Sam Walton essays

Sam Walton essays There were several characteristics of Sam Walton that enabled him to be successful in his life and business dealings. Sam Walton could do anything he put his mind to. This can be witnessed in his ability to transform a small town store into a 25 billion-dollar industry at the time of his death. Walton did not want to be poor, and this helped to push him when the going got tough because he knew what the possible outcome would be. For example, when Walton first started producing more Wal-marts, he was in great debt. In fact the only way he could get out was to make more stores and continue to set lower prices than the competition. Walton grew up into a poor environment as a child, so he knew what it was like to be at the short end of the stick. Perhaps his difficult childhood gave him something to strive towards later on in his life. Walton learned several things from others as well. For instance, he learned to economize from his job at J.C. Penney. And while he was developing his f irst general store, Walton saw what the competition was doing wrong, and did the complete opposite, such as selling more quantity in order to make a bigger profit in the long run. It can probably be stated that Sam Walton would not have been as successful if his devoted wife had not been there along his side. Always there for him, Mrs. Walton was able to keep the entire family together during the hard and difficult times. While Sam was out doing the dirty work trying to make something of his business, Mrs. Walton was playing the role of mother and father back at home. Sam Walton had to create and develop his business in a very difficult environment. Competition was all around, and most people saw Waltons store as a dead-end flop when it first began. Before the founding of Wal-mart, all of the businesses were the same, trying to set prices in hopes of large gains from not so large quantities. Walton saw what was going on and took advantage of wh ...

10 Radon Facts (Rn or Atomic Number 86)

10 Radon Facts (Rn or Atomic Number 86) Radon is a natural radioactive element with the element symbol Rn and atomic number 86. Here are 10 radon facts. Knowing them could even save your life. Fast Facts: Radon Element Name: RadonElement Symbol: RnAtomic Number: 86Element Group: Group 18 (Noble Gas)Period: Period 6Appearance: Colorless Gas Radon is a colorless, odorless, and flavorless gas at ordinary temperature and pressure. Radon is radioactive and decays into other radioactive and toxic elements. Radon occurs in nature as the decay product of uranium, radium, thorium, and other radioactive elements. There are 33 known isotopes of radon. Rn-226 is the most common of these. It is an alpha emitter with a half-life of 1601 years. None of the isotopes of radon are stable.Radon is present in the Earths crust at an abundance of  4 x10-13  milligrams per kilogram. It is always present outdoors and in drinking water from natural sources, but at a low level in open areas. Its mainly a problem in enclosed spaces, such as indoors or in a mine.The US EPA estimates the average indoor radon concentration is 1.3 picocuries per liter (pCi/L). Its estimated approximately 1 in 15 homes in the US has high radon, which is 4.0 pCi/L or higher. High radon levels been found in every state of the United States. Radon comes from the soi l, water, and water supply. Some building materials also release radon, such as concrete, granite countertops, and wall boards. Its a myth that only older homes or ones of a certain design are susceptible to high radon levels, as the concentration depends on many factors. Because it is heavy, the gas does tend to accumulate in low-lying areas. Radon test kits can detect high levels of radon, which can generally be mitigated fairly easily and inexpensively once the threat is known. Radon is the second leading cause of lung cancer overall (after smoking) and the leading cause of lung cancer in non-smokers. Some studies link radon exposure to childhood leukemia. The element emits alpha particles, which are not able to penetrate skin, but can react with cells when the element is inhaled. Because it is monatomic, radon is able to penetrate most materials and disperses readily from its source.Some studies indicate children are at higher risk from radon exposure than adults, probably because they have more rapidly dividing cells, so genetic damage is more serious. Also, children have a higher metabolic rate.The element radon has gone by other names. It was one of the first radioactive elements that was discovered. Fredrich E. Dorn described radon gas in 1900. He called it radium emanation because the gas came from the radium sample he was studying. William Ramsay and Robert Gray first isolated radon in 1908. They named the element niton. In 1923, the name changed to radon, after radium, one of its sources and the element involved in its discovery. Radon is a noble gas, which means it has a stable outer electron shell. For this reason, radon does not readily form chemical compounds. The element is considered chemical inert and monatomic. However, it has been known to react with fluorine to form a fluoride. Radon clathrates are also known. Radon is one of the densest gases and is the heaviest. Radon is 9 times heavier than air.Although gaseous radon is invisible, when the element is cooled below its freezing point (−96  °F or −71  °C), it emits bright luminescence that changes from yellow to orange-red as the temperature is lowered.There are some practical uses of radon. At one time, the gas was used for radiotherapy cancer treatment. It used to be used in spas, when people thought it might confer medical benefits. The gas is present in some natural spas, such as the hot springs around Hot Springs, Arkansas. Now, radon is mainly used as a radioactive label to study surface chemical reactions and to initiate react ions.While radon is not considered a commercial product, it may be produced by isolating gases off of a radium salt. The gas mixture can then be sparked to combine hydrogen and oxygen, removing them as water. Carbon dioxide is removed by adsorption. Then, radon may be isolated from nitrogen by freezing out the radon. Sources Haynes, William M., ed. (2011). CRC Handbook of Chemistry and Physics (92nd ed.). Boca Raton, FL: CRC Press. p. 4.122. ISBN 1439855110Kusky, Timothy M. (2003). Geological Hazards: A Sourcebook. Greenwood Press. pp. 236–239. ISBN 9781573564694.

Social and Cultural Factors are the Most Important in Determining Essay

Social and Cultural Factors are the Most Important in Determining Gender Roles - Essay Example From this research it is clear that gender roles have existed for almost as long as the human race has existed and it is quite possible that they will continue to exist in the future. According to the essay â€Å"Sex Roles† by McCubbin and Dahl, this is because gender roles depend on social orientations and cultural practices that mold people’s lives and mentalities. For example, if a person considers himself or herself to be female, he, or she would be expected to display the characteristics that are typically associated with being female. It would include traits such as being gentle, dependent, and expressive of their feelings. Therefore, culture and society is more important in determining the gender roles of an individual than their biological orientations are because biological factors remain constant depending on a person’s gender and yet social and cultural helps to determine gender roles of individuals within it and help individuals understand their socie ties. Even though the researcher agrees with McCubbin and Dahlwhen in their further argument that a person’s biological factors within a society have long been used to predict the person’s behavior, evidence discredits biological factors in favor of social and cultural factors. This is because the latter conditions vary with gender roles across societies. Similarly, according to the essay â€Å"Sex Roles† by McCubbin and Dahlwhen research on the relationship between sex hormones, that is the main biological factor, and physical and behavioral attributes is not yet complete.

Portfolio of two banks Essay Example | Topics and Well Written Essays - 1000 words

Portfolio of two banks - Essay Example The vision of the company is to provide its customers innovative products and services. The presence of Mashreq Bank is expanding as its performance is among the highest ranking banks in the UAE. The bank is renowned all across UAE and out of every two households one individual has an account in Mashreq Bank. The company has identified the importance of customer satisfaction and creating value therefore there is a number of â€Å"Service Centers† and also one of the largest â€Å"Automated Teller Machine (ATM) network all over the country. The bank is also on the verge of globalization and has twelve offices overseas (including Europe, United States, Asia and Africa). Mashreq Bank is one of the most profitable banks in UAE. It started successfully from the first year of inception and the financial growth is strong during the last decades. The bank has witnessed its market share rising, a solid equity base, the asset base keeps on growing and the returns gathered from the Assets increments. These are the competitive advantages the bank posses and also these characteristics are the bases of the â€Å"strong Financial Position† of the Bank. The Emirates National Bank of Dubai was formed in the year 2007. It was a merger between the second and the fourth largest banks of United Arab Emirates. The biggest advantage to the bank is that it gained the name of the two most renowned banks of the region. The reason of the merger was to become a giant and provide enhanced value in corporate, retail, private, Islamic services and the investment banking across the region. ENBD is the leading group in the market (Dubai); the bank celebrated its 50th anniversary. The vision of the bank is to achieve global recognition and to provide the most effective and efficient â€Å"Financial Services† all over the globe. The bank has 215 branches and the ATM and cash deposit machines fitted across the region and overseas are 889. The bank is promoting its Islamic

Nurses floating to different specialized areas Essay Example for Free

Nurses floating to different specialized areas Essay Abstract: Floating is a staffing strategy that is seen as a solution to the general problem of nursing shortage. Floating involves utilizing nurses to work in different specialized units. Floating has its advantages in that it gives nurses an opportunity for overall professional development and relieves them from additional responsibilities such as delegating and staffing. Float nurses stick to patient care. However, as they have to work in units for which they are not sufficiently educated or trained, they find themselves inadequate in providing quality patient care. Moreover, it affects their overall sense of connectedness with their patients, their peers, and their specialty department. Thus, floating of nurses is considered by many as a threat to both nurses and patients. However, more recently, it has been found that the float nurse can be trained to meet varied needs of specialized units. This is made all the more easier when the float nurse undergoes training for a cluster of closely related specialty units. Resource teams are float pools where specialty of the nurse is recognized and training is provided as per needs by the management. Introduction: Nursing shortage is one of the major issues facing the healthcare sector of the United States. This is attributed mainly due to lack of enthusiasm amongst the youngsters today for pursuing nursing as a career option and secondly due to the rising population. To counter the increasing demands of nursing, the concept of floating has been introduced in many hospitals and clinical settings. Floating is a very recent phenomenon in nursing introduced mainly due to problems such as staffing shortages and fluctuating census (Dziuba-Ellis, 2006). Nurses are in general trained to work in particular specialties. But working in different specialized units requires them to undergo cross-training. This causes stress to the nurses and they lose their efficiency and confidence of attending to critically ill patients in specialized departments. In fact, when nurses are floated to different specialized units, both the nurses and the patients suffer. While the nurses find themselves inadequately trained to work in certain specialized units, patients face the danger of negligent or faulty treatment. Suitable analysis of issues involved in floating of nurses to different specialized units shows that this is highly risky both from the viewpoint of nurses and the viewpoint of patients. This problem is particularly relevant in today’s context as the concept of having a float pool of nurses is touted as a solution to the overwhelming national problem of nursing shortage. This paper focuses on the issue of floating of nurses to various specialized units in the United States – the reasons for floating, impact of such floating on nurses, impact of floating on patients and how to adapt this concept to the situation of nursing shortage. This paper will not cover alternate solutions to nursing shortage. The floating of professional nurses to unfamiliar practice settings should be avoided as it leads to unsafe practice situations and if at all floating is found to be totally essential, it must be ensured that it is allowed only in emergency situations when an increased demand for nurses with general basic skills is expected. Literature Review: The research report titled Nursing Resource Team: An Innovative Approach to Staffing by Baumann et al (June 2005) contrasts the traditional float pools with resource teams and after detailed analysis of the case study of the Nursing Resource Team at Hamilton Health Sciences from September 2002 until June 2004, concludes that resource teams as an innovative staffing strategy creates opportunities for full-time work, and provide nurses with opportunities for professional development. According to Baumann et al, floating is not a new practice. Nursing shortages that existed between 1974 and 1979 lead to innovative staffing solutions and floating was one of them. However, floating came to be known as resource team in 1981 when the term was first used in an article to describe the creation and organization of a float pool (Baumann et al, 2005). Earlier, float pools or resource teams were used across Canada and the US to save expenditure, counter the shortage of nurses, fluctuations in patient census, acuity, volume, and care demands. Baumann et al point out that use of float pools/resource teams is often viewed as a staffing strategy – one that facilitates flexible manipulation of staff. Today, float pools are more of a recruitment and retention strategy and this is proved by a study conducted by Crimlisk (Crimlisk et al, 2002). Contrary to this finding, however, experts in Canada suggest float staff do not serve retention purposes. According to Baumann et al, the NRT approach is different from the float pool in that it recognizes nursing expertise. In the case of float pools, a nurse is regarded as a generic worked who is able to work with different patient groups and utilize many skill sets. Further, the literature indicates that float nurses may be deployed as either assistive or replacement staff. According to a study by organizational development specialist Suzanne C. Luongo, titled â€Å"Connectedness as a Motivator for Nurse Retention at the Bedside† (2004). It has been found that floating is a disruption to connectedness to patients and families, connectedness to peers and connectedness to administration of the institution. This study was based on group interviews of staff nurses who have been at the bedside for a minimum of 5 years and have received high evaluations. While the first study focused on defining the concept of floating and explaining how it is applied in the nursing context, the second study raises the warning that float nurses may not enjoy their job because the job takes away the connection that a nurse needs to develop with the patients, the peers, and to the administration. When nurses are shifted through various specialized units, they cannot follow up on patients continuously; they cannot form stable friendships among other nurses and will not form any attachment to any specialized unit (Luongo, 2004). Crimlisk et al (2002) in their study titled â€Å"New graduate RNs in a float pool: An inner-city hospital experience† focus on the view of nurse managers and nurse educators that fresh graduate RNs cannot be included in a float pool. They prefer to have experienced nurses with multiple skills. However, the authors say that new graduate RNs are highly motivated, ready-to-learn, educationally prepared and intellectually stimulated though they do not have much clinical experience. The authors present a program for training new graduate RNs to practice nursing in a float pool. It has been proved that the program resulted in a 96% retention rate Boston Medical Center Nursing Division (Crimlisk et al, 2002). Moreover, the program offered the medical surgical units a strong clinical support float nurse, nursing managers a staffing solution in times of need, and the new graduate RN a broad range of clinical experiences making them more valuable members of the healthcare team. According to Crimlisk et al, this training model can be replicated in other institutions. Thus, this study gives a positive approach to the inevitable staffing solution of having a float pool of nurses. Crimlisk concludes that fresh graduate nurses who do not have the experience needed to become a float nurse should be trained specially to become more flexible and versatile (Crimlisk et al, 2002). Thus, this study holds that floating of nurses to specialized departments does not necessarily need only experienced nurses. With training, even newly graduated RNs can handle various specialized services in nursing. The article titled Full-Time or Part-Time Work in Nursing: Preferences, Tradeoffs and choices by Jennifer Blythe et al (2005), reviews historical trends in full-time and part time work in the general workforce and among nurses in particular. The study was conducted at three teaching hospitals in Ontario with more than 400 beds and included 10 focus groups of RNs and RPNs. Fourteen additional interviews were conducted with hospital administrators who were knowledgeable about nursing work arrangements. According to this paper human resources managers in all hospitals agreed that investment in full time staff saved â€Å"costs, provided better coverage, higher commitment, lower turnover and more continuity of car and more stable relationships in nursing and multidisciplinary teams† (Blythe et al, 2005). To increase full time jobs, the paper reports that one hospital offered a float pool of full time nurses in critical care, maternal-child and medical surgical areas. This float pool was part of a training strategy to help novice nurses to progress from medical surgical settings to specialist areas with shortages. However, it was found that these floating jobs appealed only to nurses with particular needs. The first study indicated that float nurses could be absorbed as assistive or replacement staff. According to the second study float nurses suffer due to lack of connectedness whereas the third study showed that float nurses could be trained to acquire new skills. But despite such training and absorption, this study takes a neutral stand that only some nurses can enjoy the experiences that come through float jobs depending on their needs. While the lack of connectedness and lack of training are cited to be discouraging factors in floating nurses, this study brings in a third angle – that of needs of nurses. Only nurses with particular needs would like floating to different specialized units. According to the study by Hugonnet et al (2004) titled â€Å"Nursing resources: a major determinant of nosocomial infection? † there is growing concern that changes in nurse workforce and hospital-restructuring interventions negatively impact on patient outcomes. The review focuses on the association between understaffing and health-care-associated infections. Previous studies have shown that overcrowding, understaffing or a misbalance between workload and resources are important determinants of nosocomial infections and cross-transmission of microorganisms. Importantly, not only the number of staff but also the level of their training affects outcomes. The evidence that cost-driven downsizing and changes in staffing patterns causes harm to patients cannot be ignored, and should not be considered as an inevitable outcome (Hugonnet et al, 2004). The fact that ‘level of training’ affects outcomes is a major finding as float nurses often suffer from inadequate skills. In this study it has been found that such inadequacy can lead to nosocomial infections and cross-transmission of microorganisms (Hugonnet, 2004). Thus it is indirectly implied that floating of nurses can lead to such infections and cross transmission of microorganisms. This study brings out a scientific drawback in the floating of nurses – one that could be detrimental physically to both nurses and the patients. This finding is further strengthened by the finding of Stone et al (2004) who point out that nursing shortage is managed by many health care facilities by expanded use of nonpermanent staff, such as float pool and agency nurses. Overwork and fatigue among these nurses have been associated with medication errors and falls, increased deaths, and spread of infection among patients and health care workers (Stone et al, 2004). Issue Analysis: RNs at many health care institutions have traditionally been required to float to other units as a solution to the issue of staffing shortage. Staffing practices, like floating, cross-training and the use of larger float pools are highly debated with focus on quality patient care and less stressful environment at work for nurses. Studies show that nurses naturally want to use the expertise theyve gained over the years on their own specialized units. But if they must work in a different area, or even if they choose to work on different units, they want the appropriate orientation to provide competent, safe care. According to Christine Kane-Urrabazo, MSN, RN, in Said another way: our obligation to float, floating is a viable solution to the issue of nursing shortage. She says that the though floating is opposed on the basis of many arguments, they are not justifiable when weighted against the consequences of not floating (Kane-Urrabazo, 2006). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), requires all accredited organizations to ensure that â€Å"†¦all staff providing patient care and services on behalf of the organization are properly oriented to their jobs and the work environment before providing care, treatment, and services† (JCAHO, 2004, p. 5). This means, regardless of the settings, it is important for professional nurses to maintain clinical competence. According to the American Nurses Association (ANA, 2005), it is recommended that there should be a systematic plan for the cross-training of staff expected to float to ensure competence (2005). â€Å"The Psychological Stresses of Intensive Care Unit Nursing† by Hay and Oken focuses on floating in the ICU that provides complex nursing care (1972). The float nurse in the ICU is exposed to traumatic events such as death and dying, posing threats of object loss and personal failure. The nurse in the ICU needs to be familiar in handling many kinds of complex technical equipments and make correct measurements. The nurse in the ICU should be capable of making observations about her patients condition, to interpret subtle changes and use judgment to take appropriate action. Moreover, the nurse must maintain detailed records. Because of this and the nature of her tasks, temporarily floating in nurses from elsewhere when staff is short can be dangerous when the specialized unit concerned is the ICU (Hay and Oken, 1972). Kelly Herbig, RN-OCN, Rockford Memorial Hospital, Rockford, in her article titled â€Å"The highs of floating† in Nursing Spectrum says that she enjoys a lot of benefits as a float nurse. She points out that as a float nurse, she needs to focus only on patient care and need not deal with issues of staffing, delegating, and other charge-nurse responsibilities. Kelly Herbig says: â€Å"Floating to different departments and units affords me the chance to meet and work with a wide variety of staff and physicians†¦.. Talking to them about their experiences and viewpoints has helped me broaden my own views and given me a new perspective on nursing† (Herbig, 2004). Best of all she says that as a float staff, she is often viewed positively as â€Å"the help, the relief, the answer to the problem of short staffing†. On the contrary we have the case of Jackie. Badzek et al (1998) in her research article titled Administrative ethics and confidentiality privacy issues cites the case of Jackie. As a float nurse, Jackie found her work very stressful. She had to rotate between many units and patients. Each day she worked on a different unit with different co-workers. She developed few friendships or collegial relationships. She was often dispensing medications and treatments she found unfamiliar. When she attempted to ask questions, she found she approached gruff busy attending doctors and young uninformed house staff. Feeling trapped, Jackie began to divert narcotics (Badzek et al, 1998). This case highlights the plight of the float nurse without specific training and also offers a glimpse to the stress levels of an untrained float nurse. Many states have laws that indicate that it’s considered negligent or unprofessional for a nurse to offer or perform services for which she is not qualified by education, training, or experience. Therefore, accepting floating assignments for which the nurse is not qualified can jeopardize his or her career. There can be lawsuits and also disciplinary action by the state board of nursing. Disciplinary action can include license limitation, suspension, or revocation, and possibly mandatory continuing education (Gobis, 2001). In the study titled â€Å"When terror is routine: how Israeli nurses cope with multi-casualty terror†, authors Riba and Reches report on the case of Israeli nurses working in hospitals and looking after emergency care in times of terror attacks (Riba and Reches, 2002). Based on qualitative analysis of the data collected from focus group discussions involving 60 nurses and analysis of problems faced by them, the authors make a few recommendations in the context of floating. Riba and Riches recommend that post-basic courses in emergency medicine and trauma should be expanded to include emergency room logistics, stress management techniques, and debriefing strategies. Moreover, for nurses floating into emergency care from other departments, they suggest that an annual workshop should be held that includes drills for emergency care. They also suggest that the ER charge nurse should be provided training in leadership and group dynamics. Thus we find that the training that should be insisted for float nurses should be related to the specialized units for which they are chosen to work. This finding is also in accordance with the conclusion of the research report titled Nursing Resource Team: An Innovative Approach to Staffing by Baumann et al (June 2005). Indicators that can be used to measure success of these specially trained staff would be based on measuring retention in clinical settings where such trained float personnel are used. Susan Trossman, RN in her article titled â€Å"Staffing smart: A difficult proposition† says that cross-training to several units will make a nurse end up being an expert at little things and lose in-depth specialty advantage. Kim Armstrong, RNC, has worked at Tacoma General Hospital in Washington for 20 years. She agrees that cross-training gives RNs a greater range of skills. But, she says, It also dilutes skills. She clearly points out that floating nurses to various units and making them accept assignments for which they are educationally unprepared are putting their patients and their livelihood at risk. A nurse at the Elms College hearing illustrates this point. I was recently floated to Hematology/Oncology unit and had 8 patients. Six patients were on research protocols, each with 6 to 10 medications that I had to deliver. I didnt know any of these drugs. Many nurses do not even know their deficits (Nursing Report, 2001). In this context, it must be noted that there is a direct relationship to the skill of nurses and the number of nurses to patient outcomes (Nursing Report, 2001). All the above arguments indicate to only one clear solution. In a country that is facing nursing shortage, it would be unreasonable to say that floating should be totally banned. As numerous studies have shown, what is needed is adequate training of staff for various specialties. This argument is further stressed by Ruth Shumaker, RN, CNOR, and president of the Association of Operating Room Nurses, Inc. : The valuable nurse in the next millennium is the one who can do more who has the knowledge base to function as a specialist but also as a generalist working in multiple areas† (Trossman, 1999). Recommendations: While it is understood that float nurses need special training and education, one should remember that such skills imparted through short term programs tend to be forgotten if not used constantly. Hence they need regular scheduled workshops. Some recommendations to remember while choosing to have a float pool of nurses are (NYSNA, 2005): †¢ Nurses should not be floated to unfamiliar practice settings. †¢ If floating is deemed necessary, it should only be permitted in emergency situations that call for general nursing care. †¢ The RN should be able to self-evaluate and ask for further knowledge or training as her job needs. She should be granted the right to refuse assignments for which she is neither qualified nor trained. †¢ The charge nurse/supervisor should take the responsibility of allotting a particular float nurse to a particular specialized unit. If possible, she should assign a regular staff member of the specialized unit to guide and instruct the new float nurse. †¢ The healthcare facility should be able to perform needs assessment on a continuous process and provide inter department training as per needs. By monitoring trends in nursing indicators such as turnover, satisfaction, work-related illnesses and injury, overtime, etc. , they should also evaluate and maintain the quality of the nurse’s work life. Conclusion: Further research should be conducted as to the type of skills a float nurse is expected to perform in her various specialized units. It has been proved that resource teams that are an improvised float pool are ideal to counter the problem of nursing shortage. In resource teams, nurses work in their area of clinical expertise and preference, developing â€Å"in-depth knowledge of particular clinical populations. † Sometimes, nurses may be assigned as generalists and specialists from the float pool or resource team. It has been found that training is better possible when nurses are assigned to clinical clusters with certain patient populations. Examples of clustered units include critical care and emergency departments, adult medical-surgical, and pediatrics. However, nurses may also be sent to areas such as medical-surgical for which it is assumed only generic skills are required. The following general points should be remembered while implementing float pool nursing as a staffing strategy: Innovations should be introduced in a phased manner; it is important to have consistent leadership during the implementation phase; Orientation and interpretative sessions must be planned and roles of float nurses should be charted in detail; Evaluation should be done on a continual basis. With respect to the float pool of nurses, it must be ensured that their number is large enough so that there is no overtime. Care should be taken to ensure that clinical clusters include relatively narrow and related skill sets and areas of expertise. To make floating of nurses to different specialty units, a viable solution to the problems of nursing shortage and quality care, it is important that the top management, the nurse in charge and the float nurse all work in synchronization towards providing respect and support for development of float nurses as specialists with patient-specific expertise and experience. When individual nurses are deployed only to those areas for which they possess the requisite skills, there is mutual benefit for the nurses as well as for the patients to whom they offer their valuable services. Bibliography: American Nurses Association (2005). Utilization guide for the ANA â€Å"Principles for nurse staffing†. Silver Spring, MD: Author Joint Commission on Accreditation of Healthcare Organizations. (2004). Systems analysis. Ensure that your float staff and contracted staff are providing safe care. Joint Commission Perspectives on Patient Safety, 4(7), 5-6. New York State Nurses Association. (2005). NYSNA position statements, RN staffing effectiveness and nursing shortage. Latham, NY: Author. http://www. nysna. org/programs/nai/practice/positions/floating. htm Kane-Urrabazo, Christine (2006). Said Another Way: Our Obligation to Float. Nursing Forum. Volume 41, Issue 2, Page 95. April 2006. http://www. blackwell-synergy. com/doi/abs/10. 1111/j. 1744-6198. 2006. 00043. x Luongo et al (2004). Connectedness as a Motivator for Nurse Retention at the Bedside. July 24, 2004. Nurse Retention. http://stti. confex. com/stti/inrc15/techprogram/paper_17745. htm Hugonnet et al (2004). Nursing resources: a major determinant of nosocomial infection? Current Opinion in Infectious Diseases. 17(4):329-333, August 2004. Copyright Lippincott Williams Wilkins, Inc. http://www. co-infectiousdiseases. com/pt/re/coinfdis/abstract. 00001432-200408000-00009. htm;jsessionid=FDkbKKGyZ54nPbDSzyJwhhhBs1b8hS866nCYvc8Lxqp2qV1zHRp5! 2082300909! -949856145! 8091! -1 Crimlisk et al (2002). New graduate RNs in a float pool. An inner-city hospital experience. Journal of Nursing Administration. April 2002. 32(4):211-7. http://www. ncbi. nlm. nih. gov/entrez/query. fcgi? db=pubmedcmd=Retrievedopt=AbstractPluslist_uids=11984257itool=iconabstrquery_hl=6itool=pubmed_docsum Crimlisk et al (2002). New Graduate RNs in a Float Pool: An Inner-city Hospital Experience. Journal of Nursing Administration. 32(4):211-217, April 2002. http://www. jonajournal. com/pt/re/jona/abstract. 00005110-200204000-00010. htm;jsessionid=FDmP1gHbHHxZW8Rvmffskj9WcBrHyqH9WYdGTLq0ftDVdJyt8141! 2082300909! -949856145! 8091! -1 Dziuba-Ellis, Jennifer (2006). Float Pools and Resource Teams: A Review of the Literature. Journal of Nursing Care Quality. 21(4):352-359, October/December 2006. http://www. jncqjournal. com/pt/re/jncq/abstract. 00001786-200610000-00013. htm;jsessionid=FDmJkWq3P7J4btG4yWyy9L1CdkfnTw61myy60RB4WYG5RFRJ32wy! 2082300909! -949856145! 8091! -1 Badzek et al (1998). Administrative Ethics and Confidentiality Privacy Issues. Online Journal of Issues in Nursing. December 31, 1998. Available at http://www. nursingworld. org/ojin/topic8/topic8_2. htm Stone et al (2004). Nurses working conditions: Implications for infectious disease. November 2004. Emerging Infectious Diseases 10(11), pp. 1984-1989. http://www. ahrq. gov/RESEARCH/dec04/1204RA4. htm Herbig, Kelly (2004). The Highs of Floating. Nursing Spectrum. http://nsweb. nursingspectrum. com/cfforms/GuestLecture/HighsOfFloating. cfm Gobis, Linda (2001). The Perils of Floating: When nurses are directed to work outside their areas of expertise. The American Journal of Nursing. September 2001. Volume 101, Issue 9. http://www. nursingworld. org/AJN/2001/sept/Wrights. htm Riba and Reches (2002). When terror is routine: how Israeli nurses cope with multi-casualty terror. Online Journal of Issues in Nursing. Vol. #7 No. #3, Manuscript 5. Available: http://www. nursingworld. org/ojin/topic19/tpc19_5. htm Trossman, Susan (1999). Staffing smart: A difficult proposition. American Nurse. Nursing World. 1999. http://nursingworld. org/tan/99janfeb/float. htm. Nursing Report (2001). Report of the Legislative Special Commission on Nursing and Nursing Practice. May 2001. http://www. mass. gov/legis/reports/nursingreport. htm Blythe et al (2005). Full-Time or Part-Time Work in Nursing: Preferences, Tradeoffs and choices. Healthcare Quarterly Vol. 8 No. 3. 2005. Pages 69-77. www. nhsru. com/documents/Full-time%20or%20part-time%20work%20in%20nursing%202005. pdf Hay, Donald and Oken, Donald (1972). The Psychological Stresses of Intensive Care Unit Nursing. Psychosomatic Medicine. Volume 34, No. 2. March/April 1972. www. psychosomaticmedicine. org/cgi/reprint/34/2/109. pdf.

Taiwanese National Health Insurance Card :: Insurance Coverage Taiwan Essays

Taiwanese National Health Insurance Card Taiwanese government has been providing health insurance coverage to all its citizens since 1997. Initially, the National Health Insurance Agency managed and tracked citizen's medical usage via four versions of paper national health insurance card. The health insurance card, the newly born handbook, the pregnancy handbook, and major disease/handicap certificate. Whenever a citizen visits health clinic, the visit is recorded on the back of the appropriate ID. When the card is full, the citizen exchange the used card for a new one at the local NHI office. The NHI also receive medical records from medical establishments when they file for claims. Starting July 2003, the health insurance agency began its modernization process. It started consolidating four paper versions with the digital version-- a smart card containing IC chip. By Jan. 1, 2004, the entire country was upgraded to the digital NHI card. The goal of the modernization process is to reduce the NHI's operational overhead so that more resources may be directed toward medical care. It is expected to save over 42 billion NTD or roughly 1.2 USD over the period of seven years.5 In addition, visits to the health care provider will be more convenient, as patients no longer need to bring multiple ID/handbooks with them to medical facilities. And there will be no need to visit local NHI office for new ID cards. For health care providers, the digital card provides a electronic infrastructure that allows them to streamline the claim filing process avoiding mistakes. It also allow NHI to provide a more efficient collection mechanism to gather accurate information regarding ove rall citizen's health and disease statistics. Despite its well intention and the ambitious plan, the modernization plan has serious ethical consequences. When the modernization process is completed, the NHI will has the most extensive online database of Taiwanese citizens. The database will contain nearly every citizen's medical record for his or her entire life. It will also contain the most up to date personal information such as home and work addresses. Because of the extensive nature of the database, if the database is misused, the consequence will be severe. Furthermore, Several human rights advocacy group has pointed out the infrastructure is insufficient to protect citizens' privacy rights as well as the lack of will on government's side to protect individual's personal information. And there is fear that there is risk that the leaked medical information can be used to persecute a specific segment of the population.

Brand Obsolesce

Brand is a valuable intangible asset of an entity. It takes a large span of time to build up a brand. Reliability and permanence of a brand depends directly upon goodwill and performance of an entity. There may be slight variations in its value in monetary terms but marketing tools such as advertisements and word-of-mouth publicity can help in regaining its status. There is no particular reason for a brand to be obsolete once it’s built up in its entirety. A brand can only be successful if its owner company possesses some goodwill in the market.A company’s goodwill depends upon factors like its past performance, integrity, objectivity and ethical values. These factors are mostly regulated by frameworks which possess legitimate power and it becomes a responsibility of a company to respond to the requirements of such frameworks. If a company succeeds in complying with the standards and other regulations, its goodwill becomes stable. Once a company’s goodwill is est ablished, it keeps growing with the passage of time. A quite familiar example might be of a very successful brand, Coca Cola.This brand has been around since 1944 and it’s getting more and more successful by the minute. There have been slight variations in its value, but such variations did not hamper its growth. A brand needs to be acclimatized with the changing behavioral patterns of the market. The brand stewards are accomplished detectives, constantly searching for what works, and what works against, the cause (Lynn B. Upshaw, p. 42). One factor which may pose threat to the existence of a brand is its competitor.In case of Coca Cola, Pepsi has been its rival since inception. This scenario leads to ‘Brand War’ which should be handled sensitively while constructing long-run policies of a company. Advertisement is the most effective tool for faming or defaming a brand, this tool should be used to handle such situations. A company should adjust its marketing poli cies in a proactive way. Pro-active policies help a company prepare for any expected or unexpected attack on its brand, before it actually happens.Everyone agreed brands were a good thing, but no one thought much about measuring the value of a brand as a stand-alone asset (Hill & Lederer, p. 61). Brands should be quantified and valued on a regular basis. This assessment highlights any impairment in its value or any change in market trends. Continuous assessment of the value of a brand helps a company decide whether any modifications are needed in its marketing policies and what steps should be taken to regain the value of a brand, in case it has been impaired.Organizations need to develop internal alignment with their brand amongst internal stakeholders and resources, and build strong external alignment with external stakeholders, consumers and partners (Thomas, 2010). Managing brands has always been a challenge for a company. Either it is a newly created brand or it has been in exi stence for ages, it needs regular acclimatization based on feedback from the external as well as internal environment of a company.If a brand is evaluated on a regular basis and proactive steps are taken to save its value, there is no reason left for a brand to be obsolete. References Hill, S. and Lederer, C. (2001). The infinite asset: managing brands to build new value. First Edition. Harvard Business Press. Thomas, G. M. (2010). Managing brand performance: Aligning positioning, execution and experience. Journal of Brand Management, 17, 465-471. Accessed on August 19, 2010 from Upshaw, L. (1995). Building Brand Identity, John Wiley and Sons.

Similar Gothic Elements in the Work of Edgar Allan Poe and Nathaniel Hawthorne

Similar Gothic Elements in the Work of Edgar Allan Poe and Nathaniel Hawthorne Nathaniel Hawthorne and Edgar Allan Poe are considered masters of American gothic fiction. They used similar gothic elements in their writing and used it to build up a sense of impending doom. Even today numerous readers enjoy, study, and discuss the gothic elements both utilized in their work. Gothic writing is a style that is concerned with the dark side of society, an evil that lies within the self. Poe and Hawthorne contributed stories which contained dark struggles between characters and society with its rules of order of the time. Gothic writing is fantasy meant to entertain despite the fact that it depicts the political and social problems happening at the time. Nathaniel Hawthorne and Edgar Allen Poe used their writing to allow them and readers deal with the problems of society, their own lives, and their inner demons. Poe and Hawthorne’s works are still being interpreted by generations of readers on many different levels. Nathaniel Hawthorne was one of the most valiant and significant writers of fiction before the Civil War. He gained fame for publishing, The Scarlet Letter, and was praised for his literary style. The Scarlet Letter, allowed him to direct attention to issues he valued. Other stories like, â€Å"The Birthmark,† and, â€Å"Rappaccini’s Daughter,† provided a unique view of a how a male dominated society can harm its women. Author Henry James considered him a genius and the most significant writer of his time (Norton Anthology, â€Å"Nathaniel Hawthorne† 1272). Often Hawthorne’s jobs pulled him away from his writing but allowed him to support his family. Hawthorne skillfully used gothic elements in his writing to create a clear picture of some approaching death. Though he favored his poetry, Edgar Allan Poe was a master weaver of horror tales who influenced other writers such as T. S. Eliot and William Faulkner (Norton Anthology, â€Å"Edgar Allan Poe† 1531). His lifetime of troubles may have shaped his stories of haunting and death. His reputation as one of the key writers of the macabre in the 18th century is due to selections of poetry and prose such as, â€Å"The Raven,† â€Å"The Purloined Letter,† â€Å"The Tell-Tale Heart† and â€Å"The Cask of Amontillado. † His story, â€Å"The Murders in the Rue Morgue,† is considered to be the first modern detective story. Poe tried to make writing his sole means of work but found that was not possible so he spent time doing different jobs and even joining the military for a time, none of which worked out. He was prone to drinking and had health issues most of his life. For a time, he was an editor for different publications. However, after the death of his wife, Virginia, Poe’s weakness for drinking increased and partly contributed to his death. Hawthorne and Poe used gothic elements in their writing to build up the sense of impending doom. For example, â€Å"Some of Edgar Allan Poe’s work seems to follow a pattern: the indeterminate urban situations, the nightmare intensities, and above all, the confusions of consciousness as the protagonist’s madness destabilizes narrative and setting† (Lloyd-Smith, â€Å"Chapter Three† 30). Poe used these near death situations and a dreamlike feeling in his writing coupled with his morbid sense of humor to reverse the outlook of his readers. He combined in his poetry and prose ways to make his readers quiver unspeakably and tantalize them with psychological complexities. In the selections â€Å"The Fall of the House of Usher,† and â€Å"The Murders at Rue Morgue,† he incorporates gothic elements of fantastic excess which invite and challenge interpretation (Lloyd-Smith, â€Å"Chapter Three† 32). To illustrate this, â€Å"Nathaniel Hawthorne similarly internalized and domesticated the Gothic to explore its insights into the psychology of everyday life, and its applicability to history† (Lloyd-Smith, â€Å"Chapter Three† 33). His tales are full of magical or fetish objects which are used to show a series of historical and personal meanings (Lloyd-Smith â€Å"Chapter Three† 33). Hawthorne used these elements to create a atmosphere of gothic strangeness that fascinate the reader due to the variety of meanings it contains such as the scarlet letter in his novel, The Scarlet Letter, â€Å" or the cryptic veil in â€Å"The Minister’s Black Veil. In particular, â€Å"‘The Fall of the House of Usher,’ is justly the most famous of all Poe’s gothic horrors. For it is only within the context of this nightmare that one can explain why â€Å"Usher,† occupies such an important place in the 19th century development of the Gothic genr e. With great attention to economy of expression and unity of effect, this pattern would be revisited by countless other Gothic stylists† (Dougherty 6). This means that Poe used the fantasy of impending doom in â€Å"The Fall of the House of Usher† to change it from being just an upper class dream, to a tale of horror which brought together some of the political situations in the nineteenth century such as those of race and class. Hawthorne and Poe successfully incorporated gothic elements in their writing which provides greater insight to the meaning and interpretation of their works. Nathaniel Hawthorne and Edgar Allan Poe utilized specific literary elements to bring their stories to life for their readers. For instance, Poe uses imagery to transform â€Å"The Fall of the House of Usher,† into a rebellion of inharmonious elements. The house has the same structure as a human head, with windows shaped like eyes, and as it begins to fall into disrepair so to do the humans inhabiting the home, Roderick and Madeline. They are no longer governed by reason and there is a shift to corruption, insanity, and irrational behavior (Bloom 32). This means that the disintegration of the home mirrors the impending death of those living in the home as well. Ultimately, the home crumbles and is swallowed into the waters of a small lake after Madeline and Roderick die. In addition, Nathaniel Hawthorne prolific use of â€Å"emblems in his writing alerts us that they are allegories and that the stories go beyond the regional, historic, pastoral and gothic boundaries which generate and define them† (Heim & Bloom 49). This means in â€Å"The Birthmark,† the birthmark itself actually symbolizes life as opposed to imperfection because when Aylmer removes it from his wife’s face, he achieves the perfection he is seeking, but at the cost of her life. Alas, it was too true! The fatal Hand gad grappled with the mystery of life, and was the bond by which an angelic spirit kept itself in union with a mortal frame. As the last crimson tint of the birth-mark—that sole token of human imperfection—faded from her cheek, the parting breath of the now perfect woman passed into the atmosphere, and her soul, lingering a mome nt, near her husband, took its heavenward flight† (Norton Anthology, â€Å"Nathaniel Hawthorne† 1331). In addition, the emblem he uses in The Scarlet Letter, suggests the reader should seek more meaning regarding what it really was and what it was telling the reader because it was about more than just about forbidden love. In â€Å"Rappaccini’s Daughter, the garden itself became a source of poison despite its incredible beauty because the flowers that made it beautiful could kill anyone who comes close to them. Moreover, â€Å"Hawthorne’s tales are critiques of the nature and efficacy of conflicting values with which moral problems can be met† (Heim & Bloom 53). This means that because of his Puritan heritage, Hawthorne used his writing to explore the exchange of and the difficulty between situations dealing with desires and imagination. He looked at the moral problems and the limitations where desires and actions connect and struggle. In The Scarlet Letter, the circumstance is set for the struggle of forbidden sexual intercourse between Minister Dimmesdale and Hester Prynne. Poe and Hawthorne contributed stories which contained struggles between characters and the society and its rules of order of the time. For example, Hawthorne’s tales are often constructed to suggest that they are narratives veiled by something in the structure of the narrative itself† (Heim & Bloom 68). This means that Hawthorne’s selections describe people who are torn between their own wishes and the differing demands of society and its rules of right and wrong. They test one’s limits and the possibilities of sin and virtue with a great anxi ety for righteousness. Hawthorne had an intimate understanding of the elements that makeup and set apart the human condition. To illustrate, for Edgar Allan Poe â€Å"reason seems a masquerade, adopted only when convenient as in his analysis of his own poem, â€Å"The Raven,† that refuses submission to its rule. He claimed the existence of a Higher Reason, accessible by intuition and introspection and Poe’s fiction plays around this theme showing how his narrators attempt to contain their irrational experiences, drives, and desires within the rational framework†(Lloyd-Smith, â€Å"Chapter Five† 68). Poe believed reason was useful on his terms and the irrational could be controlled to a certain degree. This is why he is considered the father of the short story. In addition, Poe’s prose, â€Å"continually confronts the material of the real body; or the corpse. Death is perpetually confronted, but the doorway opens only to the horror of this intransigent ‘real’† such as in, â€Å"The Tell Tale Heart, which begins with the narrator explaining his reason for committing murder (Lloyd-Smith, â€Å"Chapter Five† 69). â€Å"He had never wronged me. He had never given me insult. For his gold I had no desire. I think it was his eye! Yes, it was this! He had the eye of a vulture—a pale blue eye, with a film over it. Whenever it fell upon me, my blood ran cold; and so by degrees—very gradually—I made up my mind to take the life of the old man, and thus rid myself of the eye forever† (290 Poe). Also, characters in Poe’s stories seem to be awaiting death and cheat it long enough to be able to convey their last message before meeting some horrifying end. His narrators also began by explaining the reason for their misdeeds or misfortunes to the reader as a preface to the actual story. Hawthorne and Poe also used their writing to allow them to deal with the problems of society, their own lives, and their inner demons. To illustrate, â€Å"The Gothic world Hawthorne created in his fiction—with it’s his gloomy settings, concern with death, and explorations of the demonic—is central to his moral and thematic purposes as it allowed him a broad realm through which he could tell the dark truths about the world as he perceived it† (Lloyd-Smith, â€Å"Chapter Five† 71). This means that the gothic elements he used in this writing allowed him to tell about social injustices he felt strongly about. Some such issues were slavery and the degradation of women in a male dominated society. For example, â€Å"Poe's works are associated with death and horror, and he finds a place among the gothic writers. In fact, Poe's use of death as a central motif finds service only in his pursuit of the â€Å"effect† which Poe suggests should be the motivation behind the creation and development of any short story†Ã‚  (Pahl 8). The use of death as a central theme in his writing was helpful only if they produced a physical effect on the reader. Poe felt this gothic element should be the driving force behind any short story that is to be developed and worthy of reading. In addition, â€Å"Poe strived to achieve an emotional effect of either melancholy or terror when he chose the unanticipated and undeserved death of young maidens–soul mates either as wives or sisters–as the subject most likely to inspire this gothic effect† (Pahl 10). Poe often chose to portray women in his works as weak, sickly and almost deserving of some ghastly demise. The characters were usually young and whose roles were that of sisters or wives in the selections. Finally, Hawthorne and Poe both had a fascination with death and the supernatural, which they included in their writing. These gothic elements coupled with the lessons about life, death, morality, sin and virtue in a male dominated world make their writing major sources of study and discussion even today. Readers can choose to focus on Poe’s specific situations set up to produce a reaction or Hawthorne’s ability to draw attention to details and setting. Clearly these two gothic fiction writers helped establish the American short story with a dark twist. Works Cited Bloom, Harold. â€Å"Thematic Analysis of â€Å"The Haunted Palace†. â€Å"Bloom’s Major Poets: Edgar Allan Poe (Jan. 1999): 32-35. Literary Reference Center. EBSCO. Laredo Community College Library, Laredo, TX. 06 June 2009 http://search. ebscohost. com/login. aspx? direct=true&db=lfh&AN=16466202&site=ehost-live Dougherty, Stephen. â€Å"Foucault in the House of Usher: Some Historical Permutations in Poe's Gothic. † Papers on Language & Literature 37. 1 (n. d. ): 3. Literary Reference Center. EBSCO. Laredo Community College Library, Laredo, TX. 0 June 2009 http://search. ebscohost. com/login. aspx? direct=true&db=lfh&AN=4316178&site=ehost-live Hawthorne, Nathaniel. The Norton Anthology of American Literature. Ed. Nina Baym et al. Vol. B. New York, W. W. Norton & Co. , 2007. 1272-1495. Heims, Neil, and Harold Bloom.. â€Å"An Introduction to Some Elements of Nathaniel Hawthorne's Fiction. † Bloom's BioCritiques: Nathaniel Hawthorne (Jan. 2003 ): 49-78. Literary Reference Center. EBSCO. Laredo Community College Library, Laredo, TX. 24 June 2009 http://search. ebscohost. com/login. spx? direct=true=lfh=16305750=ehost-live Lloyd-Smith, Allan. â€Å"Chapter Five: Major Themes in American Gothic. † 65-132. Continuum International Publishing Group Ltd – Books, 2004. Literary Reference Center. EBSCO. Laredo Community College Library, Laredo, TX. 24 June 2009 http://search. ebscohost. com/login. aspx? direct=true=lfh=23674509=ehost-live   Lloyd-Smith, Allan. â€Å"Chapter Three: How to Read American Gothic. † 25-35. Continuum International Publishing Group Ltd — Books, 2004. Literary Reference Center. EBSCO. Laredo Community College Library, Laredo, TX. 25 June 2009 http://search. ebscohost. com/login. aspx? direct=true=lfh=23674507=ehost-live Pahl, Dennis. Architects of the Abyss The Indeterminate Fictions of Poe, Hawthorne and Melville. Columbia: University of Missouri Press, 1989. Poe, Edgar A. The Norton Anthology of American Literature. Ed. Nina Baym et al. Vol. B. New York, W. W. Norton & Co. , 2007. 1528-1626. Poe, Edgar A. â€Å"The Tell Tale Heart. † The Portable Poe. Ed. Philip Van Doren Stern. New

Wound care essentials summative assignment The WritePass Journal

Wound care essentials summative assignment Reference List Wound care essentials summative assignment IntroductionSection 1. Search strategySection 2. Wound aetiologySection 3. Wound AssessmentSection 4. Wound ManagementSection 5.Reference ListRelated Introduction Section 1. Search strategy Describe the strategy you used to retrieve the right resources to help you write your assignment. You must include the key words you used, the databases used and other sources of your literature such as websites, the years searched and the type of literature you were looking for. Approximate word count: 150-200 Your answer here: Keywords used in the search engine are: diabetic, foot, ulceration, risk, prospective, aetiology, prevalence, cost, infection, dressing, treatment, amputation, wound, management, policy, guidelines, UK, Philippines, South Asia, Europe, which were consecutively joined together, using the Boolean Operation of adding AND and an asterisk to each terms. The main databases used were CINAHL plus and PubMed.   Another source of evidence that the researcher used is the official website of the National Institute for Health and Clinical Excellence in which a clinical guideline was used deemed necessary for the said topic. The World Health Organization and the National Health Services websites were also used in collecting data for statistics as well as the Department of Health website in the Philippines. Peer reviewed articles have been searched using the said databases and have been sources of information. Limitations in this search have been identified. These are as follows: The search has been limited for ten years only to make the search more manageable and clinically up to date while capturing key information. The search is only applicable for humans aged 65 and up, regardless of gender.   This bracket has been chosen because according to the World Health Organization (2006) diabetic foot ulceration is rampant in this age group. The search is limited for peer reviewed journals only. The search is not confined to the United Kingdom only; hence, statistics from Asia were also gathered. Section 2. Wound aetiology Select a common wound type (e.g. diabetic foot ulceration, pressure ulcer, leg ulcer, fungating wound, dehisced surgical wound. Now explain and discuss: What your chosen wound type is How this type of wound develops (including contributory factors) How this type of wound is recognised (common characteristics) Who it affects Prevalence in UK and home country (if known) Approximate word count:   800-1000 Your answer here: The type of wound that the author chose is diabetic foot ulceration. This was chosen because this type of wound is prevalent in the nursing home that the author is currently working at and Diabetes itself is a serious health issue worldwide.   Consequently, diabetic foot ulceration is considered to be one of the most significant complications of diabetes, representing a worldwide issue of medical, social, and economic problem greatly affecting the patient’s quality of life. (World Health Organization, 2004)   Earlier definitions of diabetic foot ulceration dated back to 1985 by the World Health Organization stating that it is an infection, ulceration, and/or destruction of deep tissue related with neurological abnormalities and various degrees of peripheral vascular disease in the lower extremities. This has been argued by Brownlee (2005) that the term ‘diabetic’ foot signifies that there are specific qualities about the feet of the individual with diabetes th at sets this disease apart from other conditions that affect the lower extremities. However they added that anything which affects the foot in those with diabetes can also affect the foot in those without the disease. Thus the definition by De Heus-van Putten (1994) best neutralise those views, stating that diabetic foot ulcers is the many different lesions of the skin, nails, bone, and connective tissue in the foot which occur more often in diabetic patients than non-diabetic patients, such conditions like ulcers, neuropathic fractures, infections, gangrene, and amputation. This is supported by the contemporary study of Vileikyte (2001), presenting that the diabetic patients are statistically more likely to develop foot ulcer that usually leads to disablement and leg amputation. The aetiology of diabetic foot ulceration comprises many components. A multicentre study by Rathur and Boulton (2007) attributed 63% of diabetic foot ulcers to diabetic neuropathy and peripheral vascular di sease to be the main causative factors of diabetic foot ulceration. Peripheral neuropathy is a complication of diabetes that is the result of overtime damage of the nerve due to high blood sugar levels (Jerosch-Herold, 2005). This complication consequently contribute to the cause of diabetic foot ulcer for the nerves that relay messages of pain and sensation to the lower limb are generally affected, leading to numbness or even complete loss of sensation in the legs and feet. Losing sensation would also mean not knowing if the feet are hurt or damage. This explains why diabetic patients are usually prone to problems like minor cuts, bruises and blisters without them feeling it.   Ã‚  Furthermore, another risk factor is the peripheral vascular disease wherein there is narrowing of the arteries caused by fatty deposits that accumulate in the lining of the arteries resulting to poor blood circulation to the feet (Medina, Scott-Paul, Ghahary Tredget-Edward, 2005). Inadequate blood sup ply to the wound means decrease healing and is likely to be damaged. This explains why even a mild injury like stepping in small object or a small scratch in bare foot can eventually become ulcer for a diabetic patient. Moreover, according to Veves, Giurini, and LoGerfo (2006), predisposing factors that may act in combination to the two main risk factors are the unrecognised trauma, the biomechanical abnormalities or deformity, the limited joint mobility, and the increased susceptibility to infection. Demographic factors also play an effect on diabetic foot ulceration, such as age, gender, ethnicity and lifestyle (Medina, Scott-Paul, Ghahary Tredget-Edward, 2003).   According to the World Health Organization (2004) Diabetic foot ulcerations are common on individuals who have Type 1 and Type 2 Diabetes and who are in the age bracket of 65 years old and above. This statistics is not only relevant here in the UK but also worldwide. People who have diabetes for a longer period or man age their diabetes less effectively are more likely to develop foot ulcers.  Smoking, not taking  exercise, being  overweight and having  high cholesterol  or blood pressure can all increase diabetes foot ulcer risk (Diabetes UK, 2004). Previous foot ulcers and diabetes complications can increase foot ulcer likelihood, as can ill-fitting shoes or previous foot problems such as bunions, etc. Diabetic foot ulceration usually located in increased pressure points on the bottom of the feet. However, ulcers related to trauma can occur anywhere on the foot (Diabetes UK, 2004)   Anatomical distribution of diabetic foot ulceration comprises 50% of ulcers are on the toes; 30-40% are on the plantar metatarsal head; 10-15% are on the dorsum (sole) of the foot; 5-10% are on the ankle; and up to 10% are multiple ulcers (Department of Health, 2002). According to the National Diabetes Support Team (2006), the appearance of a diabetic foot ulcer generally has a base with pink/red or brown/black, depending on the patient’s blood circulations, and with a border of ‘punched-out’ like appearance while surrounded by callous skin. It has a bed with necrotic cap or ulcer (underlying tissues are exposed). Ulcers  with a mainly neuropathic aetiology will have a healthy granulating bed whilst those with a significant arterial component will have a necrotic bed (Reiber, 200 1). The International Diabetes Federation (2005) accounts that there are 170 million cases of diabetics reported worldwide. By 2025, this figure is expected to rise to 300 million. These diabetics patient have a 12-25% risk of suffering a foot ulcer at some time in their life. According to Reed (2004), elderly people with diabetics have twice the risk of developing foot ulcer, three times the risk of developing foot abscess and four times the risk of developing osteomyelitis. Similarly, diabetics were at greater risk of either local amputations or higher amputations (Hall DeFrances, 2003). Since different regions of the world have populations that at variance in body builds, footwear, habits and lifestyles, the differences in the prevalence of diabetic foot ulceration is expected. Such differences are likely to be found in Asia, Africa and America for developing countries will experience the greatest rise in the prevalence of Type 2 diabetes in the next twenty years (Stanley Colli er, 2009). Thus, people living in these countries will be expected to have greater risks of ulceration in the later years. However, Abbott et al (2005) focused on Type 2 diabetics among migrant populations of South Asia and African-Carribean populations, compared with data from Europeans living in the UK, and revealed a three to four times higher incidence of ulceration in the Europeans. The lower risk of South Asians was attributed to the lower rates of foot deformity, peripheral vascular disease and neuropathy. In the Philippines on the other hand, the author was not able to find statistics regarding the prevalence of diabetic foot ulcerations on individuals with either Type 1 or Type 2 Diabetes. Apparently, the Department of Health Philippines website does not have relevant statistics regarding the above matter however, according to the World Health Organization (2004), the prevalence of people having diabetes in Asia is fast rising and it may comprise to 75% of all diabetics in 2025 worldwide. Section 3. Wound Assessment Identify one feature of your chosen wound type that is commonly identified during the assessment process and critically discuss different ways of assessing this problem. Your discussion must make clear which aspect of wound assessment you have chosen e.g. exudate, odour, infection, and include an exploration of the different options available for measuring, describing and documenting it. You must link your discussion to the contemporary wound care literature. Approximate word count: 800-1000 Your answer here: When a diabetic patient develops an ulcer, it is very essential to know that the ulcer presents in the perspective of the diabetic. However, in the case of a diabetic patient, the skin usually in the feet does not heal efficiently and is prone to develop an ulcer as discussed on the previous section. This is what the writer believes to be the foremost feature of the diabetic foot ulceration that needs major consideration for it can eventually result to infection. Assessing the delay wound healing of a diabetic foot and its relation to the aspect of infection involves thorough evaluation, thus, a general assessment by the multidisciplinary care approach of the patient with diabetic foot ulcer is fundamental. This includes evaluating for evidence of retinal and cerebro-vascular pathology that could relate to foot and ankle problem (Pham et al, 2000). The said evidence can play a part to falls, traumatic injury and poor foot hygiene of the patient and can aid in appropriate treatment of the wound. The renal and cardiac disease evaluation is another pathological assessment that can contribute to the evaluation of poor healing potential (Stanley Collier, 2009). The standard observations of blood pressure, heart rate and temperature are also requisite assessment for these can reveal overriding features of sepsis such as pyrexia, tachycardia and general malaise (Costigan, Thordarson Debnath, 2007).   Stanley and Collier (2009) also added that in spection of the diabetic foot such as the characteristics of the skin, nails, and web spaces, is important for it can reveal pathology of the nails (Paronychia) or the cause of the spread of infection. Generally, limb-threatening infections can be defined by cellulitis extending 2cm from the ulcer perimeter, as well as deep abscess, osteomyelitis   or critical ischemia (Frykberg et al, 2002). The existence of odor and exudates, and extent of cellulitis should be properly noted for these are indicative of osteomylitis which could indicate infection (Frykberg et al, 2002). In the case of neurological assessment, Jerosch-Herold ‘s (2005) assessment review stated that Semmes-Weinstein monofilament is considered to be the most reliable test for evaluating any loss of protective sensation done in the sole of the feet. The test is not only relevant in assessing loss of sensation; it also evaluates foot deformity, risk for ulceration and signs of infection. Moreover, a vital part in this assessment is the classification of diabetic foot ulcer itself. This is supported by Frykberg et al (2002) stating that classifying ulcer is important in order to facilitate a logical approach to treatment and aid in the prediction of outcome. In line with that, there are several wound classification guidelines used universally to assess the diabetic foot ulcer. One of this is the Wagner ulcer classification system (1987) is the most widely accepted descriptive classification of diabetic foot ulcerations. It categorises wound depth according to 6 wound grades. These include: grade 0 (intact skin), grade 1 (superficial ulcer), grade 2 (deep ulcer that includes tendon, bone, or joint), grade 3 (deep ulcer with abscess or osteomyelitis), grade 4 (forefoot gangrene) and lastly grade 5 (whole foot gangrene). However, the downside of the Wagner classification system is that it does not specifically address the aspect of infection and circulation problem, which are actually the important parameters of diabetic foot ulceration.   However, this method is not really very reliable in assessing ischemia and infection because only useful guidance in the management of each class of ulcer is provided. Nonetheless, a more comprehensive scale has been developed at the University of Texas, which includes risk stratification and expresses tissue breakdown, infection and gangrene separately. According to Abbott et al (2005),   this system is generally predictive of the outcome for it uses four grades of ulcer depth (0 to 3) and then stages them into four stages (A to D) basing on the presence or absence of ischemia and   infection. The classification system assesses the depth of ulcer penetration, the presence of wound infection, and the presence of clinical signs of lower-extremity ischemia. Similarly, the International Working Group on the Diabetic Foot (2004) has proposed the PEDIS classification which grades the wound on a 5-feature basis: Perfusion (arterial supply), Extent (area), Depth, Infection, and Sensation. Finally, according to the Infectious Diseases Society of America guidelines (2004), the infected diabetic foot is sub-classified into the categories of mild (restricted involvement of only skin and subcutaneous tissues), moderate (more extensive or affecting deeper tissues), and severe (accompanied by systemic signs of infection or metabolic instability). In addition to that, another form of assessment for infection is the surface swab. But according to Bowker and Pfiefer (2001), it is inadequate for identifying the type of bacteria causing limb-threatening deep infection. The most accurate and reliable technique involves removing exudates from the ulcer, getting a little tissue biopsy from the base of the ulcer and sending the sample to the laboratory in appropriate aerobic and anaerobic culture material. Plain film radiographs should also be obtained to look for tissue, gas and foreign bodies and to evaluate the infected ulcer for bone involvement. (Sutter Shelton, 2006) Probing to bone using aseptic technique is also done to find out if osteomyelitis is present. Section 4. Wound Management Using the same wound feature that you identified in Section 3; critically discuss the different ways there are of managing this problem. Your discussion must include: The different types of wound care dressings, products and treatments that could be used to manage this problem Other appropriate/related aspects of patient care such as nutrition and positioning How the patient experience can be improved Approximate word count: 800-1000 Your answer here: After a comprehensive assessment, an ulcer management plan must be developed to direct treatment goals. In the treatment of diabetic foot ulceration, the primary goal is to attain wound closure and to control infection (Frykberg et al, 2002). In order to achieve this goal good wound care techniques are required. Part of this wound technique are dressings. Wound dressings represent a part of the management of diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide protection for the wound and promote healing. (Hilton, Williams, Beuker, Miller Harding, 2002) In line with that, the NHS (2002) released a guide for useful dressings which included dressings for infected diabetic wound. Dressings that are low or non-adhering must be used on infected diabetic wounds with daily dressing changes. According to Foster, Greenhill, and Edmonds (2007), the ideal dressing for infected diabetic foot ulcers are those that fit in the shoes and does not take up too much room, it could withstand shear forces and carry out properly in an enclosed environment, does not increase the risk of infection, absorbs exudates suitably as well as allow drainage and it can be changed frequently and can be removed easily. Hydrocolloids are the best example of such dressings. They contain gel-forming agents, such as gelatin, so when the dressing comes into contact with wound exudate it absorbs ï ¬â€šuid and forms a gel which creates a moist healing environment (Heenan, 2008).   According to Pudner (2001), it is advisable to use hydrocolloids in a diabetic foot ulcer as they absorb exudates and can give a visual indication of the need to change dressing. This kind of dressing can be easily removed by gently lifting an edge of the dressing and pulling carefully upwards to reduce the seal of the dressing on the skin and thus minimise trauma to the wound bed and surrounding skin. (Pudner, 2001) Regular dressing changes are done to monitor deterioration of the ulcer. Dressi ngs with Inadine, Iodoflex or Iodosorb are also used to reduce bacterial inhabitation in the ulceration. Daily Flamazine dressings are also recommended for the treatment of Pseudomonas infection. (Sibbald et al, 2003) When the infected diabetic wound become heavily exudated, foams and alginate may be used because they are highly absorbent.   Hydrogels facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing Inadine and Silver may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds. All dressings require frequent change for wound inspection. (Armstrong, Lavery Harkless, 2003) Another management is debridement. The purpose of this is to remove dead or devitalised tissue. (Bowker Pfeifer, 2004) It is also recognised as one of the most important methods of wound bed preparation because it promotes the release of growth factors which contribute to progressive wound healing. (Leaper, 2002) Ulcer debridement is performed to remove unhealthy tissues such as necrotic, callus and fibrous tissue and recondition them back to bleeding tissues in order to facilitate full image of the extent of the ulcer and its underlying problems like abscesses or osteomyelitis (National Diabetes Support Team, 2006).   Offloading must also be part of the management plan for the infected diabetic foot ulcers to relieve pressure from the wound to allow healing to take place. (Doupis Vevies, 2008) However, offloading devices might be impractical for diabetic individuals who are frail or susceptible to falls, and a disadvantage of devices that cannot be removed is interference with b athing and showering. (Caravaggi, Faglia, De Giglio, 2000) In addition to the management stated above, antibiotic treatment is also necessary. The antibiotic regimen should be based on the anticipated spectrum of infecting organisms. (Chantelau, Tanudjaja Altenhofer, 2006) The combination of an aminopenicillin and a penicillinase inhibitor has the required activity but other options include a quinolone plus either metronidazole or clindamycin. (Tentolouris, Jude Smirnoff, 2003)   In addition to antibiotic therapy, It may also be necessary to promote non weight bearing strategies such as bed rest and or use of wheelchair, crutches, walker, or cane. Diabetic individuals may also be advised to replace or modify their footwear. The lack of sensation associated with neuropathy can result in the tendency to buy shoes that are too small or too tight. It is necessary to accommodate any foot changes or deformities. Orthoses or custom-made shoe inserts may be required for pressure reduction. (Armstrong, Lavery, Harkless, 2003) In selecting devices , the ability of a device to remove or redistribute pressure, the ease of application, cost-effectiveness, and ability to gain compliance must be taken into consideration. Proper footcare and general skincare must also be implemented. Feet should be checked daily for further cuts, sores, blisters, bruises or dry skin to prevent further ulcer formation. Bringing blood glucose levels within normal range is essential. (International Diabetes Federation, 2009) Strictly managing diabetes is the first stage in treating all the other complications and even the condition itself. Diet and exercise will almost certainly play a role in preventing as well as treating diabetes. (Embil, 2003) Section 5. Identify a contemporary source of evidence based guidance (i.e. a clinical guideline) which could be used as a basis for providing a high standard of care to patients with this type of wound. Critically discuss how the guidance given in this document might influence your nursing practice including whether you believe there are any omissions or recommendations made that would be difficult to manage in your own placement. Please also comment on whether the Guideline recommendations could be implemented in your home country e.g. Philippines, Sri Lanka, Malaysia, China. You must clearly state the title your chosen guideline document and link your work to other healthcare literature where appropriate. Approximate word count: 400-500 Please start this section by stating the name of your chosen Clinical Guideline. Name of Guideline: Clinical Guidelines for Type 2 Diabetes Prevention and management of foot problems A very crucial statement in the guideline states that diabetic individuals should have their feet and legs examined for specific problems at least once a year. This is highly recommended and should be implemented. Diabetic individuals need help to detect problems when they develop neuropathy and lack of protective pain sensation. If this is carried out, prevalence of infection and other diabetic complications will surely go down. With regards to the whole healthcare setting, the NICE guideline recommends that health care professionals who carry out examinations must be properly trained but specific details of the training are not given. Nurses as well as other members of the healthcare team would need specific trainings most especially on handling equipments as well as imparting management to the affected individuals. It was also mentioned that diabetic individuals with active problems will be seen by the multidisciplinary foot care team that consists of highly trained podiatrists and orthotists, nurses with training in dressing diabetic foot wounds and diabetes specialists with expertise in lower limb complications. However, there is currently a shortage of podiatrists, nurses and other specialised members of the healthcare team. Lack of clarity about the membership of the multidisciplinary team may affect in the implementation of the guideline. Regarding ulcer management, there is a further problem with the section in the NICE guidelines on how ulcers should be managed. One or more interventions are suggested, including dressings, antibiotics to treat infection, and pressure relief by the use of special shoes or total contact casts. However, there is little guidance as to which intervention should be chosen and in which circumstance. Unfortunately, this could lead to a reinforcement of current practice where many patients with diabetic foot ulcers have dressings applied to their ulcers with no further interventions until the ulcer deteriorates. (Rathur Boulton, 2007) Nurses caring for patients with diabetic foot ulcers should understand that, in addition to dressings, patients need effective pressure relief and management of infection. As with regards to the author’s workplace which is a nursing home, although the guideline is flawed, as all guidelines are, the author believes that it will be really helpful in the management of diabetic foot problems since almost all of the residents who have diabetes are experiencing foot problems already. However, it will be better if the guideline made recommendations regarding services exclusive to nursing homes to address to the specific needs of the diabetic residents. The author believes that this guideline is not achievable to the Philippines. In view of the current health care setting of the country, it will be very had to implement the guideline due mainly to lack of funding and a huge shortage of specialist health care professionals. The Philippines is one of the countries in South East Asia that prevalence rate of diabetic foot ulcerations and infections are fast rising (WHO,2004) but unfortunately, the country is also understaffed and underfunded. The author believes that for the NICE guidelines to be implemented whether in the placement or for the whole healthcare setting, it will be necessary to recruit and train a lot of diabetic foot professionals or better yet, educate existing health care professionals. Careful monitoring of the diabetic individuals will be essential as well as imparting proper lifestyle change and management. Reference List Abbot, C.A, Carrington, A.L., Ash, H., Bath, S., Every, L.C., Griffiths, J., et al. (2002). The Northwest diabetes foot care study: incidence of and risk factors for new diabetic foot ulceration in a community based cohort. Wiley.19(5). 377-384. Abbott, C.A., Garrow, A.P., Carrington, A.L., Morris, J., Van Ross, E.R. Boulton, A.J. (2005). Foot ulcer risk is lower in South-Asian and African-Caribbean compared with European diabetic patients in the UK. The North-West Diabetes Foot Care Study,  Diabetes Care, 28(8), 1869–1875. Armstrong, P.G., Lavery, L.A., Harkless, L.B. (2003). Validation of a wound classification system. Diabetes Care. 21 (5). 855-859. Brownlee, M. (2005). The pathology of diabetic complications. Diabetes. 54. 1615-1625. Bowker, J.H., Pfeifer, M.A. (2001). The Diabetic Foot. 6th edition. St. Louis: Mosby Caravaggi, C., Faglia, E., De Giglio, R., Mantero, M., Quarantello, A., Sommaria, E., et al. (2000). Effectiveness and safety of non removable fibreglass off-bearing cast versus a thereapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care. (12). 1746-1751. Chantelau, E., Tanudjaja, T. Altenhofer, F. (2006). Antibiotic treatment for uncomplicated neuropathic foot ulcers in diabetes: a controlled trial. Diabetic Medicine. 13. 156-159. Costigan, W., Thordarson, D.B., Debnath, U.K. (2007). Operative management of  ankle fractures  in patients with  diabetes mellitus,  Foot  and Ankle  International, 28(1), 32–37. De Heus-van Putten,  M.A. (1994). The role of the Dutch podiatrist m the treatment of diabetic feet. Journal of British Podiatric Medicine,49(42), 161-164. Department of Health. (2002). National service framework for  diabetes. London: HSMO. Diabetes UK. (2004). Epedimiology and Statistics. London: HSMO Doupies, J., Vevis, A. (2008). Classification, diagnosis, and treatment of diabetic foot ulcers. Retrieved March 30, 2009, from woundresearch.com/article/8706. Embil, J. (2003). Getting to the bottom of the diabetic foot. The Canadian Journal of CME. 3:76-86. Foster, A.V.M., Greenhill, M.T., Edmonds, M.E. (2004). Comparing two dressings in the treatment of diabetic foot ulcers. J Wound Care. 3: 224-228. Frykberg, R.G., Armstrong, D.G., Gurini, J., Edwards, H., Kraviette, M., Kavitz, S., et al. (2002). Diabetic foot disorders: a clinical practice guideline. The Journal of Foot and Ankle Surgery. 39(5). Hall, M.J. DeFrances, C.J. (2001).  National Hospital Discharge Survey. Advance data from vital and health statistics; No: 332, National Center for Health Statistics:Hyattsville. Heenan, A. (2008). Frequently asked questions: hydrocolloid dressings.   Retrieved February 2007 from www.worldwidewounds.com/1998/april/Hydrocolloid-FAQ/hydrocolloid-questions.html Hilton, J.R., Williams, B.T., Beuker, B.M., Harding, K.G. (2004). Wound dressings in diabetic foot disease. Medline. 1:39, 100-103. International Diabetes Federation. Diabetes. (2009). atlas 2nd edition. Brussels. Leaper, D. (2002). Sharp technique for wound debridement. Retrieved December 15, 2005 from www.worldwidewounds.com/2002/december/leaper/sharp-debridement.html Medina, A,, Scott Paul, G., Ghahary, A. Tredget Edward, E. (2005).   Pathophysiology of chronic nonhealing wounds,  Burn Care Rehabilitation,  26(4), 306–319. .National Diabetes Support Team. (2006). Diabetic foot  guide, NHS Clinical Governance Support Team. London: NHS. National Health Service . (2002). Diabetic Foot Ulcer Dressings Guidance and Referral Advice. Leicester. National Institute for Clinical Excellence. (2004). Prevention and Management of foot problems in people with type 2 diabetes. Retrived January 2002 from nice.org.uk/nicemedia/live/10934/29246/29246.pdf Pham, H., Armstrong, D.G, Harvey,   C., Harkless, L.B., Giurini, J.M. Veves, A. (2000). Screening techniques to identify people at high risk for  diabetic foot  ulceration: a prospective multicenter trial,  Diabetes  Care, 23(5), 606–611. Pudner, R. (2001). Hydrocolloid dressings in wound management. Retrieved February 2007 from www.jcn.co.uk/journal.asp?MonthNum=048 Rathur, H.M Boulton, A.J. (2007). The diabetic foot. Clinics in Dermatology, 25(1),109-201. Reed, J.F. (2004). An audit of lower extremity complications in octogenarian patients with diabetes mellitus,  International Journal of Lower Extremity Wounds, 3  (3), 161–164. Reiber, G.E., Smith, D.G.,    Wallace., C.,(2002). Effect of therapeutic footwear on ulceration in patients with diabetes. Journal of the American Medicine Association. 287: 2552-2558. Sibbald, R.G., Williams, D., Orstead, H.R., Campbell, K., Keart, D., Krasner, D. et al. (2003). Preparing the wound bed: Focus on infection and inflammation. Ostomy/Wound Management. 49 (11). 24-51. Sutter, J.H., Shelton, D.K. (2006). Three phase bone scan in osteomyelitis and other musculoskeletal disorders. Diabetes Medicine. 24 (12). 93-98. Tentolouris, N., Jude, E.B., Smirnoff, I. (2003). Methicillin resistant Staphylococcus Aureus, an increasing problem in the diabetic foot clinic: a worsening problem. Diabetic Medicine. 20 (2). 159-161. Veves, A., Giurini, J. LoGerfo, F. (2006).  The Diabetic Foot: Medical and Surgical Management.  Totowa, NJ: Humana Press. Vileikyte, L. (2001).   Diabetic foot ulcers: a quality of life issue.  Diabetes Metabolism Research and   Review,17(4), 46–249. Wagner, F.W. (1987). The diabetic foot.   Orthopedics, 10, 163–72. World Health Organization.   (2004). Adherence to Long term Therapies in Diabetes. Geneva.

How To Get Merit Scholarships and Honors at State Schools

How To Get Merit Scholarships and Honors at State Schools SAT / ACT Prep Online Guides and Tips Don't get lost in the crowd. Do you want to stay close to home for college, but don’t want to get lost in the crowd of a large state school? Or do you want to know how to make the most of your experience at large university? It’s possible to get a selective, small college experience at a large university, through programs like honors colleges and merit scholarships. But how can you find these programs, and how can you ensure you'll be considered for merit scholarships and honors colleges? We will give you the info you need to make sure you don’t miss out on opportunities near you. Think Beyond the "Safety School" Many people don’t stress out about applying to their local state schools because they have application deadlines later in the year – sometimes as late as May or June. In some cases, since students consider state schools their â€Å"safety schools† where admission is all but guaranteed, they don’t put as much effort into their state school applications. However, many of the deadlines for honors colleges and merit scholarships at large universities are much earlier – sometimes as early as October of your senior year. And some of these programs and scholarships have special applications. If you’re not aware of deadlines before senior year starts, it’s easy to miss out on scholarships and other programs that can really enrich your college experience. Many of these programs are as competitive as getting into selective colleges, so it’s also important to put together a competitive application. In short, you should treat these applications like you’re applying to a selective school. So how do you find these programs, and how can you make sure you’re competitive? We will answer those questions here. Why Apply for Special Programs? By special programs, we mean merit scholarships, honors programs or honors colleges, or any programs that require extra or early applications. We will focus on merit scholarships and honors colleges in this post, since they are the most common special programs at larger universities, but make sure to check out the website of any school you’re interested in and see what extra options they have for undergraduates. So why apply to these programs? There are three main reasons. Make College Cheaper College is expensive. Even if you stay in state, tuition, room, board, textbooks, and other fees can add up quickly. You should definitely apply for need-based financial aid if you need it, but getting a merit scholarship can often fill in where financial aid falls short. Many merit scholarships cover half or all of tuition. Some even cover room and board as well. Also, many honors colleges offer their students opportunities for research or study abroad funding. This can help finance experiences that can otherwise be expensive or otherwise unattainable. It's hard to turn down money, especially when it can help you get a college education. Get a Small-School Experience Going to large university is great because of all the resources and classes available to you, but it’s easy to feel lost in the crowd, especially as a freshman. Being a part of a smaller program or merit scholarship cohort can give you a small-school experience within a larger university. These programs often have special advising or mentor systems that can also help you acclimate to college life. Many have special housing options that will allow you to get to know other people in your program easily. This can make it easy to build a community, even as a freshman. Distinguish Yourself for Jobs Although this seems really far away, graduating with honors or having a merit scholarship can really set you apart when it comes time to apply for jobs and/or graduate programs during your senior year of college. You can take steps now to give yourself a huge leg up when it’s time to enter the â€Å"real world.† So how do you get merit scholarships? How do you get into honors colleges? We will explain how to find these programs and how to apply. Merit Scholarships: How To Apply Unlike financial aid, merit scholarships are given based on student achievement – your test scores, GPA, and the overall strength of your application. The amount of a merit scholarship can vary widely – anything from a $1,000 stipend to full tuition, room, and board. To be considered for merit scholarships, you often have to meet an earlier deadline or submit an additional application. For example, at the University of North Carolina, Chapel Hill,you have to apply by the early action deadline of October 15 to be considered for the Pogue Scholarship (which covers tuition, room, and board). Additionally, there is another separate application for the Robertson scholarship (which covers tuition, room, board, fees, and expenses for up to three summer experiences), which you have to complete by November 15th to ensure you will be considered for it. To look at another example, University of Colorado, Boulder has a separate scholarship application that requires, at a minimum, an extra essay, but could also require extra letters of recommendation and eligibility materials based on which scholarships you apply to. The window to apply is December through March, with a deadline of February 15th for the presidential scholarship. For more on merit scholarships, including some with automatic funding based on test scores, see our article. Also note that some of those have earlier deadlines as well. How to Research Merit Scholarships For any state schools you are applying to, search to see if they have a merit scholarship program, and take note of any extra application materials or earlier deadlines. (We will give you a table at the end of this post you can use to organize dates and deadlines.) For example, to find the University of Colorado Boulder scholarships, I searched â€Å"University of Colorado Boulder Merit Scholarships.† I clicked on the third result and was able to read about individual scholarships, and also find the page about the general scholarship application. Read more on UC Boulder's Scholarships here. Honors Colleges and Honors Programs: How To Apply Many larger universities have smaller honors programs or honors colleges within them, to give a smaller college experience within a larger university. Honors colleges often have special classes, housing, and sometimes even funding opportunities for research or study abroad. For example, the Schreyer Honors College at Pennsylvania State University offers special classes, exclusive study abroad opportunities, and research placements. Furthermore, this program offers special housing, and that housing is guaranteed housing for four years. This isn’t always the case at large universities! But to get these benefits you have to put in more work. Honors colleges are usually much more competitive than general university admission, and often require extra application components. They typically have much earlier deadlines than general University admission, as well. For example, the Schreyer Honors College has a separate application other than the general Penn State application. They recommend completing your application by November 30, with a firm deadline of January 15, to be considered for the program. (The regular university application isn’t due until January 31.) Next Steps For any large universities you are applying to, search to see if they have an honors college or honors program, and take note of earlier deadlines or application materials. To find honors programs, search â€Å"[Name of College/University] Honors College† or â€Å"[Name of College/University] Honors Program.† I found the honors college at Penn State by doing the following search: Just entering in that search time brought up Schreyer’s main website, as well as links to admission and aid on the first page. If you can’t find information on an honors college or honors program through searching, you can contact the admissions office via phone or email and ask if they have any honors programs. How To Put Together a Competitive Application Finding these programs is one thing. How can you make sure you are a competitive applicant when you apply to honors colleges and merit scholarships? Maximize Your ACT/SAT Score For many merit scholarships and honors programs, the standardized score ranges are much higher than general university admission. This means that having a high SAT or ACT score will help you get into honors programs and win scholarships – and in some cases, you need a minimum score. For example, at the University of Nebraska, an ACT score of at least 20, or an SAT score of at least 950 (Math and Critical Reading) are the benchmarks given for admission. But you can be considered for the Honors Program if you have either an ACT composite score of 30 or an SAT of 1300 (Math and Critical Reading). Notice the large difference between regular admission and honors admission score benchmarks. It’s important to choose either the SAT or ACT and to study so you can get the best possible score. Don’t split your time between the two tests. It’s likely that you will do better on one that the other, so you should spend all of your time preparing for that test. (If you need help deciding between the SAT and ACT, see our post.) Also, make sure you give yourself enough time to study. We recommend at least five weeks, but the longer, the better! The more time you can put in, the better your score outcome will be. Take the Most Challenging Classes Possible Another important factor in making your application competitive is having an impressive transcript and GPA. However, a high GPA alone does not mean much – it’s important you have also been challenging yourself with hard courses. Whether that means taking IB, AP, or honors, find the hardest classes at your school and take them. Be careful not to overload your schedule with tons of AP and IB classes and burn yourself out. Prioritize taking tough classes in subjects you are passionate about. And finally, don’t blow off senior year. Colleges will see your senior year schedule when you apply, so it’s important to keep up your momentum and take a challenging senior year schedule. Obviously you need to leave room for college applications, but don’t slack off and take three free periods. Get Involved with Activities and the Community Having a competitive college application isn’t just getting good grades and high test scores. You also need to get involved in your community in some way. Whether that’s joining clubs or sports at your high school, doing service work, or being involved in a local youth group, find something you are passionate about and get involved. And remember to emphasize breadth over depth. It’s much better to be very involved in two clubs than to join ten clubs but barely show up. Aim for leadership positions and awards wherever possible. Don't treat extracurriculars like a list to be checked off. The goal isn't to have the longest list of clubs. Choose a few things that are important to you and get really involved! When it comes time to apply, list your extracurricular involvements in order of the time spent on them. And remember to emphasize leadership positions, awards, or other recognitions you have earned for each activity. Don’t Ignore the Essay(s) A final, crucial component of your application will be the essay. Many honors programs or merit scholarships have a separate essay – or essays! – to write. Sometimes they will give you a specific prompt, or other times they will want to learn more about you and give an open-ended prompt. For example, the Schreyer Honors College has three additional essays, with new prompts every year. The University of Michigan has a list of topics to choose from. So while the prompt and length of the essay or essays can vary from program to program, and the prompts can even be quite playful, it’s very important not to wait until the last minute to write your essays. The essay will be the main opportunity for you to share your personality, passions, and intellectual interests. If you’re aiming to get into an honors college or get a merit scholarship, having a strong essay will be crucial. To write the best essay possible, start early – at least a month before the deadline. Write a draft, and then take time to edit it so it’s true to your own voice. You can also have friends or teachers look over it to see if they think it sounds like you – just make sure it is 100% your own work. Get Good Recommendation Letters Although not all universities require letters of recommendation for admission, most honors programs and merit scholarships will require at least one, but more likely two. When asking teachers for recommendations, try to find teachers who have taught you recently – junior year is ideal – and can give specific praise about your academic abilities. Sometimes, giving the teacher a sample of work you did in their class to jog their memory or give them something to refer to in the letter can be helpful. Also, try to get your letters from teachers in different subjects. Being an impressive student in both science and English is more impressive than getting rave reviews from two English teachers. Final Touches on Your Application Make sure to report any strong SAT Subject Test, AP, or IB test scores you have. Even if they are not required anywhere on the application, including these scores can give the admissions committee more information on your academic abilities and achievements. This also goes for any academic awards like National Merit or being on the honor roll. If you know someone – like a coach, boss, youth group leader, or mentor – who could write an additional letter of recommendation, it’s worth asking for one. Often, people who know you outside of school can give more information about your work ethic, abilities, and passions than your teachers can. Don’t feel pressured to submit an extra letter if you don’t have someone like this, but if you know someone will write you a strong letter, strongly consider asking them. The Bottom Line Being part of an honors program and/or getting a merit scholarship can really enrich your college experience and make you a more competitive job or graduate school applicant. For any university you’re applying to, check to see if they have any honors programs or merit scholarships. To get into these programs you have to be aware of earlier deadlines and extra applications. You can use a table like the one below to organize your list of prospective colleges. Name of College/ University Regular Application Deadline Honors Program? (Yes/No) Honors Program Deadline Merit Scholarships? (Yes/No) Merit Scholarship Deadline And finally, you should aim to submit the best application possible. Treat these opportunities like you are applying to selective schools – write the best possible essays, get great letters of recommendation, and maximize your scores. If you do this, you can get a selective college experience close to home. What’s Next? Want to aim for a perfect SAT score, or quite close? See our guide to getting a 1600 by our full scorer. Speaking of maximizing your scores, learn how to improve a low SAT math score, or if you’re taking the ACT, get math tips from our full scorer. Need some tips for your college essays? Learn what not to do. Want to improve your SAT score by 160 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: How To Get Merit Scholarships and Honors at State Schools SAT / ACT Prep Online Guides and Tips Don't get lost in the crowd. Do you want to stay close to home for college, but don’t want to get lost in the crowd of a large state school? Or do you want to know how to make the most of your experience at large university? It’s possible to get a selective, small college experience at a large university, through programs like honors colleges and merit scholarships. But how can you find these programs, and how can you ensure you'll be considered for merit scholarships and honors colleges? We will give you the info you need to make sure you don’t miss out on opportunities near you. DUMMY CTA Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: Think Beyond the "Safety School" Many people don’t stress out about applying to their local state schools because they have application deadlines later in the year – sometimes as late as May or June. In some cases, since students consider state schools their â€Å"safety schools† where admission is all but guaranteed, they don’t put as much effort into their state school applications. However, many of the deadlines for honors colleges and merit scholarships at large universities are much earlier – sometimes as early as October of your senior year. And some of these programs and scholarships have special applications. If you’re not aware of deadlines before senior year starts, it’s easy to miss out on scholarships and other programs that can really enrich your college experience. Many of these programs are as competitive as getting into selective colleges, so it’s also important to put together a competitive application. In short, you should treat these applications like you’re applying to a selective school. So how do you find these programs, and how can you make sure you’re competitive? We will answer those questions here. Why Apply for Special Programs? By special programs, we mean merit scholarships, honors programs or honors colleges, or any programs that require extra or early applications. We will focus on merit scholarships and honors colleges in this post, since they are the most common special programs at larger universities, but make sure to check out the website of any school you’re interested in and see what extra options they have for undergraduates. So why apply to these programs? There are three main reasons. Make College Cheaper College is expensive. Even if you stay in state, tuition, room, board, textbooks, and other fees can add up quickly. You should definitely apply for need-based financial aid if you need it, but getting a merit scholarship can often fill in where financial aid falls short. Many merit scholarships cover half or all of tuition. Some even cover room and board as well. Also, many honors colleges offer their students opportunities for research or study abroad funding. This can help finance experiences that can otherwise be expensive or otherwise unattainable. It's hard to turn down money, especially when it can help you get a college education. Get a Small-School Experience Going to large university is great because of all the resources and classes available to you, but it’s easy to feel lost in the crowd, especially as a freshman. Being a part of a smaller program or merit scholarship cohort can give you a small-school experience within a larger university. These programs often have special advising or mentor systems that can also help you acclimate to college life. Many have special housing options that will allow you to get to know other people in your program easily. This can make it easy to build a community, even as a freshman. DUMMY CTA Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: Distinguish Yourself for Jobs Although this seems really far away, graduating with honors or having a merit scholarship can really set you apart when it comes time to apply for jobs and/or graduate programs during your senior year of college. You can take steps now to give yourself a huge leg up when it’s time to enter the â€Å"real world.† So how do you get merit scholarships? How do you get into honors colleges? We will explain how to find these programs and how to apply. DUMMY CTA Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: Merit Scholarships: How To Apply Unlike financial aid, merit scholarships are given based on student achievement – your test scores, GPA, and the overall strength of your application. The amount of a merit scholarship can vary widely – anything from a $1,000 stipend to full tuition, room, and board. To be considered for merit scholarships, you often have to meet an earlier deadline or submit an additional application. For example, at the University of North Carolina, Chapel Hill,you have to apply by the early action deadline of October 15 to be considered for the Pogue Scholarship (which covers tuition, room, and board). Additionally, there is another separate application for the Robertson scholarship (which covers tuition, room, board, fees, and expenses for up to three summer experiences), which you have to complete by November 15th to ensure you will be considered for it. To look at another example, University of Colorado Boulder has a separate scholarship application that requires, at a minimum, an extra essay, but could also require extra letters of recommendation and eligibility materials based on which scholarships you apply to. The window to apply is December through March, with a deadline of February 15th for the presidential scholarship. For more on merit scholarships, including some with automatic funding based on test scores, see our article. Also note that some of those have earlier deadlines as well. How to Research Merit Scholarships For any state schools you are applying to, search to see if they have a merit scholarship program, and take note of any extra application materials or earlier deadlines. (We will give you a table at the end of this post you can use to organize dates and deadlines.) For example, to find the University of Colorado Boulder scholarships, I searched â€Å"University of Colorado Boulder Merit Scholarships.† I clicked on the third result and was able to read about individual scholarships, and also find the page about the general scholarship application. Read more on UC Boulder's Scholarships here. Honors Colleges and Honors Programs: How To Apply Many larger universities have smaller honors programs or honors colleges within them, to give a smaller college experience within a larger university. Honors colleges often have special classes, housing, and sometimes even funding opportunities for research or study abroad. For example, the Schreyer Honors College at Pennsylvania State University offers special classes, exclusive study abroad opportunities, and research placements. Furthermore, this program offers special housing, and that housing is guaranteed housing for four years. This isn’t always the case at large universities! But to get these benefits you have to put in more work. Honors colleges are usually much more competitive than general university admission, and often require extra application components. They typically have much earlier deadlines than general University admission, as well. For example, the Schreyer Honors College has a separate application other than the general Penn State application. They recommend completing your application by November 30, with a firm deadline of January 15, to be considered for the program. (The regular university application isn’t due until January 31.) Next Steps DUMMY CTA Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: For any large universities you are applying to, search to see if they have an honors college or honors program, and take note of earlier deadlines or application materials. To find honors programs, search â€Å"[Name of College/University] Honors College† or â€Å"[Name of College/University] Honors Program.† I found the honors college at Penn State by doing the following search: Just entering in that search time brought up Schreyer’s main website, as well as links to admission and aid on the first page. If you can’t find information on an honors college or honors program through searching, you can contact the admissions office via phone or email and ask if they have any honors programs. How To Put Together a Competitive Application Finding these programs is one thing. How can you make sure you are a competitive applicant when you apply to honors colleges and merit scholarships? Maximize your ACT/SAT Score For many merit scholarships and honors programs, the standardized score ranges are much higher than general university admission. This means that having a high SAT or ACT score will help you get into honors programs and win scholarships – and in some cases, you need a minimum score. For example, at the University of Nebraska, an ACT score of at least 20, or an SAT score of at least 950 (Math and Critical Reading) are the benchmarks given for admission. But you can be considered for the Honors Program if you have either an ACT composite score of 30 or an SAT of 1300 (Math and Critical Reading). Notice the large difference between regular admission and honors admission score benchmarks. It’s important to choose either the SAT or ACT and to study so you can get the best possible score. Don’t split your time between the two tests. It’s likely that you will do better on one that the other, so you should spend all of your time preparing for that test. (If you need help deciding between the SAT and ACT, see our post.) Also, make sure you give yourself enough time to study. We recommend at least five weeks, but the longer, the better! The more time you can put in, the better your score outcome will be. Take the Most Challenging Classes Possible Another important factor in making your application competitive is having an impressive transcript and GPA. However, a high GPA alone does not mean much – it’s important you have also been challenging yourself with hard courses. Whether that means taking IB, AP, or honors, find the hardest classes at your school and take them. Be careful not to overload your schedule with tons of AP and IB classes and burn yourself out. Prioritize taking tough classes in subjects you are passionate about. And finally, don’t blow off senior year. Colleges will see your senior year schedule when you apply, so it’s important to keep up your momentum and take a challenging senior year schedule. Obviously you need to leave room for college applications, but don’t slack off and take three free periods. Get Involved with Activities and the Community Having a competitive college application isn’t just getting good grades and high test scores. You also need to get involved in your community in some way. Whether that’s joining clubs or sports at your high school, doing service work, or being involved in a local youth group, find something you are passionate about and get involved. And remember to emphasize breadth over depth. It’s much better to be very involved in two clubs than to join ten clubs but barely show up. Aim for leadership positions and awards wherever possible. Don't treat extracurriculars like a list to be checked off. The goal isn't to have the longest list of clubs. Choose a few things that are important to you and get really involved! When it comes time to apply, list your extracurricular involvements in order of the time spent on them. And remember to emphasize leadership positions, awards, or other recognitions you have earned for each activity. DUMMY CTA Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: Don’t Ignore the Essay(s) A final, crucial component of your application will be the essay. Many honors programs or merit scholarships have a separate essay – or essays! – to write. Sometimes they will give you a specific prompt, or other times they will want to learn more about you and give an open-ended prompt. For example, the Schreyer Honors College has three additional essays, including the prompt, â€Å"You are required to spend the next year of your life either in the past or the future. What year would you travel to and why?† The University of Michigan has a list of topics to choose from, including â€Å"Tell us about a great recipe† and â€Å"Discuss the concept of ‘random.’† So while the prompt and length of the essay or essays can vary from program to program, and the prompts can even be quite playful, it’s very important not to wait until the last minute to write your essays. The essay will be the main opportunity for you to share your personality, passions, and intellectual interests. If you’re aiming to get into an honors college or get a merit scholarship, having a strong essay will be crucial. To write the best essay possible, start early – at least a month before the deadline. Write a draft, and then take time to edit it so it’s true to your own voice. You can also have friends or teachers look over it to see if they think it sounds like you – just make sure it is 100% your own work. Get Good Recommendation Letters Although not all universities require letters of recommendation for admission, most honors programs and merit scholarships will require at least one, but more likely two. When asking teachers for recommendations, try to find teachers who have taught you recently – junior year is ideal – and can give specific praise about your academic abilities. Sometimes, giving the teacher a sample of work you did in their class to jog their memory or give them something to refer to in the letter can be helpful. Also, try to get your letters from teachers in different subjects. Being an impressive student in both science and English is more impressive than getting rave reviews from two English teachers. Final Touches on Your Application Make sure to report any strong SAT Subject Test, AP, or IB test scores you have. Even if they are not required anywhere on the application, including these scores can give the admissions committee more information on your academic abilities and achievements. This also goes for any academic awards like National Merit or being on the honor roll. If you know someone – like a coach, boss, youth group leader, or mentor – who could write an additional letter of recommendation, it’s worth asking for one. Often, people who know you outside of school can give more information about your work ethic, abilities, and passions than your teachers can. Don’t feel pressured to submit an extra letter if you don’t have someone like this, but if you know someone will write you a strong letter, strongly consider asking them. DUMMY CTA Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: The Bottom Line Being part of an honors program and/or getting a merit scholarship can really enrich your college experience and make you a more competitive job or graduate school applicant. For any university you’re applying to, check to see if they have any honors programs or merit scholarships. To get into these programs you have to be aware of earlier deadlines and extra applications. You can use a table like the one below to organize your list of prospective colleges. Name of College/ University Regular Application Deadline Honors Program? (Yes/No) Honors Program Deadline Merit Scholarships? (Yes/No) Merit Scholarship Deadline And finally, you should aim to submit the best application possible. Treat these opportunities like you are applying to selective schools – write the best possible essays, get great letters of recommendation, and maximize your scores. If you do this, you can get a selective college experience close to home. What’s Next? Want to aim for a perfect SAT score, or quite close? See our guide to getting a 2400 by our full scorer. Speaking of maximizing your scores, learn how to improve a low SAT math score, or if you’re taking the ACT, get math tips from our full scorer. Need some tips for your college essays? Learn what not to do. Want to improve your SAT score by 240 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now: