Security Challenges for Health Information Systems

Security Challenges for Health Information Systems Curtis Anderson   Health Care Information Systems faces challenges of many organizations protecting their information systems from potential threats, such as viruses, accidental fires, untested software, and employee theft of data. Falling into three categories: Human threats (intentional or unintentional human tampering), Natural and environmental (floods, fires, and power outages), and Technology functions (failure of drives, and no backup), viruses are the most common and virulent forms of computer tampering. Another common security issues has to do with internal breaches, usually caused by installation or use of unauthorized software, illegal and illicit communication surfing sites, and e-mail harassment, and using an organizations computer for personal gain. Hardware, like software, used in health care information systems must be protected from loss caused by theft, thereby exposing confidential patient information (Wager, Lee, Glaser, 2013, p. 352-356). The Department of Health and Human Services Security Rules published in the Federal Register on February 20, 2003 (68 Fed. Reg. 34, 8333-8381), and was updated by the HITECH legislation, which is governed by HIPAA Security Rule protects ePHI health information that is maintained or transmitted in electronically, is closely related to HIPAA Privacy Rule, which governs all protected health information (PHI) (Wager et al., 2013, p. 356). With the advancement of mobile technology and the development of applications found in many portable devices, health intervention is beneficial in the delivery of health care data. A conducted systematic review and meta-analysis shows the effectiveness of mobile-health technology, through a controlled trial of mobile technology interventions that is used to improve the delivery process of health care information. The conducted independent study of data allocation concealment, allocation sequence, measured the effects by calculating estimates, and random effects meta-analysis(Free et al., 2013). The study showed a low risk of bias, where the health care trials supported outcomes for the appropriate management of disease, and showed significant benefits to the improvement in nurse/surgeon communication use of mobile phones for reducing diagnoses with the use of mobile technology. The conclusion of these trials showed health care providers supporting the process of intervention benefici al, but a more quality trial outcome is needed to be certain of the results. Security Challenges The responsibility of the healthcare organization should be to protect health information at all times; a critical process of security practices and regulatory compliance in the healthcare industry (Kwon Johnson, 2013). Using the Ward’s cluster analysis, a minimum variance that is based on the adoption security practice between organizations, measured the dichotomous data to indicate the presence or the absence of security practices. When identifying the relationship of clusters and regulatory compliance, the results of the Healthcare Information and Management Systems Society conducted a telephone-based survey, which found the United States healthcare organizations adoption of security practices, breach incident, and perceived compliance levels related to Health Inform Technology for Economic and Clinical Health, and the Health Insurance Portability and Accountability Act, that state laws governing patient information security, identified three clusters: Leaders, Follower, a nd Laggers, producing a difference of non-technical practices, with the highest level compliance being associate with the organization who employed the use of a balance approach using the technical and non-technical practice (Kwon Johnson, 2013). Security Strategies Security incidents have been closely related to the use of laptops, other portable and/or mobile devices and external hardware storage that contain or used to access Electronic Protected Health Information (EPHI), falls under the responsibility of HIPAA Security Rule, which requires reviewing and modifying security policies and procedures on a regular basis (HIPAA Security Guidance, 2006). The reinforcing of ways to protect EPHI when accessed or used outside of and organization’s purview, using strategies can be reasonable and appropriate to conduct business activities using a portable medial/device (such as USB flash drives) to store EPHI, and the ability to access or transport EPHI using laptops, person digital assistants (PDAs) , home computers and non-corporate equipment, delegated by the Centers for Medicare and Medicaid Services (CMS), enforce HIPAA Security Standards, to determine actions covered by the organizations is reasonable and appropriate to safeguard the confid entially, integrity and availability of EPHI (HIPAA Security Guidance, 2006). The organization should establish risk analysis and risk management drive policies to reduce vulnerabilities that can be associated with remote access, and offsite use of EPHI. Establishing training policies in the workplace to address any vulnerability that may be associates with remote access to EPHI, by changing and safeguarding passwords, protecting remote device/media by creating polices that prohibits these devise unattended, and the transmitting of EPHE on open networks or downloading EPHI on open networks or downloading EPHI on a remote computer (HIPAA Security Guidance, 2006). It is important that a security incident and non-compliance issue be address in order to manage any harmful effects of the loss of the device, by securing and securing evidence, managing harmful effects, and notifying the affected party. Allowing for or the requiring of offsite use of, or access to EPHI should have and established strategy plan developed and implemented for the authorization and access of EPHI in accordance with HIPAA Security Rule  §164.308(a)(4) and the HIPAA Privacy Rule  §164.508(HIPAA Security Guidance, 2006). Social Networks Underlying factors have concluded that a lack of information regarding the benefits, and limitations of social media health communication amongst the general public, and health professionals, use a systematic approach to identify, these benefits, and/or limitations of social media to communicate health data by a methodological quality of study that is assessed. There were seven main issues of social media, which includes focusing on increased interactions with others, to facilitate, share, and obtaining health messages, as the new dimension to health care medium use by the public, patients, and health professionals who communicate health issues for improving health outcomes. The study shows that social media can be used as a powerful tool, which offers collaboration between users, and social interaction for a range of individuals to share data electronically (Moorhead et al., 2013). Securing Data on Social Networks There is a remarkable surge surrounding personal health record (PHR) systems for the patient and consumer, however biomedical studies do not show a potentially adequate capability and utility of PHR system (Tang, Ash, Bates, Overhage, Sands, 2006), hinders toe widespread deployment of PHR adoption. Since health care records are more than just a static repository for patient data, it combines data, knowledge, and software tools, to help patients become active participants in their own care. However, the challenges of, technical, social, organizational, legal, and financial requires further study, that requires stakeholder, patients, provider, employers, payers, government, and research institutions to play key roles for developing PHR technology to overcome the barriers to the widespread adoption of PHRs, and develop polices, the cost associate with PHR in medical errors, dollars, and lives, to realize the potential benefits of routine health care and catastrophic disasters (Tang et al., 2006). Strategies to Safeguard Data The use of new technology, applications and platforms, such as â€Å"social media,† has created new opportunities in healthcare but raises privacy and security challenges, The need to adapt old police and procedures, privacy and security protocols to cover communication channels and date sharing needs to be used effectively to protect a healthcare organization from the risk of a disclosing the privacy of a patient’s data (Social Media in Healthcare: Privacy and Security Considerations, n.d.). This process of using online tools and platform for sharing content and information for the purpose of: Delivering pre-development content – sending e-mail or posting on a website, engaging a population in discussion – to facilitate brand awareness/customer satisfaction, and manage communication – that offers individuals and organization a convenient organized way to consolidate their communication. The challenges healthcare organizations face is: Ethical challenges – an acceptable standard of regulatory and legal requirements that is mandated by Title II of HIPAA, and Sarbanes-Oxley Act (SOX), the National Center for Ethics in Healthcare (NCHEC), and the World Health Organization Ethics and Health Initiative (Social Media in Healthcare: Privacy and Security Considerations, n.d.), to avoid any misconduct or unethical behavior becoming a serious issue with regard to the use of social media. The U.S Supreme Court decision on Sorrell v. IMS Health, Inc. addressed the issue of aggregated databases and the sale of prescriber data for marketing prescription drugs, where the ability to distribute, exchange, and use date from multiple sources is integral to clinical informatics, research, public health, quality improvement, and other healthcare operations. A pharmacy filling a prescription collects detailed information which includes patient and provider names, drugs, and the dosage and prescribed quantities, and the date of the prescription being filled, allows a pharmacy to sell prescription information to data-mining companies of a patient’s information once it has been de-identified by meeting the HIPAA standards. However, legislation sought to restrict the sale of prescription date for marketing purpose using the prescription confidentiality law of 2006, where a data-mining company must obtain permission from the provider before selling prescription records (Peters en, DeMuro, Goodman, Kaplan, 2013). Hackers, cyberattacks and data breaches are the major attacks from outsiders, the motive and type of hackers is complex to chief information security officers (CISOs) and their staff in order to take action to protect and defend their data system. Causing grate consequences to the organizations, along with bad press, impact on reputation, and drop in share prices, requires legal action if a breach involves personal data theft. Identified as a data breach, the loss of control compromises unauthorized disclosure, unauthorized acquisition, and unauthorized access to data physically or electronically (Hayden, 2015). The protection of all date is impossible, as the proliferation of portable media, smartphones, USB drives and laptops increase the opportunity for the loss or theft of these devices along with their data requires that steps be taken to enable the encryption of mobile devise, and to immediately inform security management of a device being stolen, lost, data being compromised. Trends in enterprise mobility has made mobile device security imperative, and the sales of smartphones is surpassing PC sales, the completive edge and benefits of mobility can be lost if the smartphone and tablet PC are not protected against mobile security threats: Mobile malware – Smartphones and table are susceptible to worms, viruses, Trojans and spyware. Eavesdropping – wireless networks use of link-level security lack end-to-end upper-layer security, allowing for unencrypted data to be eavesdropped upon. Unauthorized access – the storing of login information to applications on mobile devise can be easily access to allow intruders access to email accounts and applications, and social media networks. Theft and loss – storing significant amounts of sensitive data on a mobile device can be critical if you are in a hurry and leave you iPhone in a taxicab, restaurant, and data loss can occur. Unlicensed and unmanaged applications – this can cost a c ompany in legal cost (Learning guide: Mobile device protection, 2015). Government and Quasi-government Benefitting from health surveillance, has pioneered, informatics analysis, and solutions in the field of informatics to serve other facets of public health, to include emergency response, environmental health, nursing, and administration. As the systematic application of information and computer science and technology, public health practice, research, and learning professions apply mathematic, engineering, information science, and social science to public health problems and processes that are important to biomedical or health informatics (Savel Foldy, 2012). With seven ongoing elements of any public health surveillance system: Planning and system design – to identify information and sources that addresses the surveillance goal. Data Collection – The use of different collection methods, to identify the appropriate use of a structured data system that supports easier, faster, and higher-quality data entry fields compared to free test, useful vocabulary, and data standa rds. Date management and collation – are used to share data across different computing/technology platforms to link data with data from a legacy system. Analysis – is used for the statistical and visualization application, to generate algorithms that alert users of aberrations in health event. Interpretation – this is useful to compare information from one surveillance program with other data sets. Application to public health programs – this utility assesses surveillance data directly flowing into an information system that support public health interventions and information elements (Savel Foldy, 2012). The challenges of surveillance informatics includes an efficient and effective way to combine sources of complex data and information into an actionable knowledgeable to meet the challenges to arise at a faster, better, and lower cost surveillance and interpretation of health events and trends, the leveraging of technology standards ability to not only talk and listen, but understand each other. Adopting such a system is insufficient since both semantic and syntactic standard must be implemented and tested to ensure system validity. In conclusion, healthcare security is vital to the securing and protecting a patient’s privacy and healthcare information from being breached, lost, stolen, while protecting the healthcare system from viruses, worms, malware and spyware, that can affect the integrity of an organization, a drop in stock prices, and legal issues. Protecting any system that stores vital organization and personal information should be a priority. References Free, C., Phillips, G., Watson, L., Galli, L., Felix, L., Edwards, P., Haines, A. (2013). The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. Retrieved May 20, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/23458994 HIPAA Security Guidance. (2006). Retrieved May 20, 2015, from http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/remoteuse.pdf Hayden, E. (2015). Data breach protection requires new barriers. Retrieved May 20, 2015, from http://searchsecurity.techtarget.com/feature/Data-breach-protection-requires-new-barriers Kwon, J., Johnson, E. M. (2013). Security practices and regulatory compliance in the healthcare industry. Retrieved May 20, 2015, from http://connection.ebscohost.com/c/articles/84758015/security-practices-regulatory-compliance-healthcare-industry Learning guide: Mobile device protection. (2015). Retrieved May 20, 2015, from http://searchmobilecomputing.techtarget.com/guides/Mobile-device-protection-and-security-threat-measures Moorhead, PhD, MSc, S. A., Hazlett, PhD, MSc, D. E., Harrison, MSc, L., Carroll, MD, MPH, J. K., Irwin, PhD, A., Hoving, PhD, C. (2013). A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication. Retrieved May 20, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636326/ Petersen, C., DeMuro, P., Goodman, K. W., Kaplan, B. (2013). Sorrell v. IMS Health: issues and opportunities for informaticians. Retrieved May 20, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/23104048 Savel, MD, T. G., Foldy, MD, S. (2012). The Role of Public Health Informatics in Enhancing Public Health Surveillance. Retrieved May 20, 2015, from http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a5.htm?s_cid=su6103a5_x Social Media in Healthcare: Privacy and Security Considerations. (n.d.). Retrieved May 20, 2015, from http://himss.files.cms-plus.com/HIMSSorg/Content/files/Social_Media_Healthcare_WP_F Tang, MD, MS, P. C., Ash, PhD, J. S., Bates, MD, D. W., Overhage, MD, PhD, J. M., Sands, MD, MPH, D. Z. (2006). Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption. Retrieved May 20, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447551/ Wager, K. A., Lee, F. W., Glaser, J. P. (2013). Health Care Information Systems (3rd ed.). San Francisco, CA: Jossey-Bass.

Cross-cultural communication, Essay

The purpose of this essay is to use reflection on an aspect of my learning that I have come across so far as a student nurse, and how I plan to use this knowledge when I start my placements. This will give me a good base on which to build my interpersonal skills. After having a brief introduction on various religions, it brought to my attention the diversity in multi cultural societies and how, as a nurse I need a good understanding of treatment and communication barriers that I will come across. The United Kingdom (UK) has welcomed a mixture of ethnic groups, each bringing with their own culture, with their own language. Multiculturalism is an ideology that promotes the institutionalism of communities containing multiple cultures. I have taken it upon myself to find out information to gain more knowledge on different religions, values and beliefs, and the different aspects of care this relates to. This will then enable me to support patients and their families more efficiently, effectively and in a patient centred manor. In terms of using reflection throughout this essay, I Plan to use Gibbs Reflective Cycle (Gibbs 1988). This will help with structural preferences. I will also be reflecting individually on some of the knowledge I gained. Reflection aims to bridge the gap between theory and practice to show the interrelation of skills and knowledge. Reflection relates to me as a student nurse as suggested by Hargreaves (1997 pp.04) â€Å"that reflective practice is often included in professional education programs as a way of encouraging practitioners to critically evaluate their behaviour, beliefs and ideas on practice†. She states that this will lead to improved clinical expertise and, consequently, improve nursing care. Description The first Lecture I received on Religion was an Introduction to the chaplaincy team. They provide spiritual guidance for anyone needing advice, courage and support. Wittenburg-Lyles E, (2008) explains that The Chaplaincy team are able to provide visits to local places. This lecture increased my awareness of faith and moral issues. During my placements, I will come across many different cultures and religions. This is when I realised I needed to do a lot of research into different faiths to enable me to support my patients and their beliefs. I was given an example that I may come across. Some religious belief in praying on their knees, if a patient for some reason needed to have their leg amputated, this would then effect a certain aspect of their life. Therefore I would need to support them in a way that they could still meet there religious needs. I will reflect on this in practice by widening my knowledge on different religions. Next, we explored Morals, Values and beliefs; here I learnt about the responsibilities I will have as a nurse, for example, how to respect patient’s dignity and privacy (Baillie, 2011). I have an understanding that each individual is unique. I will reflect on this in practice by treating each patient as an individual. Regardless of their race, ethnic, gender, sexual orientation, age, physical abilities, religious beliefs or political beliefs. Thirdly in another lecture, I was introduced to two service users and cultural perspectives in health care. A Buddhist from the Chaplaincy service came in to the university. I found it very interesting finding out some Buddhism’s beliefs. For an example, death is inevitable and Buddhists like to prepare for death when meditating. Buda’s also like to carry a small Buda, picture of a Buda or beads for chanting to remember their teacher. We then had a talk about Christianity from a Catholic Farther. I learnt that there will be dietary requirements inside Christianity, as some Christians will only eat fish on a Friday, no meat. They also like to carry on them a symbol of Christianity. That may be beads, holy water or a wooden cross. Christians do not like to be overly exposed during personal care needs. This has now widened my knowledge on two different religions. I shall reflect on this by taking the knowledge I have gained into practice, for when I come across patients with these beliefs. As a nurse sometimes there will be conflict when it comes to religions of employees but you must not to be judgemental, (Nursing and Midwifery council (NMC), 2010). Because of being a nurse, this is mainly due to infection control. Some staff maybe asked to remove clothing or jewellery, which could be against their religious beliefs, although head wear is now allowed for nursing and doctors. Some would argue this is discrimination, as some can get away with it. I think this is a typical example of how religious beliefs can also affect staff as well as patients and relatives. NMC (2010) states that as a nurse I may recognise diversity and respect with cultural differences, values and beliefs of others including the people you care for and other members of staff. Feelings I feel the lectures I attended were very interesting, it was not until this point that I realised it would be a very interesting topic to reflect upon and learn more about. Both the Buddhist and the Christian, were very helpful when anyone wanted to know anything, they both leased with the class at the start of their lecture by making a plan of what, we as a class wanted to cover throughout the duration of the lecture. I do feel that I held back too much when it came to questions at the end and could have asked some more questions myself, all though others asked similar questions to what I was thinking. The information I gained during these three lectures has been useful. But I felt as if I still needed to widen my knowledge further by doing some research. I believe the first step is to be self aware of my own cultural beliefs. Being self aware is crucial as will identify any prejudices or attitudes that could be making a barrier in front of good communication, best practice and patient advocacy. Festini F (2009) comments that, Effective communication is the main aspect of delivering culturally competent care. This is where I needed to reflect upon myself by looking into the Johari Window and the four Quadrants. Being self aware is a two way process. If we do not know who we are, we don’t know how we appear to others. This made me realise I need to become more confident in myself when asking questions in front of my group. This will take time with feeling comfortable. Evaluation Throughout my learning on this topic so far, it has been very useful to see where my knowledge is lacking. I know need to research further into this topic. It has given me the incentive to widen my knowledge. These lectures on religion have been an eye opener. I have realised there is so much complexity in relation to region and different faiths that as a nurse, I will need to know about. Previously I would have had no knowledge on this. I will improve on this by using a range of research ideas to gain knowledge which will then increase efficiency, I will continue to reflect on this area in order to develop as a nurse. Analysis It was at this point I realised that although the information that I have gained so far has been more than useful, it did not answer all my questions. As I still need some more guidance on what to do in situations I may come across when out in practice, whether this may be communication or treatment barrier issues. Morals are influenced by cultural values, beliefs and religion, not only by the law (Griffith and Tengnah, 2010). Morals values and beliefs and assumptions influence healthcare. I understand that cultural and language barriers can complicate situations. As a professional I must have the ability to interact effectively with clients and other professionals. During social interaction, I believe that nurses should avoid stereotyping when caring for patients from different cultures, suggested by Alexis, (2011). I have come cross a few patients from different religions with their own languages whilst I have been working in care. When communicating with a patient that does not speak English as their first language, care can be compromised if effective communication is not used. When explaining something to the patient, there needs to be a balance between using simple sentences without being patronising. For example I would ask do you hurt anywhere, or are you in any pain? Instead of saying, are you in any discomfort? I would encourage staff not to use as many medical terms, I understand this may otherwise be confusing and distressing for the patient. I would only ask one question at a time to avoid overwhelming the individual. When asking patients these questions, I must also understand a patient’s cultural perceptions and experiences regarding pain (Magnusson, 2011). I can reflect on this when I go into practice by involving their cultural perceptions when decision making on pain relief. I think sometimes a quiet time is a good time to access your patient’s communication skills. I would then have more time to look at their non-verbal clues, posture, facial expressions, is there any eye contact used or maybe there are signs of anxiety. When situations arise around communication barriers I work with other members of staff, the patient’s relatives and different members of the multidisciplinary team so that I can find out the best ways possible to communicate with them, and any particular activities of daily living or rituals (Roper, Logan and Tierney, 1998), that are important and relevant to their cultural needs. In some of my findings, I came across some good examples of how there could be a barrier between you and your patient in terms of personal care. I found that some patients do not feel comfortable if they are being touched by the opposite sex. Others dislike their heads being uncovered, they must keep it covered with clothing for modesty. These views come mainly from Jewish and Islamic religions. I found it very interesting to know that two different religions may not like a certain part of care to be carried out but for two completely different reasons. Asian Americans do not like any touching of the head as their view is that it is impolite, as they believe that their spirit resides there. I found out that in some cases all you need to do is ask for permission. This reflects back to good communication skills. I consider the main objective of communication between the nurse and patients is that messages are understood accurately. My research told me that most health agencies have access to medical interpreters for major languages. There is usually a member of the family that maybe helpful by speaking English, but they are not as reliable as interpreters, explained by, Griffith, (2009). Another reason why not to use a family member as an interpreter is that they might only translate the bits that they want the patient to hear and not the full story. I understand that if there is a family member interpreter or a professional interpreter, the potential for misunderstanding can increase. I found the information from Ting Toomey (1999) very interesting for this. She describes three ways that culture can interfere with effective cross cultural understanding. These being, Cognitive constraints, Behaviour constraints and Emotional constraints. I believe that it is crucial that all staff should document the specific communication skills that are needed with each individual patient and the patient’s response. As suggested by Festini, (2011). Weather this be in the medical record or a care plan. In my past experiences it is also crucial that these affective communication skills are past on through handovers, which increases the opportunity for successful staff-patient interactions, (Randell, 2011). I plan to take my ideas and past experiences into practice with me. As I feel it works brilliantly and is effective in terms of meeting patients, beliefs and preferences. I am also aware that each placement I go to may have a different way of doing things. I look forward to gaining new knowledge that may better my communication skills for people with cultural preferences. It is also essential to remember privacy when assessing a patient from a different culture. A quiet setting is always best, most importantly somewhere where you will not be disturbed. This is where I would utilise my background knowledge into different religions, and use different strategies with in my knowledge. For example, some religions do not like direct eye contact. I read more into this when I spoke to some of the students in my class, as some of them are from different cultures. One from Zimbabwe explained to me that in Zimbabwe they only look people into the eye when they are looking for a fight or trouble. He also explained how he had to change his perception of others looking at him when he moved to the UK as every English man he came across looked into his eyes, this at first was scary for him, but he is now okay with it. This has brought to my attention that although this cannot be avoided, I as a nurse should still be respectful to their beliefs and consider the patients preferences. I also researched some of the decisions that patients make in connection to religious beliefs regarding treatment. Law can be used to challenge the decisions a parent or next of kin (NOK) decides but this usually only happens when the treatment is life saving. The NOK or the patient themselves need to be able to make an informed decision in order to give consent or refuse treatment. I am aware that some religions refuse certain life saving treatments, and understand my role as a nurse is to advocate in my patients best interest, inform the patient or NOK of treatment options and consequences of refusing treatment. Emergency situations will not arise everyday in my nurse training or career, but I have more knowledge of my role should I be faced with this type of situation. Where religion may sway a patient’s decision all other options for treatment should be considered (Haan, 2005). As a nurse, it is my job to ensure my patient has an advocate, alternatives, and support to understand consequences of treatments and what will happen if they refuse. Conclusion Initially I was unsure of which area of my learning I should reflect upon. After having worked in care previously, I felt looking into religion would not only be something good to reflect on but something interesting I could also learn upon. After everything I have learnt within this topic so far, I have gained a new perspective on religions, morals and beliefs. . I wasn’t sure whether I was going to use a reflective model because I wasn’t sure if it was going to be appropriate as it is very structured. Once I had started to educate myself on a Multicultural Society and throughout planning my notes I began to realise how helpful it was to have a structure, I was able to structure my notes into different sections which proved to be very useful. Throughout writing my essay I have learnt to have a lot more belief in myself and the ability I have in writing an essay. But I have been able to identify my lack of knowledge on religion and culture. I think social issues will arise when staff members have a lack of understanding and knowledge of different religious beliefs, other than their own. This gave me the incentive to learn and research more to gain a better understanding, and widen my knowledge. Therefore I will be able to educate other nurses. I belief I could still now, expand on this knowledge further and I plan to do this throughout my time as a student and in my future career. Action Plan My action plan will include and implement a method of reviewing everything that I have learnt from past experiences and research, thereby using reflective thinking. I will be apply the knowledge I have Learnt and encompass this in practice as a student nurse and also a registered nurse, which will help me become a safe and competent practitioner. If I was to come across a patient with specific religious beliefs I feel I could support them as well as their family by, not only by ensuring I provide good holistic care but also allowing them to maintain a good link with their religious beliefs. If I was to come across a patient that I could not talk to, I would use past experiences by using models and pictures which to a degree would be a great help. This would help the patients to identify their treatment procedures or help me to identify their needs. I understand that some patients I meet may have a family member that may make the decisions as their next of kin, or medical power of attorney. I believe I would also need to communicate well with the family member. I would take into consideration maybe a spiritual advisor, not just painkillers as a healer. In some people’s eyes, their god or spiritual leader is their way of healing. If in my career I come across a child patient for example in A&E, which had a religion barrier in the way of treatment. I would have to support certain legislations to ensure the refusing of medical treatment did not cause death, if parents deny this; I would have to involve other professionals. From my findings I now have good cross cultural communications skills, this can enhance my nursing. I could build the patients confidence in situations I may come across. By being aware and alert I feel I could improve the patient’s safety and wellbeing by minimising any cultural differences. I will enable my patients to continue with their religious practice whilst in a health care setting. â€Å"Word Count: 3004† References Alexis, O. 2011. Health and cultural sensitivity in a diversifying society. British journal of healthcare assistants , 5 (6), p.297. Baillie, L. 2011. Respecting dignity in care in diverse care settings: strategies of UK nurses. International Journal of nursing practice. 17 (4) p.336. Festini, F., 2009. Providing transcultural to children and parents: an exploratory study from Italy. Journal of nursing scholarship, 41 (2), pp.220-7. Forrest, M.E.S., 2011. On becoming a critically reflective practitioner, Health information and libraries journal, [online] Available at: onlinelibrary.wiley.com/doi/10.1111/j.1471-1842.2008.00787.x/full [Accessed 01 may 2012]. Griffith, J.K., 2004. The religious aspects of nursing care. 4th ed. UBC School of Nursing. Griffith, R. and Tengnah, C., 2010. Law and professional issues in nursing. 2nd ed. Cornwall: Learning matters Ltd. Haan, J., 2005. A Jehovah’s witness with complex abdominal trauma and coagulopathy: use of factor VII and a review to the literature. American Surgeon, 71 (5), pp. 414-5. Hargreaves, J., 2002. Reflecting on your expert practice. Nursing Times Net. [online]28 February. http://www.nursingtimes.net/nursing-practice-clinical-research/reflecting-on-your-expert-practice. [ 29 April 2012]. Logan, Rogan, Tierney., 2000. The Roper, Logan and Tierney (1996) Model: perceptions and operationalization of the model in psychiatric nursing with in a health board in Ireland. Jan Journal of advanced nursing, 31 (6). Pp.1333-1341. Magnusson, JE., 2011. Understanding the role of culture in pain: maori practitioner perspectives relation to the experience of pain. New Zealand medical journal. 124 (1328), pp.41-51. Randell, R., 2011. The importance of the verbal shift handover report: a multi-site case study. International Journal of medical informatics, 80 (11), pp. 803-12. Wittenberg-lyles, E., 2008. Communication dynamics in hospice teams, understanding the role of the chaplain in interdisciplinary team collaboration. Journal of palliative medicine, 11 (10), p.336. International online training program on intractable conflict, 1999. Cultural barriers to effective communication. [online] Available at: www.colorado.edu/conflict/peace/problem/cultrbar. htm [Accessed 10 April 2012) Nursing and Midwifery Council, 2010. Standards of conduct, performance and ethics for nurses and midwifes, London: NMC

Important Solutions for Writing a Journal Article

Important Solutions for Writing a Journal Article Points to remember There is not any hard and fast rule that you have to write your scientific journal in a particular order. If so, the moment the short article is published, it is going to be digitally archived and will stay visible for the entire world to see for as long as electronic records exist. If you're going to visit the trouble of compiling information and writing it down in an in depth and total fashion, you should allow folks to read it. How much you are able to write in each day will change from person to person. Naturally, based on your degree of writing skill and how comfortable you're writing a big paper that could have profound impacts on your academic career, you could be thinking that a thesis example would be the ideal situation to get you started. There are several methods of writing the example proof. There isn't any simple way. One of the absolute most troublesome challenges about it's sitting down and starting. The Nuiances of Writing a Journal Article Moreover, you have to be concise in all sections of the report. Using as few as 5-10 words, you ought to be able to inform your audience what's your news is about and why they need to go up ahead and read it. You may opt to join a few of the websites that are content providers to internet businesses, or maybe you want to submit articles on your favourite topics to a number of the consignment'' sites that let you to set your own price and get paid whenever your article sells. Abstract writing is a certain skill which requires practice and total familiarity with your argument and article content. Writing a research paper is sort of interesting as you dig into various interesting material to set in your paper. You're heavily invested in the job, and you would like to find the best possible exposure for it in the perfect journal. Writing for the web is quite different than that which you might be employed to in different regions of your life. Here's What I Know About Writing a Journal Article There are many articles on the internet that it is possible to take advantage of if you wish to learn the ropes of writing highly effective headlines for newspapers. Generally speaking, it is advisable to be citation-rich for journal articles. A scientific article isn't a novel. If you're writing a journal article or dissertation then be sure to consult your relevant style guide for their specific rules. Therefore, before you begin writing, get all the opinions of all of the folks that are involved with the story that you're writing about. Some could simply produce an idea, others might see something which triggers a story, and at times a story is handed to a writer. Among the biggest mistakes authors make with ghostwriters is to try and rush a book by hiring more than 1 ghostwriter to compose various chapters. The worst thing which can occur, nevertheless, is that your bad article slips through the review procedure. Though a weak, rambling introduction will normally indicate the subsequent essay also lacks clarity, an excellent introduction will enable the reader know just what will happen through the paper. After having a complete grasp of the research, after that you can create a substantial and appropriate review. You'll do the exact same thing whenever you have the rush of getting your very first carton of books delivered to you. Naturally, it is extremely important to be realistic. The journal article review isn't complete without a succinct review of the featured study. To begin with, you should choose a great topic. Lastly, provide the page numbers where the post are available. Finally, make sure to celebrate thoroughly whenever your article is accepted. Writing newspaper articles is relatively easy because there is only a single format which every journalist should follow. Keeping a journal is a strong tool which you're able to give to yourself everyday. To begin a journal, you simply have to be inclined to write. Most journals will request that you select five to seven keywords that may be used in search engines.

Dorian Gray Fear or Corruption - Free Essay Example

Sample details Pages: 3 Words: 800 Downloads: 6 Date added: 2019/05/13 Category Literature Essay Level High school Tags: The Picture of Dorian Gray Essay Did you like this example? In the book, The Picture of Dorian Gray, it is believed by many people that Lord Henry has corrupted Dorian Gray, but this may not be true. Many believe, that Dorian Gray hates Lord Henry because he is alone in the world. Having someone just like himself scares him; Therefore, Dorian Gray lets Lord Henry believe that he has corrupted him, but why? It is possible that Dorian Gray wants to have someone in the world like him. Don’t waste time! Our writers will create an original "Dorian Gray: Fear or Corruption" essay for you Create order Dorian Gray believes that he is alone in the world because he is a narcissist. He feels that no one understands who he is. As soon as hes at this vulnerable moment, he meets Lord Henry. Dorian Gray feels alone in the world and wants a companion who is just like him. As soon as Dorian was thinking these thoughts, Lord Henry came. This was the perfect timing and Dorian realized that Lord Henry could be his companion. Dorian is alone in the world, and that makes him become cruel to Lord Henry, when he realizes that Lord Henry is just like him. Cruelty equals loneliness, Oscar Wilde says. As you know, the beginning of the book starts off with Basil painting a portrait of Dorian Gray and Lord Henry wanting to meet him, and eventually ends up corrupting him. This may not be the case. We can see that Dorian Gray is scared of Lord Henry from the beginning. He says, Have you really a very bad influence, Lord Henry? As bad as Basil says? (19). It seems as though Dorian Gray is intrigued in knowing if Lord Henrys influence is cruel, its as if Dorian Gray wants it to be bad, so he has a reason to be scared and to hate him. Lord Henry responds to Dorian Gray by saying, There is no such thing as a good influence, Mr. Gray. All influence is immoral immoral from the scientific point of view. (20). Lord Henry is saying that there is no such thing as bad influence, the only reason people believe this is because no matter what influence you are given, it will take you away from who you really are. With these quotes, Dorian is testing Lord Henry to see if he is just like Dorian and i n the end, Dorian is happy that he has finally, found someone just like him. Then, Lord Henry goes on to talk about temptation and continues to corrupt Dorian Gray. With this, Dorian responds with, Stop! You bewilder me. I dont know what to say ( ) Let me think. Or, rather, let me try not to think. (21). In class, we spoke about how at this point, everything Lord Henry has said, was too much for Dorian, and he does not understand anything that Lord Henry is saying. But instead, Dorian was testing Lord Henry to see if his mind thought just like Dorians. Dorian acts like he did not understand what Lord Henry says because it is all part of his plan to make Lord Henry believe that he is corrupting him. Another point in the book is when Lord Henry and Dorian Gray are discussing Sibyl Vane, Dorians part-time lover. Lord Henry says, People like you ( ) what are your actual relations with Sibyl Vane? ( ) it is only the sacred things that are worth touching. (51). To which Dorian replies, Harry! Sibyl Vane is sacred! (51). Dorian is acting like what Lord Henry just sa id is insane; having sex with a virgin. Lord Henry goes on to say, It is only the sacred things that are worth touching, Dorian. (51). Again, we see here that Lord Henry tries to corrupt Dorian, and Dorian allows him to do so, with the fact in mind that Dorian knew all of this already, and he continued to let Lord Henry believe that he has corrupted him. Next, we wonder why Dorian Gray would allow Lord Henry to believe that he has corrupted him. Perhaps because he felt as if he was alone in the world. That no one understood who he was a narcissist. When Sibyl Vane dies, Dorian Gray runs to Lord Henry to confide in him. He says, why is it that I cannot feel this tragedy as much as I want to? I dont think I am heartless. Do you? ( ) I dont like that explanation, Harry, but I am glad you dont think I am heartless. I am nothing of the kind. I know I am not. And yet I must admit that this thing that has happened does not affect me as it should. It seems to me to be simply like a wonderful ending to a wonderful play. It has all the terrible beauty of a Greek tragedy, a tragedy in which I took a great part, but by which I have not been wounded. (96).

Antigone A Portrait Of Ancient Greece - 2905 Words

Kelly Devlin Dr. Anna Peak IH 0951-002 10 December 2014 Antigone, a Portrait of Ancient Greece Famous for its production of tragedies, Ancient Greece often employed the use of drama and conflict to illustrate tales relevant to the society at the time. The playwright Sophocles is a prime example of this. In his tragedy Antigone, Sophocles tackles issues such as the role of the gods, the proper behavior of women, and the power of a leader. These motifs not only add value to the narrative, but offer the reader a glimpse of the state of Greek society of the time. Artifacts such as the ones found at the Penn Museum of Archaeology and Anthropology provide evidence of the context of Antigone, and illuminate meaning in Sophocles’ text that may have remained hidden. Using this context and analysis, Antigone’s actions prove to be justified according to the values of her culture. The central conflict in Antigone poses a moral question. Does Creon have the authority to forbid Antigone to follow the will of the gods? To Antigone, the wil l of the gods is more important than following the law of the state. To Creon, maintaining stability in Thebes outweighs the wishes of a young woman. Both parties have valid reasons for their choices. However, not enough information is at hand. More research must be done; the only way to accurately determine the answer to the question posed is to determine the social context in which the play takes place. Several aspects of Ancient Greek culture mustShow MoreRelatedtheme of alienation n no where man by kamala markandeya23279 Words   |  94 Pagesï » ¿ANTIGONE KEY LITERARY ELEMENTS SETTING This tragedy is set against the background of the Oedipus legend. It illustrates how the curse on the House of Labdacus (who is the grandson of Cadmus, founder of Thebes, and the father of Laius, whose son is Oedipus) brought about the deaths of Oedipus and his wife-mother, Jocasta, as well as the double fratricide of Eteocles and Polynices. Furthermore, Antigone dies after defying King Creon. The play is set in Thebes, a powerful city-state north of

The Hidden Truth About People That Write Papers for You

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Corporate Social Responsibility and Specific Strategy Differences free essay sample

?Group 7 Exercises (suitable for use with the chapter relating to global competition and competing in foreign markets) 1. Is the international market arena in which your athletic footwear company competes characterized by multicountry competition or global competition? Explain why. We will say that it is global competition, because global competition refers to the situation when products and services requirements from country to country are similar and close. We will say that in this market they are pretty similar. Of course there is a need to adjust our prices in countries with lower purchasing power but demand is huge for same products as in other regions. 2. Is your company employing a global strategy in branded footwear or a strategy that varies significantly from geographic region to geographic region? If the latter, what are the specific strategy differences from region to region? Our company employs global strategy. 3. Is your company employing a global strategy in private-label footwear or a strategy that varies significantly from geographic region to geographic region? If the latter, what are the specific strategy differences from region to region? Same strategy in this market as well. Only price is a bit different. 4. To what extent, if any, have you and your co-managers adapted your companys strategy to take shifting exchange rates into account? In other words, have you undertaken any actions to try to (a) minimize the impact of adverse shifts in exchange rates or (b) capitalize on the impact of favorable exchange rate shifts? Why or why not? Unfortunately we don’t have production capacities in all regions and due to that fact it is impossible to completely minimize effect of exchange rates. We chose to maintain our production in current regions (NA and AP). Hence, we are trying to mitigate exchange rate effect if it is (by exporting from regions where currency depreciates to the regions where currency appreciate) possible if it is not we are trying to reduce or limit export in those regions, regions with adverse exchange rates, and/or to transfer our costs to customers in those regions. Due to unavailability of hedging this risk with long term contracts (futures, options) this seems like best choice we have. To what extent, if any, have you and your co-managers adapted your companys strategy to take geographic differences in import tariffs into account? We did that by exporting from NA to LA where tariffs are non-existent. Also, the only tariffs we are paying are in EA region but they are not high enough to endanger our profitability. Group 8 Exercises (suitable for use with the chapter relating to ethical strategies, social responsibility and environmental sustainability) 1. What is your companys strategy for exercising social responsibility and being a good corporate citizen? We invest money in work diversity programs and ethic training of all employees. Also we invest money in energy efficiency initiatives. 2. Would your company pursue a corporate social responsibility strategy if there was no payoff in the form of a higher image rating? Why or why not? Probably not because it doesn’t have any impact on the game and the goal of the game is to have high profits. Hence, if our goal is to win this game that would be useless spending of money. 3. Should shareholders be pleased with your companys social responsibility strategy and the amount of resources you are devoting to this effort? Cite at least 3 convincing reasons in support of your answer. Our shareholders are pleased. 1)We invest enough money to maintain good picture 2)But we don’t overspend in that area which will diminish our shareholders’ EPS 3) and ROI 4. Is there anything that your company is doing that could be considered as shady by your competitors? There is nothing that our competitors could consider â€Å"shady† in our company operations. However, they will give better answer on this question. 5. Is there anything that any of your competitors are doing that you consider as shady or unethical? There is nothing we consider â€Å"shady† in operations of our competitors. 6. Is it unethical or at least socially irresponsible for a company to avoid conducting its business in a manner in an environmentally sustainable manner? Why or why not? It is â€Å"unethical† and irresponsible because we should think about future generations. Business should involve examining business processes and practices in terms of people, planet and profit, and seeking out ways to create a positive impact in each of these areas. For example, implementing environmentally sustainable practices and green supply chain management has the potential to eliminate waste and generate cost savings, leading to a stronger bottom line. 7. Is it unethical or at least socially irresponsible for a company to make no charitable contributions whatsoever? Support your answer? It could be perceived as unethical. However in essence of business is making profit not making charitable contributions. Also, a lot of companies which gives charitable contributions do that because of some latent or manifest benefit they could have. For example tax breaks or image improvement. Group 9 Exercises (suitable for use with chapters relating to strategy implementation, strategy execution, and efforts to achieve operating excellence) 1. Do you and your co-managers deliberately shift resources from one area to another to better support strategy execution efforts? If so, cite at least 3 such instances. During the course of the game we shifted resources from one are to the other. 1. We decreased rebate offer but increased advertising budget and retailer support. 2. We lower expenses for superior materials but boosted TQM/Six Sigma, Enhanced features and best practices. 3. During the first six years we put all our resources to branded and internet sales, we shifted some of those resources from private-label segment which we neglected in that period. 2. Do you and your co-managers regularly study the benchmarking data on pages 5 and 6 of each years Footwear Industry Report to see how well your company is doing? Do you consider the benchmarking information provided to be valuable? Why or why not? Cite three recent instances in which your examination of the benchmarking statistics has caused you and your co-managers to take corrective actions to boost company performance. Yes, after every round we carefully study those pages in order to benchmark our efforts against efforts of our competitors. They are very valuable, because according to those reports we could find out where our performance lag and try to improve those weak links. 1. We noticed that we invest too much money in advertising because all our competitors invest less money and have same effect, after that we decreased our investing in advertisements. 2. Also, we noticed that our compensations our too high and they do not really correspond to the level of productivity. (Our rivals had smaller wages but better productivity) After that we decreased adjusted compensations. 3. On page 5 Financial summary we noticed that we should warehouse expenses, afterwards we took proper actions to do that. 3. What is your company approach to workforce compensation? Is there any hard evidence you can cite that indicates your companys workforce compensation strategy is working? For example, has your companys compensation approach actually boosted productivity? Can you cite evidence indicating that the productivity gains have resulted in lower labor costs? If the productivity gains have not translated into lower labor costs, then is it fair to say that your companys work force compensation approach is a failure? According to benchmark page 6 in FIR we have best workers’ compensations in the industry. According to the same page we have the highest productivity in NA region as well as in AP region. We are doing well in this aspect. Higher productivity decreased number of workers we need to produce certain number of shoes. Hence we lower costs of production by employing fewer workers than earlier. Also, due to the fewer workers we also lower costs due to the less supervision costs we are paying. All in all our compensation policy is success. 4. Are you and your co-managers consciously trying to achieve operating excellence? What are the 3-4 best indicators of operating excellence at your company? Based on these indicators, how well does your company measure up? Is there any evidence indicating that your companys management team is doing a better job of achieving operating excellence than are the management teams at rival companies? Our good result during whole game (steady market share and profitability) indicates that we are creating value for our customer which is one attribute of operational excellence. Also we think systematically about the game, we consider our company as an open system in constant interactions with its environment (Different market forces) and constant internal interactions. This is the second indicator of our operational excellence. At the end we always seek perfection and we are focused on processes. We are trying to eliminate all handoffs and bottlenecks and to improve all processes of our company. We are constant process of trying to improve all our decisions and processes. We would rather say: Good Strategy + Good Strategy Execution = Good Management that is formula which describes our approach. Ipso facto we were among three top companies during the whole game and first for five consecutive years.