Two Separate Levels of Governance at a Teaching Hospital Essay Example for Free

Two Separate Levels of Governance at a Teaching Hospital Essay Dr. Darrick Kent (2007) is an assistant professor of family medicine, director of curriculum and head of medical information systems at a teaching hospital with a popular residency training program.   The hospital has two hundred and seventy beds with faculty and residents making approximately five hundred and sixty bedside patient visits every week.   According to Dr. Kent, the organizational size of his hospital – with approximately two hundred and ten people working on different shifts during each month – is substantial enough for him to try out new methods of governance as in charge of the medical information systems.    In other words, he would like to ease the governance of the facility by all means with the use of latest technology. As an example, Dr. Kent has introduced the Personal Digital Assistant (PDA) to all members of the faculty as well as residents at the hospital.   According to him, it was necessary to introduce the PDA to the residents and faculty members across the facility.   He knew that his â€Å"colleagues† would benefit from the PDA that makes it easier for everybody to communicate across the facility, and is also loaded with trusted references (Kent).   Because of his decision, the facility is currently using its annual budget for electronic medical references from Skyscrape Inc.   These references are the same as the actual books written by some of the world’s best medical authors and sold by top medical publishers (Kent).   Ã‚  Ã‚  Ã‚   Throughout his day at the teaching hospital, Dr. Kent is approached by his colleagues with a variety of questions, not only about medical information systems but also about the medical practice in general.   Especially in times of emergency, Dr. Kent is considered a ready reference for information about drugs as well as diseases.   Despite the PDA in everybody’s palm, Dr. Kent is considered by his colleagues as a superior authority on medical information â€Å"because of the nervousness felt by the new doctors and nurses† at the facility (Kent).   Still excited about the PDA, which was introduced at the facility in 2005, he explained this part of his job with an example:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The other day I was presented with a case of myocardial infarction by way of calls received from the emergency room physicians in order to review a patient.   With my PDA in hand, I did not have to go to my office and open up the Griffith’s 5-Minute Clinical Consultant before checking its index.   Instead, I simply typed ‘MYO’ on my PDA and got all the information required to send back to the emergency room physicians in the matter of moments.   Ã‚  Ã‚  At present, Dr. Kent is seriously considering the introduction of nursing informatics at the facility.   According to him, nursing is a scientific discipline with a focus on information or knowledge.   Hence, nursing informatics, too, is focused on the easy access of crucial information to nurses.   Indeed, nursing informatics has the power to embrace all pieces of information that a nurse would require at any time. Whether it is patient data or information about medicines that is required by a nurse at any given time, the help that information technology can provide in accessing required information cannot be discounted.   With Dr. Kent’s decision to install appropriate nursing informatics at the facility, nurses would no longer have to flip through â€Å"book after book† to find needed information at a time of emergency (Kent).   No longer would they have to go searching for doctors either (Kent).   Ã‚  Ã‚  Ã‚   Also according to Dr. Kent, everybody is considered a colleague at his facility.   Even the nurses are nowadays enjoying the concept of â€Å"shared governance† in practice (Kent).   Linda Chavez (2007), an acute care nurse at the same facility confirmed Dr. Kent’s report on shared governance for the nurses.   She has worked with the teaching hospital for thirteen years.   Now a teaching nurse (for acute care) at the healthcare facility, Ms. Chavez is thrilled about Dr. Kent’s decision to install nursing informatics which would make her job much easier. She has little part to play in this decision of Dr. Kent or other senior members of the hospital.   Still, she has recently joined a council group at the hospital with nurses and other members of the facility making joint decisions that usually have a dramatic impact on the quality of patient care.   The council group has already been consulted about the introduction of nursing informatics at the facility.   However, â€Å"the final decision rests with Dr. Kent,† Ms. Chavez explained.   Ã‚  Ã‚  Ã‚   The council group considers all of its members as equals.   Nevertheless, the seniority of the directors of the facility remains unperturbed.   Moreover, everybody at the facility is not invited to become a member of the group.   â€Å"The final decision about the group members rests on the directors of the facility, and they are allowed to remove anybody from the group at whatever time they will† (Chavez).    The council group that Ms. Chavez joined in late 2006 is responsible for evaluating the status quo, besides recommending changes that the members deem necessary.   Nevertheless, she emphasized that her role in governance is strictly restricted to â€Å"recommendations† (Chavez).   Ã‚  Ã‚  Ã‚   Ms. Chavez is grateful that nurses may now join the council group upon invitation at the facility.   The concept was first introduced at the hospital in the year 2005.   Ms. Chavez explained the importance of nurses joining the council group thus:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Back in 2005, some of the nurses in the council group complained about Coumadin, a blood thinner that many of the patients at the facility were administered.   Seeing that changes in blood consistency often put patients at risk of fatal bleeding or clotting, and we had no procedure in place for determining how regularly patients should return to get their blood tested; this issue raised by nurses was an extremely important one.   So, the council decided to Two Separate Levels of Governance at a Teaching Hospital  address it once and for all.   There was extensive research conducted, after which the hospital  issued new guidelines based on the findings of other council members. For Ms. Chavez and the other nurses that are currently a part of the council group, it is invigorating to join hands with the physicians in implementing important changes across the facility.   Even so, directors such as Dr. Kent have â€Å"the upper hand† (Chavez).   Also according to Ms. Chavez, nurses have always taken their limited role in the governance of a healthcare facility for granted. Although the council group is â€Å"a breath of fresh air,† most of the nurses at the facility are not allowed to join it yet (Chavez).   Because the facility where Dr. Kent and Ms. Chavez work â€Å"would always be a teaching hospital,† the directors are considered authority figures and physicians rarely are (Chavez).   All the same, both interviewees remain generally satisfied with their particular levels of governance (Chavez Kent). References Chavez, L. (2007). Personal Interview. Kent, D. (2007). Personal Interview.

History, Culture and Identity of Mothers and Daughters in Amy Tan’s The

History, Culture and Identity of Mothers and Daughters in Amy Tan’s The Joy Luck Club   Ã‚  Ã‚   Amy Tan’s The Joy Luck Club is a novel that deals with many controversial issues. These issues unfold in her stories about four Chinese mothers and their American raised daughters. The novel begins with the mothers talking about their own childhood’s and the relationship that they had with their mothers. Then it focuses on the daughters and how they were raised, then to the daughters current lives, and finally back to the mothers who finish their stories. Tan uses these mother-daughter relationships to describe conflicts of history, culture, and identity and how each of these themes are intertwined with one another through the mothers and daughters.   Ã‚  Ã‚   The mothers and daughters not only experience a generation gap, but since the mothers were born in China and the daughters were born in America, they also experience a certain cultural gap. This leads to miscommunication and misunderstanding on both parts. To the mothers, their Chinese heritage is very meaningful to them and the Americanized daughters don’t always understand this. The daughters get embarrassed by their mothers’ broken English. For instance, at one point Lindo Jong says "But inside I am becoming ashamed. I am ashamed she is ashamed. Because she is my daughter and I am proud of her, and I am her mother and she is not proud of me." (pg. 291). Lindo is hurt because her daughter Waverly, is talking to her like she is a child. Waverly does not do this on purpose, she just has a hard time understanding her mother and her background, like the other daughters in the book.   Ã‚  Ã‚   "Living with their traditional culture in American society, Chinese-American women suffer the prob... ...ying to save their daughters from the cultural barriers, and identity crisis’ that they had to face. It is in listening to these stories that the daughters find their true identities and become the people that they really are. They realize that they do not have to look at their mothers’ as their opponents, but instead their equals. They accept and even honor the fact that they are the same as their mothers. The Joy Luck Club tells a strong and powerful story that shows the importance of history, culture, and identity in mother daughter relationships, and also in everyday life.    Works Cited Do, Thuan Thi. Chinese-American Women in American Culture. 1992 http://www.ics.uci.edu/~tdo/ea/chinese.html    Jokinen, Anniina. Anniina's Amy Tan Page. 1996 http://www.luminarium.org/contemporary/amytan/    Tan, Amy. The Joy Luck Club. New York: Random House, 1989.

Should there be separation of church and state?

Ancient Greek civilization and culture continues to be one of the landmarks of world history because of the invaluable contribution that the Greeks have made in virtually all areas of human endeavor. However, civilization is not static and Greek society was swept into the same historical process that led all societies to the modern world of capitalism. What is distinct about Greek society today is the direct role that the church plays in the realm of politics, where most other countries have developed forms of government that excluded the direct participation of religious entities. What is the church’s role in the Greek state of affairs? Should there be a separation of powers of church and state in the context of Greece? The Orthodox Church in Greek Society The Orthodox Church traces its roots to the Orthodox Church based in Constantinople. It is the most dominant religion in Greece, claiming influence over 90% of the country’s population, a very wide political base that could determine the winner in national elections.   The subsequent nationalization of the Church further institutionalized its political power and created a culture/national identity where traditional church values are the core (Geographic 2004). Like most church hierarchies, the Greek Orthodox Church has always played as a conservative political force. It supported the monarchy and also aligned itself with the right wing military junta in the 1960’s in order to wage a common battle against a common threat – communism (Maniatis 2002). It also perceives pluralism and other liberal ideas as a challenge to its monopoly in the cultural sphere and has vigorously opposed such influences. It’s involvement in politics resulted in factionalism but nevertheless, it has undeniable influence over government policies and programs (Geographic 2004). Currently, Orthodox Church officials are actually employed by the government through the Ministry of National Education and Religious Affairs which incidentally, also manages the properties of the church (BBC 2005). Recently, scandals rocked the Orthodox Church with allegations of embezzlement, smuggling and bribing of judges. On the Separation of Church and State From the perspective of a person outside looking in, I believe that there should be a separation of church and state. This position is based on the premises that the Church (or religion in general), especially if it is conservative promotes an ideology that preserves the traditional way of life and the status quo in society. If the church is part of governance, naturally it ensures the consistency of laws, policies and programs with the tenets of the church. For instance, because homosexuality and divorce is contrary to Church teachings, it leaves out the agenda of women and gay’s rights. Because the Orthodox Church opposes multi-culturalism, it promotes religious and cultural discrimination to governance. Because science is contrary to church teachings, how then can scientific study be actively promoted by government institutions? As such, government can not effectively respond to the breadth of social issues first through objective study followed by the institution of measures appropriate with empirical evidence if there is no actual separation of church and state. Finally, if the church also functions as part of Civil Society, or as a check and balance to government, it can not do so if it is employed by that institution with its officials actually receiving salary from it. It would be a case of conflict of interest and undermines the interest of the public. List of References Geographic (2004) Greek Church and State.  [18 February 2008] BBC One Minute News: Europe (2005) Greek Church Plans Scandal Summit. Available   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   from

Briefing The Seveso Disaster - TCDD

Few industrial accidents can match the severity of the Seveso disaster of 1976. Despite the resulting long-term health problems and environmental risks, however, the accidental release of gases including TCDD -- a form of cancer-causing dioxin -- into a residential area of Italy had some positive legacies, including the creation of tighter environmental regulations and health protections throughout Europe. Seveso: Before and After the Disaster A small suburban town some 10 miles north of Milan, Italy, Seveso had a population of about 17,000 in the 1970s. Other nearby cities include Desio, Cesano Maderno and Meda; together, these formed a mix of urban, residential and small farming areas. A local chemical plant, constructed many years earlier in Meda, was owned by ICMESA, a subsidiary of pharmaceutical giant Hoffman-La Roche. Overall, the plant was not perceived as a threat by the local population. All that changed, however, on the afternoon of Saturday, July 10, 1976, as parts of the plant were being shut down for the weekend. While residents of Seveso and the surrounding area were tending their gardens, running errands or watching their children play, one of the buildings in the chemical plant was getting dangerously hot as cooling mechanisms were turned off. When the temperature inside one of the plants tanks reached a critical level, a pressure release valve opened, and about six metric tons of toxic gas were emitted from the facility. The resulting gas cloud that drifted over the Seveso area contained an estimated one kilogram of TCDD, technically known as 2,3,7,8-tetrachlorodibenzodioxin. TCDD in Seveso TCDD is one type of dioxin, a family of chemical compounds that are a by-product of industrial activities like bleaching wood pulp, incinerating garbage, metal smelting, and chemical production. Dioxin is also present in small amounts in the herbicide Agent Orange, which was used throughout Southeast Asia during the Vietnam War. Dioxin is universally recognized as a carcinogen (a cancer-causing agent). Its also known to cause reproductive, immune and developmental effects in mammals, and can cause severe liver problems in people exposed to high levels of the compound. Chloracne, a serious skin condition that resembles very bad acne, can also result from high exposures to dioxin. Within a few hours after the ICMESA facility gas release, over 37,000 people throughout the Seveso area were exposed to unprecedented levels of dioxin. Among the first to suffer, however, were the areas animals. According to Time, One farmer saw his cat keel over, and when he went to pick up the body, the tail fell off. When authorities dug the cat up for examination two days later, said the farmer, all that was left was its skull. Despite their exposure to high levels of dioxin, it was a few days before people began to feel the effects: nausea, blurred vision, skin lesions and the development of severe chloracne, particularly among children. As a result of the slow development of symptoms, the area around Seveso was not immediately evacuated. Dead animals, especially chickens and rabbits kept as food, began to overwhelm the citys resources, and many were slaughtered on an emergency basis to prevent people from eating them. (Dioxin accumulates in fatty tissue, and can be ingested by eating plants or animals that have been exposed to it.) By 1978, an estimated 80,000 animals were slaughtered. The Legacy of Seveso The response to the Seveso accident was widely criticized as slow and bungled. Several days passed before it was announced that a gas containing dioxin had been released from the facility; evacuation of the worst-affected areas took several more days. Research into the long-term health effects of the Seveso disaster is ongoing. One study from 2008 found that babies born to women living in the contaminated area at the time of the accident were about six times more likely to have altered thyroid function than other babies. Additionally, a 2009 report found an increase in breast and lymphatic cancers in the area. However, other research into liver, immune, neurologic and reproductive effects yielded no conclusive information. Seveso and its residents continue to function as a kind of living laboratory into the effects of dioxin exposure on people and animals. Throughout Europe, the name Seveso is now associated with tough regulations that require any facilities storing, manufacturing or handling hazardous materials to inform local authorities and communities about the nature of their facility, and to create and publicize measures to prevent and respond to any accident that may occur. The ICMESA plant is now completely closed, and the Seveso Oak Forest park was created above the buried facility. Beneath the wooded park, however, sits two tanks that hold the remains of thousands of slaughtered animals, the destroyed chemical plant and the soil that had the highest degree of dioxin contamination.