Evaluation instrument, and the Resource Utilization Group Classification System. Despite the existence of several measurement tools for patient acuity, the literature is inconsistent with respect to the definition and measurement of the concept. This concept analysis paper has the main aim of evaluating the definitions of acuity in various disciplines, concepts related to patient acuity, usages of the concept, antecedents of patient acuity, and the consequences of patient acuity. A personal definition of the concept is also provided along with a conceptual model. Before analyzing the concept of acuity, there is the need to have valid measurements, which emphasize on the clarity of the concept being measured. Regardless of the fact that â€Å"acuity† is frequently used, the inconsistent definition and measurement tools of the concept have made it impossible to make a cross-comparison of acuity measurements in diverse settings. In addition, this inconsistency has increased the difficulty of exploring the relationship between acuity and its respective outcomes. As a result, there is the need to perform a concept analysis in order to clarify the meaning and move towards the development of standardized definitions as well as measurements as it relates to acuity. The concept analysis was guided by the Morse’s concept classification method (Morse, 1995). According to Morse (1995), a concept will rarely seem well described and mature, which can be attributed to vast literature covering the concept that provides comprehensive descriptions, clinical empirical evidence as well as quantitative tools used in measuring the concept. However, a closer look reveals inconsistent definitions and several rival implicit theories, which is the case with the concept of patient acuity. The concept clarification method recommended by Morse (1995) encompasses performing a review of literature, and content analysis of literature with respect to the underlying values. In addition, the concept analysis process involves analyzing the attributes of the concept including the consequences and antecedents. A search for the term â€Å"acuity† was performed in the abstract and titles of papers published in the English language in electronic databases and citation indexes such as Google Scholar, PsycINFO, MEDLINE, CINAHL, and PubMed. The Oxford and Merriam-Webster English Dictionaries were also searched. A complementary Internet search using Google was performed. The searches yielded about 100 papers. Only one published report on the topic of concept analysis of patient acuity was found. An inclusion and exclusion criteria was employed in order to filter the papers to remain with relevant resources. Specifically, papers with the term â€Å"acuity† in the abstract or title were incorporated in the concept analysis whereas papers that lacked the term were excluded. The reason for the exclusion of the papers lacking the term â€Å"acuity† in the abstract and title was the possibility that no novel information regarding the concept of acuity could be obtained from these s ources. Definitions of Acuity The Miriam-Webster dictionary defined acuity as â€Å"the ability to understand, hear or see something easily.† In this light, acuity denotes the keenness associated with perception. The Oxford English Dictionary defines acuity as â€Å"keenness or sharpness of hearing, vision or thought.† In literature, there are several definitions of acuity that vary across discipline. For instance, Hebasevich (2012) defined acuity in healthcare settings as the intensity of care needed for a patient determined by a registered need. In this respect, six categories exist that range from minimal care to intensive care. In healthcare settings, when acuity increases, there is the need to allocate more nursing resources in order to guarantee safe care. Hughes (2008) defines patient acuity as the patient requirements for nursing care, which are used in the management of nursing quality, costs and personnel resources. In psychology, acuity has been defined as the sharpness of the mind, which depends on a number of factors including understanding, concentration and focus. An elderly individual with Alzheimer’s Disease is considered to have low mental acuity since he/she is unlikely to remember the events that happened during their youth. In addition, the elderly individual is unlikely to have a precise memory of when and how something occurred. He/she may be slow in understanding relatively simple things like operating a remote control. A person can enhance his/her mental acuity using activities that engage the mind such as mental puzzles. Gorman and Campbell (1995) also defined mental acuity as the sharpness of the mind in terms of understanding, concentration, memory and focus. However, mental acuity is not concerned with intelligence. Mental acuity denotes how well or poorly an individual’s brain is functioning and not his/her ability to undertake complex tasks. A number of factors have irreversible impacts on mental acuity such as the onset of Alzheimer’s disease, encephalitis and prolonged substance abuse. Moreover, some short-term conditions that lessen mental acuity also exist such as high stress and fatigue levels, distractions, external and external interruptions. Table 1 below illustrates the various definitions of acuity as found in the review of literature. Education, Medicine, Psychology, and Nursing Despite the fact that there are some different terminologies and views in the definition of acuity in the various disciplines, a common theme that spans across all the definitions of acuity is that the concept measures something. In all of the definitions, it is evident that acuity denotes the degree to which something being described by the various disciplines manifests itself. For instance, in medicine, acuity denotes the degree to which an illness is severe, or the extent to which an illness requires urgent medical attention. Visual acuity refers to the range to which a person is capable of seeing clearly at a certain distance (Pelosini et al., 2012). In the context of nursing, acuity refers to the aggregate of the nursing services required, which may be in the form of the level of difficulty of the nursing care needs (Buerhaus, 2009), the level of demand for the nursing skills and service (Boudreaux, Friedman, Chansky, Baumann, 2004), the level of patient’s dependence on the nursing staff (Hughes, 2008), the amount of time required to offer nursing care, and the amount of nursing care (Arling, Kane, Mueller, Lewis, 2007). Similarly, in psychology it is evident that acuity denotes the amount of the psychological element being defined; for instance, acuity may denote the severity of the psychological distress, cognition and memory, and sharpness of the mind (Turnage, Kennedy, Smith, Baltzley, Lane, 1992). A similar approach is evident in the definition of acuity in the field of education. From all the definitions, acute represents the smallest degree of whatever is being defined. For instance in medicine, a disease that requires the most urgent medical attention is considered acute. Similarly, a serious psychological distress can be considered acute such as acute depression, implying that it is severe. In mental or intellectual acuity, people with high degrees of sharpness, concentration can be considered to have acute intelligence. Among the various definitions of acuity in the various fields, it is evident that the field of nursing offers the most comprehensive definition of acuity. The definition of acuity in nursing spans focuses on complexity, workload and nursing care needs, which all represent intensity. The nursing care needs represent the amount and concentration of nursing care required – high acuity demands more nursing care and vice versa. Nursing workload with respect to acuity represents the time required in offering the nursing care as well as the level to which a patient relies on nursing staff. Complexity symbolizes the degree of difficulty of the care requirements and the demand for the nursing skills and services. Overall, the definition of nursing is multi-dimensional, as opposed to the definition of acuity in other disciplines, which focus only on a single aspect. Concept Use In order to provide a further clarification of the concept of acuity, it is necessary to examine the different uses and situations involving the usage of the concept. In order to delineate the use of the concept of acuity, it is imperative to establish the attributes associated with the concept. In this respect, the attributes associated with acuity revealed four uses and situations where â€Å"acuity† could be applied, which included patient-related acuity, non-patient related acuity, provider-related acuity, and system-related acuity (Hughes, 2008; Boudreaux, Friedman, Chansky, Baumann, 2004; Cherry, 2003; Chin Muramatsu, 2003). Patient-related acuity emphasizes on the onset of an illness or the timing of the medication intervention such as the treatment of a disease. For instance, high patient acuity could be used when a patient requires urgent medical attention. Patient-related acuity can also be used in differentiating care facilities in terms of those providing long-term care and acute care facilities. Acute care facilities attend to patients with high patient acuity; that is, those requiring urgent medical attention. This is in contrast to long-term care facilities that attend to patients with low acuity. Acute care can also involve the patient receiving active albeit short-term treatment to severe injury. Acute care is in contrast to longer-term care or chronic care. Patient-related acuity can also be used in describing the severity of the illness. An example of the inflammatory acuity, which denotes the extent of the actual inflammatory process, or with respect to a particular illness such as chronic kidney disease or an acute cold. Emergency departments use the term injury acuity for triage purposes. In addition, psychological acuity can be used to represent the severity of a psychological disease such as acute depression. It is evident that in patient-related acuity, the use of acute implies the highest level of severity, requiring urgent attention, and nursing care administered on a short-term basis. This is in contrast with chronic, which represents the need for long-term care. Chronic and acute are on the opposite ends of the patient condition spectrum (Abualrub, 2007). In the context of patient-related acuity, the intensity of nursing care and illness severity can be used in determining the level of patient acuity. It is imperative to note that intensity and severity aspects of acuity are similar, and their uses overlap. Intensity and severity can be utilized interchangeably to refer to the type, duration and amount of nursing care needs required by a particular group of patients. Intensity and severity can also refer to the seriousness of the illness (Abualrub, 2007). The concept of acuity can also be used in non-medical settings to represent keenness or sharpness in various domains including sensation, social intellectual, and coming to a point. With respect to sensation, there are numerous uses of acuity including visual acuity (Pelosini, et al., 2012), tactile acuity, spatial acuity, sensory acuity (Turnage, Kennedy, Smith, Baltzley, Lane, 1992), proprioceptive acuity, perceptual acuity, olfactory acuity, and auditory acuity (Cherry Reed, 2007). Visual acuity is the most commonly used in the non-patient acuity and refers to the clearness and acuteness of one’s vision. Auditory acuity refers to the ability to trace a sound in a given space (Rischbieth, 2006). Essentially, auditory acuity places emphasis on localization acuity. With respect to coming to a point, papers that used this description of the concept of acuity referred to positioning or repositioning of the sense acuity. These papers had the main objective of determining a quantitative error of measure in regards to the positioning of joints in order to relive pain, facilitate a motion range, and come up with diagnostic techniques as well as rehabilitation programs that can be applied to joint-related injuries. In the intellectual domain, intellectual acuity is mostly used when referring to memory and cognition (Cherry, 2003). An example of this could be the strategies that are utilized in helping elderly people maintain their mental capacities and capabilities during aging, and interventions and medicines utilized improving attentiveness and memory among others. Social acuity is used to refer to keenness, sensibility and social awareness with respect to one’s ability to interact with other individuals socially (Salvia, Ysseldyke, Bolt, 20 12; Rischbieth, 2006). Provider-related acuity refers to the intensity of nursing care required for a patient. In this case, intensity represents the care burden that a patient imposes on the nursing staff in regards to surveillance, mental concentration, skills and time in order to satisfy the needs of the patient. The intensity aspect of acuity can be looked at in three ways: in terms of complexity, workload, and care needs (Boudreaux, Friedman, Chansky, Baumann, 2004; Chin Muramatsu, 2003; Pelosini, et al., 2012). Complexity in provider-related acuity refers to the level of difficulty of the medical and nursing care needs of the patient, which involves physicians and nurses’ surveillance, concentration and skill needed to offer care services for patient(s). Workload is an attribute of acuity, whereby high patient acuity requires a high nursing workload. In this respect, high patient acuity is described by a decrease in the period of stay for patients and an escalation in the illness severity (H ughes, 2008). Nursing workload usually denotes a surge in the demand for nursing skills and services, and measures the nursing requirements to satisfy the needs of a patient (Arling, Kane, Mueller, Lewis, 2007; Cherry Reed, 2007). With respect to nursing care needs, it is evident that the severity of the illness often determines the nursing care needs; as a result, there is a close relationship between the intensity and severity aspects of acuity. Seriousness of the illness can be perceived as the amount of nursing resources and care utilized by the patient. Intensity can be looked at in terms of the amount of time needed to offer care to the patient. Some of the measures of nursing intensity could include the nursing intensity weights, and the nursing hours per patient per day (Abualrub, 2007). Other aspects of provider related acuity include the extent to which the patient depends on the nursing staff for their health care needs, which is sometimes referred to as nursing depende ncy. Patient severity could also be used to describe the nursing interventions and the amount and type of nursing care activities (direct and indirect) that are needed for the patient. Other measures of patient severity aspect of provider-related acuity can include patient debility and functional status. With respect to provider-related acuity, based on the review of literature, it can be argued that high acuity requires more nursing care, an increased workload, and complex patient needs; the case is the oppose for low acuity patients. System-related acuity is concerned with the pairing of attributes of acuity with other concepts. The uses of system-related acuity include triage/urgency, classification system and case mix. Urgency/triage are used in emergency medicine settings in ascertaining the severity of illness in order to ensure that the patient is matched with the suitable nursing and medical requirements (Abualrub, 2007; Craig Huber, 2007; Rischbieth, 2006). Classification systems are used in pairing acuity with nursing costs. In this context, acuity denotes the amount of care required. This often involves measuring the patient characteristics in order to ascertain the amount of nursing resources required and determine the nursing assignments. In addition, the classification systems can be used to match and predict staffing needs with respect to the patient needs. Case-mix is also an aspect of system-related acuity and is concerned with the number of patients in a given hospital who can be put in the same group depending on their nursing care needs. The case mix determines the resource utilization needed by a patient grouped in every category (Abualrub, 2007). Patients can also be grouped in accordance with the illness severity and the intensity of care. Acuity measurements can also be utilized in a number of other predictions such as the assignment of patients to nurses or case managers, budgeting, staffing, costs of care, mortality and morbidity (Abualrub, 2007). Antecedents The nursing work environment is continuously evolving, which as a result has increased the demands placed on nurses while at the same time increasing the distance between the nurse and patient, requiring the presence and attention of nurses. There is widespread agreement in the literature that patient acuity is rising, which can be attributed to a number of factors. The first factor is the shortened length of patient stay in hospitals as hospitals embark on reengineering their workflows in order to lessen delays. This reengineering has focuses on nursing care and nurses through various. For instance, a hospital can adopt a screening tool aimed at enabling nurses to recognize patients who may require physical therapy as well as produce early consultation to be undertaken with the physical therapy department. Moreover, other hospitals are modifying their discharge procedures in order to make sure that the discharge takes place early during the day in order to accommodate patients being transferred from emergency rooms and surgery. Moreover, other hospitals have embarked on enhancing multidisciplinary rounds in order to make sure that all departments within the hospital have adequate information in a timely manner. It is evident that all of these changes have resulted in novel demands of the nursing staff’s time and has lessened the nurse-time for lower-intensity patients. An increase in throughput results in a high rate of admissions, which increases the demands placed on the nurses’ time. In addition, the durations of patient stay are also being reduced because of the fact that patients are being discharged at a faster rate to post-acute care in home health and skilled nursing facilities. The outcome of faster discharge is an increase in patient acuity in both hospitals and patients placed under post-acute care. Therefore, nursing in post-acute care and hospital care are handling higher acuity patients. According to Lang, Hodge, Olson, Romano, Kravitz (2004), the rising patient acuity and the novel work demands posed by the modified workflow cannot be addressed using higher nursing staffing levels; instead, there is the need to change the manner in which nursing staff use their time. The second factor contributing to patient acuity is an increase in demand for nursing services because of the aging of the population. It is projected that from 2000 through 2020, the population will grow by 18% (Duffield OBrien-Pallas, 2003; Lang, Hodge, Olson, Romano, Kravitz, 2004). In addition, the population growth for the over-65 population will be 54%, which translates to an increase in healthcare needs by this population. Studies have affirmed that the population is aging, and that elderly people comprise a considerable and growing percentage of people being admitted in hospitals and emergency departments. Elderly people usually develop complex health illnesses that are likely to result in chronic diseases. In addition, in hospital settings, elderly patients have reported relatively higher adverse events rates as well as higher chances of becoming deconditioned. According to Duffield OBrien-Pallas (2003), nurses must use all means necessary to avoid prolonging the duration of stay in hospitals for older patients, which requires the use of care models that shun deconditioning while at the same time promoting functioning. In addition, it is imperative to note that an increase in the demand for acute services has increased consistently during the last decades, with older people comprising of the fastest increasing population of those admitted for acute services. Lankshear, Sheldon, Maynard (2005) notes that the increased demand for acute services goes hand in hand with the decrease in the number of available acute hospital beds as well as the increased use of early patient discharge models. The clinical needs and problems of elderly patients are significantly different from the needs and problems presented by younger people (Craig Huber, 2007; Mazzocco, Feigenson, Halberda, 2011). A majority of elderly patients are often admitted with either sub-acute or acute illness that manifests itself ambiguously and is likely to be characterized by functional and mental deterioration. In addition, elderly patients are likely to have multifaceted social needs and several co-morbidities. Studies have shown that elderly have a lesser likelihood of being cleared from acute units. Moreover, when they are admitted, they are more likely to stay in the hospital for longer durations. Elderly patients also have higher rates of readmission (Abualrub, 2007). The healthcare cost pressure has also been associated with the increase in patient acuity. The increase in the use of managed care during the 1990s played a pivotal role in increasing the cost pressure, especially in hospitals employing large numbers of registered nurses. During the 1990s, places with higher enrollments of managed care were characterized by slower employment growth and wage growth for registered nurses when compared to places having lower enrollments. With the spread of managed care, the employment and wage growth for registered nurses fell at the national level in the late 1990s (Hall, Doran, Pink, 2004). This resulted in changes in hospital payment systems in order to lower spending and reduce the duration of patient stay in hospitals. Therefore, registered nurses in hospitals treat patients who are averagely sick although the intensity of their work increased, contributing to patient acuity (Lankshear, Sheldon, Maynard, 2005; Rischbieth, 2006). The nursing work environment and workload have also been linked to patient acuity. As a response to the increasing cost pressure, hospitals embarked on cutting the staffing levels and adopted mandatory overtime policies aimed at ensuring the availability of nurses during unanticipated increases in the number of patients admitted. The outcome has been an increase in nursing workload. In addition, this has resulted in a reduced nurses’ control with respect to weekend and night work. A direct implication of the increased workload could have been an increase in the wages of nurses; however, their wages have actually remained constant, which can be attributed to the increased competition in the healthcare industry. Increased workload contributes to high patient acuity in two ways. First, it reduces the nursing time and resources available to a patient. Second, it contributes to nursing shortage since it discourages people from entering or remaining in the nursing profession. Studie s have affirmed that nurses with higher patient loads (workloads) report higher burnout and dissatisfaction. Consequences Numerous studies have reported a significant relationship between the levels of nursing staffing (patient acuity) and the quality of care for patients in both nursing homes and hospitals. For instance, a study conducted by Unruh (2003) reported that increasing the number of hours of nursing care per day per patient is related to improved health outcomes such as reduced duration of stay; reduced rates of illnesses including cardiac arrest, pneumonia, gastrointestinal bleeding, and urinary tract infections; and reduced mortality associated with complications. Another study by Lankshear, Sheldon, Maynard (2005) revealed that increasing the number of patients per nurse (patient load) increases the probability of patients dying. Specifically, the study reported that, for each patient increased for each nurse, there is a 7% increased chance of death within one month of admission. The researchers also indicated that, for each patient increased per nurse, there is a 7% increase in the proba bility of dying from complications. In the context of nursing homes, studies have also reported a relationship between the quality of care and staffing levels (patient acuity) (Lankshear, Sheldon, Maynard, 2005). Studies have also documented the outcomes associated with increased nursing workload, which is an attribute of patient-related acuity (Hall, Doran, Pink, 2004; Hall, Doran, Pink, 2004; Hughes, 2008). The workload on nurses can be grouped into three categories including the unit, job, and patient levels. At the unit level, the nurse-patient ration is often used in measuring the level of nurse workload. Studies have reported that increased nursing workloads (lower nurse-patient ratio) can negatively affect patient outcomes. As a result, it has been suggested that increasing the number of nursing staff in a unit and reducing the number of patients that are assigned to a single nurse can help in enhancing patient care (Unruh, 2003). Nevertheless, these suggestions are not feasible because of nursing shortages and costs. At the job level, the extent of the nursing workload is determined by the specialty such as operating nurse versus Intensive Care Unit nurse. Studies have reported a re lationship between job-level nursing workload and nursing outcomes like job satisfaction and stress. At the patient level, the extent of the workload depends on the patient’s clinical condition. Several empirical studies have explored relationship between nursing workload and patient outcomes (Duffield OBrien-Pallas, 2003; Hughes, 2008). Increased nurse workload is associated with sub-optimal patient outcomes as well as lessened patient satisfaction (Rothberg, Abraham, Lindenauer, Rose, 2005; Unruh, 2003). The majority of the research studies exploring the effect of nursing workload on patient outcomes have placed an emphasis on the nursing staffing levels – an attribute of patient acuity. For instance, reduced levels of nursing staffing has been associated with increased rates of pneumonia. In this regard, Unruh (2003) reported that increasing the number working hours of nurses by 1 hour per patient day results in an 8.9% increase in the likelihood of surgical patients developing pneumonia. The study also reported that higher pneumonia rates for units that staff fewer nurses. The levels of nursing staffing have also been reported to have an effect on nosocomial infections. In this respect, increasing the number of nursing hours for a patient resulted in a decrease in the rates of urinary tract infection (Hal l, Doran, Pink, 2004). The understaffing of nursing personnel has also been associated with an increase in the prevalence of E cloacae (Rischbieth, 2006). Evidence also suggests that nurse-staffing levels have an effect on mortality and failure to rescue. For instance, increasing the number of hours of registered nurses care per day resulted in reduced rates of failure to rescue. In addition, lower nurse-patient rations have been associated with an increase in the length of stay for admitted patients; specifically, a nurse patient ratio of 1:2 for the case of evening shifts results in a 20% increase in the duration of stay (Duffield OBrien-Pallas, 2003). Moreover, increased working hours are associated with a reduction in the duration of stay (Buerhaus, 2009). Nursing workload does not only affect patient outcomes but nursing hours as well. There is no doubt that nursing workload has an impact on the time available for a nurse allocate for the various tasks. When the workload is high, nurses are unlikely to have adequate time in undertaking tasks having a direct impact on patient outcome. In addition, increased workload for nurses is likely to lessen the time that nurses spend communicating with other physicians, monitoring patients, and make use of safe practices. For instance, nurses may have no time to conform medications. Increased workload for nurses also resulted in decreased motivation and dissatisfaction, which can lead to reduced morale, increased absenteeism, increased organizational turnover, reduced job performance, and poor quality of care. Stress and burnout have also been associated with increased workload for nurses, which can contribute to medical errors because of the reduced attention that nurses put on performing critic al tasks. Nursing workload has also been associated with work-around and violations among nursing staff. Violations comprise of nurses intentionally deviating from established practices that are necessary to guarantee safe operations and improved health outcomes. In this respect, increased nursing workload has been established to increase the difficulty of nurses adhering to guidelines and rules, which in turn can compromise quality of care and patient safety. An example of violation is insufficient hand washing. Moreover, increased nursing workload increases the probability of making errors during decision-making; this is because high workload increases high cognitive workload, which can result in mistakes, lapses or slips. An example of this is nurses forgetting to administer drugs to patients. Rationale for Antecedents, Criteria and Consequences Selection The antecedent healthcare cost pressure was excluded from the table because it has no direct impact on patients. It is evident that the cost pressures on hospitals can be attributed to the competitive nature of the healthcare industry rather than patient-related and nurse-related factors. Nurses and patients are only on the receiving end in the sense that hospitals have to respond to cost pressures by cutting staffing levels, which ultimately affects patients, albeit indirectly. Essentially, because of the cost pressures, hospitals have changed their payment systems in order to cut spending and reduce the duration of patient stay in hospitals. Therefore, registered nurses in hospitals treat patients who are moderately sick although the intensity of their work has increased, contributing to patient acuity. The underlying argument is that, although they indirectly affect patient acuity, they cannot be used in determining the nursing care requirements by patients. In included shortened length of stay, high demand for nurses because of an aging population and nursing workload because they have a direct effect on the amount of nursing care resources allocated to a patient. The criteria intensity of nurse work and clinical condition of the patient were used because they are measures that can be used in determining the staffing levels – an attribute of patient acuity. In addition, the nurse-patient ratio was included as a criterion because it is a measure of the nurse workload – also an attribute of patient acuity. Increased patient acuity was included in the consequences because of the resulting effect associated with increased demand for nurses and shortened length of patient stay. In addition, I synthesized the negative patient outcomes associated with nursing workload as poor health outcomes, and negative nurse outcomes such as poor job satisfaction, low motivation and morale, and increased burnout and stress, which are all linked to higher patient acuity. Personal Definitions of Concept The severity aspect of acuity can be used to refer to the patient’s psychological and physical status, which is the clinical condition of the patient. The intensity aspect of acuity represents the nursing care requirements and needs of the patient, which can be used to refer to the nursing workload for a particular patient or a group of patients. Therefore, the nursing workload depends on the intensity of care needs, which further depends on the illness severity. From this, acuity can be defined as the degree of illness severity and the corresponding workload intensity that required for the patient. It is imperative note that this definition incorporates both patient needs and the corresponding care required from the nurse. The association between intensity and severity aspect of patient acuity can be both non-linear and linear. For instance, Lankshear, Sheldon, Maynard (2005) pointed out that a direct positive relationship exists between patient acuity and the intensity of n ursing care, which suggests that, with an increase in the severity of illness, the nursing care needs increase. Nevertheless, the association between intensity of care and illness severity can also be influenced by the treatment goals. For instance, the nursing care requirements for a patient who have undergone a bone marrow transplant is likely to increase with respect to illness severity in instances where the treatment plan draws upon curative care when compared to a treatment plan that draws upon palliative care (Arling, Kane, Mueller, Lewis, 2007). The association between intensity of care and illness severity is linear to a degree to which the patient decides to decline further treatment. At this point, the nursing care requirements are significantly reduced whereas the severity of the illness remains high. In the same light, patients needing long-term care may need complex interventions and therapies despite the fact that their illness severity is relatively stable relative to a patient that requires short-term care (high acuity patient) (Rothberg, Abraham, Lindenauer, Rose, 2005). In order to further clarify the concept of acuity, it is imperative to develop an operational definition that can be used in measuring acuity. In this regard, two attributes of acuity can be measured including provider-related and patient-related acuity. Provider-related acuity focuses on the measures intensity, which can be measured using nursing care needs in terms of amount, nursing care needs in terms of time, workload and complexity of care. The nursing care needs measured in terms of the amount, can be assessed by counting data about the number of tasks/activities accomplished for a single patient within 24 hours (Buerhaus, 2009). Nursing Intensity Weights can also be used in assessing the nursing care needs, which is based on a scale that ranges from 1 to 5 based on the nursing care requirements with higher scores indicating higher requirements (Abualrub, 2007). The nursing care needs in terms of time can be measured using the nursing hours per patient day (HPPD) and the minut es needed for particular indirect and direct care activities. Workload can be determined by using count data relating to nursing needs indicators. The care complexity is a categorical variable that depends on primary diagnosis, needs of the patient, and the case manager activities. Patient-related acuity can be measured using the Acute Physiology, Age, Chronic, Health Evaluation (APACHE), which is a weighted score relating to the patient physiological status including chronic health and age (Craig Huber, 2007). Conceptual Framework This concept analysis of acuity has a number of implications for nursing research and practices. For nursing researchers, it is imperative to distinguish the acuity attribute that is being researched between severity (patient-related acuity) and intensity (provider-related). With respect to practices, it is evident that there are no consistent tool that is being used in measuring acuity, especially when measuring provider-related acuity. This is because the developers of these tools were not precise regarding the acuity attribute being measured. Therefore, these tools used in measuring acuity were not helpful in clinical situations. It is imperative to develop the tools for measuring acuity by drawing upon sound conceptual framework in order to affirm their relevance as well as validity for a specific patient population. From this concept analysis paper, I have discovered that patient acuity is a multifaceted concept that should be analyzed from both the provider and patient perspect ive, after which the two perspectives should be reconciled in order to match the patient requirements with the amount of nursing care provided in terms of amount and time.

The eNotes Blog 8 Ways to Use Social Media forHomework

8 Ways to Use Social Media forHomework Students use their social media accounts all day long- likely both in and out of school. Meet them on their turf by assigning homework to be completed on various social media websites. Students will be excited to use the websites they love, and you can take lessons outside the classroom and bring them into the real world. Twitter 1. Hashtag Discussions Give students a discussion prompt, along with a hashtag to use, and watch as the conversation happens that evening. While students will be logging on at different times, it will be interesting to watch the discussion unfold. Require each student to write at least three responses and reply to at least one of their peer’s tweets. With Twitter as a discussion forum, you can join in as well, helping the conversation along if it seems to be lacking in substance. 2. Trending Current Events Citizen journalists are everywhere on Twitter. Use this as an opportunity to teach students how to follow and understand real-time, current-event reporting on social media. Choose one of the trending topics on Twitter (â€Å"Trends† is located on the homepage feed) and then ask students to find at least three reputable sources that discuss this current event. 3. 140-Word Reviews Students love movie day in class, but are they really paying attention? For homework, have students write a review of the movie in 140 words or less on Twitter. You can create a hashtag for this homework assignment so it’s easier for you to make sure that all students submit their review. Facebook 4. Business Facebook Page Design If you’re teaching students about business or economics, this is a great way to add that ever-elusive, real-world element. After students have written their business plan, have them create a Facebook page for their new company. They’ll need to create and determine a number of elements, all of which you can include in your rubric. For example: Create a logo Create a cover photo Fill in the â€Å"About† tab: you can decide what areas they’ll need to fill in (category, subcategories, short and long description, etc.) Post at least three things on your wall: encourage students to share information about their company or content that supports their â€Å"mission† 5. Classroom Poll Have one student a week write a poll question in your private classroom Facebook group based on the lesson of their choice. The other students have to log on and write a comment as their response to the question. The polling student puts that information into a Google spreadsheet at the end of the week and reports on the results and what they mean. Pinterest 6. Project/Paper Outline Boards Instead of having students write an outline, have them create it on Pinterest. Each student creates boards- you can choose a minimum number- for the various topics they plan to discuss in their paper. Their boards then act as creative inspiration when typing their first draft. Require them to label their boards (topics) as they plan to in their paper and write a paragraph about that particular section (topic) in the description area of their board. When finished, encourage students to add some of their inspiration photos to the final paper. 7. Visual Book Reports Have each student choose three main themes from the book, write a summary about the theme in the â€Å"description† area of the board, and then use imagery to show the themes from their point of view. Instagram 8. Photo Contest Instead of having students write about a topic, have them show you their understanding of it in photographs via Instagram. For example, ask students to explore the themes of To Kill a Mockingbird. Students would take pictures that depict the main ideas that were discussed in class. Note: If you already use social media in your classroom, adding these assignments to your current plans will be easy. If not, be sure you have permission from all parents (check out this social media permission form) before giving any of these assignments to students. This is a guest post from contributing writer, Jessica Sanders.  Jessica is the Director of Social Outreach for  Learn2Earn, an online fundraising platform that allows students to raise money by reading books. She grew up reading books like The Giver and Holes and is passionate about making reading as exciting for young kids today as it has always been for her. Follow Learn2Earn on Twitter and Facebook, and send content inquiries to social@learn2earn.org.

See Below Essay Example | Topics and Well Written Essays - 250 words - 6

See Below - Essay Example Further, some people do not reason about some practices such as singing praise songs when worshipping in order to endorse their faith or belief system. On the other hand, morality can be independent of any belief system because it concerns much about what the society considers and accepts as good and acceptable behavior concerning most aspects of relationships, life, and inter-actions (Statman and Sagi 42). If religion is taken as a basis for morality, morality is strengthened because religious faiths are significant in offering morality direction and guidance of actions that are virtuous in a materialistic and corrupt world. In addition, it is not easy to differentiate right or evil from wrong unless a person has infinite or divine reference point, which in real sense is good. Religion provides this infinite reference point (Statman and Sagi 46). In addition, morality is strengthened because it is via religion that the platform of determining what is good or bad is

Google's company acquisition and partnership Essay

Google's company acquisition and partnership - Essay Example Google Company has also licensed the platform that has helped limit control over activities that hardware makers do with android. Due to this control, the company has been able to produce androids with unique functions and features that satisfy customer needs (Lee, 2012). Partnership is a legal relationship by which companies formed through signing of an agreement carry on business as co-owners. Samsung and Google signed a ten-year partnership to license each other’s current patients and those filed in the future. As a result, Samsung will now be able to access the patents Google garnered as part of its $12.5 billion acquisition of Motorola in the year 2011 (Glasby & Dickinson, 2014). There are various reasons as to why Google is in android takeover. Firstly, it is their growth strategy. Android demand has been increasing and due to this, Google Company will be in a position to develop their business by meeting needs of customers. Therefore, making profits that will enable them expand the business (MCmorris, 2005). Secondly, their acquisition will help them diversify their risks. The addition also helps in meeting customer needs by producing androids with unique features and functions. Android phones have also been on demand to replace iPhones. The replacement of this product would mean increasing sales of androids hence increasing profits. The result will help in the development of the firm and expansion of the company, as well as assist in familiarizing the company products with the consumers. The other primary reason for the acquisition is helping Google advertises their company. Since androids are globally used, adding Google apps may assist the organization to make product promotion feasible. Another crucial reason is the talented engineers in Android Company and their great technology. Google wanted the engineers to help in