Perfect college essays
Tuesday, August 25, 2020
Jeffersons Pillow essays
Jefferson's Pillow expositions Who were the authors of America? At the point when one thinks about the words establishing fathers, the primary thing that should ring a bell are national figures like George Washington, James Madison, George Mason and Thomas Jefferson. Despite the fact that these men are authors of America, they were additionally organizers of a social foundation that would be installed in American life for many years. This social organization is also called bondage. In the book Jeffersons Pillow by Roger Wilkins, Wilkins examines the genuine truth about the authors and the establishing of the country. The standard anecdote about the establishing of the country has been told a great many occasions, yet there is consistently one significant piece of the story that is forgotten about. The voices that are never heard are the voices of blacks in the general public of the new country. The pages of a great many history books are loaded up with the achievement of whites, yet there consistently appear to be clear pages that ought to contain the account of the commitment of blacks. This reality upsets numerous blacks today and at last outcomes in the demise of dark energy. The possibility that blacks never existed is because of the way that Washington, Madison, Mason, and Jefferson were attempting to delete history while they were composing it. With the end goal for blacks to pick up nationalism and to comprehend what our identity is, we should test all the more profoundly into who these four [men] were.(Wilkins 10) George Washington is known as the principal father of the nation, however should be thought of as the main man to delete the composition on the writing board. He was a man of numerous points of interest and extraordinary achievement. Washington is constantly commended and lauded for the work he accomplished for the nation, however many don't have a clue or decide to disregard the opposite side of this man. His opposite side was confronted with a battle managing thoughts on bondage. For instance, Washington frantically required men to battle, yet would not let the 20% of the dark populace battle. It is characteristic ... <!
Saturday, August 22, 2020
Argument. Men and particularly princes Essay Example for Free
Contention. Men and especially sovereigns Essay Contention Presentation à â â â â â â â â â â Men and especially sovereigns should be cautious when settling on their choices and they ought not be worried by the settling on choices that consistently favors their subjects and companions however they ought to be concerned more on the results of their choices and whether those choices will profit their state. I emphatically accept that there ought not be methodology and strategies set to be utilized by sovereigns in managing their companions and subjects. This is on the grounds that various circumstances require to be dealt with contrastingly since the social orders continues changing and along these lines, sovereigns ought not follow set systems and strategies. à â â â â â â â â â â Princes are decided by their subjects through their characteristics which will make their subjects either to commend them or to accuse them. Notwithstanding, it would be extremely hard for the rulers to satisfy all the characteristics that their subjects anticipate that them should have because of human instinct. Thusly, sovereigns ought to be exceptionally mindful so as to escape from terrible notoriety of those indecencies which would cause them to lose the state. à â â â â â â â â â â I concur with the explanation that a quality which is by all accounts a righteousness, whenever sought after may wind up destructing the person who chooses to seek after such a quality; while another quality which gives off an impression of being a bad habit, if an individual chooses to seek after such a bad habit may wind up being increasingly useful to such an individual and to the general public. Along these lines, rulers ought to be reasonable when settling on choices since a quality which is by all accounts bad habit may wind up being a prudence, and the other way around. à â â â â â â â â â â Princes can be liberal which is by all accounts a righteousness yet may wind up giving them an awful notoriety among their subjects. This is on the grounds that such rulers perhaps liberal and wind up spending every one of their assets or overburdening their subjects with inordinate charges and doing everything conceivable so as to the assets. This nature of liberality may give such sovereigns a terrible notoriety and his liberality may wind up culpable their subjects along these lines detesting their rulers. Likewise through not being liberal may lead them to give off an impression of being a penny pincher as per their subjects. à â â â â â â â â â â For example, Pope Julius II despite the fact that he utilized his liberality to accomplish papacy anyway he chose to end his liberality so as to lessen the uses in order to have the option to take up arms. Along these lines, rulers should utilize any goodness, for example, liberality such that won't hurt them. In such manner, sovereigns ought to abstain from overburdening subjects or getting poor because of their liberality. Additionally, all together for a ruler to abstain from decimating their standard they ought wouldn't fret being marked as grumpy persons since this would be a key bad habit that would assist them with ruling their subjects. à â â â â â â â â â â Although sovereigns ought to abstain from being coldblooded and ought to be forgiving yet they ought to be mindful so as not to mishandle their benevolence. This is on the grounds that being too lenient might be mishandled which may prompt issue in a state coming about to expanded wrongdoings accordingly hurting the general public on the loose. For example, in spite of the fact that cesare Borgia was respected savage, he had the option to reestablish request, harmony and solidarity in Romagna through his cold-bloodedness. Hence sovereigns ought wouldn't fret being refereed to be coldblooded in their endeavors to keep their subjects steadfast and joined together. It would be a lot more secure for sovereigns to be dreaded than being adored by their subjects. In such manner they ought to successfully guarantee that there is organization, harmony and solidarity in their states regardless of whether it implies taking someoneââ¬â¢s life to serve their s tates on the loose. This may result to a portion of their subjects detesting them nonetheless, this would be less unsafe to them and furthermore it would useful to their states on the loose. à â â â â â â â â â â Princes ought not mind much on staying faithful to their commitments to their subjects and in certain conditions the sovereigns should control their subjectââ¬â¢s mind with wisdom if this would be progressively more secure for them and furthermore if this would be increasingly useful to their state. Sovereigns must know about how to manage various circumstances since satisfying their guarantees in certain conditions would carry damage to them and to their subjects. In such circumstances such rulers ought to be savvy and skill to mislead their subjects to abstain from satisfying their guarantees where they feel that keeping their words would carry mischief to their state or to themselves. à â â â â â â â â â â in such manner, rulers are not required to have all the great characteristics yet it is significant for them to show up as though they have them. This is on the grounds that having those all characteristics and rehearsing every one of them would bring more mischief. For instance, showing up being dependable, strict, lenient, reliable and altruistic among other great characteristics would be important and sovereigns should realize how to rehearse them in various circumstances, in any case, rehearsing every one of them would prompt more damage than anything else as subjects would abuse them to cause issue which may build the crime percentages which would be hurtful to the states. References Machiavelli, NiccoloãÅ"â⠬. The sovereign. Beauty Fourche: NuVision Publications, 2004. Print. Source archive
Tuesday, August 11, 2020
My Tips for Budgeting Saving as a College Student
My Tips for Budgeting Saving as a College Student Ah, the life of a broke college student. With all of the living expenses thrown your way, financial literacy is an important skill to master during your time at college. Of course, everyoneâs financial background and situation is different, but regardless, it is important to learn how to budget and save your money responsibly early on in your adult life. Over the past few years, I have learned just how beneficial and critical it is to develop sound money spending and saving habits now so that I will be less likely to make any grave money mistakes in the future. But saving money is daunting in college. Most college students do not have a large income, and it often seems like every payday youâre left with $10 after paying your bills, setting aside money for school-related purchases like books, and buying groceries. There are ways, though, to budget your money in a way that allows you to pay for all of your essential needs and still have some money leftover for saving (and fun purchases too!) One trick Iâve adapted to help me save money in college is getting an automatic savings app. At the end of last year, I downloaded the app Digit, which pulls money out of my account Monday through Friday and saves it for me in the app. What I love about Digit is that it learns your spending habits, particularly any bills or monthly payments you regularly make. The app then uses this information to make sure that it doesnât take too much money out of your account if it knows that you have any bills coming up! Digit also allows you to pause saving whenever you want and set a low balance protection plan so that it doesnât save any money for you if your account is below the dollar amount you set (if your account drops below this amount, it also will pull some of your saved money and put it back into your account.) While the app is $2.99 a month, I have found that it has helped me save money quickly without even having to do anything! Digit ensures that I am always saving money, and it made saving a lot less intimidating as well! Another budgeting tactic I use is buying cheaper alternatives when it comes to household essentials such as paper towels, trash bags, etc. Finding less expensive brands and stores that sell quality items is a great way to save money! Grocery shopping at Aldis and buying non-name brand household items that do not need to be the highest quality has allowed me to have extra money every month to save and to spend on the things that I like to treat myself to, like Starbucks and going out to eat with my friends. Determining what items are worth the splurge and what you can cut back on is one of the simplest and cheapest ways to budget your money in a smarter way. It costs you nothing and also helps you cut out any unnecessary expenses! Iâve also learned that itâs important to realize that there is no good or bad amount of money to save. Saving is saving, so if you can only afford to save $5 every two weeks, do that! Having some money set aside for emergencies and large expenses will always be better than having no money saved at all. Just be sure that you never save more money than you can afford. You might have to adjust your savings amount if your bills increase or you have a big payment coming up, but never let the amount discourage you from saving and budgeting your money. ?? Taylor Class of 2021 Hey yâall, Iâm a History and Gender and Women Studies double major and a French minor from Chicago! I concentrate in all things Black and Black women studies and love long-distance running.
Saturday, May 23, 2020
Jesus Christ Superstar A Fresh Modern Take - Free Essay Example
Sample details Pages: 2 Words: 636 Downloads: 1 Date added: 2019/06/26 Category Religion Essay Level High school Tags: Jesus Christ Essay Did you like this example? When NBC decided to take on a live-in-concert version of Jesus Christ Superstar on Easter Sunday, they were taking on a huge task that could easily turn disastrous. The 1970 rock opera album written by Andrew Lloyd Webber and Tim Rice followed by a spectacular movie adaptation by Norman Jewison in 1973 shone a new and controversial light on the days before Jesus crucifixion. With some disastrous live musicals lurking in the past, Jesus Christ Superstar had a lot to live up too, and ended up being a success in connecting to its audience. A stroke of genius with this task was the decision to perform the musical at the Marcy Avenue Armory in front of a live audience. With a mosh pit at the base of the stage, actors could interact with the audience members through handshakes and high fives. The frenzied energy from the audience buoyed the cast members and sustained vigor and liveliness to the production. This was especially seen with John Legends first appearance as Jesus Christ. The crowd was encouraged to go wild every time he appeared, thus adding to the idea that Jesus worshippers were becoming too fanatic. Donââ¬â¢t waste time! Our writers will create an original "Jesus Christ Superstar: A Fresh Modern Take" essay for you Create order The second part that led to this masterpiece was the casting. In a musical entitled Jesus Christ Superstar, the star of the show was not John Legend, but was Hamilton alum Brandon Victor Dixon starring as a conflicted Judas. John Legends performance started off slow and his one-note acting held him back during moments that should have carried more emotion. However, he delivered where it most mattered with the beautifully tragic Gethsemane (I Only Want to Say). Dixon, however, captivated the audience throughout the entire production. His performance was powerful in the way that he consistently brought strength and emotion during his characters darkest hours. He finished with a spectacular and stunning rendition of the number Superstar. Dixons performance proved him to be the real superstar. The other cast members held their own weight. Sara Bareilles lent her gentle strength to her performance of Everythings Alright and I Dont Know How to Love Him. Ben Daniels imbued his role of Pontius Pilate with regality, and later on, with desperation and despair, as he realized he could not save Jesus Christ. A showstopper cameo that added to the nostalgia of this live production was the appearance of Alice Cooper in a gaudy and extravagant orange suit as King Herod. Again, the live audience came into play here as they fell in adoration at King Herods Song. The set was simple, but largely effective. Scaffolding loomed in the background with the stage clear for the casts large dance numbers. In one instance, this lack of the set fails. Instead of the traditional temple scene where Jesus destroys the vendors stalls, Superstars version is a wooden cross covered in glitter that the cast members writhe upon. This version failed to capture the destruction, the sacrilege committed, and Jesuss true anger at this blasphemy. On the other hand, Jesus crucifixion was a brilliant feat. He was lifted up in the air, as the walls behind him disappeared in a shape of the cross, and a heavenly light shone down. The creative artistry in this scene was stunning and left the audience with one last divine impression. Jesus Christ Superstar pulled off the miracle of being a successful televised live musical. The musical had a lot to live to up to following the widely popular 1973 movie, and yet, it channeled the nostalgia of the past while connecting to a new audience. With an energetic, multicultural cast littered with pop legends and Broadway stars, the vocal power was spectacular and mesmerizing. The interaction from the live audience lifted the performance to a new level and a new form of art. The resurrection of Jesus Christ Superstar was a superb achievement.
Tuesday, May 12, 2020
The Unexamined Life Is Not Worth Living - 1834 Words
The unexamined life is not worth living. (Apology, 41e) Socrates held this statement to himself to a point where he allowed the courts to take his life because they donââ¬â¢t want him to continue his quest of insights, questions and knowledge. The philosophy of Socrates as explained by Plato offers an important concept of what it means to live the examined life and what makes a life either examined or unexamined. The combination of Euthyphro, The Apology and the Republic help understand what Socrates means when he says that the unexamined life is not worth living, proving it what he believed, a valid statement. What Socrates means by an unexamined life, is we are just coasting through and not making any decisions or asking any questions. What Socrates means by living the examined life, that itââ¬â¢s logical when people are striving to know themselves and to understand our lives if they have any meaning or value to them. An examined life would be trying to understand your purpo se of why you are here and what you are presently thinking. By examining your life, you therefore are understanding yourself and will not be subject to actions motivated by passion or instinct.Socrates uses examples defending his case about the unexamined life. ââ¬Å"That is because I am so desirous of your wisdom, and I concentrate my mind on it, so that no word of yours may fall to the ground.â⬠(Euthyphro, 18d) Socrates could not see a point in living if you were unable to ask questions and challenge your wayShow MoreRelatedUnexamined Life Is Not Worth Living1851 Words à |à 8 Pagesconvicted for impiety to the gods and for corrupting the youth because he had taught the young adults to question, he was given the opportunity to propose his own penalty. He refused to give up his mission as the one calling Athens to the examined way of life. He refused to leave Athens, if the condition were to be that he had to give up teaching. He summed up his defense in the following way: If I say that I cannot hold my peace (by giving up my mission) because that would be to disobey the godRead MoreThe Unexamined Life Is Not Worth Living1450 Words à |à 6 Pagesb) The unexamined life is not worth living, quoted Socrates. It appears that, following his brilliant logic, the key to living philosophically is exactly how one interprets and scrutinizes their own life in a philosophical context. As with the nature of philosophy itself, living philosophically is also ambiguous, and it could very well be that one lives philosophically even if they do not necessarily realize it. Take, for instance, a person who questions why humans and all life forms must die;Read MoreUnexamined Life Not Worth Living For1300 Words à |à 6 PagesUnexamined Life Not Worth Living For In this paper I will argue that Socrates is right about an unexamined life is no worth living for, however too much examination leads to the absurd and too little tends to keep you from obtaining knowledge, not being able to free your-self as humans are meant to be free. Socrates was a philosopher who believed that humans were meant to obtain all type of knowledge, and that such knowledge could only be achieved through examination. As Socrates stated ââ¬Å"it is theRead MoreThe, The Unexamined Life Is Not Worth Living1744 Words à |à 7 Pages I wholeheartedly embrace the sentiments of Socrates when Plato stated in the Apology, ââ¬Å"The unexamined life is not worth living.â⬠Upon reflection, and asking myself, what exactly does this mean, I feel as if my life has evolved full circle. I finally understand the meaning and purpose of my life ââ¬â the myth I believe and know I should be living. This course has put a lot of things into perspective for me by putting my thoughts, experiences, and feelings into words and statements that prior to I couldRead MoreThe Unexamined Life Is Not Worth Living Essay1577 Words à |à 7 Pagesââ¬Å"The unexamined life is not worth living.â⬠This quote, by a famous philosopher Socrates, amplifies the idea of critical thinking and its true importance. This quote explains that if we as individuals do not evaluate ourselves, then we stop living as human beings.This quote can present what is truly at stake when dealing with critical thinking. Critical thinking allows human beings to question the status quo naturally with no effect. Critical thinking is an important practice and technique one shouldRead MoreThe Unexamined Life Is Not Worth Living1344 Words à |à 6 Pages ââ¬Å"An unexamined life is not worth livingâ⬠Imagine living a life without change, development and growth. Imagine living a life without any consciousness of what life has to offer. As mind-boggling as this may sound, there are actually many people on this earth that have not taken the effort to know themselves. People should be able to fairly judge their lives. Man should be able to gain wisdom by the examinations of the deeds theyââ¬â¢ve done to prepare for the future. Life is no longer worth livingRead MoreUnexamined Life Is Not Worth Living964 Words à |à 4 Pagespremise that ââ¬Å"the unexamined life is not worth livingâ⬠. To understand this quote, we should know what a premise is in relation to his quote. A premise is using a statement to support an opinionated conclusion, for example, getting at least 7 hours of sleep a night lets you wake up not tired, proving that you should go to sleep early. So, what he means by an ââ¬Å"unexamined life is not worth livingâ⬠is that a life without being producti ve or bettering yourself isnââ¬â¢t a life worth living because you donââ¬â¢tRead MoreThe Unexamined Life Is Not Worth Living2068 Words à |à 9 PagesProject Due Date: 12/04/2014 Date Submitted: 12/04/2014 Myth/Narrative I Am Living I enthusiastically embrace the sentiment of Socrates that, ââ¬Å"The unexamined life is not worth living.â⬠Upon reflection, and asking myself, what exactly does this mean, I feel as if my life has progressed full circle. I finally understand, to a greater extent, the meaning and purpose of my life ââ¬â the myth I believe and know I should be living. Through the course readings, text, and concepts, the authors have inspiredRead MoreThe Unexamined Life Is Not Worth Living1629 Words à |à 7 Pages ââ¬Å"The unexamined life is not worth living,â⬠Plato says in The Apology. When people think about the great problems facing humanity, their attention tends to turn to issues such as poverty, warfare, pollution, and disease. While these problems are important and urgent, there are other problems which are equally urgent, but often overlooked. Are human beings born with a map for life? Can that map lead people to happiness? If there is a map, every human being can attain ha ppiness easily. Is there anyRead MoreThe Unexamined Life Is Not Worth Living1978 Words à |à 8 Pagesââ¬Å"The unexamined life is not worth living.â⬠Socrates, the great Greek philosopher, has never spoken truer words. The unexamined life is a recurring theme in both Platoââ¬â¢s The Allegory of the Cave and Richard Wrightââ¬â¢s The Library Card. There are many ways to achieve enlightenment, for example, going out and obtaining information, through individualism, learning from mistakes, becoming an intellectual reader, or contemplation. Enlightenment was important to both Plato and Richard Wright. Plato believed
Wednesday, May 6, 2020
Australian Constitution â⬠Essay Free Essays
ââ¬â Like the American political system, the Australian system is divided into two levels (federal and local), For instance the FED cannot tell the local government how to make their local laws and regulate their government and the local canââ¬â¢t do that to the FED. ââ¬â The Australian Government is different from the United States though in that it has a Parliament like the British. The government is made up of the Prime Minister and his cabinet and at any time the Parliament (which is just like the American Congress) can remove the Government or force it to call an in which neither level can change the power of the other nor make laws that the other has rights over. We will write a custom essay sample on Australian Constitution ââ¬â Essay or any similar topic only for you Order Now election. ââ¬â Also the Australian Constitution does not say that a politicianââ¬â¢s term has to be fixed like an American politicianââ¬â¢s does. For instance the President will without a doubt serve a full four years baring impeachment or assignation, but in Australia Governor-General or Prime Minister can be kicked out at anytime ââ¬â The U. S. Constitution clearly describes the separation of powers. The members of the executive branch cannot sit in Congress and so forth, but in the Australian Government has what they call an independent judiciary system where the government and parliament are not separated. The ministers can be members of parliament and the Prime Minister can dissolve parliament if he so chooses. ââ¬â Like the U. S. the Australian Constitution is written down and is entrenched and very hard to change. Their constitution does most everything the American one does including separation of powers, division and powers of the different branches of government, has a form of supremacy clause which says commonwealth law is supreme over state law, and the last chapter deals with amending or changing the constitution. ââ¬â Where the U. S. has a President who is head of the executive branch, the Australians have a Queen and her representative the Governor-General, who in many ways is like a president in that he is the Comand in Chief of the military. The Governor-General can however dissolve both houses of Parliament if they are deadlocked and he can appoint sitting time for the Parliament. As discussed earlier the Australians like the British have a Prime Minister. ââ¬â Like the American Constitution the Australian one has a preamble but the constitution itself is divided into chapters, parts, and sections that deal with each specific form of government with the first being Parliament. The preamble is divided into parts where the rest of the constitution is in chapters with sections within each chapter. Overall the Australian Constitution is very much like ours in that it has to deal with the same problems that we do. It has sections that deal with race, equality, elections, and many other things. It seems that while the Australians seem to be more British in their political set up, they are in fact very much like us as well. While the country is trying to decide whether to be more like a monarchy as always or change into so mewhat of a republic, their constitution remains unchanging and the Supreme Law of the Land. How to cite Australian Constitution ââ¬â Essay, Essay examples
Saturday, May 2, 2020
Addressing Medication Errors Occurring in Nursing
Question: Discuss about the Addressing Medication Errors Occurring in Nursing. Answer: Introduction In any healthcare scenario, the process of achieving effective therapeutic outcomes depends on various factors like treatment process, patient safety, communication, nursing care, drug interventions etc. (Fletcher, Fletcher Fletcher, 2012). Any kind of minor or major mistake in any of these factors can lead to drastic loss of patient health and healthcare organisation. Out of these factors drug intervention or medication is the most fundamental requirement to achieve treatment. Any kind of mistake or negligence in drug intervention process can result in direct side effect on patients health (Grove, Burns Gray, 2014). According to Raban Westbrook (2014), medication error is reported to be a reason for thousands of demises and millions of hospitalisation globally. Hence, fixation of any medication error becomes a fundamental requirement in healthcare scenario. The medication administration and management is one of the fundamental nursing roles that critically depend on the nursing skills and knowledge. The nursing staffs have the responsibility to administrate, monitor and manage the drug intervention for hospitalised patients. Therefore, continuous observance, alertness and approaches are required in healthcare scenario to avoid the potential chances of medical error (Grove, Burns Gray, 2014). According to Unver, Tastan Akbayrak (2012) studies the proper definition for medication error is any avoidable incident that risks to incongruous medication use causing or leading patient harm, although being under the control of medical professional, carer or consumer. The medication error incidences are related to healthcare products, medical practices, medical prescriptions, procedures, nursing practices, product labelling, compounding, distribution, education, dispensing, monitoring, utilisation and communication. Any kind of negligence in these events can lead to medication errors. Therefore, adopting best possible strategies to avoid this medication error in healthcare scenario is one of the major priority concerns (Fletcher, Fletcher Fletcher, 2012). As a registered nurse, it is been noticed in my clinical scenario that issue of medication error is gaining a possible position where around 60% risk event in hospital occur due to medication negligences in the nursing care unit. Some of the most common factors related to these medication errors are new staff, insufficient training, incorrect administration technique, prescription errors (incorrect dosage), expired medication usage, wrong patient identification, and preparation errors (mixing incorrect multiple medications, dose calculation errors). These factorial causes of medication error indicate nursing medication negligence in the clinical scenario. Therefore, it is critically required to minimise these events and manage medication error to improve medical care facility provided by nursing care unit. This Quality Improvement Project is specifically designed to manage this issue of medication error in healthcare scenario. The various negligences and issues in nursing care will be addressed as per the quality improvement process provided in this project to get a control over events of medication error in the organisation. Statement of problem or clinical question The medication errors described above are clearly indicating the lack of knowledge, calibre and guidance provided to the nursing staff of the hospital. The administration, prescription and preparation errors directly specify the issue in nursing skills and practice. Therefore, this quality improvement project will work to improve the nursing skills by providing a Short-term Periodic Training (STPT) Program that will acknowledge the staff about different strategies to avoid such medication error while dealing with patients in the hospital. This nursing training program is safe and specifically developed to improve nursing practice within the short duration of time to improve medical care. Project Aim The aim of this quality improvement project will be to implement Short-term Periodic Training Program (STPT program) to overcome nursing issues and mishandling that are increasing the risk of medication errors in healthcare scenario of selected organisation. Relevance of project to clinical practice The medication error is always considered to be a major clinical issue because it directly affects the patient safety and treatment process. Any kind of minor negligence in medication process is prone to develop major clinical consequences (Fletcher, Fletcher Fletcher, 2012). This project will help to decrease the risk cases occurring due to medication errors caused by mishandling and negligences of nursing staff in the healthcare organisation. The Short-term Nursing Program will work to overcome the identified factors leading to the medication error in nursing care unit causing high risk to patient safety. Hence, this quality improvement intervention will help to overcome the medication error harming medical care process. Review literature Nursing and medication error The establishment of patient safety and health betterment is the very first priority of quality healthcare services management. There are various faults and errors that lead to the imbalance in quality outcomes where medication error holds a top most position. After doctors prescribe a medicine the major role players are the nurses whose fundamental work is to manage the treatment of their patient (Grove, Burns Gray, 2014). According to a recent study related to Medication Safety in Australia provided by Chiang et al. (2010) the faults in nursing administration leads to 70% medication errors. Faults like wrong dose, wrong rate, wrong volume or dose incompatibility were reason of 90% medication error in nursing care unit resulting in surgical requirement, long patient stay and permanent health defects in the patients. Unver, Tastan, Akbayrak (2012) studied the causes of medication error as per nurses viewpoint where the findings indicated more than ten leading factors of medication error responded by paediatric nurses. The major once were stress (70%), burnout (45%), complicated prescription (30%), unfamiliar medicines (40%), work pressure (35%), knowledge deficiencies (20%), and lack of facilities (4%). Further, in a survey studied by Pham et al. (2012) indicated that majority of nursing staff is not aware of the correct form of medication error. Only 20% nurses mentioned medication error as the wrong dose, incorrect time of dose, and wrong mode of transmission and wrong administration process. However, rest 80% of nurses mentioned medication error as lack of documentation and reporting as the medication error. Hence, this literature indicated a lack of proper nursing education that detects the wrong perceptions of nurses about medication error. Role of nursing education and training in medication error Kalisch Aebersold (2010) indicated that nursing experience and education is one of the critical factors that is directly linked to medication error. The less experienced and skilled nurses cause 50% of medication errors that includes wrong patient, incorrect dilution calculations, incorrect dosage, incorrect administration and improper reporting. Seys et al. (2012) supported by indicating that nave nurses are generally not able to recognise their medication error as well as they lack proper knowledge in warrant reporting. This indicates a lack in professional training system of the healthcare organisation. In the study of Sears, Goldsworthy Goodman (2010) related to nurses viewpoint on medication error, it is clearly indicated that lack of pharmacological knowledge is a major reason for medication error as per viewpoint of 237 professional nurses. Hence, this directly indicates a requirement of improved training intervention in nursing practice. Chhabra et al. (2012) studied in a survey that 80% of new nurses commit medication error in first six months of their nursing practice where 70% remained unreported by them and 10% caused serious health hazards to the patient. Successful strategies and programs to address medication errors committed by nurses There are different strategies and programs implemented at various organisations in a different manner to cope up with the medication error. Agyemang While (2010) Opine the use of different strategies to avoid three major causes that are knowledge gaps, performance lapse, and failure of the safety system of medication. The strategies of MEDMARX program are described below: - Implementation of health record reviewing process Patient and clinician education Bar-code medicine management Reviewing the medication reporting format Computerised medical entry Further, Mueller et al. (2012) studied that E-learning is the most contemporary form of nursing education with the help of which nurses can get instant solutions for their issue related to medication process. This e-learning strategy helped to improve pharmaceutical knowledge and dosage calculation for nurses. The E-learning facility is new to nursing practices but possesses potential positive outcomes. Seys et al. (2012) studied the use of one nursing education program named as SCRIPT study that was developed to improve the issues like unreadable prescriptions, improper antibiotics documentation, and poor communication leading to medication error. The SCRIPT abbreviation was used in a manner to detail educational message about the program that indicated, S: Senior doctor cross-check, C: Check allergies, R: wRite indications for antibiotics, I: (Initial Date) of charting medicine in parenthesis, P: PRINT and sign your name, T: Appropriate Targets for infusions in the nursing practice . The post education results indicated a decrease in prescription error, dose infusions and communication errors. Mohammad et al. (2010) studied an Evidence-based quality improvement program (IQ program) used in hospitals of sixteen states where 30% of 616 critical care hospitals participated in program implementation. The findings indicated that project was successful in improving medication quality and safety in 90% of hospitals. The program used five strategies that are maintaining skilled nursing and pharmacist staff, use of pharmacological reconciliation techniques, implementing technological softwares (telehealth), improving nurse workflow and improving cultural defects in the organisation. Kwan et al. (2013) indicated that reviewing and updating service techniques with education and training on the periodic basis is effective to refine the nursing staff as per dwelling issues and problems in healthcare. This periodic training program can help to regularly update healthcare services as per the changing environmental complex situations. Outline of project procedure and Dissemination of findings This Quality Improvement research proposal will work to rectify the on-going medication errors that clearly highlight a lack of pharmaceutical knowledge, skills and training in the nursing staff of the organisation. The identified issue are insufficient training, incorrect administration technique, prescription errors (incorrect dosage), expired medication usage, wrong patient identification, and preparation errors (mixing incorrect multiple medications, dose calculation errors) that are leading to medication error establishment. Therefore, to overcome these factors that dwell medication error a Short-term Periodic Training Program (STPT) will be proposed in this project that will help to overcome these issues in the clinical scenario. This STPT will be a short-term 5 days training that will be provided to nursing staff of organisation in every six months to address the identified medication errors. As per the detected causes of medication error, this STPT will be designed and modified in every 6 month period by the experts to upgrade the nursing education and knowledge to cope up with changing healthcare environment and to address the medication errors for medical care improvement. This STPT program will involve an array of five strategies where each strategy will be guided to nurses on each day of the program. These strategies will be produced as per the identified medication error and mistakes in healthcare functionality. The establishment of STPT program will help to achieve equilibrium to manage the regular issues in medication services as well as the program will work to regularly upgrade the skills, education and knowledge of nursing staff within the organisation. Hence, this intervention will provide a regular process to control the medication complexity and establish the proper working environment. This quality improvement intervention will be planned using PDSA approach to regularly analyse the outcomes of this program. According to Nakayama et al. (2010) P-plan, D-do, S-study and A-act is a cycle that helps to analyse the impact of any trail or change in particular scenario. The planning phase involves the planning of change, do phase involves the implementation of change, study phase is accessing or studying the outcomes of change, and act phase involve determining the modification required in next change cycle. PDSA is considered as the ideal model of improvement. Figure 1: PDSA approach for quality improvement (Source: Nakayama et al. 2010, p. 337) In this project, PDSA cycle will be used to implement and test the effect of STPT program for addressing medication error. The below provided is the PDSA design and processes that will lead to development and evaluation of quality improvement program STPT for addressing the medication error in the present clinical scenario. P-Plan Team assembly Creating aim statement Determining the current approach Identifying the potential solutions For the planning phase, the required authorities that include management committee, medical specialists, senior nursing staff and senior pharmacist will be invited to attend a meeting where the medication issues identified will be discussed in details. The aim statement will be to educate nursing staff as per the identified medication error causes in the clinical scenario. The issues will be identifies using the baseline performance audit and health information data of the involved patients. As per the discussion, possible solutions or strategies will be identified to manage these issues. As the current issues are lack of pharmaceutical knowledge, skills and training in nursing staff the proposed training and education strategies are: - Educating about five rights of medication administration that are the right drug, right patient, right time, right route and right dosage. Educating about reconciliation procedures Educating about e-learning process to improve knowledge Educating about process to documenting medication information and reporting medication error Guiding about the use of drug guide and suggesting to carry it all the time (Jones Treiber, 2010). D-Do Analyse the improvement theory Initiate the STPT program intervention Collect the data to analyse Document the collected information The education program will be conducted with complete medical, pharmaceutical and surgical nursing staff. The program process will be carried for five days (2 hours) where each day a particular strategy will be taught by nursing teachers to the staff using audio-visual presentations. The education program will be designed as time efficient and simple. After the completion of the program a feedback form will be generated that is required to be filled by each participant of the program. This feedback data will help to analyse the effectiveness of program among audiences. After the completion of the educational program, a post-intervention will be checked for next five-week to detect the improvements in medication errors. S-Study Studying and analysing the collected data Identifying the errors and improvements In this phase of PDSA analysis, the collected feedback and audit information will be analysed to detect the improvement in medication error factors, mortality and serious hospitalisation, and impact on nursing staff for the implemented STPT program. A-Act Re-analysing the STPT program strategies Establishing future strategies Improving errors in plan This phase of PDSA cycle is to re-examine the error in program development and implementing the possible solution for mistakes detected as per analysis. The modifications will be made in program education strategies in the next STPT program as per the identified medication errors in clinical functionality. As per this quality improvement project of implementing a Short-term periodic training program to overcome medication error in organisation, it is expected that findings will demonstrate a clear decrease in the medication error events and improvement in patient safety. The PDSA approach applied for quality improvement development and analysis allows reviewing the program strategy in every periodic repetition of STPT program. Hence, this technique can be modified as per post education intervention outcomes using PDSA model of quality improvement. References Fletcher, R. H., Fletcher, S. W., Fletcher, G. S. (2012).Clinical epidemiology: the essentials. Lippincott Williams Wilkins. Grove, S. K., Burns, N., Gray, J. R. (2014).Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences. Agyemang, R. E. O., While, A. (2010). Medication errors: types, causes and impact on nursing practice.British journal of Nursing,19(6). Chhabra, P. T., Rattinger, G. B., Dutcher, S. K., Hare, M. E., Parsons, K. L., Zuckerman, I. H. (2012). Medication reconciliation during the transition to and from long-term care settings: a systematic review.Research in Social and Administrative Pharmacy,8(1), 60-75. Chiang, H. Y., Lin, S. Y., Hsu, S. C., Ma, S. C. (2010). Factors determining hospital nurses' failures in reporting medication errors in Taiwan.Nursing outlook,58(1), 17-25. Jones, J. H., Treiber, L. (2010). When the 5 rights go wrong: medication errors from the nursing perspective.Journal of Nursing Care Quality,25(3), 240-247. Kalisch, B. J., Aebersold, M. (2010). Interruptions and multitasking in nursing care.The joint commission journal on quality and patient safety,36(3), 126-132. Kwan, J. L., Lo, L., Sampson, M., Shojania, K. G. (2013). Medication reconciliation during transitions of care as a patient safety strategy: a systematic review.Annals of internal medicine,158(5_Part_2), 397-403. Mohammad Nejad, I., Hojjati, H., Sharifniya, S. H., Ehsani, S. R. (2010). Evaluation of medication error in nursing students in four educational hospitals in Tehran.Iranian Journal of Medical Ethics and History of Medicine,3, 60-69. Mueller, S. K., Sponsler, K. C., Kripalani, S., Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: a systematic review.Archives of internal medicine,172(14), 1057-1069. Nakayama, D. K., Bushey, T. N., Hubbard, I., Cole, D., Brown, A., Grant, T. M., Shaker, I. J. (2010). Using a plan-do-study-act cycle to introduce a new OR service line.AORN journal,92(3), 335-343. Pham, J. C., Aswani, M. S., Rosen, M., Lee, H., Huddle, M., Weeks, K., Pronovost, P. J. (2012). Reducing medical errors and adverse events.Annual review of medicine,63, 447-463. Raban, M. Z., Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review.BMJ quality safety,23(5), 414-421. Sears, K., Goldsworthy, S., Goodman, W. M. (2010). The relationship between simulation in nursing education and medication safety.Journal of Nursing Education,49(1), 52-55. Seys, D., Wu, A. W., Van Gerven, E., Vleugels, A., Euwema, M., Panella, M., ... Vanhaecht, K. (2012). Health care professionals as second victims after adverse events: a systematic review.Evaluation the health professions, 0163278712458918. Unver, V., Tastan, S., Akbayrak, N. (2012). Medication errors: perspectives of newly graduated and experienced nurses.International journal of nursing practice,18(4), 317-324.
Subscribe to:
Posts (Atom)