Assessing Professional Boundaries Between Emergency Nurses And Doctors Nursing Essay

Assessing Professional Boundaries Between Emergency Nurses And Doctors Nursing Essay Nurse is a profession that serves the need of society in the area of health. The roles of nurses have expanded because they carry out multiple roles in healthcare. In this paper I will discuss on Professional boundaries in my workplace context. As describe by Hawkin et al (1991), professional is define as someone who highly skilled, whereas boundaries is a line or border that marks a limit and context is the circumstances in which an event occurs. If we look around us, we will see that every living being has its own limit and bound by its own territory in which it dwell and defend against any sort of invasion. Boundaries have it own fundamental place in life. It fundamental that even criminals who thrive on violating the integrity of others have their own boundaries. Unlike the law, which is absolute, rules allow things to function smoothly because everyone within a particular context agrees upon it. Rules can refer to a game or office procedures. Our moral values provide our own internal guidance about what is wrong or what is not in sense of good value, stated; Raymond Lloyd (2009). Im a qualified registered nurse, working in Emergency and Trauma Department (ED), ED provides 24 hours emergency care. Operating twenty-four hours, my ED provides the different level of care and patient needs and it also provides a comprehensive service which includes pre-hospital resuscitation, stabilization and definitive care. Service also includes Disaster Management, Domestic Violence, and Emergency Medicine. The purpose of this paper is to access the professional boundaries of roles and practice between nurses and doctors at Emergency and Trauma Department. In this paper, I will highlight and analyzed the concept of boundaries and contextualize the theory in the political context of professions, the nature of the professional relationship, provides information to help members recognize potential crisis situations, debate issues of boundaries evidence within my practice and suggests some strategies in managing professional boundaries on defibrillator. Occasionally, most of the nurses in my ED today are still nurses seemed uncertain about the limitation or boundary of their own work. But, sometimes boundaries are often consider not clear-cut issue of right or wrong. Its dependent upon numerous factors and required careful thinking through of all the issue, always keeps in mind that all action must be in the best interest of patient care. All the staffs in ED are required to take Basic Life Support (BLS), and Advance Cardiac Life Support (ACLS) and Paediatric Advanced Life Support (PALS). Why we need this training? Because its involves advanced medical skills, certification and training. Is purposely offered for medical professionals such as doctor, assistant medical officer (AMO) and nurses, since lay public do not have the necessary knowledge and skills except for BLS where lay public can go for training but in different syllabus compared to health care provider. Although, ED staff especially nurses and AMO underwent the training and qualified, pass the courses in theory and practically. It still not a ticket for them to ride in fast lane because, they must be well trained, recertification and monitored by experienced support staff such as nurses or AMO, senior doctor or specialist. Why we still have to be monitored? Because, from my experience although the doctor pertain his MBBS (in  Latin  Medicinae Baccalaureus, Baccalaureus Chirurgiae or Bachelor of Medicine, Bachelor of surgery) from Wikipedia, the free encyclopedia, (2010) but he or she still new in service, some are still not competent to use the defibrillator machine. Sometimes doctors also required to attend this short-course of BLS, ACLS or PALS because anyone whos works in ED must to be well trained with these courses. Example like in resuscitation, the goal of  ACLS  is to begin and identify what is wrong with the patient and when it is the best time can perform defibrillators to patient and also a long term treatment plan can be created.  These short-courses  guidelines are constantly changing, due to new information in the medical field, and frequent (every 5 year for ACLS, PALS and 3 years for BLS) as these standard guidelines provided by Ministry of Health (MOH) Malaysia, recertification is required for each personal after they are certified. Recertification also ensures that the material is always fresh, so that a healthcare provider or ED staff can confidently make the right decision in a critical moment. As a trained nurse at ED, providing encompasses and comprehensive treatment plan is essential step whereby sometimes I have to perform defibrillation when a patient having ventricular tachycardia (VT) with hemodynamical instability in order for proper treatment plans. My workplace environment is dedicated and confined to the critically ill patients with unstable hemodynamic and in need of urgent emergency life saving treatment which stipulates that all trauma patients requiring prompt and urgent treatment within a prescribed and stipulated time is observed strictly.   My ED, nurses do defibrillation because of the recertification and trust gain from senior doctors and specialist or consultant. According to General Medical Council (2001), doctor can delegate medical care to nurses, or AMO if they had the trust and believe it is the best for the patients but in count that the nurses must experienced and competent person. Unfortunately, some doctors always take an advantage of this procedure because of some nurses are seemed uncertain about their own limitation or boundaries of working practice. Usually this procedure should be performed by them instead of nurses. Perform defibrillation to patient has been commonly practiced by most of the senior nurses and this knowledge have been past down to new intern; I meant the newly in service staff nurse. It seems likely this positive act becoming norm, among the nurses and other paramedic especially in ED. As describe by Burkhdart Nathaniel (2008), different culture have it own different approach by intera cting individual, consisting of learned pattern of values, belief, behaviour and custom shared by the group. My ED is interdisciplinary department multidisciplines. These approaches change the professional boundaries. As define by Avis, Drysdale, Gregg, Neufeldt Scargill (1983), professional boundaries is a behaviours where by boundaries are crossed. Boundary includes the concept of limits, lines or borders. Boundary can be crossed, can be violated, or misconduct can come to mind. Crossing of a boundary involves a brief act or behaviour outside of the helpful zone. See appendix. Apparently, it divided into two substitution which is vertical substitution and horizontal substitution. The vertical of my workplace is by hierarchy starting from top to bottom. Examples as specialist is the highest of the hierarchy give order to hierarchy below them like medical officer and the order move on till the lowest hierarchy. See appendix. While the horizontal substitution is the interaction between workers in same phase or level. Examples like para-professional (Nurses, AMO, Cardiovascular Technician), where both are in same a group who had a similar roles and same hierarchy grade. Therefore in emergency situation, performing defibrillation the act just dont bound on doctor shoulder only. It can be either nurses or AMO, using their expertise and clinical judgments in diagnosed and to save patient life. As these working boundaries happen in my ED, realized it or not these act has an impact towards the patient. ED is a unique place for clinical experience where most of the cases are sudden or unexpected incident that requires immediate attention and need the staff on high alert in providing fast and effective care as well as treated according to their severity. Unfortunately, it hard for new doctor to conduct the situation without any experience. In addition, the aim of my workplace is to become an excellent working env ironment and culture through suitable working conditions, teaching and humanistic approach for all new staff in every categories will failed if the competency, skill and knowledge of new staff is doubted in performing the procedure. The reason to have a standard guideline in ED is to provide professional guidance in making decisions with specific practice, according to their severity. While allowing flexibility in professional judgment and meets Nursing and Midwifery Board Malaysia criteria for guideline development for a safe standard of practice and facilitate the  nursing profession to demonstrate responsibility and accountability in practice. To uphold a high standard of safe nursing care by competent and caring nurses through the implementation of regulatory processes and code of conduct established in Nursing Act 1950. The disadvantage in my unit is the shortage of doctor in recovery area, where their present is do come helpful if the patient place at recovery develop complication such as VT. As experienced nurse, providing an excellent work and comprehensive service with the knowledge and skill can make me become autonomous. The patient who are acutely ill were not being assessed and treated quickly eno ugh, it will deteriorate their condition, Norris Melby (2005). Since the workload in ED increases prior to the amount of a patient had burden the existing nurses role in ED. Sometimes situation at ED a bit chaos with multiple task had to be done at the same time such as; had to be chaperon, send blood specimen to Lab, send patient for X-Ray and as well as documented patient data since ED operates, based on the Total Hospital Information System  (T.H.I.S.). ENB/DoH (2001) explained, in accessing the effectiveness management of information and associated technology which is now part of patient and client care management. Meanwhile, the doctor are facing the same issue as their also had a shortage issue of working personnel. This impact the excellent service provided in patient care due to load of workload. According to Halcomb et al (2002), in term of cost to the health system, workforce implication and value to consumer, alternate cause to the nurse and paramedic should be explored. Therefore the nurses manager in my unit should encourage each staff to attend courses to increase each knowledges especially in cardiac care management. In any professional relationship there is an inherent power imbalance. Nurses have a responsibility to ensure that relationship based on plans and goals in objective and the outcome of interaction between professional with para-professional. It means it is the responsibility of the nurse to maintain their professional and personal boundaries, in the best interest of patient. When a nurse crosses that boundary, they are generally behaving in unprofessional manner and misusing the power in the relationship recognized by Masterson (2002). It seem, some of the nurses missing the chance to build up its own core principles by taking more expanded roles said Radcliffe, 2000. Most of professional practitioner like doctor is delighted to see nurses take over his job like perform defibrillation. This regarded as basic activities and bored for them. But there is some dispute, were some nurses uncertain and disagreed about the changing work boundaries and expended rule would make it harder for n urses to undertake nursing task. Most of the nurses insist that their main concern was nursing care. The scope of professional practice; UKCC, 1992 support role expansion providing it does not result in unnecessary fragmentation of patient care or lead to inappropriate delegation of work. In concluding this issue I have analyzed the concept of boundaries in context of nursing care. My advice can be categories into three; engagement for future collaboration involving in clinical management, moving away from the traditional relationship, with differences in power and influence, nurses and doctors are now becoming equal partners in the clinical field with professional respect, diplomacy and sensitivity in helping and supportive. Although it is important to understand each professions roles and responsibilities, as well as areas of conflict and disagreement, it is the mutual understanding of nurses and doctors will lead, the way to true clinical collaborative in ED. The nature of emergency practice makes it even more vital towards communicate and clarify the ways in which, relationship can be affected by vibrant relations in provide fast and effective patient friendly services for our patients, their family and the community within excellent working culture and humanistic approach.

Character, Dignity, and Self-Respect Essay

This paper will summarize the movie Glory and relate one or two characters to Aristotle, Epictetus, and Saint Augustine on character, dignity, and self-respect. Alina Campbell This paper will summarize the movie Glory and relate one or two characters to Aristotle, Epictetus, and Saint Augustine on character, dignity, and self-respect. The movie Glory is based on a true story about the Commander of the 54th Massachusetts Volunteer Infantry which was the first black regiment to be listed in the service of the United States. It is based on the letters by Col. Robert Shaw. Col. Shaw felt he was involved in something that he was not completely sure about, considering he had previously lost a lot of soldiers to battle. He was now faced with survivor’s guilt which he knew would heal in time. Shaw later became a mighty leader that lead the black regiment to take on the battle in Fort Wagner. Aristotle Character is mental and moral qualities distinctive to an individual. Aristotle believed character to be neither a feeling or a capacity or a mere tendency to act in certain ways (Sommers & Sommers, 2010). He believed instead that character was a settled condition we are in when we are well off in relation to our feelings and our actions. The virtues of character are dispositions to act in a certain way in response to similar situations. Good conduct arises from habits that in turn can only be acquired by repeated action and correction. Col. Robert Gould Shaw fits Aristotle’s view of Character best in my opinion. He was not only the commander of the 54th Massachusetts Volunteer Infantry, their voice. The black men that fought with Shaw were slaves that wanted to fight for their freedom. When Shaw was told of the United States Government planning to form this regiment of black soldiers he agreed to take the Commanding position. He then asked his best friend Major Cabot Forbes to fight along with him and Forbes accepted. At one point Shaw fights for these men to get the proper uniform and boots. He also refuses pay along with them after finding out that they are paid less than the white soldiers. Both Shaw and Forbes strongly connected with this group of men: the angry Private Trip (Denzel Washington); Private Jupiter Sharts (Jhine Kennedy); Corporal Thomas Searles (Andre Braugher), a very smart and educated man that grew up with Shaw and worked for Shaw’s father, and Sgt. Maj. John Rawlins (Morgan Freeman), a runaway slave who speaks with the voice of wisdom and reason. Dignity is the state of quality of being worthy of honor or respect. Aristotle’s view on dignity consists of the consciousness that we deserve honors, not in processing them. You cannot earn dignity through external awards; instead it is something you bestow upon yourself. â€Å"Dignity consists not in possessing recognition from others, but in consciousness that we deserve recognition from others† (Sommers &Sommers, 2010). The character played by Morgan Freeman, Rawlings, knew that being a slave was not worth much, so he decided to help Shaw fight the battle at Fort Wagner. Forbes also displayed dignity in the movie. Forbes was Col. Shaw’s best friend and is who told Col. Shaw of this regiment. Due to the type of relationship the two had, Col. Shaw asked Forbes to come along with him to prepare the black slaves. Forbes agreed and stood by Col. Shaw and these black men through the name calling, getting the proper shoes, and receiving their uniforms like the white soldiers had while fighting in the Civil War. Aristotle describes the position of character, dignity and self- respect as character being a state concern with choice, lying in a mean relative to us, that this is determined by reason and in such a way that a man of wisdom would determine it. It is a mean between two vices that depends on excess that depends on defect (Sommers & Sommers, 2010) Aristotle feels neither a feeling nor a capacity nor a tendency to behave in specific ways. It is the settled condition we are in when we are well off in a relation to our feelings and actions when we are in a mean or intermediate state in regard to them. Meaning we have a vicious character that we are badly off in relation to feeling and actions, and we fail the means in regards to them. The character that I felt showed this type of role would be Denzel and Andre’s characters, known as Trip and Thomas. Trip was a runaway slave that was very angry. He didn’t have anybody and had been previously beaten several times. Trip had specific thoughts of the white man and they were that the slaves were seen as monkeys. He thought that the slaves should be dressed up in uniform and fight, since the white men would only get themselves killed and wouldn’t be able to win. Andre Braugher played Thomas. He was an educated man that had worked for Col. Shaw’s father. He believed that black men should know how to read and have pride within themselves. In the movie Glory, Thomas had learned to take a lot. Thomas assumed that since he and Col. Shaw were close friends that he would be treated a bit differently, but to his surprise, he was called out by his best friend to train a lot faster than he was and then yelled at. Thomas learned much at the end of the movie, including self-respect. Thomas had been shot in a previous battle and he asked Col. Shaw to promise that he wouldn’t send him back, which Shaw didn’t allow Thomas to continue in battle. Later in the movie, Col. Shaw asks who would be willing to standin the place of the flagman, should something happen, and Thomas stated that he would and did. Epictetus Epictetus held the Orthodox Stoic view that everything in the universe is directed by divine will. Epictetus was different from the early stoics in that he believed happiness was found in maintaining one’s moral character as opposed to striving for moral excellence. He emphasized self-knowledge and keeping one’s moral character in order as the way to achieve a happy life. Epictetus warned his students to expect persecution since their actions and attitudes would be different from those around them. He encouraged them to view life as an athletic challenge, a festival or a short military service, where success would come from a combination of correct choices and skill. Epictetus believed that â€Å"grief was the most offensive emotion; he considered the suffering of grief as an act of evil. It was a willful act, going against the will of God to have all men share happiness† (Stockdale, 1995). Col. Robert Shaw, through his personal growth and internal realizations fulfilled his leadership duties on the battlefield, as well as beyond. He chose to take the beliefs he had from his life prior to war to another level. Shaw struggled with the question of equality among the races yet he recognized the character and desires of the Black Americans and chose to act on their behalf as well as the Unions. Shaw felt that his soldiers, regardless of color, deserved respect just as much as the white soldiers. Shaw was willing to not take pay to make a point that his soldiers deserved the same pay as their fellow white soldiers. He stuck his neck out to make sure they received the proper gear in order to fight. Shaw had finally decided to not let the grief from the prior battle to control him, he chose to help in the happiness of the slaves and continue to fight for their freedom. Saint Augustine Augustine’s approach was not just brilliant, it was practical. His insight is intellectually credible and emotionally satisfying in that it gives hope and offers meaning to the Christian trying to make sense out of life in a fallen world (Sommers & Sommers, 2010). To Augustine, anything that had being was good. Good as the ground of being was perfectly good, along with everything he brought into being. This goodness was a property that came in varying degrees. The obstacles that Col. Robert Gould Shaw had to overcome is the fact that he failed in battle another time. He had to pick himself back up, and he then led the black regiment in the Civil War and was refused to let these black soldiers be treated with any less respect than the white soldiers. Another hardship that Col. Shaw and his black soldiers had to endure was the fact they were getting under paid, they were not given the proper shoes to march in, and the fact they were not given the proper uniforms like the other soldiers. Col. Shaw had shown a life of character, dignity and self- respect by being the honorable Commander that he was. Col. Shaw never let others views get in the way of his personal view of his soldiers. Col. Shaw had self- respect even though he had been defeated, prior to leading the 54th Massachusetts Volunteer Infantry soldiers with dignity and never gave up on them.  He was a man that believed in faith and that the black soldiers were no different than any others.

Case Study Green Supply Chain Management - 2806 Words

GREEN SUPPLY CHAIN MANAGEMENT Fadi Akle 15136084 GREEN SUPPLY CHAIN MANAGEMENT Supply chain management is one of the important competitive approaches for the organization today. The issue of having green supply chain management is vital for successful implementation of the industrial ecosystem and industrial ecology. This therefore, gives organizations number of reason for implantation of green supply chain policies. The reasons may range from active and proactive strategies of the business to competitive strategies of the business. From environmental and organizations perspective, it is imperative that organizations have proper understanding of exactly what is expected of them and what is happening in this field. It is†¦show more content†¦Some of these companies implement their competitive advantage by improving on their environmental activities (Green and Bhadauria 2012, 214). This is done through complying with the various legislations that touch on the environment. The main idea of complying with these environmental laws is concern for the custom ers and the environmental impact that their businesses impose. Besides, they as well take the responsibility since it is expensive to pay for environmental cleanups and punishment from the government (Zhu and Lai 2011, 129). Complaints from their consumers and fear of pollution is also another determinant that makes businesses to comply with the environmental laws (Zhu and Lai 2011, 129). No wonder organizations believe that green supply chain management has the effect in the ever increasing environmental performance through minimization of waste, and achieving some savings in the cost. In addition, there has been increased synergy in the business parties, it enhances efficiency in the partners and their various supply networks (Zhu and Lai 2011, 130). 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Future Tense Definition and Examples in English Grammar

In English grammar, the future is a verb tense (or form) indicating action that has not yet begun. There is no separate inflection (or ending) for the future in English. The simple future is usually expressed by placing the auxiliary will or shall in front of the base form of a verb (I will leave tonight). Other ways to express the future include (but are not limited to) the use of: a present form of ​be plus going to: We are going to leave.the present progressive: They are leaving tomorrow.the simple present: The children leave on Wednesday. Examples and Observations Never believe any war will be smooth and easy.(Winston Churchill)Nothing will work unless you do.(Maya Angelou)I will not charge admission to the bathroom.(Bart Simpson, The Simpsons)Ill be back.(Arnold Schwarzenegger, The Terminator)Scully: Homer, were going to ask you a few simple yes or no questions. Do you understand?Homer: Yes. (Lie detector blows up.)(The Simpsons)You will find happiness, he told her. They were at lunch. The winter held days of sunshine, noons of infinite calm. He broke a piece of bread to cover his confusion, dismayed at the tense of his verb.(James Salter, Light Years. Random House, 1975)And from the sun we are going to find more and more uses for that energy whose power we are so conscious of today.(President John Kennedy, remarks at the Hanford Electric Generating Plant in Hanford, Washington, September 26, 1963)I am about to—or I am going to—die: either expression is used.(Last words of Dominique Bouhours, a 17-century French grammarian) The Status of the Future Tense in English Some languages have three tenses: past, present, and future... English does not have a future tense, at least not as an inflectional category.(Barry J. Blake, All About Language. Oxford University Press, 2008)[T]he future tense has a different status from the other tenses. Rather than being a form of the verb, it is expressed by the modal auxiliary will. Its no accident that the future shares its syntax with words for necessity (must), possibility (can, may, might), and moral obligation (should, ought to), because what will happen is conceptually related to what must happen, what can happen, what should happen, and what we intend to happen. The word will itself is ambiguous between future tense and an expression of determination (as in Sharks or no sharks, I will swim to Alcatraz), and its homonyms show up in free will, strong-willed, and to will something to happen. The same ambiguity between the future and the intended can be found in another marker for the future tense, going to o r gonna. Its as if the language is affirming the ethos that people have the power to make their own futures.(Steven Pinker, The Stuff of Thought. Viking, 2007)Many recent grammarians do not accept future as a tense because it is expressed periphrastically with auxiliaries and because its meaning is partly modal.(Matti Rissanen, Syntax, Cambridge History of the English Language, Vol. 3, ed. by Roger Lass. Cambridge University Press, 2000) The Difference Between Shall and Will The difference between the two verbs is that shall is rather formal-sounding, and a little old-fashioned. Whats more, it is mostly used in British English, and normally only with first-person singular or plural subjects. Recent research has shown that the use of shall is declining rapidly both in the UK and in the US.(Bas Aarts, Oxford Modern English Grammar. Oxford University Press, 2011) Evolving Future Constructions [T]he original job description of these two verbs [shall and will] was not to mark future either—shall meant to owe... and will meant to desire, want... Both verbs were pressed into grammatical service just as (be) going to is currently. Shall is the oldest future marker. It has become rather rare in Australian English, having been pushed out by will. Now gonna is ousting will in exactly the same way. Just as ordinary words wear out over time, so too do grammatical ones. We are always in the business of seeking new future constructions and there are plenty of fresh recruits on the market. Wanna and halfta are both potential future auxiliaries. But their take-over will never happen in our lifetime—youll be relieved about this, Im sure.(Kate Burridge, Gift of the Gob: Morsels of English Language History. HarperCollins Australia, 2011)