The Discursive Management of Financial Risk Scandals Case Study

The Discursive Management of Financial Risk Scandals - Case Study Example Hamilton (2003) attributed Enron’s failure to a culture of conceit that led the society in general and economists in specific to buy the idea that it had the capacity to handle complex corporate risks in a successful manner. As such, Enron’s corporate culture was less concerned about advancing the ethics of respect and honesty. These important values were overlooked in a systematic process which saw the firm shift its focus to the doctrine of subsidiarity and maximization of profits at any cost. By keeping each Enron division autonomous from the others, Hamilton (2003) noted that the financial manipulators and their closest internal associates only were aware of the bigger picture of Enron’s financial position. I agree with Hamilton on the reasons for Enron’s downfall. This is especially true considering that overreliance on decentralization by a large company in an environment where there are inadequate operational and pecuniary controls is normally associated with failure. In addition, the seemingly diverted, hands-off company board including the chairman was a recipe for financial failure, as they could not initiate adequate checks and balances on the executive managers such as Skilling (Ailon, 2012). As a consequence, the accounting staffs, auditors, and company lawyers equally failed in their mandates. Eventually, the company’s complex financial records became so confusing to the public, the shareholders and even the spin-doctors, hence the failure. In spite of Enron’s dramatic move to formally admit bankruptcy in 2001, the failure did not occur by accident. According to Temple (2014), there were several presuppositions to the event including a business culture that spawned greed and scam while maintaining cosmetic value rather than real value. Following the  merger, the company’s assets tremendously expanded to an extent that it was ranked seventh among the top-ten American companies in terms of revenue. Managing the massive assets usually does not want any form of risky investments and misrepresentation of financial statements as Enron did before its collapse.  

Migratory Behavior of Mallard Ducks Essay Example for Free

Migratory Behavior of Mallard Ducks Essay There are four fundamental decisions that most animals make when it comes to mechanisms of adaptation: where to live, how to gather food, how to avoid predators, and what tactics to use to reproduce (Alcock, 1993). Habitat preferences in animals require satisfying their needs (ignoring or actively avoiding others, nutritional needs to perform growth, development and reproduction) at the same time experiencing higher fitness than those unable to settle in the favored habitat. There were also several hypothesis presented which correlates habitat preference and fitness. The seasonal dispersion of some animals like ducks is a costly business in terms of energetic expenses and risk to exposure to predators. On the other hand, considering dispersal cost, animals that do not respond to dispersion pay the price of deterioration due to the inability to adapt to the prevailing ecological conditions. Considering the inbreeding avoidance hypothesis (Ralls et. al, 1979), on ducks in particular, Mallard ducks may have migrated then for the purpose of expanding their genetic pool by interbreeding with Anas rubipes a close relative of the Anas playrynhos. The costly dispersal of Mallards may have been to avoid inbreeding depression primary of which is to circumvent the expression of damaging recessive alleles resulting from the mating of two closely related mates of the same species. This further correlates with the mate competition hypothesis (Moore and Ali, 1984), which states that males tend to fight against one another for mates therefore looser find it more energy efficient to seek closely related species to which they may successfully mate. When mating season is over, male disperses to avoid their daughters when these female become sexually mature. Animals engage into energetically exhaustive activity trying to complete the course of their journey to attain its fundamental goals. As the animal arrives to its destination, the issue of territoriality always comes to mind whenever a new species is introduced into a new environment and every time the visitor interacts with the native. While other animals ignore or tolerate the presence of a new species in its territory, others are extraordinarily aggressive in defending their territory from intruders. Territoriality among animals contributes to reproductive successes or failure to the contrary which further leads to interspecific competition. If suitable breeding sites really are short of supply, then one should be able to find non-territorial, non-breeding, individuals in populations of territorial animals. If this is so, the niche similarity of the visitors to the native may introduce interspecific competition with the available supplies. Territoriality may also influence the reproductive success of these visitors as it was found by Dhondt and Schillemans (1983). Territorial animals may invade the nesting sites of migratory birds which may lead to decreased viability and clutch. The ability of birds to fly and survive various environmental conditions has led to their development over time. Seasonal migration of mallard ducks (Anas platyrynchos) has been one of the intriguing aspects of its behavior. This behavior has been influenced mainly by several factors such as foraging (Heitmeyer, 2006), competition (Mc Auley, et al. , 2004), reproductive behaviors (Hill, 1984) which also includes the preservation of nesting sites, and interbreeding (Brodsky, 1989) and seasonal weather conditions (Ridgill, et al. , 1990 in D. Hill, 1992, Whyte Bolen, 1984, Poiani Johnson, 1991). Statement of the Problem From previous articles, it has been reported that Mallard ducks are reoccupying old territories throughout the United States and Canada (Talent, et. al. , 1983). From this observation, it can be inferred that various ecological changes in both habitat and inhabitants may take place. Since mallard ducks in this regard are annual visitors in these habitats, the temporary habitation of previous and new territories may significantly affect native animal species. With the combined hypothesis that Mallard ducks migrate from previously occupied territories due to overlapping conditions which may occupy new territories due to insufficiency of the previous, the study will assess the behavioral patterns of Mallard ducks towards returning to previous foraging territories and establishing new foraging regions (migratory routes) outside of their original habitats, specifically the study will address four major areas of concern. 1. What behavior of the Anas playrynchos determines the suitability of a habitat to be considered sufficient which helps it decide to inhabit previous foraging territories and new regions outside of their original habitats? 2. What behavioral mechanism will the Anas platyrynchos exhibit upon visiting a previous foraging territory and new regions outside of their original habitats if a highly territorial organisms was encountered upon landing? 3. What general behavioral model applies during the interaction of two closely related species (Anas rubipes and Anas platyrynchos) occupying the same niche in terms of: a. Reproductive tactics b. Foraging preferences c. Territoriality 4. What chances that the introduction of less territorial animal may cause significant adaptive stress (competitive stress) to a more territorial species? Hypotheses It is hypothesized that there is no significant differences in the previously reported behavioral mechanisms in Anas platyrynchos that helps it determine to decide on its habitat preferences. Alternatively, Anas platyrynchos establishes new migratory routes due to impending factors such as avoidance of predators, seasonal weather conditions, reproductive tactics and foraging preferences. Else, Anas platyrynchos establishes new migratory route or return to previous foraging areas due to certain conditions such as habitat destruction, scarcity of supplies needed to reproduce, and extreme territoriality between natives and migrants. Experimental Design In order to test these hypotheses, the study will be divided into two phases: the in vivo phase and in vitro phase. At the in vitro phase, groups of experimental populations of Mallard ducks will be placed in a study area which will allow observation of significant behavioral patterns relevant to foraging, reproductive tactics/quality such as mate preference, clutch size, egg size and viability, and interspecific competition. Two species of closely related species of ducks the Anas rubipes (native, will be allowed to acclimatize until such time that they one or two reproductive cycles have been achieved) and Anas platyrynchos (introduced species, will be introduced only after the native have been acclimatized well) will be situated in the same habitat which will be observed for close interaction. Behavioral patterns on mate preferences and competitive exclusion will be observed by on-site observation using a hidden observation platform. Foraging preferences will be looked upon by collection and analysis of droppings from both species. Geographical invasion of feeding territories will be looked upon by assigning quadrat areas which will be initially determined by the territorial preferences of both species of ducks. Territoriality will be measured by the number of times the more aggressive native will disturb the nesting sites of the migrants and the instance that the migrant will be driven away from a specific foraging site. Specific effects of such behavior will be measured by performing initial and final biometry of the two species of ducks. Decrease in biometric qualities from both adult and eggs would mean the inability to adapt into such competitive behavior. Possible effects of migrant foraging on native non-avian species will also be observed by recording the feeding activity of non-avian species living along the vicinity which might directly contribute to the promotion or disruption of the food chain brought about by the introduction of a new consumer. To observe the habitat preference of ducks with is natural behavior in its intact natural behavior, the in vivo phase will be done. Radio satellite transceivers will be wing banded on representative Anas platyrynchos through catch and tag method (including the alpha male) that are about to engage into seasonal journey to trace their possible destinations and stop-over. The result will be compared to previous annual migration data (20 years in succession or more depending on the available information) to establish a pattern supporting the behavioral mechanism that the ducks employ in selecting a habitat which sooth their preference. On site visitation of previously reported migration destinations will be surveyed to confirm habitation of previously occupied regions. Ecological evaluation and mapping of visited areas (stop-over and final destination) will be done and compared with other visited areas for specific pattern. Thorough monitoring of migration paths via remote sensing will be followed to confirm if ever there is a change in the migratory route. Conclusions will be based on the assessment of significant differences between the previously reported data and the novel information. Summary All in all, birds may move to various locations for survival. If the prevailing conditions decrease fitness, migratory ducks may move to different locations to continue to find food, reproduce and avoid predation. When the conditions increase fitness, these ducks will then return to their natal site where they will breed and raise their young. It may be that physical conditions and forces that govern the earth’s magnetic poles, hormonal changes, changing weather patterns or other various factors contribute to the birds urge to migrate to their seasonal habitats. For the purpose of this paper, the most important factor to be considered are the consequences to native animals belonging in the same niche brought about by abrupt or gradual changes in migratory routes and the resulting occupation of new or old territories. In the evolutionary perspective, animals are able to adapt into their environment mainly by employing specific behavioral mechanisms that would enable them to perfectly cope. At the event that an animal fails to establish equilibrium with its environment, serious complications arise. The study will better establish significant behavioral patterns in Mallard ducks which enable to blend in and adapt in variable habitats. Such adaptive behavior may serve as a key towards preserving animal species that are in danger of extinction simply because the adaptive behavior is not appropriate for survival. References Cited Alcock, John. 1993. Animal Behavior: an evolutionary approach, 5th ed. Sinauer Associates, USA. 279-379. Dhondt A. A. , and J. Schillemans. 1983. Reproductive success of the great tit in relation to its territorial status. Animal Behavior 31:902-912. Heitmeyer, M. E. 2006. The Importance of Winter Floods to Mallards in the Mississippi Alluvial Valley. Journal of Wildlife Management. Vol. 70, No. 1. pp. 101-110. Hill, David. 1992. Cold Weather Movements of Waterfowls in Western Europe. The Journal of Animal Ecology, Vol. 61, No. 1. Feb. , pp. 238-239. Hill, D. A. 1984. Population Regulation in the Mallard (Anas platyrynchos). Journal of Animal Ecology. 53. pp. 191-202. Mc Auley, D. G. , et. al. 2004. Dynamic use of wetlands by black Mallards: Evidence Against Competitive Exclusion. Wildlife Society Bulletin. Vol. 32. , No. 2. pp. 465-473. Poiani, K. A. , Johnson, W. C. 1991. Global Warming and Prairie Wetlands. BioScience, Vol. 41, No. 9. Oct. pp. 611-618. Talent, L. G. , et. al. 1983. Survival of Mallard Broods in South-Central North Dakota. The Condor, Vol. 85, No. 1. Feb. , 1983, pp. 74-78. Whyte, R. J. , and Bolen, E. G. 1984. Impact of Winter Stress on Mallards Body Composition. The Condor, Vol. 86, No. 4. pp. 477-482. Moore, J. , and R. Ali. 1984. Are dispersal and inbreeding avoidance related? Animal behavior 32:94-112. Ralls, K. , et. al. 1979. Inbreeding and juvenile mortality in small populations of ungulates. Science 206: 1101-1103.

Medical ward objectives and staffing levels

Medical ward objectives and staffing levels This is a 34 bedded medical ward admitting male patients with different conditions.The specialties are as follows: Specialties Consultant Beds Gastro-Enterology Dr. Salim AL.Harthi 6 Neurology Dr. Jaber AL.Khaburi 5 Respiratory Dr. Nasser AL.Busaidi 5 Cardiology Dr. Abdullah AL.Riyami 4 Endocrinology Dr. Noor Al.Busaidi 4 Infectious Disease Dr. Saif AL.Abri 4 Rheumatology Dr. Ramnath Misra 4 Hematology Dr.Muhana AL.Maslahi 2 Ward Objectives:- To plan, organize, implement and evaluate the nursing services to ensure that a high standard patient care is delivered within the ward. To maintain optimum professional code of conduct, practice and good staff morale of professional nurse. To maintain effective communication with patient and their relatives concerning the nature and management of clinical conditions and their outcomes. To ensure all staff have been updating their knowledge by conducting some lectures within the ward level and training programs within CPE department. To facilitate the integration of newly qualified Omani nurse into their roles and responsibilities in the tertiary medical services consistent with the national policy on Omanization and fully aware administrative roles and regulation pertaining their employment. To conduct regular staff performance appraisals to assess competency, progress, strengths, weaknesses and identify further education and training needs. To schedule and deploy sufficient numbers of staff to provide 24hrs nursing care to ensure safe clinical practice. To ensure optimum utilization of the hospital resources towards the appropriate provision of nursing services throughout the ward. Staffing Levels:- Staff levels Omani Staff Expatriates Staff Senior Junior Senior Ward Nurse 1 Staff Nurse 1 13 3 Ward Coordinator Nil Medical Orderlies 1 3 Total staff 27staff (-1staff in Female Medical 1, plan for transfer. Ward Activities:- Termination, Omanization, Transferring, Resignation and New staff:- Sr. No Ward Activities No. Of Staff Nurse Remarks 1 Termination Nil Nil 2 Omanization 2 S/N Seena affected date 01/08/2009 S/N Smitha affected date 06/09/2009 3 Transferring 3+ 1 Temporary 1 S/N Wafa Harib affect date 02/05/09 to Royal Hospital OPD S/N Suganthi affect date 02/05/09 to MM1 S/N Enci affected date 06/06/09 to FM2 + S/N Faiza affected date 01/11/09 to FM1 (Temporary) M/O Said affected date 02/05/2009 to Royal Hospital X-Ray Department 4 Resignation 1 S/N Ajitha Affected date 06/12/2009 5 New Staff 2 S/N + 1 M/O S/N Idris Al-Farsi S/N Sangoor Al-Yusufi + M/O Turki Barghash New Equipment:- 1. Glide sheet for patient turning 6/7/09 2. Our old cardiac monitor has been replaced. Activities in Male Medical Two Within Each Month:- Male Medical Two is kept for conducting the MRCP exams four times per year which always take one week; each time of these exams went so smoothly and will give as chance for tarrow clean the ward. The ward is the Disaster ward in the medical unit, all staff in the ward have good knowledge of the step how to followed in any emergency situation (of each month 1st week there is discussion Disaster matter to upgrade staff knowledge) On 13/11/2009 there was a disaster drill which has prove to us that the objective of disaster action cards are met throughout the feedback we received verbally from Nursing Administration. 2nd Week in each month kept for upgrade staff knowledge about Professional Code of Conduct by given lecture with scenarios in one of the element. 3rd Week in each month kept for upgrade staff knowledge about Medication action side effect, by lecture given by assigned staff 10-15 minutes prior to hand over of morning shift. 4th Week in each month kept for upgrade staff knowledge about Firewast management by lecture given by assigned staff 10-15 minutes prior to hand over of morning shift. Ongoing monitoring is being done on:- Nursing Records Auditing which we are doing since July 2001. Daily patient Fall Assessment Score. Wound care assessment. Daily followed screening for any infection (MRSAMDRAB) Daily followed Nursing process which started on 2nd September 2002. Discharge planning started on October 2002 Monthly Environmental Audit. Six Month report. Education, Training and Quality Management for 2009 SR Courses 2009 No of S/N completed Remark 1 Ward Management 1 3 2 High Dependency 3 3 3 Pain Management 4 22 4 ECG interpretation 1 11 5 Preceptor ship 3 23 Upgrade their knowledge by refreshment preceptor workshop. 6 IV Therapy Drug Calculation 28(All staff) 7 IV Cannulation 7 We are following up with other 8 staff practice cannulation till they are competent. 8 Wound stoma care 3 4 They are helping to teach other staff in the ward level and follow up the care about wounds. 9 Post Kidney Transplant 1 1 10 Recertification BCLS 28(All staff) Every 2 years 11 Manual Handling 23 Other 5staff who are joining MM2 in last 3years they are learn more about it from senior staff during work. 12 Physical Assessment 3 6 Recertification of BCLS and management of Cardiac Arrest:- All of nurses certified more than 2 years ago have been recertified. Nurses within the ward has been assessed for their competency in management of cardiac arrest at the ward level in recognizing cardiopulmonary arrest, move rapidly towards Life saving. The plan for ward basic CPR within Ward level, which aim to check the staff competency with it. Strategic Plan for next year:- To continue the ward activities, upgrade the standard of care and services to the patient. To plan, organize, implement and evaluate the nursing services to ensure that a high quality patient care is delivered within the ward level. To maintain optimum Professional Code of conduct, practice and good staff morale of professional nurse. To ensure all staff has been updating their knowledge by conducting different courses in CPE and some lectures within the ward level regarding cases, medication and infection control. To finalize Endoscopy Procedure Brochure this is made by staff in Male Medical Two. To continue give first priority for CPE program courses to Omani staff to improve their competencies and skills. Plan to give 3 lecture within medical unit by our staff regarding (fall prevention, CVP care and medication calculation during emergence). Done by :- Saif AL.Ghuzaili

Lasik Eye Surgery Essay -- Eyesight Vision Corrective Surgery

Putting a Close Eye on LASIK Laser-Assisted In situ Keratomileusis (LASIK) is a surgical operation intended to allow an individual to live independent of glasses or contacts. Since 1995, when the Food and Drug Administration approved the type of laser used in corrective eye surgery, optometrists have developed a number of different procedures to clear up foggy or blurry vision in one's eye. In 1998, the Lasik surgery became the most common type of surgery, and remains the number one refractive eye surgery today. The surgery itself lasts no longer than 15 minutes per eye, and begins with the doctor placing a number of eye numbing drops into the patient's eyes to eliminate any possibilities of pain during the procedure. The first step in the procedure involves the cutting of a flap in the cornea by a computer programmed device called a microkeratome. By cutting the flap, the surgeon is able to use tiny tweezers-like instruments to unpeel the sliced flap. With the flap peeled back from the cornea the laser is used to remove small pieces of the inner part of the cornea, but the laser has only a specified wavelength which does not allow it to pass through the cornea to any other portion of the eye. The flap is then repositioned without stitches and is secure after seconds of drying ("Lasik Eye Surgery"). Doctors claim that the surgery is so popular because the patient's vision is restored rapidly and there is little to no post- surgery pain. But while the number of patients receiving the procedure rises, so do the number of complications and patient complaints. Patients whose vision was successfully restored cite that the success of the operation is dependent on the experience and skill of the surgeon, but many cases can be ... ...ped to assist with this problem, but currently over fifty percent of patients will experience poor night vision in the first month following their surgery, and of those, half will experience permanent night vision problems. http://archives.thedaily.washington.edu/2001/010901/N5.Lasereyesu.html http://www.kathygriffin.net/lasik.php Works Cited Elliott, Louise. " Laser eye surgery may damage night-vision long term." The Canadian Press. 17 July 2000. Canoe Network. 1 Nov. 2005. . "Lasik Surgery." Wake Forest University Eye Center. 23 August 2005. Wake Forest University Baptist Medical Center. 1 Nov. 2005. http://www1.wfubmc.edu/lasik/LASIK+Eye+Surgery/. "Lasik Eye Surgery." Center for Devices and Radiological Health. 9 March 2005. U.S. Food and Drug Administration. 1 Nov. 2005. http://www.fda.gov/cdrh/LASIK/risks.htm.

Barriers, challenges, and strategies Essay

Most clinical health care workers are aware that achieving the paradigm of evidence-based practice (EBP) is the gold star standard that one strives for in his/her clinical practice. EBP is expected of healthcare clinicians and has become a synonym for quality care both by the institution of healthcare and its consumers (Brim & Schoonover, 2009). This essay will define EBP for nurses. The barriers, challenges and strategies to implementing evidence-based nursing practice (EBNP) will be discussed with reference to relevant and authoritative literature. As well, the relevance and the links that EBNP has with the clinical area of Intensive Care will be discussed. EBP is the integration, by clinicians, of clinical expertise which is meticulous, explicit and uses current clinically appraised professional knowledge (Eizenberg, 2011; Kenny, Richard, Ceniceros, & Blaize, 2010). EBP accommodates patient preferences, views and values; while also guiding, supporting, validating and answering health care workers clinical judgements, practices, and questions (Eizenberg, 2011; Kenny et al., 2010; Matula, 2005; Wolf, 2005). EBP is a process of asking a clinical question; searching for clinical evidence; critically appraising this evidence and then expertly integrating this evidence with patient’s values, views and preferences; evaluation of how the changes to practice have had on outcomes; and finally disseminating the results that the EBP or change had on patient outcomes (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010). The definition of EBP and EBNP and the implementation of EBNP appear to be straightforward and easily accomplished; however, EBNP implementation is far removed from being easy (Brim & Schoonover, 2009; Cullen, Titler, & Rempel, 2011; Eizenberg, 2011; Kenny et al., 2010; Tolson, Booth, & Lowndes, 2008). Nursing research has uncover ed numerous challenges and barriers which the implementation of EBNP faces. These challenges and barriers can be classified as a research, a clinician, an organisational, a nursing professional barrier, and not least patient barriers (Fernandez, Davidson, & Griffiths, 2008; Gerrish et al., 2011; Hutchinson &Johnston, 2006; Ross, 2010). Eizenberg (2011), Gerrish et al. (2011), and Ross (2010) found that nurses face research and clinician barriers that include not having the time, skills and knowledge to critically critique and/or synthesise research literature, unable to effectively use and search databases electronically, hold negative views toward research and feel research is too complex, as  well research at times is not clear on how to implement the findings and findings can be contradictory. Due to these barriers, nurses tend to rely on synthesised evidence such as evidence-based protocols, policies and procedures (Gerrish et al., 2011). Eizenberg (2011) and Gerrish et al. (2011) also found that nurses prefer to acquire information through third parties such as their colleagues, the workplace, through patient care experience, and the knowledge they received from their nursing education. Eizenberg (2011) found that the organisation is the greatest factor in successful EBNP implementation. The organisation controls access and the budget to and for evidence resources such as computers with internet access, a well-equipped library, and access to educational opportunities in EBNP procedures and theory (Eizenberg, 2011). The barrier of not having the authority to change a nursing practice also lies with the organisation – a nurse may have the necessary research knowledge and experience to effectively change practice but cannot implement practice change due to the organisation not giving him/her the authority to instill change (Eizenberg, 2011). Few nursing staff members are given the opportunity to participate in the development of evidence-based policies and procedures; therefore, most nurses are not engaged to support EBP. Ross (2010) further found organisational barriers such as the organisation giving priority to other goals (for example excess sick leave) over EBNP, the organisation may perceive that the staff are not ready or willing to implement EBNP, and that the organisation believes EBNP is unachievable. These organisational barriers prevent EBNP being accomplished and to the greater extent of not being implemented. A barrier of nursing profession relates to the medical dominance of healthcare; as such, nurses are not afforded the power, authority, autonomy and respect from colleagues for nursing practice that the status of being a profession decrees (Brim & Schoonover, 2009; Eizenberg, 2011; Gerrish et al., 2011). A further nursing profession barrier is it can be difficult to instill enthusiasm or information about an EBNP if turnover is high; there is a shortage of experienced nurses; and support from colleagues is lacking (Gerrish et al., 2011; Mark, Latimer, & Hardy, 2010). Due to high turnover and staff shortages, nurses are unable to leave the bedside and have limited time to participate in EBNP projects such as journal clubs, or to attend training in EBP, PICO  (Population/Intervention/Comparison/Outcome), and database searches (Brim & Schoonover, 2009; Brown, Johnson, & Appling, 2011). Nurses, as Kenny et al. (2010) found were hesitant to change their practice if the change would perceivably increase an already heavy workload. Brim & Schoonover (2009) found that some nurses believed EBNP to be an optional course of action as they were never shown a clear direction of what EBNP is essential to nursing and his/her practice. One of the main premises of EBNP is that the evidence and the v alues and beliefs of the patient/s are synthesised together to form an EBNP which is foremost favourable for a positive outcome for the patient/s (Fernandez et al., 2008). Such factors as treatment, travel, and prescription costs; denial of diagnosis; inadequate knowledge level of disease and strategies to decrease risk factors; lack of social support; and cultural issues can all potentially become barriers to implementing an EBNP for a patient or patients (Fernandez et al., 2008). The high acuity of an intensive care unit (ICU) patient significantly affects a nurse’s ability to search a database for answers (Brim & Schoonover, 2009; Kenny et al., 2010). An answer to a question is usually needed immediately or momentarily; therefore, ICU nurses rely on experience, colleagues, and knowledge of evidence-based policies, procedures and guidelines (Eizenberg, 2011; Gerrish et al., 2011). I know I rely heavily upon in-services, experience, and speaking with the ICU Clinical Nurse Educators and Nurse Educators who will do a literature search to acquire information or answers to a question I have posed – but once again this evidence/information h as been synthesised by others and is third hand and I have not fully practiced EBN (Eizenberg, 2011; Gerrish et al., 2011). To try and challenge this barrier I do try and read the clinical information the educator obtained at a later date – usually at home or on a break. Strategies to overcome these challenges and barriers abound from EBP and EBNP journal articles and books. Some of the leading strategies are for the organisation to fully support EBNP through infrastructure, strong leadership from nurse managers and/or advanced practice nurses, and by ensuring a context in which EBNP can flourish (Gerrish et al., 2011; Tolson et al., 2008). The infrastructure needs to provide access to a computer which can access online databases. Infrastructure needed to be in place includes a staffed evidence based nursing library with a librarian able to educate nurses on the process of  EBNP (Pochciol & Warren, 2009). The added challenge is to have EBNP info accessible to the nurse at the patient’s bedside (Pochciol & Warren, 2009). Nursing leaders need a Master’s degree or above, as studies show that leaders with these credentials read and implement more research literature; are more confident; and they consider themselves more competent in supporting others through the EBNP process (Eizenberg, 2011; Gerrish et al., 2011). Leaders, as suggested by Cullen et al. (2011), hold the responsibility to provide support; to build, to create, and maintain an organisational culture that has the capacity to support EBP at both a clinical and administration level. Leaders must be given the power, authority, and support to introduce change – without this authority change cannot occur (Eizenberg, 2011). Scholars agree that if EBNP is to succeed and be sustainable nurses need to be educated and mentored on the implementation process of EBNP (Brim & Schoonover, 2009; Brown et al., 2011; Eizenberg, 2011; Gerrish et al., 2011; Pochciol & Warren, 2009; Ross, 2010; Tolson et al., 2008). EBNP education of nurses needs to begin at orientation to the hospital and is essential that this education is continually built upon and supported with extra education given to nurse managers, educators and advanced practice nurses (Pochciol & Warren, 2009 & Tolson et al, 2008). Ross (2010) suggests nurses information literacy be improved to ensure nurses are able to practice EBN. Information literacy is the ability to competently recognise, locate, and evaluate the fundamental information required at a given point (Ross, 2010). The ICU, where I am employed, has undergone significant changes to the staff and managerial side of the unit. At one point the Clinical Nurse Specialists ratio decreased to less than 5% of nursing staff and there was not a permanent full time Clinical Nurse Consultant. Without the necessary support acquired from these roles the education of ICU nurses and the implementation of new practices, policies and procedures decreased significantly. These barriers significantly halted EBNP from occurring in the ICU as there were very few highly educated leaders available to support EBNP. As suggested by Eizenberg, (2011), Gerrish et al. (2011), and Cullen et al. (2011), educated leaders and managers are needed to keep and instill EBNP to an institution. To obtain Magnet Status hospitals must ensure that EBNP is in place, is supported, and is sustained by the organisation (Brown et al., 2011). To procure nurse  interest in EBNP, and maintain Magnet Status, some hospitals have linked participation in EBNP to clinical ladder advancement and a monetary reward in the form of a wage increase with advancement up the ladder (Whitmer, Aver, Beerman, & Weishaupt, 2011). To hold their position on the clinical advancement ladder the nurse must show, yearly, that he/she is supporting, or implementing, or participating in EBNP within the setting they are employed (Whitmer et al, 2011). The benefits of practicing EBN includes: patients ability to access effective evidence based treatment information; facilitates consistent improvement, through decision making, to healthcare systems; facilitates decisions based on up-to-date evidence and technologies; and reduces variances in nursing care from one nurse to another – standard and competencies are evidence based and consistent; through evidence based competencies the professional status of nursing is elevated to higher heights (Gerrish et al., 2011; Eizenberg, 2011). In conclusion, the challenges/barriers, barrier strategies, and benefits of EBNP has been discussed. Little discussion on EBNP within an ICU was attempted as the ICU nurses face the same situations, challenges/barriers, strategies and benefits as nurses in other areas of healthcare (Sciarra, 2011). Nurses must be given organisational support, education and knowledge needed to participate proficiently in EBNP. References Brim, C. B., & Schoonover, H. D. (2009). Lessons learned while conducting a clinical trial to facilitate evidence-based practice: the neophyte researcher experience. The Journal of Continuing Education in Nursing, 40(8), 380-384. DOI: 10.3928/00220124-20090723-06 Brown, C. R., Johnson, A. S., & Appling, S. E. (2011). A taste of nursing research: an interactive program, introducing evidence-based practice and research to clinical nurses. Journal for Nurses in Staff development, 27(6), E1-E5. DOI: 10.1097/NND.0b013e3182371190 Cullen, L., Titler, M. G., & Rempel, G. (2011). An advanced educational program promoting evidence-based practice. Western Journal of Nursing Research, 33(3), 345-364. DOI: 10.1177/0193945910379218 Eizenberg, M. M. (2011). Implementation of evidence-based nursing practice: nurses’ personal and professional factors? Journal of Advanced Nursing, 67(1), 33-42. DOI: 10.1111/j.1365-2648.2010.05488.x Fernandez, R. S., Davidson, P., & Griffiths, R. (2008). Cardiac rehabilitation coordinators’ perceptions of patient-related barriers to implementing cardiac evidence-based guidelines. Journal of Cardiovascular Nursing, 23(5), 449-457. Gerrish, K., Guillaume, L., Kirshbaum, M., McDonnell, A., Tod, A., & Nolan, M. (2011). Factors influencing the contribution of advanced practice nurses to promoting evidence- based practice among front-line nurses: findings from a cross-sectional survey. Journal of Advanced Nursing, 67(5), 1079-1090. DOI: 10.1111/j.1365-2648.2010.05560.x Hutchinson, A. M., & Johnston, L. (2006). Beyond the BARRIES Scale: commonly reported barriers to research use. Journal of Nursing Administration, 36(4), 189-199. Kenny, D. J., Richard, M. L., Ceniceros, X., & Blaize, K. (2010). Collaborating across services to advance evidence-based nursing practice. Nursing Research, 59(1S), S11-S21. Mark, D. D., Latimer, R. W., & Hardy, M. D. (2010). â€Å"Stars† aligne d for evidence-based practice. A TriService initiative in the Pacific. Nursing Research, 59(S1), S48-S57. Matula, P. (2005). Evidence-based practice at the bedside: Igniting the spirit of inquiry. The Pennsylvania Nurse, Dec, 22. Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). The seven steps of evidence-based practice. Following this progressive, sequential approach will lead to improved health care and patient outcome. The American Journal of Nursing, 110(1), 51-53. Pochciol, J. M., & Warren, J. I. (2009). An information technology infrastructure to enable evidence-based nursing practice. Nursing Administration Quarterly, 33(4), 317-324. Ross, J. (2010). Information literacy for evidence-based practice in perianesthesia nurses: readiness for evidence-based practice. Journal of PeriAnesthesia Nursing, 25(2), 64-70. DOI: 10.1016/j.jopan.2010.01.007 Sciarra, E. (2011). Impacting practice through evidence-based education. Dimensions of Critical Care Nursing, 30(5), 269-275. 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Why Online Medical Record Keeping is perceived as the Greatest Confidentiality Threat essays

Why Online Medical Record Keeping is perceived as the Greatest Confidentiality Threat essays Computerization of medical health records will indeed promote the greater use of e-business in the medical/health arena. It will also provide physicians around the world with greater access to patient information and case studies. Tied to these benefits however, is the risk that the publication of medical records electronically poses a greater security risk and potential for breech of confidentiality. HIPAA has recently enacted legislation targeted toward simplifying e-business processes and standardizing processes, but the effectiveness of this legislation with respect to security issues has yet to be tested in the real world' marketplace. This idea is explored in greater detail below. The combination of medicine and computer technology is both promising and concerning. Alpert (2003) discusses the ubiquitous nature of the combination of medicine with computer technology, noting that computers have allowed the medical record "to be transformed from merely a chronicle of direct patient care to an essential tool of managed care." This idea is supported by other researchers including Gostin (1995) who points out those technological advances will become an essential aspect of care in the future rather than merely a convenience. Medical records store evidence of care a patient has received or will be receiving, and makes that information easily accessible to insurance agents, employers, managed care organizations and even state officials (Alpert, 2003). This may help the medical insurance approval process among other things. Naser information is increasing among individuals with no direct clinical relationship to the patient. This may include employers seeking information or non health related insurance agents. Because of the ease of use of the internet, and because of the potential for information to ...