Wednesday, January 29, 2020

History of Nursing Homes Essay Example for Free

History of Nursing Homes Essay Today, there are approximately 16,100 nursing homes in the U. S. with approximately 1. 5 million residents (www. cdc. gov). However historically, the sick, disabled, and aged were cared for at home by family members. Changes in technology and social changes have created a shift in how we care for our elderly and disabled, and there is evolution in geriatric care that continues today (Morris, 1995). Nurses have had a huge role in revolutionizing the care for our elderly and for creating what is the modern nursing home. Caring for the old age, or geriatric nursing, is often not viewed as being as prestigious as other specialties in nursing. Despite the growing elderly population and the fact that 46% of all Registered Nurses will be providing direct care to the elderly, the majority of nursing students still do not receive any specialized content in geriatric nursing (Ebersole Touhy, 2006). Later on, we will discuss the development of geriatric nursing as a specialty and as it relates to the history of long-term care. In the sixteenth century, we began to see institutions developed to care for a variety of people in need. This did not just include the elderly or disabled, but any dependent poor, sick, orphaned children, widows, insane, and even minor criminals. These institutions could be considered a predecessor to the nursing homes that eventually followed (Morris, 1995). Poor laws in Europe gave rise to these institutions referred to as workhouses, almshouses, or poorhouses. They provided very minimal nursing care, and the care was often provided by â€Å"pauper nurses† who were not trained and usually inmates themselves, often alcoholics. Agnes Jones, a Nightingale trained nurse visited a Liverpool Infirmary in 1864 and reported â€Å"deplorable† conditions. She was forced to dismiss 35 pauper nurses for drunkenness and stated that bed clothes had not been washed for months (Ebersole Touhy, 2006). These poorhouses were common in the United States as well and often had the same deplorable conditions. Carolyn Bartlett Crane, the Chairman of Charity Organization Department of Women’s Civic Improvement League of Kalamazoo, MI attempted to address these problems first with the Michigan State Nurses’ Association in 1906 and again with the Nurses’ Associated Alumni of the United States in 1907 with pleas for nursing care in these almshouses. In her 1907 paper, â€Å"Almshouse Nursing: the Human Need; the Professional Opportunity†, she described the county almshouse as a â€Å"hospital with the hospital part left out. † She went on to talk about how the specialization of institutions for certain groups, such as asylums and orphanages, left the elderly and infirm to be the majority of those left with no other options besides the poorhouses (as cited in Ebersole Touhy, 2006 p. 8). Little progress was made. In 1912, the American Nurses’ Association Board of Directors appointed an Almshouse Committee to oversee housing in these institutions. Progress continued to be slow. From 1910 to 1920 focus was taken away from elder care due to the war (Ebersole Touhy, 2006). An article published in the American Journal of Nursing in 1930 by Munson, R. N. discussed the conditions in the almshouses and lack of quality nursing care. She states, â€Å"Modern nursing in England and in this country was started with the purpose of ‘cleaning up’ just such conditions in hospitals as are still found in almshouses. † She proposed that these small almshouses be consolidated into larger facilities that are better managed (1930). Morris describes the factors that have led to the need for the care that nursing homes provide today. They describe an area of healthcare when a person is not acutely ill and in need of hospital care, but is perhaps chronically ill and cannot return independently to live in his or her home. This â€Å"middle† is ever changing and is affected by two factors: technology and social change. As we discussed earlier, care for the elderly and infirm had largely been done by individual families. Poorhouses and almshouses arose to meet the need for anyone who did not have family to care for them or means to care for themselves. The need increased in the U. S. as the immigrant population rose and there was a shift from extended to nuclear families. A child born in 1900 had a life expectancy of only forty-seven years old. As medical technology, for example, infection control, rapidly developed, the population of elderly people increased. With the rise in aged population, there was an increase in chronic disabilities associated with age (1995). In the nineteenth and twentieth centuries, living standards increased. The poorhouses began to become a thing of the past as there was a movement to specialize care for certain groups. For example: asylums for mentally ill, TB sanatoriums, veterans’ hospitals, and orphanages. There was homecare provided by public health nurses, but many refused to care for the chronically ill (Morris, 1995). As mentioned earlier, the elderly and infirm were among the last left in the poorhouses. Thanks to the efforts of many, including many nurses, there was a push to provide better care and bring trained nurses into these almshouses. By 1940, increased expectations for care and the Social Security Act led to the rise of the modern nursing home. The Social Security Act provided a means for elderly who could no longer work and widows to have financial means to pay for care. Entrepreneurs quickly took advantage and homes for the elderly were often as much for profit as for care. By the 1960s, scandals and patient neglect led to increased regulation and public control over expansion (Morris, 1995). Medicare and Medicaid provided more money for care of the elderly and also further increased government control. Rapid increases in technology and new treatments led to a further rise in the aged and vulnerable population and increasing costs. Nursing homes became linked to local hospitals and doctor referrals. Some homes specialized their services to include services for cognitive impairment or active rehabilitation. Government reimbursement and regulation became more complicated. Nursing homes became less â€Å"homes† and more medical facilities. They operated with a limited nursing staff and very little physician presence. It continues today that nursing homes face contradictory pressures to accept sicker and more difficult patients while at the same time maintaining a â€Å"home-like† atmosphere. All this while limiting costs (Morris, 1995). As more specialized care for the elderly developed, it was apparent that the needs of the elderly were not as simple as taking the principles of nursing care and applying them to the aged. Geriatric nursing has only become recognized as a specialty within the past fifty years. However, the origins of gerontological nursing can be traced all the way back to Florence Nightingale who once was a superintendent in an institution we would call a nursing home today. The clinical study of the aged can be traced back much further to Hippocrates. A Viennese physician, Ignatiz Nascher coined the word â€Å"geriatrics† in a 1909 New York Medical Journal article. In 1935, a physician named Marjorie Warren established an elderly concentrated practice with a concentration on environment, rehabilitation and motivational methods (Ebersole Touhy, 2006). Geriatric nursing is a unique specialty in that it was developed by nurses themselves. Other nursing specialties were first developed in medicine and then carried over to nursing. The reason for this difference is that medicine so often concentrates on curing illness and prolonging life. As Ebersole states, â€Å"Old people often have little life left and therefore are unattractive subjects. † Nurses, in contrast, have always sought to prevent illness and alleviate suffering (Ebersole Touhy, 2006). It seems fitting that nursing, and not medicine, would give birth to this specialty and that is something that nurse’s should take pride in. However, as mentioned earlier, geriatric nursing is often considered the least prestigious of nursing concentrations. With the continued rise of the elderly population as the baby-boomer generation ages, nurses should be prepared to care for elderly in some capacity no matter which specialty they choose. It is unfortunate that nursing schools often provide little material on geriatrics as a unique population. Care for the elderly has continued to make slow, but consistent progress even in more recent years. Although we are leaps and bounds from the almshouse, there has still been serious abuse and neglect in nursing homes and cries for change in the way we house and care for our elderly. In addition to more people receiving homecare services that allow them to live at home longer, there are other movements to change the nursing home itself. William Thomas describes an alternative concept that hopes to revolutionize long-term care, the Eden Alternative. He states, â€Å"The modern American nursing home is being crushed between the intrinsic weaknesses of the institution and the rising expectations of a new generation of elders. We are witnesses to its destruction. Like the leper colony, the tuberculosis sanitarium and insane asylum, the nursing home is about to be heaved onto the ash heap of history (Thomas, 2003 p. 42). † In 1992, the Eden Alternative began as a grant project in New York. It has changed over the years, but is based on a set of principles that aim to make facilities more like homes. The focus is on treating the residents as unique individuals first and patients second. Some changes that differ from traditional nursing homes include environmental changes like carpets, plants, and allowing pets and personal items, single rooms, and family style meals. Staff at Eden facilities do not dress in scrubs and whenever possible, a child daycare is on site to increase staff satisfaction as well as bringing more life into the facility. Currently only about 2% of U. S. nursing homes have adopted this new format despite the statistics showing significant reductions in behavioral incidents, decubitus ulcers, bedfast residents, use of restraints, and staff absenteeism. There was also an increase in census (Thomas, 2003). Going a step beyond the Eden Alternative, an even more recent development has been the â€Å"Green House† with a focus on smaller being better. These homes aim to blend seamlessly into a community and house up to eight residents in what is more than a home-like atmosphere, but very much a home. The technology would still be utilized, but as in the original Eden model, it should be woven into daily life without interfering with it. So far, Green Houses have been able to meet the increasing challenges of providing state of the art care and keeping costs down while complying with state and federal regulations (Thomas, 2003). In conclusion, the nursing home and geriatric nursing have developed to meet the needs of a changing society with ever increasing medical advances and a larger than ever population of elderly. Nurses have been a huge part in the development of what has become the modern nursing home. As the geriatric nursing specialty has grown, there has also been greater understanding of the unique needs of our aging population. It is clear that despite the advances made, there is still much dissatisfaction in how we care for our elderly population and a lot of room for improvement. New alternatives are being developed and it will be fascinating to be in the field of nursing to witness the changes that are yet to come.

Tuesday, January 21, 2020

The United States Lends Credibility to the International Criminal Court

The International Criminal Court (ICC), created in 1998 (Thayer and Ibryamova 2010), is responsible for investigating and prosecuting the most extreme cases, including crimes against humanity, aggressive crimes, war crimes, and genocide. The credibility of this institution, however, has been compromised due to the United States revocation of support and membership. Initially it is important to recognize the arguments against the United States becoming a member state of the ICC and what precipitated the U.S. withdrawing its signature from the document that instituted the Court. Once this has been established, addressing and refuting these objections will develop the arguments in favor of ICC membership. Finally, this analysis will lead to proving how the United States becoming a member state will increase the effectiveness and integrity of the International Criminal Court. One opposing standpoint to the union of the United States and the International Criminal Court is the concern of sovereignty. Those who support the United States’ decision to revoke its signature from the Rome Statute argue that by joining the ICC, America’s sovereignty would be threatened, for the country would be required to answer to a higher court. In accordance with this, many on the opposition believe it is necessary to create legislation that protects Americans from the ICC and allows the U.S. to retain its sovereignty. Consequently, the international community has expressed outrage in the United States’ actions to combat the International Criminal Court’s authority. As a world leader with one of the most sophisticated and respected judicial systems, these types of actions present the U.S. as appearing indifferent to the plight of human rights violations... ...s in International Relations (New York: Longman). Elsea, Jennifer (2006), â€Å"U.S. Policy Regarding the International Criminal Court,† in CRS Report for Congess (Washington D.C.; Library of Congress), 4. Bogdan, Attila (2008), â€Å"The United States and the International Criminal Court: Avoiding Jurisdiction Through Bilateral Agreements in Reliance on Article 98,† International Criminal Law Review, 8(1-2), 5. Barnett, Laura (2008), â€Å"The International Criminal Court: History and Role,† Library of Parliament, 2(11), 12. Chicago Council on Global Affairs (2010), â€Å"Constrained Internationalism: Adapting to New Realities,† [http://www.amicc.org/docs/Chicago_Council_Global_Views_2010.pdf], accessed 9 April 2012. American Non-Governmental Organizations Coalition for the International Criminal Court (2012), â€Å"US and ICC Info,† [http://www.amicc.org/info], accessed 9 April 2012.

Monday, January 13, 2020

Managing Knowledge and Learning Essay

Managing Knowledge and Learning at NASA and the Jet Propulsion Laboratory Summary National Aeronautics and Space Administration (NASA) was established by Congress on October 1, 1958, in order for the United States to keep up with the technological advancements achieved from former Soviet Union’s successful launch of the Sputnik (1957). The Apollo Era-Mission had risen from the support of John F. Kennedy’s goal, which was â€Å"landing a man on the Moon and returning him safely to Earth. † Prioritization at NASA evolved into the center’s motto of â€Å"Faster, Better, Cheaper† (FBC), which was mandated in the Goldin Era beginning in 1992. NASA shifted priorities from: 1) performance, 2) schedule and 3) cost to 1) increase mission performance, 2) cut cost and 3) work force reduction. However, this reform was not as successful as planned. From 1992 and 2000, six of 16 FBC missions failed. To address concern of the impact of failed missions and impending retirements of many of the most experienced NASA employees, Congress enforced that the agency search for the solution to Knowledge Management (KM) and promoting learning initiatives at NASA-JPL. NASA’s KM tools were mainly IT systems of Internet-based databases and portals for ease of lessons. The NASA KM crisis was attributed to the organization’s inability to document experiences of failures and successes of missions or projects; ultimately incapable of capturing the â€Å"experiential knowledge† from expert engineers and scientists. In addition, this lack in KM was due to â€Å"privatizing knowledge† and promoting creativity, that stemmed from NASA’s culture where competition among centers for projects and funding was the norm. Several KM Initiatives were developed including project libraries for document and data management, developing standards, establishing databases to find experts, ask technical questions, and to capture history and legacy reviews. 1) What were the pros and cons of the â€Å"Faster, Better, Cheaper† model? How might outcomes (both positive and negative) of projects executed with this model impact NASA’s stakeholders, i. e. Congress and the general public? The â€Å"Faster, Better, and Cheaper (FBC)† objectives were to cut cost and maximize mission performance. There were several advantages of the FBC reform. FBC allowed compressed development and launch schedules that lead to an increase in the number of missions. Mission time could be reduced from decades to a few years. The number of NASA projects increased from four to 40 under the FBC model. An increase in mission projects was thought to lead to additional discoveries so that NASA could gain further wisdom and space knowledge. FBC missions were changed from one big project to multiple smaller projects. Dividing the program into smaller projects helped to minimize the pressure and stress on the team if a mission failed. Furthermore, one mission failure did not consequently lead to the failure of the entire program. FBC practice allowed senior managers more freedom to implement FBC the way they found fit which promoted creativity and autonomy among senior managers. FBC also reduced the cost of each mission and NASA’s overall budget. For example, the Mars program budget was reduced from one billion dollars to $260 million. There are numerous disadvantages of the FBC reform. Applying the FBC model could lead to more mission failures. During the FBC era, there were 6 failed missions out of 16 FBC missions. Cost and schedule constraints, insufficient risk assessment, planning, and testing, underestimation of complexity and technology maturity, inattention of quality and safety, inadequate review processes, engineering, under-trained staff, poor team communication, and design errors all attributed to NASA’s mission failures. Projects conducted â€Å"faster† does not allow for adequate documentation, time for redlining the project, and recording lessons learned from one mission to the next. This could result in repeated mistakes that could be avoided by future missions. Missions carried out faster do not allow time for mentorship and sharing of knowledge. Also, the term â€Å"better† was not properly defined and was open to interpretation, which may negatively impact maintaining standard procedures and processes. The results of the FBC vision could impact NASA’s stakeholders in several ways. The increase in smaller successful missions would alleviate the risk of one large failure, although any failures will have a negative impact on stakeholders. Congress could be discouraged to provide support and funding for major space programs if they fail but might be more likely to fund smaller missions. The public could either lose or gain confidence, support, and belief in the space program depending on the magnitude of success or failure. FBC mission are less expensive which would decrease NASA’s budget and help satisfy both Congress and the general public by reducing the need for extra taxation by Congress and collection of taxes from the general public. 2) Why was the Mars Pathfinder project so successful? Explain how Anthony Spears management style impacted future missions. Project management was the key to success of the Mars Pathfinder project. It began as an experiment to test the validity of the FBC reform mandated in 1992 when Daniel Goldin was assigned as the new administrator of NASA. A clear and specific plan for the Pathfinder mission was laid out in the beginning and followed through until the end. Analogous to the success of Cisco’s ERP implementation, Anthony Spears, an excellent manager and thought leader with years of experience at NASA, gained the support of top management and the JPL institution (Spears, 1999). Spears developed a unique balance of an advisory committee of experts to support and guide the difficult project, while he recruited talented, yet naive, energetic youngster’s to do what some more experienced people thought impossible. As Spears writes in his lessons learned report it was â€Å"†¦a blend of bright, ambitious youth and scarred old timers, each challenged and empowered, all working each issue together†¦ † (1999). Together, they created a team that bonded and worked together successfully. Spears’ goal was not only the success of the Pathfinder project, but of the FBC program success, unlike the vision of future project managers. The success of Pathfinder did not translate well in future FBC missions. Risk management and testing were important to the Mars Pathfinder success. While the Mars Pathfinder team worked together successfully, the younger players went on to think they were great project managers themselves, but still hadn’t learned enough to manage their next missions successfully. In future FBC projects, some reasons for failure were poor team communication, inadequate or under-trained staff or insufficient testing in 70% of missions and insufficient risk assessment and planning on 86% of missions (exhibit 4). 3) One of the major issues in this case is the retirements of experts. Why is this a problem for NASA? Would it be less of a problem in a different type of organization? Suggest immediate steps that NASA could take to mitigate the problem. Explain your choices. By 2006 half of NASA’s workforce was eligible for retirement which could lead to a major loss of knowledge, especially tacit information, diminishing the collective wisdom of the organization. A senior manager at NASA states, â€Å"we have no formal process for transferring knowledge† from thought leaders to new managers and IT systems had not yet been sufficient in transferring â€Å"experiential knowledge† to the younger generation. Unfortunately, this would be true in many organizations unless they had sufficient knowledge management systems in place and a culture where sharing knowledge was valued and encouraged. In order to mitigate the problem of losing their knowledge base, NASA not only needs to continue to implement their KM strategy, but truly change the culture. Experienced project leaders and Subject Matter Experts (SMEs), such as design engineers, should openly share their knowledge and not just when asked for it. I support several of the planned KM initiatives such as the capture of information by improving documentation, development of an enterprise web-based portal, and the Knowledge Sharing Initiative (KSI) aimed at changing the companies’ culture. In addition to these activities, an exit strategy could be developed for retiring employees where they must follow standard procedures for employing case-based reasoning in an online database employing a searchable classification system. Additional knowledge could be disseminated by those eligible through training sessions. A reward system should be coupled to these exit requirements and could be increased if the employee decides to be available in the Expert Connections directory of SME’s that could be contacted for support after they leave. New positions might need to be created for dedicated knowledge managers such as Chief knowledge officers. It’s also possible that NASA could obtain some replacement of lost experts by collaborating with space programs in other countries. Collecting the information from experts must be coupled with management support of a corporate wide schema to store the data, methods of dissemination, and apply the information to ultimately make better decisions on projects that involve risking people’s lives. 4) Jean Holm had two options she could choose from: 1) upgrade the IT systems or, 2) change the culture. Which would you choose and why? Is there a third option? Explain your answer. In order for Holm’s to truly have a successful knowledge management system in place, implementation of a hybrid system should be in place; enforcing both upgrade to IT systems occurring simultaneously with changing the private culture into a shared one. Integration of both, changing the culture and IT upgrades will be a lengthy process so it would be critical to first strategically plan for cultivating and managing formal processes for knowledge transfers. Implementing formal processes such as required protocols, reports, standard operating procedures (SOPs) and work instructions for each mission or project should be enforced from every high-level management as it might help with the KM transfer crisis. Once every item has been completed by the high-level management it would be placed into the appropriate IT systems database in conjunction with the integration of the required knowledge management video synopsis from experienced engineers and scientist who exit the centers. Curriculums would be in place with learning modules with specific need encapsulating these protocols, reports, SOPs, work instructions and video synopsis would then be posted on the intranet, ready for the potential novice engineers and scientists entering the NASA work force; making the system more enriched and meaningful. 5) President Obama is implementing changes to NASA’s charter, which will create new ways of funding/executing projects than NASA is used to. Do a little online research. Do you agree or disagree in this change of direction? Explain. Caution; this is not to be addressed as a political issue) The Obama administration’s new NASA charter includes a couple of key parts: A) In February 2010, the Obama administration canceled the Constellation Program, which was started by former President George W. Bush’s administration in 2004. This program aimed to put US astronauts back on the moon by 2020, for the first time since the final Apollo mission. B) In April 2010, Obama proposed increasing NASA’s overall budget by about $6 billion over five years and shifting NASA’s aim for manned space program to Mars (from the moon). By the mid 2030s, â€Å"I believe we can send humans to orbit Mars and return them safely to Earth. And landing on Mars will follow,† he said. C) He also challenged the commercial space industry to take up the routine tasks that NASA would abandon – such as ferrying astronauts to and from the space station. I do not agree with him on the part A and Part B of the new charter. The Constellation Program is already 5 year old, and has spent $9. 1 billion. It has already made significant progress and will help America maintaining its space leadership position over Russia and China. On the other hand, I think that it will set a foundation for manned space mission to Mars. Obama’s vision of manned mission to Mars by mid-2030 does not seem realistic to me as he has not talked about its technology feasibility. However, I do agree with his plan’s Part C. I think that it will significantly reduce the cost for transporting people and cargo to and from low-Earth orbit, and might induce the rise of a true space economy.

Sunday, January 5, 2020

Significance of the Narrators Invisibility in Ralph...

The narrator’s invisibility first comes up in Chapter One, where he is invited to a community meeting consisting of prestigious white citizens. He comes to this meeting believing that he is to give a speech to represent his high school. He believes that in dictating a speech, the narrator will be recognized by the white community for his intelligence. Unfortunately, he is turned into entertainment when he is forced to fight in a â€Å"battle royal† with other black men. After being beaten blindfolded and pushed into an electrocuted carpet, the narrator still gathers up the strength to dictate his speech, only to find the white men â€Å"still [talking] and still [laughing], as though deaf with cotton in dirty ears† (p30). The author Ralph Ellison†¦show more content†¦He lets himself be ridiculed by turning into a puppet for the ignorant white men for entertainment purposes. Still, he holds onto the assumption that if he degrades himself, he will be rewar ded in the end. As a result, the narrator does not advance in his journey to find his identity, but rather degrades himself even more and makes him dependent on other’s opinions. Furthermore, the narrator appears invisible to others and to himself during his time as a member of the Brotherhood, an organization that appears in the novel as a euphemism to the Communist Party in real life. The narrator joins the Brotherhood in the hopes of creating an identity for himself within the organization by acquiring recognition as a prestigious black leader. He is under the assumption that the Brotherhood recognizes his ideas, his individuality, and soon becomes dedicated and loyal to their cause. However, the narrator does not discover the Brotherhood’s true intentions until after Brother Clifton’s funeral. The Brotherhood turns against the narrator for his belligerent speech at the funeral that they fear would destroy their reputation. The narrator retaliates by accusing the Brotherhood of being â€Å"the great white father† of Harlem. The â€Å"naked and old and rotten† truth comes out when the committee tells him he was hired to talk, not to think. The narrator later learns how committed the Brotherhood is to their cause with the discovery ofShow MoreRelatedMetaphors In Ralph Ellisons Invisible Man1235 Words   |  5 PagesMetaphors in Invisible Man Ellison uses many examples of metaphors in his novel to convey invisibility, especially with references to music, imagery, and the use of a nameless character. With literature that challenged the accepted ideals surrounding that time period, Ellison expresses his thoughts by comparing an invisible man to various relatable subjects in life. When the narrator firsts starts on his journey and gets constantly bumped, he states that â€Å"You constantly wonder whether you aren’tRead MoreInvisible Man By Ralph Ellison1908 Words   |  8 Pagesregarding their personal experiences. 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