Engineering college essay: November 2019

Thursday, November 28, 2019

Two main types of customer in the travel and tourism industry Essay Example For Students

Two main types of customer in the travel and tourism industry Essay Outline1 Introduction to customer service2 Types of customers3 Elderly4 Business5 Teen Groups6 Student (backpackers)7 Couples Introduction to customer service Customer service plays and important role in running any company, particularly in the travel and tourism industry. If customers receive good customer service hey will be happy and as a result they will keep using the company/organisation. Therefore, the company receives more business and in return make a decent profit. Good customer service involves working to customer need, Speaking on a respectful level sufficient product knowledge, being understanding to customers and remaining impartial, well trained staff, dealing with customer complaints promptly and efficiently, patience, providing alternative products or refunds, appearance (looking presentable), having good communication skills and working as a team. Bad customer service can contribute to customer dissatisfaction. Bad customer service involves poorly trained staff, being patronising to guests, ignoring the customers need. Ignoring customers valid complaints, having limited products available, providing a dirty and unclean en vironment, having a negative attitude towards customers and having a poor appearance which is unacceptable and unprofessional. Types of customers We will write a custom essay on Two main types of customer in the travel and tourism industry specifically for you for only $16.38 $13.9/page Order now There are two main types of customer in the travel and tourism industry. These are internal customers and external customers. Internal customers are members of staff within an organisation or outside suppliers who contribute towards the service that is provided, for example management or supervisors who are part of an organisation, even the cleaners are an internal customer. External customers are the customers who book or pay the organisation there money to stay or to use there services. Type of customer Needs How the accommodation sector meets their needs. Families Families tend to go for package holidays, as this means that all the work of organising the holiday is done for them. Also these are normally quite cheap as they are last minute deals, and they are in 3 star plus hotels. Families need to know that that there children will be safe on holiday, such as knowing that there as a high balcony, as they sometimes have young children with them, so they would like a hotel with no building work going on also they would like to see that the hotel have a childrens pool. Young families would also like to see that the hotel has a kids club, as the parents also would like some rest on there holiday. To continue, the parents would maybe also like some adult activities to do when the kids are in the kids club, such as, golf, spa treatments. Families tend to want to stay in a highly tourist populated area, near the beach and shops. This is so they dont have to rent a car, which would be more expense. There are a number of accommodations that would suit a family; Young families would go for package holidays with such companies as, Thompson, Thomas cook and First choice. These all cater for young families as they have hotels with the specification that they would like from the following column. Families with teenage children would like more to hotels with good pool facilities. And also close to bars and entertainment. They would most probably still book with Thompson and First Choice but they will just be looking at a different location and facilities. Families with their grandparents coming along will most probably be looking for a hotel that can cater for the children with a kids club and near entertainment for the teenagers also some facilities for the elderly such as entertainment like a jazz band. Elderly Elderly people would like their holiday to be relaxing and everything done for them. Their needs are a relaxing place, easy access, entertainment and bus trips. They would prefer a cruise other than a adventure holiday skiing. They would also like to have everything that they need on their doorstep as most elderly people find it hard to walk long distances. The elderly would also like to be in destinations that have shows that are from their era as that is the music that they still listen to. The elderly like to have package holidays as they are not able to book them up themselves as most of them wouldnt know where to start. Elderly people like to have everything organized for them as they like to be told what is on offer for them and choose. The elderly also like to holiday together as they would like to have a conversation with people who have gone through the same as they have, they would like to have the same interests. So most elderly people go on cruises and special resorts whi ch only allow over 60s. .u36de5dca081765c83e30c7317f841fb4 , .u36de5dca081765c83e30c7317f841fb4 .postImageUrl , .u36de5dca081765c83e30c7317f841fb4 .centered-text-area { min-height: 80px; position: relative; } .u36de5dca081765c83e30c7317f841fb4 , .u36de5dca081765c83e30c7317f841fb4:hover , .u36de5dca081765c83e30c7317f841fb4:visited , .u36de5dca081765c83e30c7317f841fb4:active { border:0!important; } .u36de5dca081765c83e30c7317f841fb4 .clearfix:after { content: ""; display: table; clear: both; } .u36de5dca081765c83e30c7317f841fb4 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u36de5dca081765c83e30c7317f841fb4:active , .u36de5dca081765c83e30c7317f841fb4:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u36de5dca081765c83e30c7317f841fb4 .centered-text-area { width: 100%; position: relative ; } .u36de5dca081765c83e30c7317f841fb4 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u36de5dca081765c83e30c7317f841fb4 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u36de5dca081765c83e30c7317f841fb4 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u36de5dca081765c83e30c7317f841fb4:hover .ctaButton { background-color: #34495E!important; } .u36de5dca081765c83e30c7317f841fb4 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u36de5dca081765c83e30c7317f841fb4 .u36de5dca081765c83e30c7317f841fb4-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u36de5dca081765c83e30c7317f841fb4:after { content: ""; display: block; clear: both; } READ: Child abuse occurs like a virus. Child abuse remai EssayThe elderly would most probably book up with a company called Saga Holidays which specialize in holidays for the elderly. The are a cruise company that only accept people over 60. This attracts a lot of elderly people as they dont want screaming kids running around on there holiday. Sage holidays amuse the elderly by have a small pool, normally a jacuzzi. They have entertainment in the sort of a jazz band and live entertainers from their era, also they have a doctor on board so that if they fall in they know there taken care of, as elderly people fall ill easier than younger people. Saga Holidays also offer different cruises like a around the world cruise as elderly people are retired and have a lot of time to relax. Also they offer cruises just around the Mediterranean to see different islands and countries. Business Business men and women would like to go to a hotel that can cater for the needs. Their main need is a need for speed as they have to rush to meetings and they dont have time are time is money for them. Their other need are 24 hour check-in as they need to be able to check-in and have a few hours of sleep but they might have to be up at 3:00AM to catch a flight. Also business men and women also would like to have wireless in their rooms as they might need to check their emails or get some work done. Wake-up calls may also be wanted as they might not have a alarm on them and have to be up early. They may also like a trouser press and they may have a conference the next morning and it has been in a suitcase for a long time. Business men and women also would like a safe in their room as they normally carry a lot of money and would not like to take it out with them. They may also like a international direct-dial telephone. Business men and women would also like to see complimentary toilet ries as they dont want to have to take shower gel and shampoo with them. Business men and women would normally go for a worldwide hotel chain as they know what they will be getting every where they go also their company would be able to pay for the stay in one payment making it more time effective to do this. They would probably book in to a Hilton hotel as they are international and they do have all of the services that business men and women require. The hilton also is luxurious and is not to expensive for the company. Teen Groups Teen groups tend to want to have a cheap package holiday as they dont have a lot of money as they are students working and studying at the same time. Teens are normally looking for a 2-3 star hotel in places such as Ibiza and spain. This is because teens are looking for cheap holidays with cheap drink. Also they are looking for a hotel that is in the middle of the bars and nightclubs, as they just want to go out at night and go to the bars and club. They dont want to have to pay for a taxi all the time. Teens are just looking in their hotels to have a decent bed, a pool and all the basics. This is because they will most probably not spend a lot of time in their hotel as they will be out at the beach and shopping or at bars. Teens will book a package holiday as they want to get a last minute deal as they dont have a lot of money and they just want a cheap holiday in their school holidays. Also as they want their holiday to include flights, airport transfers and any trips they might wa nt to go on, they can just see their holiday rep and the holiday rep will book it for them. Teens generally have a low budget and they know they wont get a lot for their money so they know they will only get the basics. .u38913cd7e0dc0d3439764c1fab6c4b3a , .u38913cd7e0dc0d3439764c1fab6c4b3a .postImageUrl , .u38913cd7e0dc0d3439764c1fab6c4b3a .centered-text-area { min-height: 80px; position: relative; } .u38913cd7e0dc0d3439764c1fab6c4b3a , .u38913cd7e0dc0d3439764c1fab6c4b3a:hover , .u38913cd7e0dc0d3439764c1fab6c4b3a:visited , .u38913cd7e0dc0d3439764c1fab6c4b3a:active { border:0!important; } .u38913cd7e0dc0d3439764c1fab6c4b3a .clearfix:after { content: ""; display: table; clear: both; } .u38913cd7e0dc0d3439764c1fab6c4b3a { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u38913cd7e0dc0d3439764c1fab6c4b3a:active , .u38913cd7e0dc0d3439764c1fab6c4b3a:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u38913cd7e0dc0d3439764c1fab6c4b3a .centered-text-area { width: 100%; position: relative ; } .u38913cd7e0dc0d3439764c1fab6c4b3a .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u38913cd7e0dc0d3439764c1fab6c4b3a .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u38913cd7e0dc0d3439764c1fab6c4b3a .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u38913cd7e0dc0d3439764c1fab6c4b3a:hover .ctaButton { background-color: #34495E!important; } .u38913cd7e0dc0d3439764c1fab6c4b3a .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u38913cd7e0dc0d3439764c1fab6c4b3a .u38913cd7e0dc0d3439764c1fab6c4b3a-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u38913cd7e0dc0d3439764c1fab6c4b3a:after { content: ""; display: block; clear: both; } READ: candidate speech EssayTeens will usually go to travel agents or go on Expedia to book their holiday. They will book it last minute as they want a good cheap deal. Teens will normally go to travel agents such as Thompson and Thomas Cook they will also probably fly with Ryanair as they are the cheapest airline. Teens will stay in hotels such as local hotels which are 2-3 star near the beach. Local hotels will have a the very basics as they are trying to earn a living but cant afford to make it a desirable hotel. These normally are very cheap and are bed and breakfast orientated. Student (backpackers) Students are looking for cheap accommodation such as hostels as they are just looking for a night stay in a place. Backpackers never have a lot of money to spend on hotels so they just book in at hostels or camp. They would use local camp sites. Backpackers normally just book accommodation when they arrive as they dont know where they will be and when they will be there. Backpackers have a small limit money wise so they will take bedding in there backpacks so they know if they are low on money they can just tent for the night. Backpackers will basically plan out there journey but they dont have a strict timetable. They are expecting in a hostel, a bed to sleep on and a bathroom also sometimes they expect some breakfast and dinner, but just soup and bread. The other advantage of using hostels when backpacking is that the places that backpackers travel to are usually off the beaten track meaning that they cant find hotels there, so hostels are helpful as they are cheap for them and the y also are in places where hotels arent. Backpackers usually book their holidays through backpackers holiday companies such as STA travel as they offer extremely cheap flights for backpackers, which are probably with no frills airlines, such as Ryanair and Easyjet. With STA travel you can also plan your trip and try to organize what you will be doing from one day to another. STA travel also offer volunteering opportunities which give backpackers a chance to go home some people less fortunate then themselves. STA travel gives backpackers a cheap and easy way to travel and plan your trip. Couples Couples are looking for luxury holidays in amazing destinations, such as maldives caribbean and are surrounded by beautiful surroundings. Couples are looking for a children free resort and they expect everything to be inclusive as they are paying a high premium for they holiday. Couple are looking for a romantic destination by the sea generally and a romantic atmosphere They expect to have restaurants in the resort such as a romantic al carte restaurant. Couples expect their resort to have a spa, maybe a gym also activities such as scuba diving and expeditions out of the resort. They may also like to see see that the resort has a golf course for the man. Couples expect to see in their room a king size bed, champagne and chocolates on arrival, a on suit bathroom also stunning views from there room. Couples also sometimes book their holiday in mind to get married or to go on their honeymoon so they want their hotel to have a luxury feel and also to be able to cater for a lot of guests if they are getting married and if they are on honeymoon to have luxury and peace before they get back to their busy lives. Couples normally book their holiday either from travel agents like Virgin or they book their flights themselves and then book the hotel separately like Sandals resorts as they only cater for people who are over 18 years old as they prize themselves on having a peaceful and romantic atmosphere without screaming children. around the resort. Sandals offer everything that a couple would want as they are at the hight of luxury. These holidays are very expensive are they are a specialty resort. Resorts such as Sandals meet the requirements for couples as they offer everything that couples expect and more are they offer that bit extra like Rolls Royce transfer from the hotel which you wouldnt find and other resorts.

Sunday, November 24, 2019

Standing Ground by Ursula Le Guin Essay Example

Standing Ground by Ursula Le Guin Essay Example Standing Ground by Ursula Le Guin Essay Standing Ground by Ursula Le Guin Essay Essay Topic: In the Waiting Room Sula Gun bases most of her stories and novels on her beliefs and disbelief. She is an atheist and relies more on philosophy than religion. Perhaps that Is why Standing Ground, a story that deals with abortion, was written with no objectivity. Lee Gull had no religious beliefs Interfering with her Intended theme. Many of her stories are based on Taoism, where there Is good In every evil and evil In every good. In her writings, Lee Gull addresses enduring human problems. She also likes to write about children and their search for identity. Lee Gun lives that to become an adult, an individual must find ways of realizing the great potential in the unknown (Heeler 1451). Standing Ground is about a girl who has been thrust into the unknown world of adulthood. She encounters many obstacles but tries to find the good in them. Therefore, by Lee Guns standards, this girl is not a girl at all; she is a woman. Thus the story suggest that maturity does not always come with age; sometimes a child is forced to be an adult and serve as the only source of loving care and support. The plot of this story Is about one girls struggle to overcome the categorization of Ewing young, while at the same time helping her brain damaged mother get an abortion. The story opens mid-afternoon, as the two mall characters, Delaware and Share,approach an abortion clinic. Standing outside the clinic are Mary and Norman, two profile demonstrators who assume that Delaware, because of her age, is having the abortion. In the midst of their chanting and sign waving Norman grazes Delaware should with his sign; this is an invasion of privacy that Delaware battles throughout the story. Once inside the clinic, the receptionist, as well as two nurses, also assumes that Delaware is the one who is pregnant and talk to her as if she were a child. Sere begins to day dream in the waiting room. At this point, the reader find out that Delaware is Shares daughter, that Share is brain damaged, and that Share is pregnant due to date rape. After battling many age related assumptions and obstacles, Delaware helps her mother through the abortion only to have her mother refer to her as a baby. Outside, Mary and Norman share their views on abortion. They later have a child like argument which proves them to be Immature. As an adolescent, Delaware has been forced to mature at an early age. She has faced many common problems of growing up. On a daily basis Delaware has to fight to be taken seriously as an adult. This is shown throughout the story as the employees in the clinic talk to her in a child like tone. Through all of this, Delaware must also try and make plans to attend college. During a conversation in the waiting room, the nurse asks Delaware if she plans on attending college. After a thoughtful pause, Delaware admits to the nurse that she would like to. However, in the back of re mind Delaware knows that she will probably never go to college because she must stay take care of her mother. It is the constant care of her mother that causes Delaware to face a slew of adult problems as well. It was Delaware who made all of the necessary appointments for Share to get her abortion. During the ordeal of the abortion, she had to deal with Insurance and finance, as well as translating the doctors technical talk about the procedure into terms that Share could understand. Delaware Is not nappy Walt near Tie, out NAS Tuna somewhat AT a Dalliance AT ten g and bad that she faces and accepts it. Clue notes that Just as in Lee Guns other writings, this is the sign of true maturity (572). Other than recognizing the balance between what she wants and what she has, Delaware also exhibits many other common characteristics of a grown adult. While dealing with Share, Delaware has what seems to be infinite patience. For example, the clinic workers repeatedly mistake Delaware for the patient. Every time Delaware calmly states otherwise. Any other adolescent would have raised their voice, but Delaware remained patient throughout. She also exhibits an amazing sense of understanding when De inning with Share. Delaware feels strange and sad about her mother and her lack of seriousness for the situation (71). It is extremely hard for Delaware to remain ready to handle the situation when Share, do to her brain damage, is always in somewhat of a playful mood. Heeler has noticed that Lee Gun often uses the protagonists conscience to help guide them through hard times (1451). Perhaps it is Delaware conscience which guides her and gives her this uncanny sense of understanding. Lastly, Delaware is mature enough to recognize her limits. When the doctor asks Delaware to allow him perform the tuba legation, he realizes that this decision is much to important to make on her own. Heeler has also written of Lee Guns belief that both the pop dive and negative choices must be maintained to suspend an identity (1451). At her young age, Delaware is somehow aware of this and is able to make what the doctor views as a negative decision with no remorse. All of these traits help reinforce the controlling idea that Delaware is remarkably mature regardless of her age. Delaware faces two main antagonist while helping her mother. One of which is the pair of closed minded profile demonstrators. Mary and Norman are extremely radar antagonist to overcome because they feel that they are inalienably right. Mary even goes as far as saying this is a war and we are the army of right (67). Their presence alone causes Delaware a great deal of stress. With their wild chanting and sign swinging, Mary and Norman make a difficult situation even harder for Delaware. The contact that Normals sign makes with her shoulder haunts Delaware the entire story. It did not do any great physical damage to her, but caused her serious mental anguish. Delaware puts up a strong facade to help her believe that she is not weak. On the inside, she is scared of all that is happening. In Delaware world, her conscience and privacy are all that she has left to hold onto. When Normals sign grazed her shoulder, he invaded her privacy and therefore caused Delaware to feel as if he had left scratch on her soul. According to Boiler, Lee Gun believes that sometimes when we seek to improve the world, we do more harm than good (1064). Norman and Mary are a perfect example of this. Blinded by their ambitions to improve the world, they do not stop to think about the possibility that they are arming an innocent girl. Another antagonist that Delaware has to overcome is her young age. Although her age is never stated, it is said that Delaware is still in high school. Most students of the high school age are irresponsible and reckless. They feel that they are super m an and that nothing can hurt them. This is the preconceived notion that the demonstrators and the clinic workers have about Delaware. Every adult that Delaware Interacts Witt In ten story assumes Tanat seen was Irresponsible, mace a reckless decision w h a boy, and is now pregnant. These assumptions not only anger Delaware, but hurt her as well. Little do these adults realize that she is here to support her mother, nor do they bother to find out before assuming. Delaware true strength and mature y shines through every time she calmly lets others know that it is Share who is pregnant. After finding out that they were mistaken, not a single adult is mature enough to apologize. Furthermore, they continue to talk to Delaware as if she is a chi . Heeler notes on Lee Gun that in order to become an adult, one must find ways of realizing the potential of the unknown (1451). Neither he demonstrators nor the clinic workers took into consideration the unknown possibly that Delaware was there for reasons other than a bad decision. Delaware faces the unknown on a daily basis while caring for Share; thus by Lee Guns standards, she is the only true adult in the story, and therefore stronger that any antagonist that she faces. There are two key scenes which help the reader to fully understand two of the main characters and how they each affect Delaware. The first is the scene in which Norman vividly describes what he believes takes place during an abortion. He thinks hat e girls are strapped down and gassed. He pictures that the doctors spread her legs and pry and pull until the fetus, or he, finally comes out. Norman also believes that the doctors poke at him with sharp tools. They cause the woman to bleed and non and grit her teeth. They use their knives to pull him out, lifeless, limp, and dead. (69) This description gives the reader an idea how truly close minded Norman is. He has dedicated his life to the fight against abortion and yet he knows onto g about it. Norman has created a primal and annalistic myth about abortion which alps him to hate those who are involved. Norman is a perfect example of Lee Guns belief that an insecure being will manifest primal myths to compensate for reality (Sc tiger 355). He is a close minded old man who believes in nothing except for the fact that he is inherently right in his fight for life. According to Lee Gun, one becomes an adult when they stop projecting evil images upon others (Heeler 1451). This s en shows that Norman, a man in his fifties, projects evil on anyone who has to do with abortion. By Lee Guns standards, Norman is nothing more than a child. This ascription of the butcher shop shows that Norman, even though extremely immature, is difficult character for Delaware to overcome. The second key scene is Shares day dream. In the day dream, the reader gains an insight into Shares mind; furthermore, they gain an insight to what Delaware must put up with on a daily basis. From the start of this scene, it is immediately vivo that Share has the mind set of a child. First, she explains her feelings about Delaware. She talks of how sometimes Delaware acts like the momma and thinks she knows everything. She also says despite that, Share loves her deeply. Through such d corruption in the scene the reader becomes aware of the unbreakable bond that Share and Delaware have. This bond Justifies any questions of why Delaware has given up a normal life to care for her mother; for the first time, Delaware reasoning for her sections is made clear. During the scene, Share also states that she is brain damaged. She describes her special class and how her teacher talks to her. Even though Share is unaware, the teachers tone is amiable and child like. The reader now NAS n Idea AT now snare must De treated Ana want Delaware NAS to endure while caring for her mother. Both of these scenes help to further understand Share and Norman, two of the main characters that Delaware interacts with. There are two separate climaxes in this story. The first, is the final argument between Mary and Norman. Throughout the story, they have both kept their thoughts about each other to themselves. Each has their own reasons for protesting, however they o not feel that the other has the merit to be there. In this final argument, they take turns screaming at one another. Mary tries to scare Norman away by threatening to tell the director of the organization on him. Norman spends by standing in the y of Mars path. In the beginning of the story, they both were portrayed as adults. In the final argument, they are reduced to smelling little children arguing over a piece of candy. At the climax, Norman and Mary find themselves exactly where they Egan; they have found no resolution, and are fighting once again with their eyes shut for a cause that they know little about. The second climax is when Delaware comes to see her mother after the abortion. Although she looked like a child tucked into bed, Share looks at Delaware and says the last line of the story: Hi baby (79). After all that Delaware has struggled thru GHz to help Share, she is still referred to as a child. This is a dramatic ending considering that now Delaware has been referred to as a child by every adult she has interacted with including Share. Delaware now realizes that despite all that she as files to care for Share, the world will forever view her as a child until she is older. The experience at the clinic has not affected Share a great deal, but it will take Delaware time to mentally conquer all that she faced during that day. There I no resolution for Delaware. She knows that the next day will be the same. She will still have to be a mother to her mother. Heeler notes that Lee Guns protagonist often must face many perennial human problems until they find happiness (1450). As e story ends, Delaware is fully aware that she will have to face many more such enduring problems before society will consider her an adult. Lee Gun incorporates a variety of literary devices into this story. She foreshadows the mistake that will commonly be made when early in the story, Mary insinuates that Delaware is the one having the baby. Mary does so in such a dramatic mannerism the it is obvious the mistake will be made again. Lee Gun also utilizes sensory imagery when Share is comparing the two pregnancies. She describes Delaware as something soft inside of me that I knew was mine(72). The reader can almost feel what it is eke to be pregnant. There is also some light comedic relief in this otherwise serious story. A somewhat comical scene occurs when Share reminds Delaware dont curse; for a split second, the roles are reversed and Share is once again the mother. Other comical scene is when Share, while sitting in the waiting room, begins a discussion with herself about what kind of ice-cream she likes the best. It is through these devices that Lee Gun makes the story more tangible for the reader. Delaware never chose to be put into her situation with Share. She did not volunteer. She faces the unknown everyday while taking care of her mother. Not by choice, but by a mandate from life. Delaware has been given circumstances to live with. SSH has done so and made the best of it. This is the sign off true adult. As Delaware has shown throughout the story, maturity does not always come with age; sometimes a canon Is Trace to De an adult Ana serve as and support. ten only source AT loving care

Standing Ground by Ursula Le Guin Essay Example

Thursday, November 21, 2019

Evaluation of the evidence for and against stem cell plasticity Article

Evaluation of the evidence for and against stem cell plasticity - Article Example This can be translated to mean that the highly regenerative tissues have stem cells while those that are poor regenerators lack stem cells (Frank, Schatton & Frank 2010, p. 41). However, cells that have been believed to be non-regenerators such as the heart and the brain have lately shown signs of regeneration. This has opened the doors for researches in stem cell population and their regenerative potential. Studies of tissue injury repair have discovered that there is a strong support for important stem cell functions in the hematopoietic system, dermal epithelium, intestinal epithelium, and skeletal muscle. This is a clear indication that stem cell plasticity can be of high importance in repairing of damaged cells in these tissues (Langer, Vacanti &Lanza 2014, p. 231). Hematopoietic stem cells (HSC) exist predominantly in the bone marrow of human beings. They have always been known to serve the purpose of generation all lineages of mature blood cell types that are needed for the maintenance of proper hematopoietic function (Cetrulo, Cetrulo&Cetrulo 2009, p. 234). However, a series of studies have challenged this assertion. These studies suggest that if bone marrow cells are enriched by hematopoietic stem cell activity, they could appear to be of contribution to the lower levels of multiple nonhematopoietic tissues because of injured or irradiated recipients (Bhattacharya & Stubblefield 2014, p. 199). These studies reveal that these activities can result to nonhematopoietic cells within the skin, intestinal epithelium, lung epithelium, kidney epithelium, pancreas, liver parenchyma, skeletal muscle, and myocardium. Some of the support for the stem cell plasticity comes from opposes of abortion. The main reason as to why this group of people is in support of stem cell plasticity is the fact that a majority of stem cell researchers always use embryos that were created in virto fertility treatment. These are the embryos that were produced but were never used. Most

Wednesday, November 20, 2019

Women in 20th century America Essay Example | Topics and Well Written Essays - 250 words

Women in 20th century America - Essay Example Hence, the number of working women has increased since the last quarter of the 20th century. Women in 20th century America were more dedicated towards their families than they are today. In the colonial times, women would help their husbands with agricultural work, knit, sew etc. Also it was part of the motherÃ¢â‚¬â„¢s job to make sure that she would effectively pass on all of her skills to her daughters so that she would in turn make a good wife/ mother. As time progressed, and the industrial revolution took place, changes occurred gradually. There were changes in methods of work, transportation etc. Consumer goods were now readily available which meant that the things that the women were required to do before were no longer required. This meant that there was more time for family. There was also a rise in perception of the people towards education and its importance. Unmarried females from the middle class got jobs and worked. More women were going for higher education. In the time of the World War II, more women got employment, whether they were married or not. In the later years, the rise in feminism in the 1960Ã¢â‚¬â„¢s led women to organize for equal rights. In the 1960Ã¢â‚¬â„¢s to 1970Ã¢â‚¬â„¢s era there were much more women employed as ever before.

Monday, November 18, 2019

Social media has shown to be more about sociology and psychology than Personal Statement

Social media has shown to be more about sociology and psychology than technology - Personal Statement Example In social media, human beings tend to influence one another; this largely constitutes aspects of sociology and psychology. For instance, Twitter and Facebook are examples of social media, which employ sociological and psychological aspects. People engage in chats and following each other on twitter since everyone wants at par with others. This influence one each otherÃ¢â‚¬â„¢s behavior can be regarded as more sociological and psychological than technological (Al-Deen and Hendricks 30-50). Interactions have made use of social media a viable option as compared to the use of technology itself. The relationships that people get in through social media influence their behavior patterns than the technology they rely on to get in such relationships. Both sociology and psychology play an essential role in social media than technology. They provide the means through which technology will be conveyed across all divides. Although technology can undergo changes to take various forms, the psychological and sociological aspects constitute social media. Many aspects of social media are more sociological and psychological than technological; this is because social media entails the harnessing of technology through social interactions between people. Thus, it can be concluded the use of sociological and psychological aspects of interactions and behavior outweighs the technological aspects of social media (Al-Deen and Hendricks

Friday, November 15, 2019

Healthcare Training in Simulated Environments

Healthcare Training in Simulated Environments Simulation Introduction Ã¢â‚¬Å"Clinical simulation is pretending for the purpose of improving behaviors for someone elses benefit (Kyle Murray, 2008, p.xxiv).Ã¢â‚¬ All respiratory therapists are trained to manage the airway of an unconscious patient. Endotracheal intubation is the most effective method of securing the airway but is a complex psychomotor skill requiring much practice. Historically, endotracheal intubation had been taught on patients, cadavers or animals, but this was not ideal. Mannequin training is one of the best options for instructing large numbers of students in a variety of skills (Gaiser, 2000) therefore the Respiratory Therapy program at TRU has adopted training on mannequins as a core component of their courses. Intubation trainers have been used for over 30 years (Good, 2003) but there is little published information on the relative merits of the available airway and intubation trainers. A variety of airway trainers with differing features are now commercially available from the low fidelity, part task trainer, that TRU respiratory therapy program utilizes, to the high fidelity, whole patient simulator that is becoming increasingly popular today. Training health care practitioners in a simulated environment without actual patients is a potential method of teaching new skills and improving patient safety (Issenberg et al, 1999; Devitt et al, 2001; Lee et al, 2003). pt safety Simulations are defined as activities that mimic the reality of a clinical environment and are designed to demonstrate procedures, decision-making, and critical thinking through techniques such as role-playing and the use of devices such as interactive videos or mannequins. A simulation may be very detailed and closely simulate reality, or it can be a grouping of components that are combined to provide some resemblance of reality. (Jeffries, 2005) definition of simulation Computer based simulations and part-task training devices can provide a certain degree of real-world application. These focus on specific skills or selected areas of human anatomy. High-fidelity patient simulators can provide real physical inputs and real environmental interactivity. To recreate all elements of a clinical situation, a full-scale or high fidelity simulation would be used. Costs of simulators will vary widely depending on purchasing costs, salaries, how faculty time is accounted for, and other factors. (Jeffries, 2005) simulators, high fidelity, costs Modern technology, such as high fidelity simulation offers unique opportunities to provide the Ã¢â‚¬Å"hands-onÃ¢â‚¬ learning. High fidelity simulation offers the ideal venue to allow practice without risk and there are an infinite number of realistic scenarios that can be presented using this technology. As an example, life threatening cardiac arrhythmias can be simulated on a life like fully computerized mannequin. Mo nitors, identical to those used in the clinical situation can replicate the arrhythmia and corresponding changes in vital signs. The Ã¢â‚¬Ëœpatient can be fully and realistically resuscitated with technical and pharmacological interventions. Viewing of videotaped performances allows personal reflection on the effectiveness of the case management. Morgan et al, 2006 example of use of high fidelity sim. High fidelity simulation provides a venue to teach and learn in a realistic yet risk free environment. The Ã¢â‚¬Ëœpatient is represented by a computer-controlled mannequin who incorporates a variety of physiological functions (e.g. heart and breath sounds, pulse, end-tidal carbon dioxide). An instrumentation computer network can replicate situations likely to be encountered in an emergency room, critical care environment or operating room. A second person controls the mannequin and the monitors. The simulator mannequin will respond on an accurate way to induced physiologic or pharmacologic interventions. The Ã¢â‚¬Ëœpatient will respond according to pre-set physiological characteristics (e.g. a young healthy adult or a geriatric patient with severe emphysema). In addition, the Ã¢â‚¬Ëœpatient has the ability to speak, move his arm, and open and close his eyes and has pupils that can dilate and constrict. The simulation room can be set up to appropriately reflect the environment, either an emergency room, a recovery room, or a fully equipped operating room. Attached monitors respond to a medical intervention. Feedback from participants in the simulated environment has attested to the Ã¢â‚¬Ëœrealism of the environment (Morgan Cleave-Hogg, 2000). Morgan et al, 2006 set up of HPS A simulator replicates a task environment with enough realism to serve a desired purpose and the simulation of critical events has been used instructionally by pilots, astronauts, the military and nuclear power plant personnel (Gaba, 2004). The fidelity, or the Ã¢â‚¬Å"realnessÃ¢â‚¬ , of simulations can vary in many ways, such as the use of simple case studies, utilization of human actors to present clinical scenarios, computer-based simulations, and the use of high-fidelity patient simulators that respond to real-world inputs realistically (Jeffries, 2005; Laerdal, 2008; Seropian, 2003). Recently, literature has described that using full-sized, patient simulators are a way of creating Ã¢â‚¬Å"life-likeÃ¢â‚¬ clinical situations (Fallacaro Crosby, 2000; Hotchkiss Mendoza, 2001; Long, 2005; Parr Sweeney, 2006). While simulation has been used by the aviation industry with flight training for years (Gaba, 2004), the use of a rudimentary human patient simulator in the health care fiel d was first introduced in 1969 to assist anesthesia residents in learning the skill of endotracheal intubation (Abrahamson, Denson, Wolf, 1969; Gaba DeAnda, 1988). The more realistic human patient simulators were not created until 1988 and were used primarily to train anesthesiologists (Gaba, 2004). Defining simulation in health care education The literature on human patient simulation has tried to define several of the terms used in this study. However, there is no general consensus on many of these terms, including a debate on whether the simulator is a mannequin or a manikin (Gaba, 2006). One key term that requires specific definition for this study is high-fidelity mannequin-based patient simulator. The term Ã¢â‚¬Å"fidelityÃ¢â‚¬ is used to designate how true to life the teaching experience must be to accomplish its objectives (Maran Glavin, 2003). Using this definition, fidelity becomes a scale where if given the objectives, a single piece of medical simulation equipment may be able to provide a Ã¢â‚¬Å"high-fidelityÃ¢â‚¬ experience for one objective but be Ã¢â‚¬Å"low-fidelityÃ¢â‚¬ for another objective. An example would be the insertion of a radial arterial catheter. If the objective were to only teach the psychomotor skills required for inserting the catheter, a relatively simple arterial blood gas access arm, part-task simulator would be adequate and provide a high-fidelity experience. But if the objective were expanded to include communication with the patient and members of the health care team, then the same device would suddenly become low-fidelity, as there is no feedback being delivered with catheter insertion and communication with the patient is not possible. Beaubien Baker (2004) noted that the term Ã¢â‚¬Ëœfidelity is frequently documented as a one-dimensional term that forces a static classification of simulation devices. Individuals with this view would have difficulty agreeing with the use of the terms as explained in the previous paragraph. Maran and Glavin (2003) offered this definition: Ã¢â‚¬Å"Fidelity is the extent to which the appearance and behaviors of the simulator/simulation match the appearance and behaviors of the simulated system (p.23).Ã¢â‚¬ Yaeger et al (2004) broke fidelity down into three general classifications: low-medium-and high-fidelity and explained that low-fidelity simulators are focused on single skills and permit learners to practice in isolation while medium fidelity simulators provide more realism but lack sufficient cues for the learner to be fully immersed in the situation. High-fidelity simulators, on the other hand, provide adequate cues to allow for full immersion and respond to treatment interventions. For the purposes of this study, the following definitions will be used: 1. High-fidelity patient simulator A full-bodied mannequin that replicates human body anatomy and physiology, is able to respond to treatment interventions, and is able to supply objective data regarding student actions through debriefing software. 2. Low-fidelity simulator A part task trainer or a full-bodied mannequin that replicates human anatomy, but does not have physiologic functions (including spontaneous breathing, palpable pulses, heart and lung sounds, and voice capabilities), does not have a physiologic response to treatment interventions, and does not have a debriefing software system. Use the next two statements at the beginning of other sections on simulation: * Ã¢â‚¬Å"Simulation is a training and feedback method in which learners practice tasks and processes in lifelike circumstances using models or virtual reality, with feedback from observers, peers, actor-patients, and video cameras to assist improvement in skills (Eder-Van Hook, 2004, p.4).Ã¢â‚¬ * Ã¢â‚¬Å"Simulation is a techniqueÃ¢â‚¬ ¦.to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p.i2).Ã¢â‚¬ When we are looking at the use of high-fidelity patient simulators in health professions education, we have to be aware of and not confuse the simulator with the simulation. As Gaba (2004) described, Ã¢â‚¬Å"Simulation is a technique not a technology (i2).Ã¢â‚¬ The mannequins or other devices are only part of the simulation. Dutta, Gaba and Krummel (2006) noted a gap in the research literature, stating, Ã¢â‚¬Å"A fundamental problem in determining the effectiveness of surgical simulation has been an inability to frame the correct research question. Are the authors assessing simulation or simulators (p.301)?Ã¢â‚¬ Simulation has many applications. The teaching of psychomotor skills seems an obvious use for simulation but there are other areas that simulation can be utilized effectively. Rauen (2004) listed several areas in addition to psychomotor skill training where simulation has been used. Her list included teaching theory, use of technology, patient assessment and pharmacology. Rauen (2004) notes that the Ã¢â‚¬Å"emphasis in simulation is often on the application and integration of knowledge, skills, and critical thinking (para 3).Ã¢â‚¬ History and Development of Simulation in Healthcare education The history of simulation in healthcare has been well documented by several authors including Bradley (2006), Cooper and Taquito (2004), Gaba (2004) and Rosen (2004) and began with the use of models to help students learn about anatomical structures. Although the use of mannequins as the simulation model is relatively new (Bradley, 2006), simulation using animals as models dates back over 2000 years. Mannequins were utilized as models in obstetrical care as early as the 16th century (Ziv, Wolpe, Small, Glick, 2003). The more modern medical simulators originated in the 1950s with the development of a part-task trainer called Ã¢â‚¬ËœResusci-Anne that revolutionized resuscitation training (Bradley, 2006; Gaba, 2004). Part-task trainers are meant to represent only a part of the human anatomy and will often consist of a limb or body part or structure. These low fidelity modesl were developed to aid in the technical, procedural, or psychomotor skills, such as venipuncture, catheterization and intubation (Kim, 2005), allowing the learner to focus on an isolated task. Some models provide feedback (visual, auditory or printed) to the learner on the quality of their performance (Bradley, 2006; Good, 2003). Another general classification of patient simulators that combines some of the elements of both three-dimensional models and task-specific simulators is partial or part task simulators (Kyle Murray, 2008). Issenberg, Gordon, Gordon Safford, and Hart (2001) used the term procedure skills simulator for this type of device. Maran and Glavin (2003) stated, Ã¢â‚¬Å"part-task trainers are designed to replicate only part of the environment (p.24).Ã¢â‚¬ and replicate anatomy and physiology of a single portion of the human body. As described by Beubien and Baker (2004), the skills taught with part task simulators Ã¢â‚¬Å"segment a complex task into its main components (p. i53).Ã¢â‚¬ Rather than creating complex scenarios commonly done with high fidelity patient simulation, part task trainers permit students to focus on individual skills instead of more comprehensive situations. Examples would be an arm with vascular structure to teach arterial blood gas procedures or a head with upper airw ay anatomy to practice advanced difficult airway procedures. The second wave of modern simulation, with the development of full-scale, computer controlled, mannequin based patient simulators started in the 1960s with the development of Sim One (Bradley, 2006; Gaba, 2004; Good, 2003). SimOne had many of the features found on the high-fidelity mannequin-based patient simulators used today. SimOne was quite lifelike, and fitted with a blood pressure cuff and intravenous port. SimOne was able to breath, it had a heartbeat, temporal and carotid pulse and a blood pressure (Abrahamson, 1997). Patient simulators have become very sophisticated over the years and now allow a wide range of invasive and non-invasive procedures to be performed on them, as well as enabling teamwork training (Davis, Buono, Ford, Paulson, Koenig and Carrison, 2006). When they are set up in a simulated and realistic environment, they are often referred to as high-fidelity simulation platforms (HFSP) or human patient simulators (HPS) (Kim, 2005). Components of the human patient simulator (HPS) include a mannequin and computer hardware and software. The HPS has characteristics expected in patients such as a pulse, heart and lung sounds, and blinking eyes with reactive pupils. The mannequin also supports invasive procedures, such as airway management, thoracentesis, pericardiocentesis and catheterization of the bladder (Laerdal, n.d.). Medical Education Technologies, Inc. (METI) introduced the Human Patient Simulator (HPS) in 1996. It has subsequently followed with PediaSim in 1999, a simulator utilizing the HPS software but scaled down to mimic a child. In 2005, BabySim was introduced. While being the first to enter the market with a full-bodied mannequin for patient simulation purposes in resuscitation with the Resusci Anne in 1960, Laerdal Medical did not introduce a high-fidelity patient simulator until 2000 with the introduction of SimMan. This device does not possess all the high-level functionality of METI HPS, but does provide adequate fidelity for many medical emergency situations. The Laerdal Medical SimMan also differs from the others in that it does not operate on mathematical models for simulator responses. Instead, it operates on instructor controls combined with script-based control logics. The Laerdal Medical SimMan patient simulator is the device to be used in this study. Details of the simulators functions are found in appendix ____. Aside from high-fidelity mannequin based patient simulators, there are many other types of simulation used in healthcare provider education and training. Collins and Harden (1998), Issenberg, Gordon, Gordon, Safford, and Hart (2001), and Ziv, Small and Wolpe (2000) discussed several other forms of simulation. The list includes animal models, human cadavers, written simulations, audio simulations, video-based simulations, three dimensional or static models, task specific simulators and virtual reality simulation. (Add VR reference?) Perhaps the next step in the evolution of health care teaching modalities is virtual reality (VR) simulation. Commercial VR simulators now exist to teach various trauma skills (Kaufman Liu, 2001). In a study of the effectiveness of using a VR bronchoscopy simulator, students quickly learned the skills needed to perform a diagnostic bronchoscopy at a level that was equal to those who had several years of experience (Colt et al, 2001). Simulation has been used for many years in the aviation and nuclear power industries and other highly complex working environments in which the consequences of error are costly (Bradley, 2006). A simulator designed to mimic the anesthesia patient was first developed in 1988, and since then, the number of hospitals and universities buying simulators for educational purposes is increasing (Henrichs, Rule, Grady and Ellis, 2002). The human patient simulator is used in health care education because it is a high-fidelity instrument that provides both educators and students with a realistic clinical environment and an interactive Ã¢â‚¬Å"patientÃ¢â‚¬ (Feingold, Calaluce and Kallen, 2004). The cost of simulation is related to the level of fidelity and the technology being used. For high fidelity patient simulators, purchase costs can range from $30,000 for the Laerdal Medical SimMan or the METI ECS to over $200,000 for the METI HPS. Optional equipment available for these simulators can make the purchase costs even higher. In addition to the simulator, it is important to create a learning environment that replicates real-world settings, complete with appropriate medical equipment. Halamek et al. (2000) stated, Ã¢â‚¬Å"The key to effective simulation-based training is achieving suspension of disbelief on the part of the subjects undergoing training, ie, subjects must be made to think and feel as though they are functioning within a real environment (para 15).Ã¢â‚¬ Creating this environment adds additional costs to setting up a simulation-based medical education program. Advantages of using simulation in health care education Patient simulation of all types, including high-fidelity patient simulation, is becoming more common in many aspects and levels of healthcare provider education (Good, 2003; Issenberg, McGaghie et al., 1999; leblond, Russell, McDonald et al, 2005). The reasons behind the increased use of patient simulation include the advancement of medical knowledge, changes in medical education, patient safety and ethics. For new healthcare providers it is also important to consider the changing student demographic, as todays students are more comfortable with technology. Issenberg, McGaghie et al. (1999) pointed out several advantages to the use of patient simulators, stating Ã¢â‚¬Å"Unlike patients, simulators do not become embarrassed or stressed; have predictable behavior; are available at any time to fit the curriculum needs; can be programmed to simulate selected findings, conditions, situations, and complications; allow standardized experience for all trainees; can be used repeatedly with fid elity and reproducibility; and can be used to train both for procedures and difficult management situations. (p. 862)Ã¢â‚¬ . Advancement of medical knowledge Medical knowledge is continually growing with new tests, medications, and technologies that all bring about innovative understandings and expertise. The problem with educating health care providers with this new knowledge is that their curriculum is of a finite length therefore innovation in the curriculum is needed in order to prepare future health care providers. Issenberg, Gordon, Gordon, Stafford, and Hart (2001) made the following comments: Ã¢â‚¬Å"Over the past few decades, medical educators have been quick to embrace new technologies and pedagogical approachesÃ¢â‚¬ ¦ in an effort to help students deal with the problem of the growing information overload. Medical knowledge, however, has advanced more rapidly than medical educationÃ¢â‚¬ ¦Simulation technologies are available today that have a positive impact on the acquisition and retention of clinical skills. (p.16) Changes in medical education Healthcare provider education has typically been taught using a lecture/apprenticeship model (McMahon, Monaghan, Falchuk, Gordon, Alexander, 2005) that relies on observation and repetition (Eder-Van Hook, 2004). Halamek et al. (2000) noted the traditional model of medical education has three components: the learner performs a reading of the literature, the learner observes others with greater experience, and then the learner develops hands-on experience. This is the traditional medical model of education that has been in use for over 2,000 years (Current state report on patient simulation in Canada, 2005). In relation to the traditional model, Issenberg, Gordon, Gordon, Stafford and Hart (2001) observed, Ã¢â‚¬Å"This process is inefficient and inevitably leads to considerable anxiety on the part of the learner, the mentor, and at times the patient (p. 19).Ã¢â‚¬ McMahon, Monaghan, Flachuk, Gordon, and Alexander (2005) stated this model Ã¢â‚¬Å"is inefficient in promoting the highest level of learned knowledge, as reflection and metacognition analysis occur independently, often without guidance and only after extended periods of time when students are able to piece together isolated experiences (p. 84-85).Ã¢â‚¬ Customarily, this format is often referred to as the Ã¢â‚¬Å"See one, do one, teach oneÃ¢â‚¬ model of medical learning (Brindley, Suen Drummond, 2007; Eder-Van Hook, 2004; Gorman, Meier, Krummel, 2000; Yaeger et al., 2004). Halamek et al. (2000) identified several problems with the current medical education model which includes; 1. Reading of the literature does not produce competency. More active rather than passive participation in the learning experience is needed; 2. Learners may have difficulty determining if their model for observation is a good or poor model. Just because the model may be senior does not mean they are competent. 3. The variability of experiences in the apprenticeship model is high, therefore learners experiences will not be equal, and 4. Many training settings do not fully represent the complexity of the real world resulting in an inability of the learners to adequately practice their decision-making skills in a Ã¢â‚¬Å"realÃ¢â‚¬ environment. Yaeger et al (2004) reinforced these points stating that healthcare education rely on two fatally flawed assumptions. The first assumption is that all clinical role models are effective and skilled, and all behaviors demonstrated by these role models are worthy of replication. The second assumption is that the end of the training period implies that a trainee is competent in all the skills necessary for successful clinical practice (Yaeger et al, 2004). Yaeger (2004) also noted that in the apprenticeship model, there is a need for a preceptor but this preceptor may not have the necessary skills to be an effective educator. Patient safety A predominant theme in many discussions of high-fidelity simulation is the concept of patient safety. In the education of healthcare providers, there are sometimes conflicting goals. As Friedrich (2002) commented in quoting Atul Gawande, Ã¢â‚¬Å"medicine has long faced a conflict between Ã¢â‚¬Ëœthe imperative to give patients the best possible care and the needs to provide novices with experiences (p. 2808).Ã¢â‚¬ When looking at the broader topic of medical simulation, the concept of patient safety is a frequently mentioned subject (Bradley, 2006; Cleave-Hogg Morgan, 2002; Ziv, Ben-David, Ziv, 2005). Much of the incentive behind the focus on patient safety relates back to the Institute of Medicine 2000 report To Err is Human: Building a Safer Health system (Kohn, Corrigan, Donaldson, 2000). This study reported over 44,000 people and possibly up to 98,000 people die each year in United States hospitals from medical errors. The total annual cost of these errors is between $17 billion and $29 billion. Even more alarming is the fact that these findings represent only the hospital sector of the healthcare system. The number of lives affected would be even higher if other parts of the healthcare system were included such as long term care facilities and Emergency Medical Services. In its summary of recommendations, the report specifically mentions simulation as a possible remedy, stating Ã¢â‚¬Å"Ã¢â‚¬ ¦establish interdisciplinary team training programs for providers that incorporate proven methods of team training, such as simulation (p.14).Ã¢â‚¬ In Canada, it was estimated there were 70,000 preventable adverse events in Canadian hospitals with an estimate of deaths associated with those errors ranging from 9,000 to 24,000 (Current state report on patient simulation in Canada, 2005). The Canadian Patient Safety Institute supports the use of simulation as a means of improving patient safety in Canadian hospitals. In the conclusion of its report on patient simulation, the institute stated: Growing awareness of adverse events in Canadian hospitals, combined with increasing emphasis on patient safety, has changed the traditional Ã¢â‚¬Å"learning by doingÃ¢â‚¬ approach to healthcare education. Anecdotal evidence reveals the promising potential of simulation to fundamentally change the way healthcare professionals practice and further hone their skills, interact across disciplines, and manage crisis situations. (Current state report on patient simulation in Canada, 2005, p.23) Ethical perspective One of the strongest statements made regarding the ethical perspective of simulations was presented by Ziv, Wolpe, Small and Click (2003). Under the title Ã¢â‚¬Å"Simulation-Based Medical Education: An Ethical ImperativeÃ¢â‚¬ , the authors presented an argument that not using simulation was more than just an education issue, it was an ethical issue. As they report, there is often an over reliance on vulnerable patient populations to serve as teaching models when other resources exist that would provide adequate and possibly, more superior replacements. The education of healthcare providers requires a balancing act between providing the best in patient care while also providing learning opportunities for the healthcare professions student (Friedrich, 2002). To protect patient safety, actual patient contact is often withheld in the healthcare provider learning process to a later period in their education. One of the principle reasons patient simulation is being indicated as a partial remedy for the medical errors crisis is its ability to impact on a particularly vulnerable time in the learning process. As Patow (2005) cited, the Ã¢â‚¬Å"learning curveÃ¢â‚¬ faced by many healthcare professions students is a source of medical errors. He continued, stating that the realism of many of the currently available simulators is quite high and allows for procedures to be practiced to mastery prior to being tested on real patients. But simulations offer much more than just practice. Since medical errors often result from ineffective processes and communication, simulation allows teams Ã¢â‚¬Å"to reflect on their own performance in detailed debriefing sessionsÃ¢â‚¬ (Patow, 2005, p.39). This opportunity to review, discuss, and learn from the simulation is an important step in the learning process. The use of patient simulation in the training of healthcare providers is not limited to new students. There is also a need to maintain education in the health professions and simulation can be utilized effectively in this area as well (Ziv, Small Wolpe, 2000). As in other reports, Ziv, Small and Wolpe (2000) restated the shortcomings of the traditional model and explained that simulation was not just for the beginner but also for the expert who is expected to Ã¢â‚¬Å"continuously acquire new knowledge and skills while treating live patients (p.489).Ã¢â‚¬ These authors feel simulation, when used across the range of health professions education, can make an impact on patient safety by removing patients from the risk of being practiced upon for learning purposes. Gaba (2004) pointed out there are also many indirect impacts of patient simulation on patient safety. These areas of impact include improvements in recruitment and retention of highly qualified healthcare providers, facilitating cultural change in an organization to one that is more patient safety focused, and enhancing quality and risk management activities. A final point on patient safety is the ability to let healthcare providers make mistakes in a safe environment. In real patients, preceptors step in prior to the mistake being beyond the point of recoverability or if the mistake occurs (particularly for those healthcare providers who are not longer students), there is a very limited instructive value to the case. Ziv, Ben-David, and Ziv (2005) stated, Ã¢â‚¬Å"Total prevention of mistakes, however, is not feasible because medicine is conducted by human beings who errÃ¢â‚¬ ¦[Simulation Based Medical Education] may offer unique ways to cope with this challenge and can be regarded as a mistake-driven educational method (p.194).Ã¢â‚¬ They continued stating that Simulation Based Medical Education is a powerful learning experience for students and professionals where Ã¢â‚¬Å"students are permitted to make mistakes and are provided with the opportunity to practice and receive constructive feedback which, it is hoped, will prevent repetition of such mistakes in real-life patients. (p.194)Ã¢â‚¬ . Ethical Use of Simulation (incorporate these paragraphs into previous on pt safety) Health care educators, whether from nursing, respiratory therapy, or medicine, find themselves in similar situations in deciding how to teach patient management to their students. Bioethicists have long condemned the use of real patients as training tools for physicians (Lynoe, Sandlung, Westberg, Duchek, 1998). Unfortunately there have been times in which the student learning has occurred to the detriment of patients (Lynoe et al, 1998). However, with the advent of high-fidelity human patient simulation approaches to learning, it may be time to adopt this method of instruction in the development of interprofessional education. The Institute of Medicine (IOM) recently issued a report on medical errors and recommended the use of interactive simulation for the enhancement of technical, behavioural and social skills of physicians (Kohn, Corrigan Donaldson, 1999). Numerous accounts are found in the medical literature touting the use of human patient simulation in the education of health care personnel at all levels, from student to attending physicians. Patient simulation is used for training personnel in several areas of medical care such as trauma, critical care, surgery and anaesthesiology, mainly due to the extensive skill required to perform adequately the procedures and techniques relevant to these areas. Several researchers have demonstrated the effectiveness of simulation in the skill development of medical personnel (Morgan et al, 2003; Lee, Pardo, Gaba, Sowb, Dicker, Straus, et al., 2003; Hammond, Bermann, Chen Kushins, 2002). In areas with low technology, such as internal medicine and in acute care areas providing less procedural skills but greater decision making requirements, the use of simulation in the education of its clinicians has progressed (Ziv, Wolpe, Small Glick, 2003). Despite the growing support for the use of simulation in health care education, there is not yet enough evidence to support its use. Simulation Research in Medical Education In 1998, Ali, Cohen, Gana Al-Bedah studied the differences in performance of senior medical students in an Adult Trauma Life Support (ATLS) course. This course uses simulated scenarios to both teach and evaluate students performance in trauma situations. The students were divided into three groups; 32 medical students completed a standard ATLS course, 12 students audited the course (without participating in the sessions or taking the written exam) and a control group of 44 matched students who had no exposure to ATLS. Of note is that some participants from all three groups were doing clinical hours in trauma hospitals during this study while others were not. The participants were observed while managing the standardized (live) patient in simulated trauma and non-trauma scenarios. The participants management of the sessions was scored on

Wednesday, November 13, 2019

Digital Democracy Essay -- Politics Media Internet Technology Essays

Digital Democracy Over the years the media has made citizens major role players in politics. Ross Perot opened eyes by putting the 1992 Election in the media and thereby allowing voters to become directly involved in politics. The Internet, the new form of mass media Ã¢â‚¬Å"has turned into a major political and media industryÃ¢â‚¬ (Grossman 16). Because of the rise the Internet has taken, the idea of direct democracy has risen. The foundation of direct democracy is in self-government. The claim is that the presence of the Internet will increase citizensÃ¢â‚¬â„¢ involvement in political issues by allowing them access to more information. This is significant because it takes a look at the impact of technology on society and politics, as well by looking at politics from the average personsÃ¢â‚¬â„¢ perspective. It is my position, however that although the Internet will make citizens more informed this would actually work to deter people from participating in politics. Through the greater establi shment of community and trust among citizens will we find the desire to participate in government and politics. Currently, our government is based on a representative form of democracy, where citizens choose representatives to make decisions on their behalf. This is a type of self-government because Ã¢â‚¬Å"by choosing those who would govern them, the people would also, in effect, be governing themselvesÃ¢â‚¬ (Grossman 40). However, with the coming of the Internet age and a higher prospect of self-government, representative democracy could soon become obsolete, being replaced by direct democracy. Direct Democracy was first introduced by The Athenians as a form of government back in fifth century BC. Direct Democracy allowed the citizens to make the rules as w... ...e nationwide disaster. Our best hope at creating a better democracy is to focus on rebuilding the community. Before we can put things in place that are meant to reconstruct society, we must first fix the foundation upon which this nation was built, and that is community. Works Cited: Bimber, Bruce. Ã¢â‚¬Å"The Internet and Political Transformation: Populism, Community, and Accelerated Pluralism.Ã¢â‚¬ Polity 31(1): 133-160. Davis, Richard. The Web of Politics. New York: Oxford Press, 1999. Davison, Donald E. New Democracy: A New Democracy means a more Direct Democracy. 1 April 2001. 27 September 2001. . Grossman, Lawrence K. The Electronic Republic. New York: Penguin Group, 1995. Kamarck, Elaine, and Joseph S. Nye, Jr. democracy.com: Governance in a Networked World. Hollis, NH: Hollis Publishing, 1999.