Ventilator associated pneumonia Essay Example | Topics and Well Written Essays - 750 words

Ventilator associated pneumonia - Essay Example This element decreases VAP by decreasing the risk of aspiration of gastrointestinal secretions and also oro-naso-pharyngeal secretions and also by improving ventilation of the patient through higher spontaneous tidal volumes when compared to supine position (Safer Healthcare Now, 2011). Hospitals in Canada can implement this component by implementation of a strategy that ensures head end elevation like documentation of the intervention in nursing flow charts at regular intervals, as a topic of discussion during multidisciplinary daily rounds and as documentation on goals sheet. A protractor must be brought into the ICU to demonstrate the nursing staff as to how 45 degrees elevation looks like. A piece of colored tape must be pasted on the wall behind the bed of the patient to ensure compliance during ventilator checks. Another implementation strategy would be to include a specification for monitoring of head of the bed by mechanical devices. An environment must be created where all h ealth professionals like orderlies and radiology technicians are encouraged to notify the nursing as to whether the head of the bed is elevated. ... The staff must be encouraged and motivated for compliance (Safer Healthcare Now, 2011). 2. Daily performance of readiness to extubate by interruption of sedation and spontaneous breathing trial This is done to decrease the duration of mechanical ventilation and also early extubation which decreases VAP. This also decreases exposure to ventilator-circuit endotracheal tube device (Safer Healthcare Now, 2011). This element can be implemented by introducing a process which temporarily interrupts sedation every day at an appropriate time, like before rounds, to reappraise the neurocognitive ability of the patient, to assume a breathing pattern that is viable and to ascertain needs for analgesia and sedation. Sedation scale must be used to prevent under-sedation. These must be standardized for all mechanically ventilated patients and both these strategies must be linked into the protocol of weaning process. Non-invasive ventilation can be used as a strategy to liberate patients from mechan ical ventilation. Compliance must be discussed every day during rounds and compliance must be used to motivate and encourage the staff (Safer Healthcare Now, 2011). 3. Use of oral tubes rather than nasal tubes for tracheal or stomach access. This reduces the risk of nosocomial sinusitis and thus decreases the risk of VAP (Safer Healthcare Now, 2011). This element can be incorporated in the hospitals by making orotracheal intubation the standard protocol for mechanical ventilation. In all patients receiving mechanical ventilation for more than 24 hours, orogastric tube must be placed for gastric decompression and feeding rather than nasogastric tube and this must also be included in the protocols in not only ICUs, but

Canada and NATO :: The North Atlantic Treaty Organization, NATO

In the book entitled Canada, NATO and The Bomb: The Western Alliance in Crisis by Tom Keating and Larry Pratt the main issue discussed was Canada’s position in Europe, North America and their view on the North Atlantic Treaty Organization. It went into specific issues dealing with political tension within Canada and tension outside Canada with other countries. It went through the years of different political parties and how they dealt with the matters of NATO. It states Canada’s opinion dealing with matters such as the alliance, war, and decision making with other countries involved in NATO. The book came across Canada’s decision making as though Canada went along with the decisions made by other countries. Canada, NATO, and The Bomb is not a book to inform it is a history book. It addressed issues that had happened previously and stated the type of involvement Canada had in it. In most cases, a book dealing with these sensitive issues, which involved other countries, would provide the pros and cons but in this case only the cons of NATO and the alliance were provided. This book showed NATO as being an organization that is very unorganized. It came across as though the countries involved did not respect each other’s thoughts and opinions. It dwells on the mistakes made by countries for example the United States, various other European countries. It made it seem as though NATO was in conflict within each other making the organization as a whole seem incapable of compromise and the defence of anything. At many points NATO wanted to vote the United States out of the organization but this obviously never happened. At one point it was a problem â€Å"about the possibility of being dominated and ultimately overwhelmed by too close an association with the United States† (pg.30) for Canada and their relationship. The themes of the book were Canada and its position in NATO and NATO’s and its position in the world. The theme was not presented clearly. One of the points were Canada and the main focus was any and everything but Canada. It stated over and over again that Canada did not approve of very much but that was it. It came across as if Canada was only complaining and nothing was being done. NATO and its position are expressed as only conflicts within the congress. It was giving history presentation information dealing with NATO, its purpose and its views on important topics.

Perspectives

Pavlov (1927), founder of classical conditioning used dogs in his experiments. The key terms within his experiment were stimulus and response. The unconditioned stimulus of the child's fear would be the presence of animals and the unconditioned response would be the behavior of crying. The unconditioned response would become conditioned as It's associated with the stimulus (Doherty, Hughes, 2009). Skinner (1966) developed operant conditioning, focusing on reinforcement or punishment to elicit changes in behavior.He found reinforced behavior becomes strengthened and repeated whereas behavior not reinforced becomes extinct and weakened. For child X, his previous experience with animals may have been negative; therefore he may prefer the experience not to occur again (Miller, 2011). Watson (1924) believed Individual differences and experiences mould our behavior as emphasized below. â€Å"Give me a dozen healthy infants, well-formed, and my own special world to bring them up in and I'l l guarantee to take any one at random and train him to become any type of specialist I might select†¦ (quoted in Schaffer, 2004, peg. 336). Influenced by Pavlov, Watson believed behavior can be controlled through understanding relationships between stimulus and response. Child Ax's home or educational setting could change to adapt a pet policy within the environment, to become confident to eradicate his fear. Bandeau (1986) emphasized on behavior as imitation with four elements; attention, mental representation, mitotic response and motivation. Child X could have seen someone showing negative affection towards an animal (attention allowing him to remember his observations (mental representation).This may be the reason as to how he behaves In the same way (mitotic response) when he felt the urge to cry (motivation) (Levine, Munich, 2011 This theory highlights people learn from imitation as a direct reinforcement of their own behavior within their environment. â€Å"The psychodr ama approach focuses on the role of internal processesÃ'›. In shaping personality, and thereby behavior. † (Clansman, Had, 2009, peg. 224) our preconscious mind or they are totally inaccessible within our unconscious mind.Our unconscious thoughts can become conscious through dream interpretation, free association and transference. Many unconscious thoughts are experiences best forgotten (Gross, 2010). Child X could have experienced a negative incident with animals causing him to erase this event from his mind. Freud recognized three structures of personality resulting in clashes. Old is the basic personality wanting everything and will do anything to feed it's desires through operating a ‘pleasure principle'. For child X, the id would make him cry while looking at animals making it uncontrollable.Superego is the sensible structure conditioned by the environment and has a conscience of both right and wrong, so would tell child X not to seek attention by crying. Ego is a mediator between id and superego; therefore controls both structures (Hermann, 1994). However, as child X grows older, his superego ill control his id through moral principles resisting temptations of crying. Humanists are optimistic and recognize behavior through own free will (Gross, 2010). Mason (1968) and Rogers (1951) regarded personal growth and fulfillment in life as basic human nature.Both theorists emphasis on growth and fulfillment for a person to be able to self-actualities (Nee, 1996). Mason believes individuals have capability to progress towards the level of self- actualization highlighted through hierarchical stages (see appendix 1). However, if there is a failure to meet lower level needs, progression to the next stage is delayed. Although there are many needs to be met at the bottom there is a potential to achieve for all (Nee, 1996). Child X may have experienced a dangerous situation with an animal; therefore his safety needs would need to be met for him to progre ss onto the next stage.Rogers believed humans have one basic aim; to self-actualities by fulfilling their own potential. His theory highlights self-esteem as the ‘real self and the ‘ideal self. Being able to achieve what one is capable of allows self-actualization and positive regard from others to promote self-esteem (Doherty, Hughes, 2009). If child X was shown positive regard when in the presence of animals, he may remove his fear and begin to self-actualities. â€Å"Cognitive psychology is concerned with†¦ Perception, learning, memory, language, emotion, concept formation and thinking. (Essence, 1995, peg. L) Cosmogonists view people and their environment as important. Piglet's (1969) constructivist theory is based on age ability of stage learning. His theory describes children's perspective on their world (Levine, Munich, 2011). Pigged identified four stages of learning (see appendix 2) believing past experiences shape children's organization of the world. Ref lecting on Piglet's stages, child X would be in the very early stages of the pre-operational stage as he cannot see his fear of animals from another perspective.Using symbolic features within this stage may allow him to make links between reality and fantasy (Dates, Grayson, 2004) forming close links to the psychodrama approach regarding accessing the unconscious mind. Child X may not access his unconscious mind due to unpleasant past experience. Weights (1978) emphasized social interactions through scaffolding and understanding of the world (Curtis, Change, 2005). Like Pigged, he constructed a stage theory (see appendix 3). Child X may understand emotions and experiences if knowledge is stored within him.Making him understand there is nothing to fear about with animals, may be beyond his intellectual capability because of his global developmental delay. He may not have reached the stage of maturity within ZAP to remove his fears. However, through reconstruction and social interacti ons, he may become used to the presence of animals within his environment. The cultural context within stages may influence his fear as family contexts may imply a ‘no pets' policy, Hereford imitating the family attitude.Behaviorist's emphasis on connections between the environment and the behavior and ignore physiological and cognitive events occurring. Pavlov and Skinner experimented on animals whereas Bandeau and Watson experimented with children. The behaviorism perspective is concerned with nurture as the environment is the stimulus of it's theories. It does not take into perspective holism, therefore against the humanistic approach (Clansman, Had, 2009). Humanists found the psychodrama approach to be too pessimistic in comparison to their optimistic approach.This approach is individualistic and studies internal world of the person rather than external. Measles hierarchy suggests moving upwards in regards to achievement similar to the stage theories for other perspectives . Although his theory is not age related, it is similar to Hoosegows as individuals' progress accordingly. However, Pigged identified children cannot progress onto the next stage without having developed fully in the previous. All these theorists have one thing in common; failure to meet lower level needs results in a delay or fixation to develop (Gross, 2010).

The Cask of Amontillado by Edgar Allan Poe Critical Essay

â€Å"Don’t Tread on Me† Edgar Allan Poe was a man like no other; he lived a life of full of hardships, from his parents dying at a young age and his foster parents disowning him to marrying his cousin and never settling down in one place. Poe had a unique and tumultuous life full of ups and downs which relate to his characters and the themes of his stories. In The Cask of Amontillado poe uses irony, symbolism and the theme of revenge to draw in the reader and to leave and deep emotional reaction to the story that won’t soon be forgotten. Edgar Allan Poe was born January 19, 1809 in Boston, Massachusetts. His Parents were both actors, his mother Elizabeth Arnold Poe and his father David Poe Jr. Both of his parents died when he was just†¦show more content†¦Montresor see the entombing of Fortunato and the expulsion of him from his life and from the world as his †treasure† which hints back to the translation of his name Montresor meaning  "my treasure.† Poe uses dramatic irony while being underground in the catacombs Fortunato throws a bottle into the air and asks Montresor if he is a mason and Montresor says he his as he shows him a trowel. Fortunato means the free masons fraternity while Montresor means that he is a literal mason, who uses stone and mortar. The play on words and the fact that Fortunato doesn’t comprehend the hint given to him by Montresor is not only ironic but terrifying. Poe continuously uses irony throughout The Cask of Amontillado to draw in and to scare. The ubiquitous irony even though sometimes under the surface elevates this story to a threshold seldom reached by authors. Because of the irony that lies under the surface it’s a story that can be read over and over always showing glimpses of information that may have not been seen before. Poe’s use of irony is magnificent and enjoyable which is why him and his stories are still so popular 150 years later. The Cask of Amontillado is strong story of revenge which leaves its mark on the mind of the reader. The powerful emotions felt by Montresor are felt from the opening line, â€Å"The thousand injuries of Fortunato I had borne as I best could, but when heShow MoreRelatedReasons Why The Cask Of Amontillado Is A Powerful Tale Of Revenge1124 Words   |  5 PagesReasons Why the Cask of Amontillado Is Brilliant!!! The Cask of Amontillado is a powerful tale of revenge. Montresor, the sinister narrator of this tale, pledges revenge upon Fortunato for an insult. 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