Japanese Immigration - Parading With Pride Essays - Issei

Japanese Immigration - Parading With Pride A 1949 parade was Los Angeles's first post-World War II event to celebrate Japanese-American culture. It honors the Nisei, second-generation Japanese-Americans, who descended from the Issei, the first generation of Japanese to come to America. Japanese immigration to America began in 1882 with the Meiji Restoration. The Meiji Restoration in Japan marked a time of Westernization and change. For the first time in two centuries, foreigners could enter Japan and Japanese citizens could leave. So, when America's Chinese Exclusion Act of 1882 barred Chinese from providing America with cheap labor, the Japanese arrived to fill the void. Many rice farmers in southwestern Japan were heavily taxed and hoped to make their fortunes in America. Also, jobless veterans from the Russo-Japanese War came to America when that war ended in 1905. More than 30,000 Japanese went to Hawaii to work on sugar plantations between 1885 and 1894. In the 1890s and continuing until 1924, there was large-scale Japanese immigration to America's mainland. The Japanese call their first-generation immigrants "Issei." Unlike the Chinese who first went to California to work on the railroads, many Japanese went directly to the Pacific Northwest where a huge fishing and timber industry needed their labor. Unlike the Chinese, Japanese immigrants included more women, so families could be started. Some women came with their husbands, others arrived as "picture brides," met by unknown future husbands on America's wharves. Their children, the second generation, are called "Nisei." Independent Japanese started their own farms on unwanted pieces of land, turning them into productive truck gardens. They sold the produce at local markets. The Japanese were not competing with Anglo-Saxon farmers who tended row crops, such as wheat and fruit trees, that required no stoop labor. During the 1920s, Japanese farmers supplied 75 percent of Seattle's vegetables. The 1924 Immigration Act cut the flow of Japanese immigration. Those already in America became educated and began to get prosperous jobs. Eventually Japantowns emerged. Most Japanese continued to practice the Buddhist religion of their ancestors. On December 7, 1941, Japan attacked Pearl Harbor in Hawaii, plunging the United States into war and dismantling the success of the Japanese-Americans. Responding to panic over security by America's military and anti-Japanese sentiment in the press, President Roosevelt signed into effect a document entitled "Executive Order 9066." This order gave Issei and Nisei 10 days to sell their businesses, homes, and belongings. Then about 120,000 Japanese-Americans were rounded up into holding areas, and shipped to "relocation centers." These relocation centers were in desolate parts of America, such as Idaho and the barren eastern slopes of California's Sierra Nevada mountains. Sometimes families were separated in the process. Starting in 1943, Japanese-Americans were freed from the centers, but most had difficulty restarting their lives. Those who had served in America's military benefited from the GI Bill of Rights and got an education. Third-generation Japanese-Americans, Sansei, also got an education and citizenship thanks to the 1952 Walter-McCarran Act. Many of those who were incarcerated were politically vindicated when Congress voted in 1988 to apologize and make cash payments to Japanese-Americans for America's treatment of them. Today, Japan is a strong economic power and many Japanese businesses have done well in America: Honda and Sony among them. Vibrant Japanese-American communities exist, especially in Pacific Coast cities like Seattle and Los Angeles, where Nisei Week celebrations like the one pictured here continue. http://www.letsfindout.com/subjects/america/japanese.html

Case study analysis from three different perspectives Essays

Case study analysis from three different perspectives Essays Case study analysis from three different perspectives Essay Case study analysis from three different perspectives Essay Case study analysis from three different perspectives Name Course Date Case study analysis from three different perspectives Ethics applies to all activities that are carried out by human beings. These are the principles that guide people in their professions. Different professions have established distinct but related ethical guidelines. The field of health is not exempted from moral and ethical standings. One of the major ethical debates is based on the issue of organ donation and the transplant process. In the case study, the doctor applies the procedural rule of first come first served. This essay provides a commentary to three perspectives on the ethical issues that arise from the procedural rule. 1. The first come first served rule should apply to all patients. In addition, the procedure should not take in to consideration the physical and financial aspect of the patient. In this case, the street person has greater chances of producing better health results than the lawyer. However, the street person has limited finances to cater for the follow-up process. The cost of treatment after the corneal transplant will require numerous procedures in order to reduce his vulnerability to other complications. However, the lawyer presents a valuable asset to society. He has a family he plays an important role in providing for his family. He is also less likely to incur further complications after surgery. In addition, the lawyer has the financial capability to cater for the follow-up process. He is also invaluable to society as he provides legal services to many people. This argument does not look into the character or potential of the street person. It is therefore unethical as the street person is discriminated based on the financial aspect. It is unethical for doctors to be bias based on prominence and wealth (Garret, et.al, 2009). The street child requires an equal and similar opportunity to the prominent lawyer. Though the lawyer has a family that relies on him, the street person is also a member of the same society as the lawyer. The lawyer may offer a viable option because of his status in society, but according to the law, everyone should have equal opportunities in the provision of healthcare whether rich or poor. 2. It is ethical for the doctor to use the first come first served rule. However, the doctor should consider the outcome of the procedure on both patients. The lawyer presents the possibility of better outcome compared to the street person. In addition, he does not have a history of illness and has fewer chances of complications after the transplant. However, this perspective should also consider the street person. Event though the lawyer presents better chances, the street person is also a patient that requires an organ. The outcome of the transplant should be taken into consideration, but the rule must apply equally either way. The street person also has the potential of benefiting society just like the lawyer. 3. This perspective differs with the rule of first come first served. The alcoholic patient presents fewer chances of following up on his treatment regimen. He also has numerous health complications that might plunge him into further health risks. The view of society is important in the medical field. However, this view should not contradict the ethical principles that guide the practice of medicine. The lawyer presents a better option as he makes a significant contribution to societal development. However, judging the alcoholic as an insignificant member of society is unethical. Alcoholics have the opportunity to change and live productive lives just like the lawyer. Patients should not be judged according to their character, as they deserve equal treatment and care. The physician is therefore correct in the procedural rule he employs. These two patients should pass through the transplant process based on their medical requirements. Therefore, the value of human life should be the p rimary consideration. References Garrett, T. M., Baillie, H. W., Garrett, R. M. (2009). Health care ethics: Principles and problems. Upper Saddle River, N.J: Prentice Hall.

Proposed Act Would Give Federal Agents Power

Proposed Act Would Give Federal Agents Power Pornography is a big deal in America and arguably has its place. While New York City, Miami and Los Angeles are all cities with big porno markets, this week, record porn site hits came from another city.   Cleveland. Ohio! During the 2016 Republican National Convention, the number of people watching pornography videos surpassed the number of people who watched the Cavaliers win the NBA Championship. Yup. Turns out, Trump is good for the porn business. A record setting 873,294 videos were viewed in The Buckeye State after Trump’s name was put into pornographic search engines. Who knew the party of Lincoln drips with erotica? Since this subject is trending, let’s see if we can tie it in with animal rights. Yes we can! There’s a connection, and it’s very disturbing. First, a little background. Bestiality, or, sex with animals, is legal in plenty of states. But it’s not enough you know that, just for fun, I’m going to call them out on it so those who live in these states can get busy on the legislation needed to outlaw this sick stuff. Alabama, Arkansas, Hawaii, Kentucky, Montana, Washington, New Hampshire, New Jersey, Nevada, New Mexico, Ohio, Texas, Vermont , Virginia, West Virginia, Wyoming and, not surprisingly, the District of Columbia. Humans are not the only ones being screwed by politicians in D.C. Oh, and you can have intimate relations with a non-human in Guam with complete immunity. As if sexual abuse of  animals isn’t bad enough, some sickos just can’t stop until the animal or animals are tortured and killed for sexual pleasure. Just ask Brent Justice, 54, and his girlfriend, Ashley Richards, 25. This deranged Houston couple was  arrested in 2012 for making and distributing dozens of â€Å"crush videos† where animals were tortured by the couple while the couple engaged in sexual acts. Graphic details of what this entails can be found here. Puncturing a kitten’s eye with a high heel shoe is just the beginning. Don’t look if you can’t deal with the facts of the case. It’s not really important that you make yourself sick. What’s important is that you take action. More on that later. The Animal Crush Video Prohibition Act passed during the Legislative Session of the 111th Congress in 2010 prohibited the trade in pornographic videos in which animal cruelty is depicted. It states, in part:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"Each of the several states and the District of Columbia criminalize intentional acts of extreme animal cruelty, such as the intentional crushing, burning, drowning, suffocating or impaling of animals for no socially redeeming purpose.† As if any of that can ever be sold to the public  as socially redeeming. The exact text of the Act can be found on GovTrack.US. Of course, nothing is ever easy so there are limits to what this law does. In a nutshell, the trade in crush videos is illegal but the act of animal cruelty isn’t. It’s confusing. So now, the 114th Congress which concludes in January, 2017, has been asked to plug up the loopholes in the 2010 act. Specifically, H.R. 2293 was introduced by Rep. Lamar Smith, (R-TX), Ted Deutch (D-FL), Tom Marino (R-PA) and Earl Blumenthal (D-CT). The Senate bill, 1831, was introduced by Senators Pat Toomey (R-PA) and Richard Blumenthal (D-CT). Entitled the Preventing Animal Cruelty and Torture Act (PACT), this bill would prohibit the extreme acts of animal cruelty depicted  in the videos. It would also provide federal prosecutors with the ammo they need to prosecute offenders when the offense is occurring in a federal jurisdiction or interstate commerce. Federal agents would be permitted to pursue animal cruelty charges revealed while agents are  investigating another interstate violation, such as drug trafficking. Prosecutors could also stop to the transport of animals for the purpose of bestiality, even if the crime occurs in one of the states listed above. Ann Chynoweth is the Vice President of the Animal Cruelty Campaign for the Humane Society of the United States. She believes the PACT Act is sensible, bi-partisan legislation that would outlaw extreme acts of animal cruelty that occur on federal property or in interstate commerce.   â€Å"The PACT Act would strengthen current federal law that outlaws the commerce in crush videos where animals are tortured for a sexual fetish.   It would give federal prosecutors the ability to not only prosecute the peddlers of these hideous videos, but also those who crush, burn, drown, suffocate or otherwise torture animals to make them,† says Ms. Chynoweth.   â€Å"There is a documented connected between animal cruelty and human violence and that is why the National Sheriffs’ Association and more than 200 law enforcement agencies from across the country have endorsed the PACT Act.† So what can you do? â€Å"Not much is moving now during the presidential elections,† says Laura Bevan, Southeast Regional Director for the HSUS. But that doesn’t mean that after November, lawmakers can sit back and rest. No, they need to get back to the task at hand, passing laws to make life better for animals because animals have an inherent right to live their lives and make their way in the world without human intervention. So find out who your reps are (you can do so here) and call, email and visit them to urge them to support the PACT act. This shouldn’t be controversial, and there’s no appropriate argument against passage of this act.

Short Story Outline Essay Example | Topics and Well Written Essays - 500 words

Short Story Outline - Essay Example Larry embodies a value system that is contrary to John’s. While John has recently moved to the town, Larry is well established. While John is socially naà ¯ve, Larry is experienced and at ease. The final character is Chuck. Like Larry, Chuck is partially an antagonist. While John and Larry function as foils in the story, Chuck represents a sort of furthered extreme in terms of antagonism. Chuck’s only relation to school is that he arrives in the morning. He is established in the town, but people have a general sense of unease about his actions. While Larry is cynical, Chuck has almost entirely given-up. The main characters relate in interesting contexts. While they share different classes, John becomes interested in their perspective and actions. Eventually during lunchtime, the three characters interact. The main conflict becomes John’s challenging of his own life paradigm. Larry and Chuck exemplify a perspective on the world that is contrary to John’s straight-laced approach. Eventually, John becomes discontent with his perspective and resolves this discontent through an encounter with Larry and Chuck. There is a complex theme and meaning to the story. In these regards, the story explores the nature of meaning in the lives of the characters. In addition, the story is a coming-of-age tale where the main protagonist sheds previous conceptions of existence for a more real-world perspective. The story follows John’s life moving to a new town, succeeding in school, and struggling to make new friends. It witnesses as John slowly becomes discontent with this perspective and this discontentment leads him to make friends with two cynical students – Larry and Chuck. After establishing this friendship, John agrees to skip class with them and go into an area behind the school. The three of them are then arrested for trespassing. The setting is fairly small. It occurs in areas throughout the school, including classrooms, the hallway, and the lunchroom. It

Business Law (company law) Essay Example | Topics and Well Written Essays - 2000 words

Business Law (company law) - Essay Example In the event that partners or external third parties decide to file a lawsuit, in actual sense they would be suing only the company with the exclusion of investors/stockholders. They are not held liable for such matters as loans as well as other debts owed by the company. In contrast to them, investors, general partners, and sole proprietors are considered to be liable for such business debts all through. Limited liability is fundamental in the exclusion of certain parties from being held liable for such liabilities. Limited liability companies have a lot of advantages that I would say, arguably, outweigh the disadvantages regarding the same. It is therefore advisable that Robert, Sarita, and Phillip to start convert their company ‘IN THE EVENT’ into a limited liability company. The respective advantages of a limited liability company are as follows. The mere existence of a limited liability company provides for the limited liability security or protection to its own members or owners. This could be arguably the most imperative advantage of this form of company. They are basically not personally accountable for the company’s business debts and liabilities. Creditors are legally crippled to pursue the personal assets (houses, savings, and etcetera) of the business’s stakeholders in order to earn back their business debts (Macintyre, 2010). This is in contrast to many other contrasting forms of business. The only liability that members have to bear is that for the amount that they are yet to pay on shares. In the event that things do go wrong, the only losses encountered by the members would be the value of shares as well as any loans made by the members to the company. However, there is an ambiguity. The protection of limited liability companies does not go as far as to cover frauds. In the unfortunate occasion that creditors incur losses via direct fraud, there is no limit to personal liability. A limited liability company

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/