Burnout in Nursing Profession

Burnout in Nursing Profession The aim of this literature review is to identify the significant factors related to burnout in the nursing profession. Nurses are most susceptible and vulnerable to the development of burnout, mainly because of the nature and emotional demands of their job. Burnout in the nursing profession is a significant concern in nursing, because it has detrimental effects both on individuals and organisations. For the individual nurse, the neuroendocrine response yields physiologic reactions that may ultimately contribute to illness. In the health care organisation, work burnout may contribute to absenteeism and turnover, both of which detract from the quality of care. Burnout is reported to originate from work itself as well as from characteristics of the individual nurse. There are also buffers to mitigate the development of burnout. Background Freudenberger (1974) first coined the term burnout to describe the build-up of feelings that professionals experience when their emotional resources are depleted (Janssen, Schaufeli Houkes 1999). Maslach and Jackson (1981) further refined this term as a syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment. Their study is a piece of seminal work and their concept on burnout has been widely accepted since. Emotional exhaustion manifests in nurses as a general loss of feeling and concern, trust, interest, and spirit. It also involves feelings of fatigue, being used up, irritability, frustration and wearing out (Maslach et al 1981). Depersonalisation refers to showing a detachment of the nurse from the patient by actively ignoring the qualities that make them unique and engaging people (Maslach et al 1981). The third dimension of the burnout syndrome is the tendency of nurses in evaluating their work negatively. Nurses feel unhappy about themselves and dissatisfied with their accomplishments on the job (Maslach et al 1981). Burnout is measured by the Maslach Burnout Inventory (Maslach et al 1981). The internal consistency of this tool has been widely tested using Cronbachs coefficient alpha (Maslach, Jackson Leiter 1996) and hence could be considered to be a standard measure for burnout (Hannigan, Edwards, Burnard, Coyle Fothergill 2000). This survey tool is a 22 item questionnaire consisting of the three subscales mentioned above of the burnout syndrome. The items are scored in a 7-point Likert scale ranging from 0 (never) to 6 (daily). A high degree of burnout is reflected in high scores on the emotional exhaustion (EE) and depersonalisation (DP) subscales and a low score on the personal accomplishment (PA) which is rated inversely. An average degree of burnout is reflected in average scores on the three subscales and a low degree of burnout is reflected in low scores on the EE and DP subscales and a high score on the PA subscales (Maslach et al 1981). Rationale Burnout is often been reported as a causing factor for attrition of nurses from the nursing profession (Armstrong-Stassen, Al-Maaitah, Cameron Horsburgh 1994). In addition burnout in nursing has been associated with poor patient satisfaction and poor patient outcome (Vahey, Aiken, Sloane, Clarke Vargas 2004, Nayeri, Negarandeh, Vaismoradi, Ahmadi Faghihzadeh 2009). These adverse outcomes of burnout could have significant indelible impact on the Singapore governments aim to establish Singapore as a reputable medical hub in the ASEAN region. Studies and statistics have shown that nurses in Singapore are at risk of developing burnout (Boey, Chan, Ko, Goh Lim 1997, Lim Yuen 1998, EnterpriseOne 2006), however, surprisingly, no research have been done in Singapore to assess the level of burnout and the related factors of burnout in their nurses. Therefore, this literature review is initiated to generate a comprehensive understanding of what is known about burnout in the nursing profes sion. This could have implications for understanding the overall well-being of the nurses in Singapore. Aims and Objectives Aim and objective: To identify the significant factors related to burnout in the nursing profession. Method A literature search was conducted using the keywords nurses and burnout on CINAHL and MEDLINE. The search is supplemented with a manual search in journals published in Singapore for further information regarding related research conducted in the local context and a supplementary follow-up of other cited materials in Google Scholar, where appropriate. Findings Collating the evidence from the literature led to the identification of three main themes for the related factors of burnout for nurses. The themes are stress of the health care professionals, individual variables and leadership as the buffering factor. The proposition that high stress clinical care settings as organisational stressors have been extensively examined. Therefore not surprisingly, studies on burnout done in medical, surgical and high dependency units were most prominent (Nayeri et al 2009, Adali Pirami 2002). Gillespie and Melby (2003) purported that the reason is because the nursing staffs working at these demanding areas are likely to spend considerable time during their working day in intense interactions with people. While Maslach-Pines (2000) suggested that it is because the nature of the work of these departments is often described as physically demanding and nurses are also continually faced with heavy demands for pity, sympathy and compassion. However, while many studies demonstrate a strong correlation between high levels of stress in high stress work environments and increased incidence and degree of burnout among nurses (Schmitz, Neumann Oppermann 2000), others produce evidence showing there is no correlat ion (Buunk, Ybema, Zee, Schaufeli Gibbons 2001). In the study conducted by Buunk et al (2001), it is being demonstrated that nurses working in high stress, specialised environments are less burned out than their counterparts working in those perceived as low stress environments. However, it should be noted that the participants for their research are nurses who have at least 10 years of working experience. They would have been able to handle their stress more efficiently and would have been less prone to burnout. Therefore, it can be argued that this research lost its reliability because the sample represents a group of generally healthy workers (Demerouti, Geurts, Bakker Euwema 2004:997). Moreover, the researchers also conducted a face-to-face interview with the participants. By the interview questions, the participants could infer that the researchers are interested to determine their stress related behaviour. Therefore, the sensitive nature of these questions would have inflict ed a response bias as participants do not want to be stigmatised as not being able to cope (Maslach, Jackson Leiter 1996). In more recent years, among the organisational stressors, workload as a contributing factor to burnout is more commonly reported and associated with the emotional aspect of the burnout syndrome (Greenglass, Burke Moore 2003, Lin, St John McVeigh 2009). Taris, Le Blanc, Schaufeli and Schreurs (2005) suggested that a high score on this single aspect of the burnout syndrome will be sufficient enough to predict burnout. Authors proposed that the 21st century health care reform has further intensified nurses workload. The work intensification studies in and around health care are providing convincing evidence on the extent to which efficiencies achieved by health care organisations are largely due to the increased workloads of nurses as a result of both staff reductions and increasing activity and patient complexity (Green 2004, Aiken, Clarke, Sloane Sochalski 2001). It is argued that increased workload will lead to increased stress and in turn leads to higher chances of burnout (Masla ch Leiter 2008). Therefore, it can be speculated that there should be widespread concomitant increase in reported severity of burnout due to the increased pressure on nurses. Nonetheless, the question remains as to why in the same situational conditions, some nurses burn out, whereas others show no syndrome. The most likely explanation is that causes of burnout are found in both the environment and the individual. Significant relationships between burnout and certain demographic characteristics have been reported but the results are still far from conclusive. The few socio-demographic variables most commonly being investigated are age, gender and marital status. In their study, Maslach, Schaufeli and Leiter (2001) reported that age has most consistently been related to burnout. Burnout has been observed more often among young workers than among those aged over 30 or 40 years and it seems to occur rather early in ones work career. Schaufeli and Greenglass (2001) accounted that regarding gender differences in burnout, results are mixed and may reflect difference in roles or occupations. Maslach et al (2001) found that emotional exhaustion has usually been reported to be more common among women, whereas depersonalisation has been more common among men. Bakker, Demerouti and Schaufeli (2002) conducted a study in which a wide range of different occupations and organisations were recruited and answered through the internet, women reported higher levels of burnout than men did, particularly when they were relatively young or had relatively little work experience. However, the respondents were mostly men and rather young (Bakker et al 2002). Schaufeli and Enzmann (1998) with regard to marital status, those who are unmarried, especially men, appear to be more prone to burnout compared with those who are married. Singles seem to experience even higher burnout levels than those who are divorced. Personality characteristics as the psychological aspects of individual variables were explored as an important variable in the burnout process in a number of investigations (Simoni Paterson 1997, Allen Mellor 2002, Bà ¼hler Land 2003). However, the specific features of personality that affect the perception of burnout remain unclear. Garrosa, Moreno-Jimà ©nez, Liang and Gonzà ¡lez (2008) proposed a model of prediction of burnout in nursing and they reported that their findings give support that personality factors are significant predictors of the three aspects of burnout. But the authors were not clear on which personality characteristics were investigated. Allen et al (2002) and Zellars, Perrewà © and Hochwarter (2000) reported that neuroticism is associated with the emotional exhaustion aspect of burnout and external locus of control also demonstrated positive relationship with burnout. However, Bà ¼hler et al (2003) and Toscano and Ponterdolph (1998) reported that finding s are mixed for hardiness. Interestingly, more recent studies indentified leadership as a factor related to burnout (Kanste, Kyngà ¤s Nikkilà ¤ 2007, Corrigan, Diwan, Campion Rashid 2002). Leadership issues did not appear as a noteworthy factor related to burnout in earlier studies, even though it had been discussed some twenty years ago by Bass (1985). Nonetheless, leadership issues cannot be considered as new, but rather they appear to have increased in relative significance. Weber (2007) articulated that the increasing calls over the last decade for considering leadership as a related factor of burnout is particularly because of the chronic recruitment and retention issues confronting the nursing profession. There is also a rich source of comment on the impact of health care reform on nurses and nursing in the health care sector research literature (Aiken et al 2001). In a study conducted by Laschinger and Leiter (2006), their findings also support the key role of strong nursing leadership in creating c onditions for work engagement and ultimately, safe, high-quality patient care. Demerouti, Bakker, Nachreiner and Schaufeli (2000), in their proposed model of burnout and life satisfaction amongst nurses, identified that an individuals engagement with their work will predict a degree of low burnout. However, Stordeur, Dhoore and Vandenberghe (2001) warned that if leaders are too tyrannical and control-oriented, their leadership could exacerbate the burnout process. Among the different types of leadership, transformational leadership has been most commonly proposed and viewed as a buffer which moderates the impact of burnout (Stordeur et al 2001). Transformational leaders are visionary, balanced, self-aware and confident of breaking existing professional boundaries (Stordeur et al 2001). Nonetheless, findings from the study by Stordeur et al (2001) have to be viewed with cautious. This is because they only attempted to measure the relationship between leadership and the emotional aspects of the burnout syndrome. The other two dimensions, depersonalisation and lack of personal accomplishment were not measured. Further studies would have to be taken to establish implicit links between leadership and burnout. Ulrich, Buerhaus, Donelan, Norman Dittus (2005) found that effective control over practice resulted in increased status, respect and recognition. Hochwà ¤lder (2008) further emphasised that through a chain reaction, transformational leadersh ip style engenders group cohesion and empowerment in nurses and hence it has been found that transformational leadership is inversely correlated with burnout in nurses. Discussions Past research on burnout in Singapore is generally anecdotal in nature (Tung 2000). Others attempt to investigate the nurses stress level and their association with the psychological well-being and several work-related outcomes such as job satisfaction, organisational commitment, intention to quit and job-induced tension (Boey et al 1997, Lim et al 1998). In a study on stress among nurses in the emergency department in Singapore, Lateef, Ng and Anatharaman (2001) reported that the nurses who are older, have more working experiences and hold higher positional post had lower stress scores as compared to those who are younger, have less working experience and have lower positional post. However, the authors did not proffer insights to explain these observable facts. While such research gives indication that there is a high level of stress in the nurses in Singapore, it cannot be implied that there would be a high degree of burnout in these nurses. While it is clear that stress results i n burnout among some individuals, also apparent, yet not explained by the empirical evidence is the fact that others faced with high levels of stress do not experience burnout. Therefore an implicit relationship of high level of stress and high degree of burnout cannot be deduced because there is evidence of high stress being associated with low burnout (Bunnk et al 2001). Therefore, studies on burnout have to be conducted to investigate the burnout phenomenon among the nurses in Singapore. For the time being, it could only be speculated that nurses in Singapore are at risk of developing burnout. From the findings, it is shown that nursing burnout appears to be the result of not only contextual factors but also individual factors. Results from the studies on the socio-demographic variables and personality characteristics are weak and ambiguous. Only age has been identified as a relatively good correlate to burnout, with younger nurses being more susceptible. It would be reasonable to believe that younger nurses are more at risk to burnout because they have to move from a familiar educational environment into the workforce where there are high expectations of them to rapidly function as a competent nurse (Schaufeli et al 1998). As a result, they experience challenges transitioning from student to practicing professional nurse (Godinez, Schweiger, Gruver Ryan 1999). Transformational leadership could result in low burnout. It is important to note that low degree of burnout represents a positive psychological state and an effective state of well-being (de Rijk, Le Blanc, Schaufeli de Jonge 1998). In the emerging literature, there is a shift from the traditional focus on weaknesses and malfunctioning toward understanding human strength and optimum functioning at work (Gustafsson Strandberg 2009). Conceiving of low burnout as wellness makes a contribution to the literature because it focuses on the positive aspects of work. Positive research has the potential to improve the image of nursing and attract a new generation to the profession. It also have implications for identifying and modifying possible areas of frustration that would result in burnout and thus help relieve the high costs of turnover by improving nurse retention (Teng, Shyu Chang 2007). The major contribution of such an approach is that it enhances the understanding of how the mana gement of the health care organisational can affect nurses well-being. This knowledge is essential for the future development and well-being of all nurses and the profession of nursing. Research implications Current research focuses on examining the burnout phenomenon in acute settings and their findings have presented evidence that the level of burnout might not be influenced by different clinical settings. Therefore, future studies should move beyond the acute care settings to better understand the burnout phenomenon. Except for one, all authors of the research used for this literature review utilised cross-sectional methodology, therefore, casual relationships cannot be made from their results. Their findings also cannot be generalised in another milieu. Longitudinal research is required in order to enhance the understanding of the burnout process. Maslach et al (1981) had pointed out that longitudinal research although presents a large challenge, it is of critical importance for the comprehension of burnout. Future longitudinal examinations should establish a profile of the nurses at the beginning of their employment then follow up over a longer period of time in correlation with burnout status and the related factors influencing the development of the burnout process (Ekstedt Fagerberg 2005). For all of the studies used for this literature review, the data are collected using self-reports from the participants. Many authors warned that self-reported data might be contaminated by common method variance, because both the independent and dependent variables are based upon one source of information which is the participants (Demerouti et al 2000). Therefore, future research should also utilised objective means for collecting the result findings. Conclusion The concept of burnout has sustained the interest of nurses and researchers for several decades. Despite the large amount of studies done in attempt to investigate and predict the related factors of burnout, no conclusive data could be drawn. This is because the health care system is in constant change. The factors that relate to burnout will present different relative significance with the changes. Notwithstanding this, the related factors to burnout could generally be classified as both organisational and personal related. Therefore, to base practice, burnout intervention programmes should be multidimensional consisting of work-related as well as personal directed approaches.

Closed Head Injury

Closed Head Injury Case Study Y. W. is a 23-year-old male student from Thailand studying electrical engineering at the university. He was ejected from a moving vehicle, which was traveling 70 mph. His injuries included a severe closed head injury with an occipital hematoma, bilateral wrist fractures, and a right pneumothorax. During his neurologic intensive care unit (NICU) stay, Y. W. was intubated and placed on mechanical ventilation, had a feeding tube inserted and was placed on tube feedings, had a Foley catheter to down drain (DD), and had multiple IVs inserted. He developed pneumonia 1 month after admission.Closed Head Injuries: Closed head injuries result from a blow to the head as occurs, for example, in a car accident when the head strikes the windshield or dashboard. These injuries cause two types of brain damage. 1. Define the term primary head injury. A primary head injury (or primary impact) is also known as a â€Å"coup injury. † The injury occurs under the site of impact with an object such as a hammer or a rock. The brain strikes the skull after the head strikes the object of impact (Lewis, et al, Fig 57-14). This is the site of the direct impact of the brain on the skull.Often there is edema around the site of impact. 2. Define the term secondary head injury. The secondary head injury is also known as contrecoup injury occurs on the side opposite the area that was impacted. These injuries tend to be more severe and overall patient prognosis depends on the amount of bleeding around the contusion site (Lewis, et al, 1425). Often it is the secondary brain injuries that show few initial symptoms and then have serious side effects days to weeks later. 3. What is normal intracranial pressure (ICP), and why is increased ICP so clinically important?Normal intracranial pressure ranges from 5 to 15 mm Hg. A sustained pressure above the upper limit is considered abnormal. Pressure changes in the brain effect the brain’s compliance. Complianc e is the â€Å"expandability of the brain† With low compliance, small changes in volume occur and result in greater increases in pressure. Elevated intracranial pressure is clinically significant because â€Å"it diminishes CPP, increases risks of brain ischemia and infarction, and is associated with a poor prognosis† (Lewis, et al, p. 1425-1427). 4. Identify at least five signs and symptoms (S/S) of increased ICP. signs and symptoms of increased ICP are †¢Decreased LOC (level of consciousness) †¢Respiratory problems (maintaining a patent airway is critical in the patient with increased ICP. Pt is at increased risk of airway obstruction (Lewis, et al, p. 1434). †¢Elevated systolic BP due to ischemia and pressure on the brainstem. †¢Bradycardia due to the ischemia and pressure on the brainstem as well. †¢Pulmonary edema due to increased sympathetic activity as a result of increased intercranial pressure. 5. List 4 medication classifications that the ICU nurses could use to decrease or control increased ICP.Some of the medications that the ICU nurses could use to decrease or control increased ICP would be: †¢Opioids (morphine sulfate and fentanyl) †¢IV anesthetic sedative propofol (Diprivan) to manage anxiety and agitation. †¢Vecuronium (Norcuron), cisatracurium besylate (Nimbex): nondepolarizing neuromuscular blocking agents: achieve complete ventilatory control in the treatment of refractory intracranial hypertension. (These agents paralyze muscles without blocking pain or noxious stimuli, therefore they are used in combination with sedatives, analgesics, or benzodiazepines (Lewis, p. 436)). †¢Dexmedetomidine (Precedex): alpha-2 agonist; used for continuous IV sedation of intubated and mechanically ventilated patients in the ICU setting for up to 24 hours. †¢Benzodiazepines are usually avoided in the ICU in management of the patient with increased ICP because of the hypotensive effect and long hal f-life. (Lewis, et al, p. 1436). 6. List 8 nursing measures that the ICU nurses could use to decrease or control increased ICP. * Maintain the patient in the head-up position. Elevation of the head of the bed reduces sagittal sinus pressure, promotes drainage from the head via the valveless venous system through the jugular veins, and decreases the vascular congestion that can produce cerebral edema† (Lewis, et al, p. 1436) * Position the bed so that it lowers the ICP while optimizing the CPP; not above 30 degrees. * Turn the patient with slow, gentle movements. Rapid changes in position may increase ICP. * Avoid extreme hip flexion—this risks raising intra-abdominal pressure which increases ICP. Turn pt every 2 hrs (minimum). * Protect the patient with ICP from self-injury with adequate padding on the bed.Because of likelihood of decreased LOC, confusion, agitation, and the possibility of seizures increase the risk for injury. * Be prepared to explain situations to fam ily and caregivers and the patient. With increased ICP, anxiety is likely and the prognosis can be distressing. By providing short, simple explanations that are appropriate, it allows the patient and the caregiver to acquire the amount of information they desire (Lewis, p. 1438). * Decorticate or decerebrate posturing is a reflex response in some patients with increased ICP. The nurse can use turning, skin care, and even passive range of motion. Monitor fluid and electrolyte status. Disturbances can have an adverse effect on ICP. Closely monitor IV fluids with the use of an accurate intravenous infusion control device or pump; monitor intake and output and daily weights. (Lewis, et al, 1437) * Perform neurological assessments every hour. 7. Y. W. ’s medication list includes clindamycin 150 mg per feeding tube q6h, ranitidine (Zantac elixir) 150 mg per feeding tube bid, and phenytoin (Dilantin) 100 mg IV piggyback (IVPB) tid. Indicate the reasons for each. †¢Clindamycin 1 50 mg per feeding tube q6h: Treatment of respiratory tract infections; to treat Y.W. ’s pneumonia. (Skyscape, 2012). †¢Ranitidine (Zantac elixir) 150 mg per feeding tube BID: Used to treat and prevent stress ulcers (stress-induced GI bleeding in critically ill patients). Due to head injury, overstimulation of the vagus nerve from TBI. †¢Phenytoin (Dilantin) 100 mg IVPB TID: Used to treat and prevent tonic-clonic seizures and complex partial seizures. Seizure is seen in 5% of patients with a non-penetrating head injury (Lewis, et al, p. 1445). 8. A STAT portable chest x-ray (CXR) is ordered after each central venous catheter (CVC) is inserted.According to hospital protocol, no one is permitted to infuse anything through the catheter until the CXR has been read by the physician or radiologist. What is the purpose of the CXR, and why isn’t fluid infused through the catheter until after the CXR is read? The chest x-ray confirms the proper placement of the central venous catheter. If fluid is infused through the catheter before a CXR has confirmed placement, the patient is at high risk for systemic infection or possible pneumothorax (which would occur if the catheter were to be entered into the lung by mistake instead of the superior vena cava).CASE STUDY PROGRESS Y. W. spent 2 months in acute care and is now on your rehabilitation unit. He follows commands but tends to get agitated with too much stimulation. His tracheostomy site is well healed, and the pneumonia is finally resolving. He is still receiving supplemental tube feeding and has some continued incontinence of both bowel and bladder. Y. W. has a supportive group of friends who are students at the university; several of them are also from Thailand. 9. Y. W. ’s latest lab results are as follows: Na 149 mmol/L, K 4. mmol/L, Cl 119 mmol/L, total CO2 21 mmol/L, BUN 12 mg/dl, creatinine 1. 2 mg/dl, glucose 123 mg/dl, WBC 15. 4 thou/cmm, Hgb 14. 9 g/dl, Hct 36. 4%, platelets 140 t hou/cmm. Are any of these of concern to you, and what would you suggest to correct them? I am concerned about 3 of the labs. Sodium: high (increased); hypernatremia; high sodium levels cause neurologic problems including intense thirst, lethargy, agitation, seizures, postural hypotension, weakness, and decreased skin turgor. Chloride: High, increased; High chloride levels occur because of increased sodium levels.It is important to correct the sodium level so the chloride level can follow suit. Again, hypernatremia and the nurse must watch out for dysrhythmias, HTN, and impaired mental response. –> Correcting increased sodium would include: Hypotonic saline (via IV) and 5% dextrose in water (IV)- (Lewis, et al, p. 312) WBC count:15. 4 increased; this increased level indicates infection. This can be attributed to the patient’s diagnosis of Pneumonia. Administration of appropriate antibiotics will help bring the white count back to a normal level. 0. Are you surprised by Y. W. ’s agitated behavior? Explain. YM’s agitation is of no surprise. Patients that have head injuries often express agitation easily. Increased intracranial pressure and the head injury the patient has experienced can cause agitated behavior to arise. It is imperative for the nurse to use interventions to decrease the agitated behavior which can further lead to feelings of anxiety. Providing a calm and non-stimulating environment, free of stressors, is a good way to do this (Lewis, et al, p. 1438).Also, the nurse can elevate the bed 15-30 degrees with appropriate oxygenation applied. 11. Outline a general rehabilitation plan for Y. W. based on the above data. The rehab plan will include -physical therapy- working on gross motor skills, walking, sitting, transferring, and range of motion -occupational therapy- aids in completion of ADLs and learning of new techniques to complete these tasks of daily living -nutrition- proper nutrition to keep patient nourished and als o consuming enough vitamins/minerals/proteins to aide in healing. nursing staff- administer antibiotics, pain medications, and supportive care. -speech therapy- to evaluate and aide with swallowing, eating/drinking, and eventually verbal communication improvements. 12. Y. W. ’s mother has just arrived in the United States and speaks no English. What measures can be taken to facilitate communication between medical personnel and the mother? First and foremost the nurse should find out what language is the mother’s native language. Most people are unaware but it is not safe to assume there is one language that will apply to an entire country.Quite a few countries speak a language based on their village. The nurse will need to acquire an interpreter that will speak the language that best suits the mother. If the patient’s friends/classmates are around, they can also be used to aid in interpretation and communication between health care staff and family. 13. Y. W. à ¢â‚¬â„¢s mother will need a place to stay while in the United States. What can you do to facilitate the initial contact with the Thai community? Hopefully the other Thai students are around or could make a suggestion for the patient’s mother.I would also ask the social worker if they know of any thai-specific cultural centers in the area. I could check with the interpreter, and see if they have a lead. I would also google Thai community San Diego and see what I could find. 14. What special discharge planning considerations are there in this case? Discharge considerations for this patient will involve knowing where the patient is discharging to. The nurse will need to know if the patient is staying in the US and continuing with follow-up outpatient rehab with our facility and if not, then where will they be.The nurse and other members of the healthcare/rehab team need to educate the patient on his injury and what comes next for him in terms of rehabilitation. The nurse needs t o consider what modifications YM has made to his lifestyle post injury. Discharge planning should include an outpatient schedule for OT, PT and Speech (assuming he will stay here). Education for caregivers and family is also very important so that the patient has a support system available during the recovery and rehabilitation process.The patient will need to be sent home with any tools he will need for ADLs, with medications or supplements that are still necessary for recovery. If the patient is in need of special services or devices (i. e. wheelchair, ramps, vehicle to accommodate special devices, etc. ), a case manager should be sought out to ensure that these needs are met. References Lewis, et al, (2011). Medical-Surgical Nursing Assessment and Management of Clinical Problems. 8th ed. Vol 1. St Louis, Missouri: Mosby. Skyscape. (2010). Skyscape Medical Resources (Version 1. 9. 11) [Mobile application software]. Retrieved from http://itunes. apple. com/

Outrageous Greek Mythology Argumentative Essay Topics Tips

Outrageous Greek Mythology Argumentative Essay Topics Tips Introducing Greek Mythology Argumentative Essay Topics Should you ever find an opportunity to compose an essay about Greek mythology, you should go right ahead and grab it. There are various legends in Greek and Roman mythology about the way the world together with the humans and assorted animals that inhabit it were created. The 2 mythologies have always been confused with one another. Unique myths define the 2 mythologies. You will need to not just guess what people wish to read about, but in addition pick a topic that matches the particular format of the essay. The procedure for getting good argumentative research essay topics is hard. Job essay writing is a kind of writing that you have to master. Writers often need to do some thorough research on the subject. You don't need to acquire super technical with legal argumentative essays, but remember to do your homework on what the recent laws about your favorite topic actually say. As a way to define a topic, you ought to think about the objective of the essay. If you own a list of strong and intriguing topics, you are going to have better probability of writing a compelling essay. If you're in a college and wish to compose an argumentative essay, you should select a subject of high importance. Greek Mythology Argumentative Essay Topics When you choose a topic, make certain you choose a well-defined, controversial matter. Therefore, the topic needs to be debatable! Popular topics are simpler to write about since there are a lot of sources to back up your statement, but from a reader's point of view, a favorite essay topic isn't exactly helpful. There are a few intriguing topics that it is possible to write on. Greek Mythology Argumentative Essay Topics: No Longer a Mystery Once you are finished with presenting your ideas and evidence, you want to conclude your arguments. It is very important to reinforce the principal points in the conclusion sensibly. It's important to select debatable argumentative essay topics as you need opposing points you can counter to your own points. To write an excellent argumentative essay the students first must investigate several sides of the argument, which permits them to make an educated stance. The Dirty Facts About Greek Mythology Argumentative Essay Topics In case it happens, do not neglect the professional academic writing services created to fulfill every student's expectations regardless of what his field of study is! Students should select a compelling topic to impress the audience and their teachers. To write a strong argumentative essay, they should begin by familiarizing themselves with some of the common, and often conflicting, positions on the research topic so that they can write an informed paper. They often look for the Odyssey paper topics on the internet, and there is nothing weird about it. Your introduction, as an example, should match the type of topic you're given to write on. After all, it's one of the most truly effective techniques to resist corruption and other consequences of false authorities. Your language selection will be dependent on the subject. The format isn't even essential, but it's good when you're starting out. The Lost Secret of Greek Mythology Argumentative Essay Topics However soon you're anticipated to file your college argumentative essay for grading, we'll write the paper for you. You would like your paper to differ. An argumentative paper is part of the persuasion. Understanding how to compose a strong argumentative paper can help you advance your very own argumentative thinking. Many employees have to compose a number of papers that are thought to be job essays. Even though the reading procedure may take at least 10 hours, it won't be boring. The role of assigning an essay to middle school students is to make awareness and permit them to develop writing skills. How to Get Started with Greek Mythology Argumentative Essay Topics? There are lots of aspects about a sport that may be argued in an essay. It's possible to always structure your issue so that it's unique to the argument which you are proposing in your essay. Rather than choosing the obvious stance, pick the opposite to create your essay unique. Persuasive essays are a fantastic method to encourage the reader to check at a particular topic in a different light. It's important to understand that essay topics are just basic ideas that leave you pondering a notion that might be a huge deal to another person. Argumentative essay is a sort of academic paper that demands profound understanding of analyzed problem and a huge collection of personal opinions and facts. It is all about arguing and debating on a topic, which is debatable. Regardless of the popular myth, a superior argumentative essay is more than simply attempting to demonstrate your point with a couple arguments.

The Epidemic Of A Public Health Crisis Essay - 2557 Words

While the age-old adage may read that ‘bigger is better,’ America as a whole has taken this phrase to heart in regards to its general population. In a society where food is cheap, easy to come by, and engineered to be incredibly palatable, overconsumption and unhealthy eating habits leads to an excess of calorie and fat intake. Coupled with this, the increasingly sedentary lifestyle of the average American often produces full days without physical exercise that, when combined with poor eating habits, leads to extreme weight gain and other subsequent severe health problems. America is in the throes of a public health crisis unlike that ever experienced in medical history: where the proportion of its constituents – both child and adult – that is obese is increasing at epidemic rates. First and foremost, the term â€Å"obesity† is defined by the Center for Disease Control (CDC) as a measure of BMI, or Body Mass Index, which is â€Å"calculated as weigh t in kilograms divided by height in meters squared, rounded to one decimal place.† Adults are considered obese if this BMI value equals or exceeds 30 and children are based on age- and gender-specific CDC growth charts from 2000, where obesity is categorized as reaching the 95th percentile or above (Ogden, 2014, p. 6). Likewise, the term â€Å"epidemic† implies that â€Å"a disease has increased in frequency in a defined geographic area far above its usual rate† (Riegelman, 2015, p. 136), which holds true for the American adult demographic: the CDCShow MoreRelatedObesity Epidemic in the United Kingdom698 Words   |  3 Pagesobesity epidemic in UK newspapers from 1996 to 2010. It claims that during this fifteen year period there was an increase in media reporting on obesity. These figures may reflect the claims that obesity was on the increase during this period. However, an article in the Sociolgical Forum suggests that â€Å"Journalists sensationalise what th ey report on by using certain themes, language or metaphors to attract public attention† (Saguy Almeling, 2008, p.57). By using words and phrases such as ‘epidemic’, ‘battlingRead MoreIs Ebola Hemorrhagic Fever ( Ehv )?1471 Words   |  6 Pagesfunction, and finally, internal and external bleeding. The virus can be from wild animals, as well as through human to human interaction. To be specific, contact with bodily fluids (such as blood, urine and feces) is required for transmission (World Health Organization (WHO) Media Centre, 2014). The average fatality rate of EHV through history has been roughly 50%, but it varies greatly from outbreak to outbreak. 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This fight can be done through a lot of places, churches, physician offices, dietary and nutrition offices this fight cannot be done by individual, people that are obesity need the public to pitch and help them in how to lose weight and start a healthy life style. This paper will address why and why not obesity is considered an epidemic, and address why the fight against obesity should be a public discussion and concerned . It is hard forRead MoreThe Opioid Crisis : What Goes Up, Must Come Down955 Words   |  4 Pages THE OPIOID CRISIS 1 The Opioid Crisis: What Goes Up, Must Come Down Pam Lane Incest, Sexual Abuse, and Trauma MHT214 Spring May 1​st​, 2017 Professor Bonnie Cole Lesson 13 Assignment THE OPIOID CRISIS 2 Abstract My personal perception of opioid addiction used to be someone shooting up heroin, an illicit drug, and overdosing was just the inevitable end on the pathway of addiction. It was something distant to me, and in my mind, only happened in the back alleys ofRead MorePrescription Opioid Abuse : An Increasing Epidemic With Solutions945 Words   |  4 Pages Prescription Opioid Abuse: An Increasing Epidemic with Solutions in Prescribing The rate of poisonings associated with drug overdoses has been on the rise, especially concerning those involving opioids (Paulozzie, Budnitz, Xi, 2006). The Centers for Disease Control and Prevention (CDC) does not mince words regarding the status of opioid utilization in the United States: ?The United States is in the midst of an opioid overdose epidemic? (CDC, 2016). Opioids are now the most common cause of prescriptionRead MoreEvidence Based Policy Making And The Influence Of Intangibles1635 Words   |  7 Pagesdecision. The $200 Million Decision During the 1990s, New Zealand experienced an epidemic of group B meningococcal disease, for which there was no vaccine. 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