Compliance of Nurses with personal protective equipment

Compliance of Nurses with personal protective equipment Introduction The identification of clients with infectious diseases through the clinical and laboratory assessment is Possible, but not always be effective. Because the most of infectious diseases such as AIDS, hepatitis and other, the Microorganisms needs to the incubation period before appearance the signs and symptoms of disease on the clients, however, the probability of transmission of infection are possible in these is period. Therefore, any patient should be regarded as a potential source of infection (Hinkin and Gammon, 2008). Use of personal protective equipment is very important to prevent infectious pathogens transmitted from patient to nurse and the versa is true. Furthermore, correctly select and use of personal protective equipment is very effective to prevent transmission of infection, in addition to reduce the risks of exposure for infectious agents (Hon et al 2008). However, the health environment filled with hazards and pathogens because of that nurses should be use effective ba rrier equipment to break down any probability to contamination by infectious agent (Hinkin and Gammon, 2008). The personal protective equipments in all contents aprons, gloves, gowns, eye protection (goggles, glasses), caps, laboratory coats, resuscitation bags and face shields/mask all of this and other, are use frequently in general care settings as very important part of standard precaution (Clark et al 2002; Pratt et al 2007). The standard precautions developed gradually from the universal precautions (Hinkin and Gammon, 2008), which began as prevention agent to prevent transmission of blood borne pathogens to healthcare workers (Wilson 2001). Standard precautions are evidence-based guidance designed to reduce incidence of healthcare associated infection and transmission of infections in healthcare environment (Pellow et al. 2004). Also all intervention and precautions must be applied by all healthcare workers to provide professional care and safety to all health worker and patients in health environment (Pratt et al. 2007). The Standard precautions it aim to prevent transmission of infection or at least reduce probability of transmission any infected pathogens to the lowest level between nurses and patients , also to protect the patients and healthcare workers at the same time by use standardized precautions such as personal protective equipments (Cullen et al, 2006). Damani (2003) did clarify the standard infection precautions guideline, health worker education are playing effective role to minimize major problems in the UK such as the antibiotic resistant and health care associated infections. Furthermore, the personal protective equipments as the important part of standard precautions and playing very effective role to prevent incident of healthcare associated infections, it was identified as one of the most common complications in the health care environment, recently which affects on approximately 10% of clients admitted to hospitals worldwide (Filetoth 2003), around 4-10% between hospitals in the developed countries (Nazarko 2008). Also the rate varies from 5-15% in the developing countries (Jarvis 2007). Globally, healthcare associated infections infect a patient every two minutes and the world loses one patient every two hours because of healthcare associated infections leading to non-compliance the healthcare workers with personal protective equipments use and anther standard precautions (Chief Medical Officers Report 2006). For instance, harbarth et al (2001) cleared the rate of hand hygiene compliance among healthcare workers nearly 34%, and Golan et al (2006) cleared the compliance for hand hygiene before provide care nearly 10% and 36% after provide care. Therefore, some studies suggest that the use of MMS, images, videos and online education is very effective to education the health care workers and increased level of compliance and application of personal protective equipments during practice (Pullen 2006), such as Hon et al (2008) reported the rate of hand hygiene compliance among healthcare workers post provide course when wear the personal protective equipment nearly 87% and 68% when taking off the personal protective equipments. The main infectious occupational risks in the healthcare environment such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Also There are some nurses more risk to transmit or received infection for or from patient such as staff nurses in surgical or operations department, because of he or she have high chances to direct contact with blood of patient and make many of specific procedures(Ganczak and Szych, 2007). Doebbeling et al (2003) did clarify the occupational blood exposure occurred frequently among the healthcare workers , also as stated in his study one-fourth to one-third of the respondents had injured by percutaneous blood exposure in the previous three months. Specifically, more than one-third of nursing had exposure more than one time to mucocutaneous blood in the previous three months. Also the exposure and injury rates to infection in health environment is vary differ according to the occupation, which depending on several factors such as the average of time spent in provide care for patient or treated of specimens, use of standard precautions during provide care, frequency use of certain devices and mostly never recapping needles. Gershon et al (1995) clarify the compliance rates among healthcare workers related for the eleven items of personal protective equipments, 97% compliance rate for gloves ; 95% for disposal of sharps; and also the compliance rate is low for others items such as 62% for wearing protective outer clothing and 63% for wearing eye protection. Therefore, Gershon et al find strongly relationship between the compliances of healthcare workers and several key factors such as perception of risk; and training on use the standard precautions as the personal protective equipments. Research questions and aims: What is the level of compliance of nursing with Personal protective equipments use? The aim for this question is to evaluate the level of compliance with Personal protective equipments use among Jordanian nurses during provides care for patients. Also to identify the level of compliance for each tool of personal protective equipments. What are the significant factors that lead to non-compliance with personal protection equipments use among Jordanian nurses during provides care? The aim for this question is to identify the significant factors that lead to non-compliance with personal protective equipments use during provides nursing care for patients. Almost all nursing interventions need to use personal protective equipment frequently during provide care for patients and especially when applying sterilizes nursing procedures for patients, Because of that this study aims to: 1-to identify mainly significant factors that led to non-compliance with personal protection equipment among Jordanian nurses during provides care. 2- To evaluate the level of compliance with Personal protective equipments use among Jordanian nurses during provides care for patients. 3- To enhance the safety for patients and caregivers in hospital in the same time. 4- To explore the gaps between knowledge and practice relater to personal protective equipments among Jordanian nursing. 5- To enhance apply the standard precautions guideline for personal protective equipments among nursing. 6- To prevent transmission of infection between the nurses and patients, also to minimise incident some of major problem in healthcare environments such as health care associated infection and antibiotic resistant. 7- To provide appropriate solutions and suggestions for these is factors. Rational of the methodology: This study was proposed to evaluate the level of compliance with Personal protective equipments use and identify the level of compliance for each tool among Jordanian nurses during provides care for patients. Also to explore the significant factors that leads to non-compliance with personal protection equipments use. However, for the above proposed research quantitative design shall be used. Quantitative researchers do not look to confirm a hypothesis, but looking forward to reject the hypothesis through the analysis of data and therefore development of statements through clarify of causal relationships (Phillips and Burbules, 2000). Moreover quantitative researches often start with a hypothesis related to phenomena to be tested and after the data are collected and analyses, support this is hypothesis or refute by clarify the relationship between the variables (Holt 2009). Furthermore, quantitative research is often used as a method trying to display causal relationships under controlled or standardized condition (Casebeer and Verhoef, 1997). Quantitative research is described as the numerical representation and processing of observations and data for the purpose of describing and explain phenomena and facts that those observations reflect. On the other hand the qualitative research is defined as the non-numerical representation and analysis of observations and data; for the purpose of determining underlying meanings and discovering the patterns of relationships (Babbie 1992). As a result the quantitative research is apply deductive approach (where data are especially collected for the purpose of hypotheses, analysis and testing ideas) rather than the qualitative research is apply inductive approach (develop the generalizations and ideas Through the data ) (Meadows 2003). Quantitative research is identified the science as objective fact or truth, different from quantitative research is identified the science depending on previous experience and thus subjectivity determined. Furthermore, quantitative research method is use numerical estimates and statistical analysis from a generalization sample related to a larger number of populations true (Casebeer and Verhoef, 1997). And thus the quantitative research involves experiments and surveys, where statistics and data are collected by using standardized methods such as structured interviews and questionnaires (Meadows 2003). On the other hand the qualitative research method is use narrative description and continual comparisons, are more often use to understand the specific sample or situations being studied (Casebeer and Verhoef, 1997). Quantitative research is an effective and necessary part of healthcare services researches; the most example of this is the controlled randomized experiment research, with its importance on experimentation and large size of sample. However, quantitative researches cover a wide broader spectrum of activity, which can contain some of small-scale descriptive studies, through to more specialization and complication studies by detect and explore the relationships between variables (Meadows 2003). Quantitative research used many of research designs for example experiments or surveys and correlational studies (Holt 2009). Also Robson (2002) classified the quantitative research to several types under the headings experimental design, quasi-experimental design and non-experimental design; however these designs sometimes are similar in several respects such as patterns of group behaviour, properties and tendencies. But meadows in (2003) classified the quantitative research strategies to two designs experimental and non-experimental designs. Also the experimental designs are characterized by the introduction or management of some variable for example randomized control trials (RCT) (Lanoe 2007). But in the non experimental designs the data are get from existing groups, for example (relational design) to consider at the relationship between a number of variables such as the scores on a pain or depression scale and age; (descriptive design) to identify the frequency and type of probl em in a specific group; (analytical design) to determination why a specific group is affected although the another is not (Meadows 2003). The qualitative studies are more complicated for generalization than the quantitative studies and more controversial. Therefore, Researchers in quantitative research rarely worry for generalizability issue. Also the goal of most qualitative studies is to present a rich of study, contextualized and considerate of human experience through the concentrated study of particular cases (Polit and Beck, 2010). Related to my aim from this is study the quantitative design is more appropriate than qualitative design. However, the designs of quantitative research are serves the proposed aims for these is study. In addition this study when looking forward to identify the relationship between the nursing compliance and personal protective equipments, identify frequency of non-compliance of nursing for the personal protective equipments and to determine which personal protective equipments more compliance and another are less compliance. And also after analyse the data will be able to identify the significant factors that lead to non-compliance with personal protective equipments use among the nursing. it was consider that the literature review could put in the picture the select of methodology and method for this study and also according to the objectives and aims of this study; in addition, this study looking forward to analysis of collected data from a largest size of sample from nurses through survey design. Thus quantitative design approach would be the most excellent approach to achieve my aims and objectives. Research methodologies: Qualitative methods The most three data collection methods common in qualitative research are interview participant observation and focus group discussions. Firstly, participant observation method the data collection in this method when the researcher watching interactions and acts of participants in a natural situation. Also perhaps the researcher has a role or task in the observation site in addition for his observation role (Greenhalgh and Taylor, 1997). Thus involve on the researcher use some of data collection techniques for example observation, interviewing and self-analysis and reflection. In addition the participant observation is aim to create a completely and specifically description of social interaction in a natural situation (Astin and Long, 2009). Also the researcher has more control on the participants especially about credibility issue and more aware about the less tangible aspects for example apathy and good will. But the participant observation the researcher might have complexity to making observe if involved in the location and recording data especially if working in busy situation such as hospital, the researcher los t the accuracy of observation if the participants might see the researcher make spying or threat (Lanoe 2007). In addition the participant observation techniques put the researcher under some particular pressure and ethical challenges (Astin and Long, 2009). Secondly, interview method is defined as the interaction and effective conversation between the researcher and participant and usually is in the form face-to-face in a natural location such as participants home or workplace (Astin and Long, 2009). Moreover the interview can give the interviewee and researcher more flexibility to express opinions, views and make dissection. But the researchers need to have communication skills of interview; Long time to collect data; difficulty in recording, analysing and coding the information; and the interviews non-confidential are not anonymous (Lanoe 2007). Quantitative methods: The most common methods to collect data in quantitative researches is the survey, which approximately always uses questionnaires, structured interviews (face-to-face or telephone), or tests and scales (Meadows 2003). Firstly, structured interview method the researcher an interviewer poses his questions exactly the same question in the same way and order on the respondent and also gives the opportunity for the researcher to filling out the answers of questionnaire (Holt 2009). But the researcher will be exposed to the same problems that face in any interview such as need to have communication skills of interview, long time to collect data and analysis, in addition difficulty to find appropriate place and time of interview especially with nurses are working in hospital (Lanoe 2007). Secondly, it was consider that the literature review could put in the picture the select of method for this study. Also and according to the objectives and aims of this study, questionnaires method approach would be the best approach to achieve the objectives and aims of this study. Questionnaires are a most method of data collection in quantitative design, also characterized mostly as relatively inexpensive; can be cover large numbers of sample by given to several participant at the same time; allow the participant a degree of privacy and answered anonymously, Therefore the participants might be more truthful. However, some famous questionnaires dont require users to get a licence from the author for use (Holt 2009). Also the questionnaires method characterized by more easier to analyse and code of data and. In addition more effectively for time to respondents and researchers especially if the respondent as the nurses working in busy area (Lanoe 2007). Nieswiadomy (2008) summarized the importance of questionnaire method by ability to provide good accurate data on population, using relatively small size of samples. In addition the advantage of questionnaire researcher can obtained large amount of data, quickly and less cost. Although, the questionnaires method needs effort to preparation and perhaps time to test validity and reliability, also some persons do not like forms. Moreover, the most limitation of questionnaire is the type of information obtained (Nieswiadomy 2008), because of some respondents might be answer casually do not bothering about their answers or trying to provide the correct answer, although the researcher cannot ask the respondent to clarification their answers (Lanoe 2007). Literature review: The purpose of the literature review is to explore and clarify the recently study, knowledge, standardise precautions guideline and theory on the compliance of nurses with personal protective equipments use, in other hand to clarify the significant factors that lead to non-compliance for it among nurses. Moreover it was considered that the literature review would inform the select of most appropriate research design and method for this study. The literature search for this study which will be using computerized databases by Athens log-in: Medline, CINAHL, Ovid, SAGE, Cochrane Database and the Evidence-Based Medicine. In addition, specific online journals as in Science Direct journal, Medscape Nurses, Medpulse Journal, BioMed central articles, Journal of advanced Nursing, BMJ Journals. Furthermore, have been limited set for each data base: date range between1996-2010, related for nursing, full text articles and journals. To provide the recently studies, information and researchers on the compliances of nurses with personal protective equipments ; and to grow deeper in topic of this study more analytically and Informatics, in addition to devise the best methods used for the same of this study; read and analyse some of the used questionnaires, and perhaps use one of their. Additional reviewing included the WHO, NHS, Jordanian Ministry of Health, and Jordanian Nursing and Midwife Council. A manual search also undertaken by examining the reference list at the end of the articles found and those that were relevant were followed through. So as to get at the latest statistics and numerical and ratio analysis to benefit of their in this study, accordingly, building of some comparative studies and explore some of the causal relations between the personal protective equipment tools and the compliances of nursing and in addition to clarify the significant factors that led to non-compliances with personal protective equipments and support that by statistically rates. Also and one of literature review strategy is critically read and analyse for text books references about nursing research, standard precaution, personal protective equipment and nursing guideline. The key words used were Nursing Personal protective equipment, Standard precaution, Nursing safety, Qualitative and quantitative research, qualitative research, quantitative research, Nursing compliance, guideline, Jordanian nursing, Knowledge, practice, attitude According to the topic, formulated questions, objectives and aims of this study the literature review clarify the picture about select of methodology and method for this study and also after the literature review has been seen on some of the questionnaires used in the same study and how collected and what the questions that used in the questionnaires. In addition, identify the most significant factors effect on the compliances of healthcare workers with personal protective equipments use.

The Difficulties of Immigrating to the USA :: Immigration Labor Jobs Migrating Essays Papers

â€Å"U.S. policy-makers and the general public believe causes of immigration are evident: poverty, unemployment, economic stagnation and overpopulation drive people to leave their countries† (Sassen, p.14). In many cases this can be a true statement, however, during the course of study it was found there are many other factors influencing migration to the United States. Either way, migration to America can only happen in two different forms, legally or illegally. The U.S. Border Patrol effortlessly tries to contain the flow of people across state lines, but the main reason this epidemic exists stems from the policies that deter people from taking the legal route. The processes involved to becoming an elite member of the American society is costly, time consuming, frustrating and can often lead to dead ends. By performing a case study on an immigrant that is taking the legal approach, the conclusion can be drawn on why individuals slip under the citizenship radar. The Netherlands, Amsterdam, a country and city with extremely liberal laws and open policies. The visualization were Dutchmen and women walk around in wooden shoes and wear large hats, why exactly would a person travel half way across the world and land in the United States? A non-bordering country, fairly unaffected by globalization and maquiladoras. I sat down a talked with a native Dutchman and asked him many of the questions from my opening paragraph and this is what I learned. His name is Koos Van Leeuwen, he lives in the northwest valley of Phoenix, Arizona: â€Å"Kevin, did it work out for in California? With the job interview you had? Were the offers they made any good? I did not get my working permit yet. Because my boss has to give more proof that they need all the education I have had. I might be over educated. But we'll see how it works out. Question 1=what made you migrate to the united states? I was studying Theology at the University of Utrecht. At the end of my studies I wanted to travel, because that is more than likely the only time that you will have the opportunity to travel. Later on you get a job and then a home and traveling for a longer period of time becomes more and more difficult. I had a few countries I wanted to visit: Japan, Canada, Australia or

The Natural History of Mahogany :: Botany

The Natural History of Mahogany Swietenia macrophylla and S. humilis are referred to as Mahogany, a tropical evergreen or deciduous tree that can attain heights of 150 feet. Mahogany is a member of the Meliaceae, which includes other trees with notable wood for cabinet making. Swietenia macrophylla is world renowned for its beautifully grained, hard, red-brown wood. It has been harvested since 1500 A.D. for its wood, with large branches being in higher demand than the trunk. This is due to the closeness of the grain in the branch's wood. Mahogany is used for furniture, fixtures, musical instruments, millwork, cars, ships, boats, caskets, airplanes, foundry patterns, veneer, and plywood (Hill, 1952). In Costa Rica, the only population of Mahogany exists in the Guanacaste-Puntarenas region where the tropical dry forests occur. Both of the species' ranges overlap in this region, with Bigleaf Mahogany, S. macrophylla, extending from the Bolivian Amazon up the Atlantic and Gulf Coast to Mexico, while Pacific Coast Mahogany, S. humilis, ranges from Mexico down the Pacific Coast to 9 degrees N in Costa Rica. The two species defy taxonomy and interbreed to form a hybrid. The hybrid grows quicker than either parent species, has intermediate characteristics, and high quality wood (Everett, 1982). Mahogany is never very abundant, even in undisturbed forests, with a density of only one tree per hectare. This, along with the destruction of tropical forests has added to the growing scarcity of Mahogany. The normal habitat of S. macrophylla and S. humilis is lowland tropical or subtropical forest, with average annual rainfall totals between 1 and 2.5 meters. If the tree is in tropical moist or wet forests, it will lose its leaves briefly. However, in tropical dry forests, such as Guanacaste, the tree will be leafless for a few months. Mahogany has pinnately-compound leaves composed of 4 to 6, ovate-acuminate leaflets. The leaf is often without a terminal leaflet. The bark has vertical scales, giving it the appearance of Silver Maple or White Oak bark. The flowers are imperfect, with greater numbers of male than female flowers. Each flower is small, yellow-white, and borne in a panicle at the end of the dry season. The fruits of the Mahogany will ripen during January-March in the Guanacaste region of Costa Rica. They are 4 to 6 inch woody capsules which contain up to 40 wind-dispersed seeds, similar to those of an Ash tree.

Hackin’ the Sack

Hackin’ the Sack. If you are a slow runner or can’t jump to save your life foot bag is the game for you. Foot bag, known today as hacky sack, was invented in 1972 by John Stalberger and Mike Marshall of Oregon City, Oregon. Recovering from knee surgery, John Stalberger decided he wanted to find a fun way to rehabilitate his knee. Mike Marshall is the one who actually created the first hacky sack. He created a hand-made bean bag and was kicking it around. During the time of John Stalberger’s recovery the two decided to kick around the bean bag for fun. They ended up turning it into a game and calling it Hackin’ the Sack. Later on the two men collaborated and marked their new game under the trademark of â€Å"Hacky Sack ®Ã¢â‚¬ . Different varieties of the sport of Hacky Sack have now came into play including â€Å"Freestyle Footbag† where players stand around in a circle and pass the hacky sack while doing tricks and there is also â€Å"Footbag Net† where players try and volley a Hacky Sack over a 5-foot-high net. The rules for playing freestyle are 1. No hands (except when serving) and no arms – shoulders are allowed in the average circle but are technically forbidden. 2. Always pass the sack to someone else when serving (unless you are playing alone). . Don’t hog the bag. This is a co-op game. If there are others playing please share. 4. Never say sorry! When you are passing the hacky sack and another player misses do NOT under any circumstances apologies. Everyone makes mistakes. 5. Don’t pass from the knee. Most likely if you try and to pass the sack from the knee it will go straight to the ground before the other play can get it. 6. Don’t play with a drink in your hand. It is nearly impossible to keep your hand and eye coordination going and you will only get frustrated and possibly lose the hacky sack. General tips while â€Å"Hackin’ the Sack† starts with proper foot wear. So ladies please do not try and play in high heels someone might get hurt. The most common footwear would have to be a nice snug, mid cut sneaker. Although preferences do vary from bare feet to boots. The second tip would be using the perfect service to play on. If you are playing out in the street on the pavement make sure you are paying attention to your surroundings. There are a lot of cars out there that you will have to dodge and make sure you stay away from all sewers you really don’t want to lose your sack down one of those. Grass is also a good ideal for playing freestyle even though it is a little more difficult to play on, but eventually you will grind away the grass and have a nice area of dirt to play on. Mike Marshall died of a heart attack in 1975, at the age of twenty-eight. Stalberger continued with the â€Å"Hacky Sack† cause and formed the National Hacky Sack Association. He later sold the rights for the Hacky Sack ® Footbag to Kransco (operating under the Wham-O label), which also manufactured the Frisbee flying disc.

How We Are Teaching Children to Think Inside the Box Essay

When children come home from school, parents usually sit down with them, go through their homework folders and ask their child, â€Å"so, what did you learn at school today?† Twenty years ago, the child may have commented on what they learned in art, music, social studies or geography. Now, a child will comment only on what they learned in their reading circle or in their math book. The fault for this lies within the No Child Left Behind (NCLB) Act. Standardized testing has turned teachers into test proctors and schools into testing facilities. Students are no longer receiving a broad education that covers many subjects; instead, their learning is streamlined to fit the content that is on the standardized tests. The NCLB Act is not working as it was intended, and as a result the American children are falling even further behind other developed nations. In fact, American students are ranked 19th out of 21 countries in math, 16th in science and last in physics (DeWeese 2). The No Child Left Behind Act needs to be tossed out before we do irreversible damage to the education system. It is not too late – we can turn everything around by getting rid of costly standardized tests, ensure students receive a broad education that includes classes in arts and music, which will better prepare them for higher education, and give control back to the individual states. In 2002, the No Child Left Behind Act was enacted by Congress, which was intended to close the learning gap between Caucasian students and minority students. The NCLB promised to promote accountability amongst teachers and school administrators, as well as assuring that all children would be proficient – according to standards set by the individual states – in reading and math by the end of the 2013-2014 school year (Ravitch 2). In addition, NCLB stated that by the end of the 2005-2006 school-year every classroom in America would have a highly qualified teacher (Paige 2). The most reliable way that the drafters of No Child Left Behind proposed collecting the data that they needed in order to keep track of accountability and proficiency was by mandating that each state issue their  students in grades 3 through 12 a standardized test annually that covers the subjects of reading, writing and math (Beveridge 1). The test that is issued is given to all students, whether they are Caucasian, African American, Hispanic, disabled, etc. and schools are graded based on the proficiency of their students. Each state sets a yearly goal that increases each year based on the mandates of the NCLB Act, in which all students will be 100 percent proficient in those three subjects by the year 2014 (Ravitch 2). On paper, the NCLB Act looked like a blessing to schools that are located in areas of low-income, minority areas and advocates for children with learning disabilities because these tests were meant to highlight the schools that are doing poorly and ensure they receive funding and training in order to turn the scores around (Darling-Hammond 1). In a letter that is addressed to parents on their website, the U.S. Department of Education explains that the NCLB Act provides â€Å"more resources to schools† through funding and â€Å"allows more flexibility† when allocating the funds (3). According to Linda Darling-Hammond, a Professor of Education at Stanford University, â€Å"the funding allocated by NCLB – less than 10 percent of most schools’ budgets – does not meet the needs of the under-resourced schools, where many students currently struggle to learn† (2). Another way schools get their funding is through the taxes that we pay. It makes sense that schools located in an area that has higher income would receive more funds than schools located in a low-income area. What happens is that with the limited funding, schools in low-income areas need to prioritize funding to raise the standardized test scores of their students because once a school fails to show improvement in their standar dized test scores, they are placed on probation the second year and parents are given a choice to leave the failing school, taking their child and the funding attached to that child to a school that is rated better. â€Å"In the third year of a school’s failure, students are entitled to free tutoring after school† according to Diane Ravitch, a research professor of education at New York University (2). The funding provided by NCLB is supposed to help pay for the free tutoring, but, like was stated before, the funding provided is not enough. What happens when a school is mandated by law to provide resources, but it cannot find room in their budget? That’s  right, they cut funding elsewhere. In an article written by Angela Pascopella, the Austin Independent School District superintendent Pascal D. Forgione explains that â€Å"NCLB also requires that schools in need of improvement set aside 10 percent of their local Title 1 funds for professional development †¦ this creates no flexibility in budgeting† (1). When schools need to restructure their budget in order to pay for tutoring and retraining teachers, the arts and music programs are the ones that suffer most. NCLB places so much emphasis on the outcome of the standardized tests. Can you really blame the school districts for re-emphasizing the importance of standardized tests when their funding relies on it? States were put in charge of providing their own assessment tests in order to provide a more focused education to their students and ensure that the students meet the state’s standards of proficiency. Tina Beveridge explains that â€Å"in 2007, the Washington Assessment of Student Learning (WASL) cost the state $113 million †¦ [and] many districts eliminated teaching positions as a result, despite the use of stimulus money. As budgets are cut nationwide, the funding for nontested subjects are affected first† (1). The fact that the distribution of funds is based on the outcome of the standardized test scores mea ns that we are blatantly failing the inner-city schools. A school will be placed on probation if they fail just one category ranging from proficiency of Caucasian students all the way down to the proficiency of the students who are just learning the English language. Schools located in higher income areas don’t really have to worry as much about budget cuts because those schools are located in areas that are predominately white and with parents who are active in their children’s education. On the other hand, schools in low income areas have to provide tutoring and other mandated actions in order to improve their proficiency rates, all the while their students are learning in â€Å"crumbling facilities, overcrowded classrooms, out-of-date textbooks, no science labs, no art or music courses and a revolving door of untrained teachers† (Darling-Hammond 2). After a few years of a school not showing improvement through their test scores, their entire teaching staff could be fired. We just saw this happen last year in Providence, Rhode Island. The school board terminated 1,976 teachers because of insufficient results and the need to make budget cuts (Chivvis 1). The turnover rate for  teachers is already extremely high, as much as 50 percent leave within 5 years in urban areas (McKinney et al 1) and the pressure of working in a low-income school district where schools are lacking basic teaching necessities is not all that appealing. The inability of low-income schools to offer teachers incentives because of funding, and with the added stress of job security, it makes one wonder how any highly qualified teachers are in the classroom. On top of that, the curriculum for students has gotten so narrow that it has taken a lot of the creativity and individualization that once attracted the best of the best to the teaching profession. Susan J. Hobart is an example of one of those teachers who used to love doing her job because she was leaving her mark on her students, in a positive way. In Hobart’s article, she tells of a letter she received from one of her students prior to the NCLB Act. The letter explained that Hobart was â€Å"differen t than other teachers, in a good way. [They] didn’t learn just from a textbook; [they] experienced the topics by ‘jumping into the textbook.’ [They] got to construct a rainforest in [their] classroom, have a fancy lunch on the Queen Elizabeth II, and go on a safari through Africa† (3). The student goes on to explain that the style of teaching she experienced during that time is what she hopes she can do when she becomes a teacher too. Unfortunately, that student’s dream will most likely not come true because the fact is that when schools are placed on probation, like Hobart’s school, they â€Å"teach test-taking strategies similar to those taught in Stanley Kaplan prep courses †¦ and spend an inordinate amount of time showing students how to ‘bubble up’† (1). With all the time and energy being placed on teaching children to read and write, you would think that they would be proficient by the time they enroll in college, right? Wrong. â€Å"42 percent of community college freshmen and 20 percent of freshmen in four-year institutions enroll in at least one remedial course †¦ 35 percent were enrolled in math, 23 percent in writing, and 20 percent in reading,† according to the Alliance for Excellent Education (1). Scho ols are so reliant on the standardized tests in order to gauge how students are understanding material that they have slacked-off in other areas like teaching basic study skills and critical thinking skills. When most of these kids graduate from high school and enter into a college setting, especially the ones who need to take remedial courses to catch-up to where  they should be when they graduate, they’re taken completely off guard with the course load and they will either succeed in managing it or struggle for the first few semesters, but the majority will drop out without a degree (Alliance for Excellent Education 1). High school is meant to prepare students for higher education or to enter the workforce, but the government is spending millions of dollars in order to remediate students and doing what high school teachers were meant to do (Alliance for Excellent Education 3). So, who is to blame? The supporters of No Child Left Behind acknowledge that there are some faults to the Act, but those like Kati Haycock believes that â€Å"although NCLB isn’t perfect, the Bush administration and Congress did something important by passing it. They called on educators to embrace a new challenge – not just access for all, but achievement for all †¦ there are no more invisible kids† (1). Supporters feel as though benefits such as holding teachers accountable for all students, including those with disabilities, and weeding out the schools that have a long history of doing poorly outweighs the negatives and that with time, the NCLB Act can be reformed to work as efficiently as it was enacted to work. Ravitch disagrees, stating that â€Å"Washington has neither the knowledge nor the capacity to micromanage the nation’s schools† (3). We have to agree with her as concerned citizens and parents. While the NCLB Act meant well when it was passed, it’s time to acknowledge that the government has spent billions of dollars trying to improve the education of America’s youth, yet 10 years later American students are still falling behind the mark set by other industrialized nations and the 201 3-2014 school year is quickly coming upon us. Not only are we falling behind globally, but minorities are still struggling behind Caucasian students. The gap between Caucasian students and minority students, that was intended to close through the NCLB Act, has remained just as far apart. E.E. Miller Elementary School, located here in Fayetteville, NC, just released their annual report card to parents. The chart below shows the break-down of students who passed both the reading and math tests provided at the end of the 2010-2011 school year. African American children, Hispanic children, and children with disabilities are still lagging far behind their Caucasian peers. African American children passed at 49.4 percent, 25.5 percent of students with disabilities passed and Hispanic children passed at rate of  56.9 percent. Remember that the NCLB expects this school, along with every other school in the Nation, to be at 100 percent proficiency by the end of the 2013-2014 school year. Source: Education First NC School Report Cards, E. E. Miller Elementary: 2010-11 School Year, Public Schools of North Carolina State Board of Education, Web, 26 Oct. 2011. In order to put this chart more in perspective, below is the 3-year trend for E.E. Miller. [pic] Source: Education First NC School Report Cards, E. E. Miller Elementary: 2010-11 School Year, Public Schools of North Carolina State Board of Education, Web, 26 Oct. 2011. While math scores are steadily improving, reading scores (the solid line) are declining. E.E. Miller has been on probation for at least 3 years, having provided tutoring to children who were struggling last year. Even with those efforts, the end of the year test suggests those students are still struggling in reading. These mandates are not working. States are spending millions of dollars per year to fulfill all of the required obligations without any fruition. We need to put education spending back into the hands of the states with more substantial federal funding. The federal government cannot expect every public elementary school, middle school and high school in this nation to fix a problem that has been prevalent for many, many years with this one-size-fits-all approach to learning. It will not happen with No Child Left Behind, and it definitely will not happen by the end of the 2013-2014 school year. We can no longer sit and watch while students in America struggle to compete o n a global level in nearly all subjects. Teachers are not educating our nation’s students to think critically and to form their own ideas or opinions; instead, teachers in failing schools are stuck teaching a curriculum that directly corresponds to what is being tested, and we are failing to prepare them for higher education. The future citizens we are molding will be of no use to society if they cannot think for themselves, which will happen if they remain in the current system. We need to undo this one-size-fits-all curriculum and re-broaden our children’s education to include subjects that will teach them think outside the box. Works Cited Alliance for Excellence in Education. â€Å"Paying Double: Inadequate High Schools and Community College Remediation.† Issue Brief: August (2006). All4Ed.Org. Web. 30 Oct. 2011. Beveridge, Tina. â€Å"No Child Left Behind and Fine Arts Classes.† Arts Education Policy Review 111.1 (2010): 4. MasterFILE Premier. EBSCO. Web. 20 Oct. 2011. Chivvis, Dana. â€Å"Providence, RI, School Board Votes to Lay Off All Teachers.† AOL News (2011). Web. 28 Oct. 2011. Darling-Hammond, Lisa. â€Å"No Child Left Behind is a Bad Law.† Opposing Viewpoints. Web. 14 Oct. 2011. DeWeese, Tom. â€Å"Public Education is Failing.† Opposing Viewpoints. Web. 14 Oct. 2011. Education First NC School Report Cards. â€Å"E. E. Miller Elementary: 2010-11 School Year.† Public Schools of North Carolina State Board of Education. Web. 26 Oct. 2011. McKinney, Sueanne E., et al. â€Å"Addressing Urban High-Poverty School Teacher Attrition by Addressing Urban High-Poverty School Teacher Retention: Why Effective Teachers Persevere.† Educational Research and Review Vol. 3 (1) pp. 001-009 (2007). Academic Journals. Web. 28 Oct. 2011. Paige, Rod. â€Å"No Child Left Behind: A Parent’s Guide.† U.S. Department of Education (2002). PDF File. 28 Oct. 2011. Pascopella, Angela. â€Å"Talking Details on NCLB.† District Administration 43.7 (2007): 22. MasterFILE Premier. EBSCO. Web. 28 Oct. 2011. Ravitch, Diane. â€Å"Time to Kill ‘No Child Left Behind’.† Education Digest 75.1 (2009): 4. MasterFILE Premier. EBSCO. Web. 20 Oct. 2011.

Economy in the century

This would eventually spur conflict, but it also proved well for the English. New power was thrust upon the country, and the English were in need of funds, quickly. Luckily, during the dawn of the English empire, a new land (with new economic opportunities) needed colonization. The new world was an expected source of income for citizens of the UK and the Crown itself. From 1550 to 1600, the population of England exploded.This â€Å"surplus population† led to a severe economic depression, partly because of farmers enclosing' croplands for sheep grazing, which forced many small farmers off of their properties. The depression hit the woolen industry, and thousands of farmers took to the streets and ended up unemployed and penniless. Immigration allowed for a new start, so the potential colonists thought. The practice of primogeniture also contributed to the homeless problem. This allowed for the eldest sons to inherit the entire estate, and it left other sons and daughters withou t land or money.The idea of new economic flow and land enticed many of these people, as well as a thirst for adventure and religious freedom. The country of England itself was enamored with the idea of the introduction of new crops that they were unable to grow in their own farms. Many small investors also appeared, hoping to liquidate their companies quickly and make profit. However, this didn't always work. In addition, England expected to benefit in being a â€Å"parent nation† for a new settlement. Eventually, the institution of slavery would also prove profitable.England expected a trade hub to come from these new colonies, and this proved true. A charter was settled, namely the charter of the Virginia Company, and Immigration began. This was a smart choice for King James – a charter was a very low cost for what appeared to only prove beneficial. These new settlements were going to be a source of economic gain. This would eventually prove false (at least, In the b eginning) however, In the moment It was very plausible. When the settlers arrived, many didn't find the lands that they had expected to.Many died, many became Ill, and there was many attacks from local Native American tribes. Most settlers already had passed away from new diseases and malnutrition, especially because the new colonists searched for gold Instead of food. There was a war against the Phaeton tribe, and It left 347 settlers dead, Including the famed John Role. These wars continued and died and eventually, the Photostats fell to disease, disorientation, and disposable. After separate states evolved, trades began. The Columbian exchange proved to be a major part of both the Crown's and America's economy.Tobacco, rice, and many other crops flourished and were quickly absorbed by England, and this created a sizeable profit for the country. Therefore, both the Crown and the settlers had expected that America was going to be a profitable endeavor, and to a certain extent, It w as. All the settlers were eventually comfortable with the same rights as Englishmen, and the Crown had profited In trade and a healthy decrease from a surplus population. I believe a strong case can be made for the economic ebb and flow of England and the America and hat the new country was an expected source of Income for both colleens and the Crown.PUSH – Economy in the 15th century By Koala-Ann Verona and the Crown itself. From 1 550 to 1600, the population of England exploded. This â€Å"enclosing† croplands for sheep grazing, which forced many small farmers off of their the charter of the Virginia Company, and immigration began. This was a smart choice would eventually prove false (at least, in the beginning) however, in the moment it had expected to. Many died, many became ill, and there was many attacks from local ND malnutrition, especially because the new colonists searched for gold instead of food.There was a war against the Phaeton tribe, and it left 347 set tlers dead, including the famed John Role. These wars continued and died and eventually, the Photostats fell to disease, disorientation, and disability. After separate states going to be a profitable endeavor, and to a certain extent, it was. All the settlers were profited in trade and a healthy decrease from a surplus population. I believe a strong that the new country was an expected source of income for both citizens and the

Health Law and Regulations Essay

In understanding regulatory agencies the differences between regulation and legislation needs defining. Legislation is the law that has been passed by a voting process and regulation is the responsibility of the regulatory board appointed to enforce laws once the law is passed; it sets forth rules on how the laws are to be implemented and to what degree. In health care the Department of Health and Human Services (HHS) has the predominant responsibility to enforce legislation that impacts the health and well-being of Americans. Under the umbrella of HHS there are 13 regulatory agencies tasked with setting rules on the enforcement of the legislation passed by lawmakers. Regulatory Agencies Two of the most influential regulatory agencies within HHS are the United States Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS), these two agencies have substantial influence on every aspect of health care delivery. The FDA is responsible for protecting and promoting public health through the regulation and supervision of food safety, medical devices, drugs, vaccines, blood products and biologics. In addition, they monitor medical errors and adverse reactions and reporting such to providers, (U.S. Department of Health and Human Services, 2011). CMS controls the Medicare program and works in collaboration with state governments to oversee Medicaid, and the State Children’s Health Insurance Program (SCHIP). In addition to these responsibilities, CMS dispenses criteria from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), surveys and certifies quality standards in long-term care facilities, and clinical laboratories, (Centers for Medicare and Medicaid Services). The proportion of national health spending sponsored by both federal, state, and local governments was 45% in 2010, a significant source of revenue depended on by providers of health care, (Centers for Medicare and Medicaid Services, 2011). Current FDA Regulations The Patient Protection and Affordable Care Act (PPAC Act), amended the Public Health Service Act (PHS Act) to create a shortened authorization route for medications found to be â€Å"highly similar† or â€Å"interchangeable† with an FDA-approved medication, (U.S. Department of Health and Human Services, 2011). The goal is similar to the Drug Price Competition and Patent Term Restoration Act of 1984 (â€Å"Hatch-Waxman Act†), which produced condensed methods for the approval of drug products under Federal Food, Drug, and Cosmetic Act (FFD&C Act). The outcome is aimed at the FDA’s instituted policy of allowing confidence on what is already known about a drug, thus protecting time and resources, (U.S. Department of Health and Human Services, 2011). To help increase access to affordable prescription medications, the FDA implemented measures to expedite the development and approval of generic drugs. Generic drugs cost 50 to 70% less than their brand-name counterparts equating to a savings of eight to ten billion dollars a year at retail pharmacies, (Crawford, June). These savings do not include the use of generic drugs in an institutional setting. PPAC expands on the practice of generic drugs and incorporates using medications that have the same efficacy as another more expensive medication leading to more options in the prescribing of medications. The practice of using generic drugs is not without concern. As evidenced by the case Pliva v. Mensing where the question was; the safety standards for brand-name drug labeling also apply to generic-drug manufacturers. The patients in the case took the generic drug metoclopramide and developed tardive dyskinesia, which was listed on the label. The patients argued the warning was not adequate and the manufacturer argued the â€Å"changes being effected† process was not available to generic-drug manufacturers because the FDA requires labels for generic versions of drugs to be identical to those of the brand-name drugs, (Glantz & Annas, 2011). The FDA upheld the manufacturer’s claim although the FDA added the manufacturer had a responsibility to request a label change if the manufacturer knew a stronger warning was needed to market the drug safely. The court found in favor of the manufacturer stating â€Å"federal law still preempted injured patients from bringing lawsuits in state courts, because the state laws in question require a safer label, not communicating with the FDA about the possibility of creating a safer label,† (Glantz & Annas, 2011, p. 682). Despite this regulatory standing, a controversial issue may entail for the FDA in the allowance of medications to be â€Å"interchanged† to promote an additional avenue for savings in prescription medications. Much foresight needs to be included to protect the safety and well-being of patients. Current CMS Regulations The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA), is legislation aimed at the adoption and â€Å"meaningful use† of health information technology. CMS was authorized to establish incentive programs for eligible Medicare and Medicaid providers who adopt, implement, upgrade, or â€Å"meaningfully use† certified electronic health records (EHR). The term â€Å"meaningful use† is an acknowledgement that improved health care is not the product of technology but a method to exchange and use health information to support clinical decisions at the point of care. To qualify for CMS’ incentive program the provider must obtain certified electronic health record technology. An incentive of $44 thousand can be achieved by an eligible professional who shows â€Å"meaningful use† over a five year period. Hospitals implementing a certified EHR system can qualify for a t wo million dollar base payment. In 2015 Medicare will implement a reduction in payment to those not displaying â€Å"meaningful use†. The decrease in payment begins at one percent and rises each year that hospitals and providers receiving Medicare payments do not make evident â€Å"meaningful use,† to a maximum reduction of five percent, (Centers for Medicare and Medicaid Services, 2011). The use of EHRs is encouraged by touting improved efficiency, cost-effectiveness, quality, and safety of health care delivery. A study on the use of EHR in 2952 hospitals in the United States revealed 12% of hospitals had instituted electronic physicians’ notes across all clinical units and 17% had instituted computerized provider-order entry for medications in all clinical units, (Jha, et al., 2009). The cited barriers to implementation of EHR were inadequate capital (74%), maintenance costs (44%), resistance of physicians (36%), unclear return on investment (32%), and lack of available staff with expertise i n information technology (30%), (Jha, et al., 2009). Ironically, the hospitals who had implemented the use of EHRs cited financial reasons such as additional compensation for electronic health record use (82%) and financial enticements for implementation (75%), (Jha, et al., 2009). The estimated cost of purchasing, installing, and implementing an EHR system in a provider’s office is approximately $40,000 and this figure does not reflect the cost of maintenance, (Blumentha, 2009). A survey by the American Hospital Association revealed â€Å"the median annual capital investment on information technology was over $700,000 and represented 15% of all capital expenses. Operating expenses were much higher at $1.7 million, or 2 percent of all operating expenses,† (National Institutes of Health, 2006, p. 18). Although there are indisputable reasons for implementing an EHR system, CMS’ incentive program is merely a pittance compared to the ongoing costs of operational expenses. The concept of all health care providers possessing an EHR system is ideal. As with any form of electronic technology comes the prospect of personal information being violated. The Health Insurance Portability and Accountability Act (HIPAA) does provide for penalties from $100 to $1.5 million, depending on the violation and whether it was done unknowingly or willfully and can include imprisonment up to 10 years. HIPAA protects the health information of individuals; â€Å"it does not create a private cause of action for those aggrieved,† (The General Counsel Department of Health and Human Services, 2005). Conclusion Federal regulatory agencies are a necessity to interpret and assist in the implementation of legislation. Without federal regulatory agencies the United States would have over 50 different interpretations on one piece of legislation. The FDA and CMS play a significant role in the ever changing health care arena. The FDA is based on scientific integrity evidenced by the recent publication of defined key principles of scientific integrity. Through this commitment to scientific integrity and quality the FDA provides medical safety to the American people. Through research and establishing guidelines the FDA has been instrumental in making generic drugs available to the public, saving them more than eight billion dollars annually. The PPAC tasked the FDA has been tasked with expanding on the generic drug practice by discovering medications that have the same efficacy as another medications leading to more cost saving options in the prescribing of medications. CMS has been tasked with implementing HITECH that has the promise of decreasing costs and errors in health care delivery. This is a lofty goal with over 80 percent of the United States hospitals without any type of electronic health record in place. The financial incentive provided by the federal government through CMS does not seem to be enough of a motivator to encourage the financial commitment of an EHR. Although, after 2015 when hospitals and providers have not demonstrated â€Å"meaningful use† these providers of Medicare services may be more inclined when losing one percent of their Medicare payments. These regulatory agencies and the legislation cited in this paper are a minute representation of the responsibility and obligation the federal agencies have to protect the well-being of the American people. The cited legislation delegated to these regulatory agencies is not only focused on health but financial constraint and safety of the American people. References Blumentha, D. (2009, April 9). Stimulating the Adoption of Health Information Technology. Retrieved from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMp0901592 Centers for Medicare and Medicaid Services. (2011, October 17). Medicare and Medicaid EHR Incentive Program Basics. Retrieved from CMS.gov: https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp Centers for Medicare and Medicaid Services. (2011, September). National Health Expenditures 2010: Sponsor Highlights. Retrieved from CMS.gov: https://www.cms.gov/NationalHealthExpendData/downloads/sponsors.pdf Centers for Medicare and Medicaid Services. (n.d.). About us. Retrieved from CMS.gov: http://www.cms.gov/home/aboutcms.asp Crawford, L. (June, 23 2004). The Law of Biologic Medicine. Retrieved from FDA: http://www.fda.gov/NewsEvents/Testimony/ucm113745.htm Glantz, L., & Annas, G. (2011, August 25). Impossible? Outlawing State Safety Laws for Generic Drugs. Retrieved from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMp1107832 Jha, A., DesRoches, C., Campbell, E. G., Donelan, K., Rao, S., Ferris, T., . . . Blumenthal, D. (2009, April 16). Use of Electronic Health Records in U.S. Hospitals. Retrieved from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsa0900592#t=articleBackground National Institutes of Health. (2006, April). Electronic Health Records Overview. Retrieved from National Institutes of Health: http://www.ncrr.nih.gov/publications/informatics/EHR.pdf The General Counsel Departmentof Health and Human Services. (2005, June 1). SCOPE OF CRIMINAL ENFORCEMENT UNDER 42 U.S.C.  § 1320d-6. Retrieved from The United States Department of Justice: http://www.justice.gov/olc/hipaa_final.htm U.S. Department of Health and Human Services. (2011, November 16). FDA Fundamentals. Retrieved from About FDA: http://www.fda.gov/AboutFDA/Transparency/Basics/ucm192695.htm U.S. Department of Health and Human Services. (2011, March 10). Implementation of the Biologics Price Competition and Innovation Act of 2009. Retrieved from U.S. Food and Drug Administration: http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/ucm215089.htm