Decision theory Essay Example for Free

Decision theory Essay How could companies use Second Life for new product or service decision making? Companies use second life which includes meeting with the sales manager, discussing about new sales techniques, building a new world where members of second life talk together about product or services and testing the new designs for new product or service before it is released to the world. Thus by taking feedback from all members companies take decisions. . How could financial companies use neural networks in Second Life to help their businesses? Neutral networks are those which involve in pattern or image recognition. This helps companies to get the required information for processing in second life. 3. How could a company such as Nike use decision support systems on Second Life to help its business? Nike uses decision support system (DSS) for information that helps to take decision. But DSS has three main models in it. They are: -Sensitivity: observe changes when variable is changed -What- if? checked what is the impact if variable changed -Goal seeking: seeking to reach goal by making changes. 4. How could an apparel company use Second Life to build a digital dashboard to monitor virtual operations? Apparel uses second life in digital dashboard to monitor virtual operations as it tracks everything in the store which includes number of customers, time spent, items purchased etc. Company also gave a special offer to the second life residents that they get promotional cards if they are shopping in inline-world apparel. Describe how the DoD is using AI to improve its operations and save lives. By using AI the DoD is able to make operations like resupply missions more efficient because human drivers and troops to protect the supply line aren’t needed. AI would also be able to perform dangerous missions without endangering troops. 2. Explain why the DoD would use an event, such as the DARPA Grand Challenge, to further technological innovation. The DARPA Grand Challenge produces lots of different ideas from diverse sources which will produce more efficient technology. The contest is also at a relatively low cost to the DoD because it would cost more than $2 million dollars to produce and test so many models on their own. 3. Describe how autonomous vehicles could be used by organizations around the world to improve business efficiency and effectiveness. If businesses were able to transport their goods without human transportation controllers it would cut costs and eliminate some of the risks from human error. 4. The Ansari X is another technological innovation competition focusing on spacecraft.

Characters, Symbolism, and Themes in The Lord of The Flies Essay

The Lord of the Flies is a story about a stranded group of boys on a deserted island after their plane crashes. It is about an adventure at the start of a new World War. The boys try to create a society by selecting a leader and doing everything they can to survive. It is all a game without adult supervision until the island becomes a nightmare and their imaginations come to life. Everything becomes more realistic when the twins, Sam and Eric, find the body of the dead parachutist hanging from a tree on the island. Then the boys declare that there is some type of beast on the island and they must kill it to stay alive. Soon the boys turn on each other and kill Simon because he is mistaken for the beast. Jack then, takes over the group of boys and hunts down Piggy and Ralph. Then Roger pushes a boulder off the cliff and kills Piggy. The boys follow Ralph, which is the main character and the boys began to set the jungle on fire in attempt to smoke Ralph out. Ralph then discovers that h e is back on the beach after collapsing from exhaustion. After looking up, he then finds a Naval officer standing over him. The officer saw the raging fire in the jungle from his ship at sea. Overwhelmingly Ralph explains what happened to the officer. He and the boys begin to cry because they realize that they are finally being rescued and are going home. Symbolism is shown throughout the story, by the little things like the conch shell and Piggy’s glasses. The pig’s head is a huge symbol, showing that the boys believe in a power of evil. In this book the main theme is civilization vs. savagery. The boys lose their civilized being and innocence ways as they become savages and kill Simon and Piggy. In The Lord of The Flies, Golding analyzes characters, ... ...Cathy Falk. Vol. 58. Detroit: Gale Research, 1990. Literature Resources from Gale. Web. 19 Jan. 2012. Slayton, Paul. "Teaching Rationale for William Golding's Lord of the Flies." Censored Books: Critical Viewpoints. Ed. Nicholas J. Karolides, Lee Burress, and John M. Kean. The Scarecrow Press, Inc, 1993. 351-357. Rpt. in Novels for Students. Ed. Diane Telgen. Vol. 2. Detroit: Gale, 1998. Literature Resources from Gale. Web. 19 Jan. 2012. SparkNotes. N.p., n.d. Web. 12 Feb 2012. 98. Literature Resources from Gale. Web. 19 Jan. 2012. Townsend, R. C. "Lord of the Flies': Fool's Gold." The Journal of General Education. Vol. 16. University Park, Pa.: The Pennsylvania State University Press, 1964. 153-160. Rpt. in Contemporary Literary Criticism. Ed. Roger Matuz and Cathy Falk. Vol. 58. Detroit: Gale Research, 1990. Literature Resources from Gale. Web. 19 Jan. 2012.

Facebook Brings More Good Than Harm

Stress is the body natural response to the changes which occurs in live. Stress is the combination of psychological,physiological and behavioral reaction. Stresss can be good or bad. Stress can affect both your body and your mind. Stress occurs when an individual is confronted by a situation that they perceive as overwhelming and cannot cope up with. The effect of stress is health problem,impact on students academic performance and changes in personal behavior. Firstly,effect of stress can lead to health problem. It can cause headaches, nausea, rise in blood pressure, pains in the chest, and insomnia.When people feel stressed by something going on around them, their bodies react by releasing chemicals into the blood. These chemicals give people more energy and strength, which can be a good thing if their stress is caused by physical danger. But this can also be a bad thing, if their stress is in response to something emotional and there is no outlet for this extra energy and strength . People under large amounts of stress can become tired, sick, and unable to concentrate or think clearly. Sometimes, they even suffer mental breakdowns. But beyond a certain point, stress stops being helpful and starts causing major damage to your health,Moreover,stress can give impact on students academic performance. The pressure to perform well in the examination or test and time allocated makes academic environment very stressful. However, academic work is never without stressful activities. Stress is defined as the physical pressure, pull, or other force exerted on one thing by another; strainIn conclusion, stress could cause depression, hopelessness, psychiatric disorders, behavioral changes and the weakening of the immune system. These effects are not all inclusive but these are the ones that most commonly effect people. Finally,stress can lead to changes in personal behavior.Students will become irriatable. His relationship between college mates and lecturers could be damag ed. Futhermore,this changes could make him depressed and leads him to violent behavior. Students are the future leaders of tomorrow and anything that interferes with their well being should be termed as denying the society their future leaders. University should conduct stress reduction sessions to the students, and lecturers too should be encouraged to advise their students where necessary. Students in Universities and colleges should control their stress and hence minimize the possibilities of psychiatric disorders and suicides. (379 words)

The Theory And Low Self Control Theory - 915 Words

Crime has existed in societies across the world for centuries, and is defined as any offense harmful against the public. However, the true nature of crime is more complex as there are many different motives and causes behind a criminal act, which cannot be contributed to a single factor (Barlow Decker, 2010). Within the field of criminology, a number of theories exist that attempt to explain why some individuals commit crime, while others abstain from it. Some theories attribute crime to the specific environment; they believe that an individual commits crime when certain ecological conditions are met (Felson, 2001). Others argue that crime is caused by the individual themselves; that criminals are the result of unrestrained thoughts and low self-control (Gottfredson Hirschi, 2001). This paper will analyze aspects of a real world scenario using both routine activity theory and low self-control theory, for the purpose of better understanding and evaluating certain criminal behavior. There are many theories that attempt to explain the cause of criminal events. One such theory is routine activity theory developed by Lawrence Cohen and Marcus Felson in 1979. This theory was meant to fill the gaps in existing models that failed to adequately address rising crime rates during the 1960 s (Browning et al., 2000). Cohen and Felson suggested that crime should be thought of as an event that occurs at a specific location and time and involves specific people and/or objects (Felson,Show MoreRelatedAnalysis Of Gottfredson And Hirschi s Low Self Control Theory2319 Words   |  10 PagesGottfredson and Hirschi’s Low Self-Control Theory, also known as A General Theory of Crime, is a criminological theory developed in 1990 that seeks to explain crime and why certain people offend and others do not. As a social control theory, it accepts the idea that socialization and social learning build self-control and will likely lead one away from offending. Low Self-Control Theo ry also comes from the classical school of thought, which states that human nature is to try to enhance pleasureRead MoreDifference Between Integrated Theory And Holistic Theory1200 Words   |  5 PagesAn integrated theory merges concepts, but it does not attempt to explain all criminal behavior from different concepts or assumptions. The difference between integrated theory and holistic theory is it does not attempt to explain all criminal behavior, but a holistic (general) theory of crime attempts to explain all forms of criminal behavior through a single approach.There are four examples of a holistic (general) theory of crime John Braithwaite’s theory of crime shaming and reintegration, GottfredsonRead MoreCybercrime Law Research Paper911 Words   |  4 Pagesbecause of forces beyond individual control and relies on the scientific method to prove it s theories (Cullen amp; Agnew, 2006 ). Individuals should not be held solely responsible for their actions because not everyone is rational. Outside factors can play an important part in determining one‟s participation in crime. Now that we have exami ned the two most dominant schools of criminological theory we can examine how two theories, self - control and routine activity, have been appliedRead MoreThe Theory Of Self Control Theory985 Words   |  4 PagesIntroduction Social control theory suggest that crime occurs when such bonds are weakened or are not well established. Self-control theory argue that without such bonds, crime is an inevitable outcome. Hence, criminality is considered as a possibility for all individuals within society, bypassed only by those who seek to maintain family and social bonds. These bonds are based on attachment to those within and outside of the family, including friends, teachers, and co-workers, commitment to activitiesRead MorePolice Corruption within XYZ Organization Essay1076 Words   |  5 Pageseffectiveness (Tankebe, 2010, p.297). To address this issue, I have identified two potential strategies aimed at reducing the prevalence of these instances. I will be using a blend of two criminological theories. The two theories that I would like to blend is the deterrence theory and the self-control theory. A blend of the two allows us to apply a direct application across a multitude of demographic groups within th e organization while still focusing on what I believe to be the main contributor to crimeRead MoreTravis Hirschis Social Control Theory: Helpful or False? Essay1194 Words   |  5 Pagesessay I will first explain what a Social Control Theory is and how Hirschi developed his theory ‘Social Bond’ from this, I will also discuss further development of his theory with Gottfredson in a ‘General Theory of Crime’. I will then discuss and consider the criticisms of both theories before providing my own conclusion, including why his theory is still relevant in today’s society. Control theories take on a different approach to other previous theories such as†¦.. Most theorists ask ‘why someoneRead MoreTo Commit a Crime or Not Based on Gottfredson and Hirschs Self-Control Theory1059 Words   |  5 PagesGottfredson and Hirsch’s self-control theory revolves around one’s inclination to commit a crime or refrain from committing a crime based on low or high self-controls. It is a general crime theory that explains all crime at all periods in time. The principal factor is self- control. In this theory, a person with low self-control is much more likely to commit a crime then a person with high self-control. For Gottfredson and Hirsch’s definition of crime, they state that a crime is an act undertakenRead MoreProposed Theories And Approaches Surrounding The True Nature Of Crime1382 Words   |  6 Pagesof proposed theories and approaches surrounding the true nature of crime and what drives criminals to act in the ways that they do . From approaches based around philosophy to those with origins in biology, sociology and psychology, there is yet to be a completely provable explanation for the motivations behind criminal behaviour. The case of 41 year old Alfred is a prime example of this as his case shows aspects of a number of different theories. The sociologically based strain theory first proposedRead MoreSelf Control Theory : A General Theory Of Crime1309 Words   |  6 PagesSelf-control theory hypothesizes that self-discipline explains a variance in the extent to which people are susceptible to specific urges, whether committing criminal or non-criminal actions. Travis Hirschi and Michael Gottfredson gave rise to self-control theory in their book named A General Theory of Crime. Because its creators define the self-control theory as a â€Å"general theory of crime†, to them it is believed that this theory can be implemented to multiple behaviors where a person is not capableRead MoreCriminology And The Criminal Justice System824 Words   |  4 PagesStout’s book titled Applied Criminology when it is stated that â€Å"Different criminological theories emerge from different contexts, are shaped by different forces and, therefore, have very different implications if applied† (Stout, 2007, p.2). The most important takeaway from the study of how Applied Criminology is taught (and learned) is that it extends far beyond the mere application of criminological theories and teachings. It concerns itself with the evolution of its own field and sub-fields, as

Is Homosexuality Morally Or Immoral - 906 Words

Homosexuality has in recent times being the topic of much heated debate. Simple opinion has divided the line between many and conclude those that stand for traditional values and those who take a progressive stance in civil rights. While the nation has become a buzz of opinions and perspectives, many arguments that have been made have been exaggerated and slandered to the extent that they are no more than myths that have been left off of a leash unchecked. Ultimately, there is nothing inherently wrong with homosexuality, and despite even the best arguments made against the principle, little carry any weight. Many people look at homosexuals and see people that they are uncomfortable with and jump to irrational conclusions, claiming that the concept is unnatural or immoral. A simple argument can be made that homosexuals cannot reproduce, and therefore should be expelled from any kind of societal recognition. However, what concisely makes the inability to reproduce a negative factor in homosexuality? The inability to procreate may stem the ability to produce a child between a couple, however, it creates the possibility for adoption. Thusly, it would serve to both take a child out of a foster home, making one less crowded and taking less a toll on the inhabitants that reside there, as well as providing a loving home for a child whom may need one. Inherently, a large population of people who do not reproduce may stall, if not solve, the growing issue of worldShow MoreRelatedIs Homosexuality Morally Or Immoral?915 Words   |  4 PagesHomosexuality has in recent times asserted the p osition of being a topic of much heated debate. Simple opinion has divided the line between many and conclude those that stand for traditional values and those who take a progressive stance in civil rights. While the nation has become a buzz of opinions and perspectives, many arguments that have been made have been exaggerated and slandered to the extent that they are no more than myths that have been left off of a leash unchecked. Ultimately, thereRead MoreThe Doctrine Of The Existence Of God1470 Words   |  6 Pagesmany years homosexuality has been a debate over acceptance but has been for the most part considered an immoral act based on religious beliefs and the obligation to obey God’s commandments. These views on homosexuality can relate to the Divine Command Theory because morality is dependent upon the actions God commands us to do. There is however controversy with the Divine Command Theory that argues that morality may not be what God says it is therefore, the basi s of homosexuality being immoral and moralRead MoreThe Moral View Of Homosexuality1708 Words   |  7 Pagesargument of homosexuality being considered moral or immoral has been an argument for as long as humans have been in existence. This argument has been viewed by philological experts and people all over the world for centuries and it continues to be a major argument today. The moral view of homosexuality has many arguments, but the arguments that are going to be mentioned are the normative ethics argument, the argument on why the moral law is true when it comes to homosexuality, and why homosexuality shouldRead MoreIs Feminism a Harmful Ideology Essay1529 Words   |  7 Pages(1) Is it immoral to infringe upon individual liberty (even if some other good can come of it)? (2) Is it immoral to discriminate based on sex (even if there are innate differences, which are relevant to the situation)? What makes these distinctly moral issues, as opposed to legal, religious, or socio-political issues? These are distinctly moral issues for a few reasons. First, answers to these questions require normative statements (yes it is immoral, or no it isnt immoral to infringe†¦)Read MoreHomosexuality Paper -Philosophy1526 Words   |  7 PagesIs Homosexuality Right Or Wrong? by Nazha Gali My topic is homosexuality and the natural law theory. The natural law theory, which was founded by Aquinas, rests on a certain view that the world has a rational order with values and purposes built into its very nature. And since homosexuality is against the orders of nature, the natural law theory totally condemns it. I disagree with this point of view because I choose not to judge homosexuals but instead I accept them as members of our society.Read MoreKant and Sexual Morality1383 Words   |  6 PagesGerman Philosopher Immanuel Kant claimed that it is morally wrong to use a person merely as a means to your end. This judgement helps us to understand and determined sexual morality. Thomas A. Mappes supports Kant’s claims and helps to further explain Kant’s statement by defining it and introducing the idea that one must give their voluntary informed consent in order for certain actions to be moral. Mappes also illustrates that voluntary informed consent can be undermi ned through both deception andRead MoreKant and Sexual Morality1394 Words   |  6 PagesGerman Philosopher Immanuel Kant claimed that it is morally wrong to use a person merely as a means to your end. This judgement helps us to understand and determined sexual morality. Thomas A. Mappes supports Kant’s claims and helps to further explain Kant’s statement by defining it and introducing the idea that one must give their voluntary informed consent in order for certain actions to be moral. Mappes also illustrates that voluntary informed consent can be undermined through both deception andRead MoreHomosexuality Is A Form Of Emotional, Romantic, And Sexual Attraction858 Words   |  4 PagesAs one of the many sexual orientations, homosexuality is a form of emotional, romantic, and sexual attraction that is primarily or exclusively to people of the same sex. Homosexuality is a fairly recent phenomenon in the twenty-first century; in fact, this sexual orientation has signif icantly increased but there is no precise way to estimate the exact numbers due to people not openly identifying as such due to homophobia (which, in everyday use, is the fear of homosexuals) and homobigotry (intoleranceRead MoreEssay about Jewish Sexual Ethics1295 Words   |  6 Pages Sexual Ethics are integral to Judaism because they provided direct guidance on how to behave morally and in accordance with the Torah and God. Although, over many years Jews were suffering from persecution, they are currently showing stability which can be attributed to the framework that is outlined through the strong ethics that they uphold. Sexual ethics provide guidance on how to behave morally, righteously and in accordance to the Torah as well as preventing promiscuity, infidelity, immoralityRead MoreEthics of Homosexuality857 Words   |  4 Pagesï » ¿ Homosexuality Homosexuality has always been a controversial topic of ethical discussion. The morality of the subject depends completely upon a person’s views. A person is often swayed one way or another and religion often plays a very large role on the subject. There are those who believe in the divine command theory and those who believe in the natural law theory. In order to properly understand either theory it is important to know the meaning behind each. According to

Ipulse Buying - 1222 Words

Rasheena Rattu P11270471 The aim of this project is to understand how visual merchandising can impact young adults impulse buying patterns. During the project I will create surveys for face to face interaction, experimental studies in controlled and structured environments such as toy stores which then would develop into case study on particular families which were interesting during the experiment. Identify-I would like to identify the key factors of visual merchandising for young adults – what works best, what persuades a young adult to buy? Compare- the different technique that works with different ages for example, a particular technique would work better with a 7 year old rather than as 15 year old. Look at different stores†¦show more content†¦A psychology experiment was done in the U.K. in 2006 by psychology professors Helga Dittmar from the University of Sussex, Suzanne Ive from the University of Sussex, and Emma Halliwell of the University of the West of England. Their findings from their experiment have been published in Developmental Psychology in 2006. Their study is also a part of the American Psychological Association her in the U.S. Their experiment is called â€Å"Does Barbie Make Girls Want to Be Thin? The Effect of Experimental Exposure to Images of Dolls on the Body Image of 5- to 8-Year-Old Girls.† In their experiment â€Å"a total of 162 girls, from ages 5 to age 8, were exposed to images of either Barbie Dolls, Emme dolls (U.S. size 16), or no dolls (baseline control) and then completed assessments of body image. The professors discovered that those exposed to Barbie doll images produced â€Å"lower self-esteem and a greater desire for a thinner body shape than in the other exposed conditions.† Although, the oldest girls did not have an immediate negative impact from the Barbie doll images. The study concluded that â€Å"these findings imply that, even if dolls cease to function as aspirational role models for older girls, early exposure to dolls epitomizing an unrealistically thin body ideal may damage girls’ body image, which would contribute to an increased risk of disordered eating and weight cycling.(Dittmar, Suzanne Ive, and Emma Halliwell. Does Barbie Make Girls Want to Be Thin?

Acute Care Nursing

Question: Describe about the Report for Acute Care Nursing. Answer: 1. Osteoporosis is mainly a disease of aged people and it occurred due to the more bone resorption as compared to the of bone formation. The central cause of occurrence of osteoporosis is deficiency of gonadal sex hormone like estrogen. Estrogen represses receptor activator of nuclear factor- B ligand (RANKL). RANKL is responsible for the osteoclast differentiation and survival, when it binds to the RANK on the cell surface of osteoclast cells. This RANKL is generally expressed on the osteoblast precursor cells and inflammatory cells like T B cells. Also, estrogen stimulates the expression of osteoprotegerin which binds to RANKL before it binds to RANK and prevent capability of RANKL to promote ostoclast formation and bone resorption and hence suppresses its ability to increase bone resorption. Deficiency of vitamin D and calcium also leads to the bone loss. In response to low calcium levels, parathyroid glands secret more amount of parathyroid hormone and this hormone promotes bone resorption by increasing more absorption of calcium in the blood to maintain optimum level of calcium in the blood. Trabecular bone are present at the end of long bones and vertebrae which plays role in bone turnover and due to the microcrack in the trabecular bone, it replaced by weaker bones (Raisz 2005; Drake et al., 2015). Open reduction and internal fixation (ORIF) is used correct as a bone break. In this open reduction means restoring fractured bone in the original position and internal fixation means steel rods, screw and plate are used to fix bone fracture. A total hip replacement (THR) is a surgical procedure used in osteoporosis in which deformed cartilage and bone of the hip joint is substituted with plastic, ceramic and metal. In THR there is more percentage of ambulation reported after discharge. In case of ORIF there is more morbidity, less compliance in terms of inhibited weight bearing and inferior outcome. In osteoporosis, due to bone loss there is the reduced possibility of plate fixation in case of ORIF. There were more number of patients already underwent ORIF, tried to move to THR (Boelch eta l., 2016; Archdeacon et al., 2013; Daurka et al., 2014) . 2. Hip replacement (THR)/arthroplasty surgery requires anesthesia for long duration. There is significant loss of blood during surgery of the patient. Reported loss of blood in THR patient is around 1500 ml with hemoglobin around 4.0 g. In Gianna also almost same amount of blood loss occurred. However there were confounding results available for the loss of blood in general and local anesthesia. Few studies showed there was no difference in the blood loss in general and local anaesthesia, on the other hand few studies showed there was more blood loss in general anaesthesia as compared to the local anaesthesia (Rozario et al., 2008; Durasek et al., 2010; Singh et al., 2012). Anaesthesia and THR leads to the hypotension in the patients undergoing surgery. Average blood pressure less than 95/50 was reported in THR surgery. In case of Gianna also blood pressure observed was 95/50. In case of THR, different studies gave different definitions for the hypotension. Hypotension considered in different studies for THR were fall in blood pressure more than 30 % systolic blood pressure, 33 % overall blood pressure, 40 mmHg and 20 % fall from the baseline (Bigler et al., 1985; Berggren et al., 1987; Davis et al., 1987). Even though, there was different criteria for hypotension in different studies, overall it has been observed that fall in blood pressure was more observed in regional anaesthesia as compared to the general anaesthesia (Couderc et al., 1977). It has been reported that blood transfusion in THR over the preoperative and postoperative period in case of regional anaesthesia was in the range of 230 to 260 ml. In case of Gianna, blood transfusion was 200 ml. In case of general and regional anaesthesia number of patients required transfusions were same however volume of transfusion required in the regional anaesthesia patients were higher as compared to the general anaesthesia patients (Valentin et al., 1986; Bredahl et al., 1991; Juelsgaard et al., 1998). Most of t he available data in case of blood transfusion was heterogeneous. There was less percentage of O2 in the blood of patients undergoing THR. In such scenario, administration of oxygen is necessary to prevent hypoxia. This condition occurred in almost 98 % patients. Oxygen saturation (SpO2) between 90 to 95%, considered optimum in case of THR surgery patients. This SpO2 correspond to the oxygen tension (Pao2) of 6080 mmHg. Oxygen saturation observed in case of Gianna was 93 %. This volume was in the adequate range considering age and THR surgery of Gianna. In earlier studies few patients were reported with Pao2 less than 60 mmHg (Couderc et al., 1977; McKenzie et al., 1984; Brown et al., 1994). Fall in the oxygen tension was reported to be different at different time points for general and local anaesthesia. There was more fall in oxygen tension in case of general anaesthesia as compared to the local anaesthesia at one hour after surgery, however there was no difference in the oxygen tension between general and local anaesthesia one day after completi on of surgery. However, in few studies there was no difference observed in oxygen and carbon dioxide tension between general and local anaesthesia. To prevent hypoxia, it has been suggested that oxygen with flow rate of 5 L/min is sufficient in case of THR patients (Rozario et al., 2008; Singh et al., 2012). However, in case of Gianna oxygen was supplied with the flow rate of 6 L/min. This volume was sufficient for Gianna. Orthopedic theaters used in the THR surgery are generally cooler than any other operation theaters with temperature is in the range of 18-20C and humidity more than 55 %. With the weakened temperature regulatory system in the THR patients and mentioned cool orthopedic theater, in case of patients undergoing THR surgery, there is rapid decrease in the body temperature of patients undergoing THR surgery (Akca et al., 2002; Moretti et al., 2009). There was very less literature available for recording of temperature, hence threshold temperature is not available. In case of Gianna, recorded temperature was 36oC which is less than the normal temperature. It was reported in the literature that there is no difference in the temperature due to the general and local anaesthesia. Effect of analgesics on the vital signs mainly depends on the baseline values of the vital signs of the individual patient. In this case of Gianna, most of the vital signs were abnormal and there was no worsening effect on vital signs by the use of analgesics (Sporer et al., 2006). 3. Dischrge plan for the Giana was prepared by a team of discharge planner, resident nurse and physician. Consent of the Giana and her family was taken for her diachrge. A case of Gianna Rossi, 79 years old, female, was admitted to emergency department after collapse. In X-ray it was revealed that Gianna has fracture in the hip due to osteoporosis. She stayed in the orthopedic ward for four days and her daily activities like eating and drinking are normal. She can walk using four-wheeled walker under supervision. Her pain can be managed with paracetamol and tramadol. Subjective : Gianna was concerned about her independence after her discharge. Objective : Giana and her family were seen packing their items. Giana received instruction from the physician and surgeon. All the payments of the hospital were done. Complete Patient Assessment (Chin-Jung et al., 2012; Al-Maqbali, 2014): Dischrge needs : Giana is doing her daily activities normally and walk on her own using four wheeled walker under supervision and gradually there is progress in this. Screening: Vital signs of Giana, those were became abnormal during and after surgery are now normal. Complaints: Giana doesnt have any complaint as such and her pain can be managed using paracetamol and tramadol. Physical screening: Giana was evaluated for getting in and out of her bed, walking with walker under observation and walking to the bathroom. All these assessments showed promising outcome. Prioritize patient needs (Advise to patient and family): Visit hospital after 2 weeks for clinical follow-up. Change dressing twice a day and dont disturb the stitches. Referred to experienced physiotherapist after two weeks because rehabilitation and physical therapy is essential. Do not take shower upto 6 days after surgery because incision and stitches may get wet and this can lead to infection. Do not allow anybody to touch incision without washing hands with antiseptic. Take paracetamol and tramadol, if she feels pain otherwise she can stop it. Call to the hospital in following situations: More redness or drainage at the incision area. If pain is not decreasing even after taking painkiller. If temperature is increasing. After the approval of discharge plan of Giana by physician and the surgeon, Giana was discharged to her home along with discharge planner, visiting nurse, physiotherapist and her family members. References: Akca, O., Sessler, D.I. (2002). Thermal management and blood loss during hip arthroplasty. Minerva Anestesiologica, 68, 1825. Al-Maqbali, M. A. (2014). Nursing intervention in discharge planning for elderly patients with hip fractures. International Journal of Orthopaedic and Trauma Nursing, 18(2), 6880. Archdeacon, M., Kazemi, N., Collinge, C., Budde, B., Schnell, S. (2013). Treatment of protrusio fractures of the acetabulum in patients 70 years and older. Journal of Orthopaedic Trauma, 27(5), 256261. Berggren, D., Gustafson, Y., Eriksson, B., Bucht, G., Hansson, L.H., Reiz, S., Winblad, B. (1987). Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesthesia and Analgesia, 66, 497-504. Bigler, D., Adelhoj, B., Petring, O.U., Pederson, N.O., Busch, P., Kalhke, P. (1985). Mental function and morbidity after acute hip surgery during spinal and general anaesthesia. Anaesthesia, 40, 672-6. Boelch, S.P., Jordan, M.C., Meffert, R.H., Jansen. H. (2016). Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. International Orthopaedics, Aug 10. [Epub ahead of print]. Bredahl, C., Hindsholm, K.B., Frandsen PC. (1991). Changes in body heat during hip fracture surgery: a comparison of spinal analgesia and general anaesthesia. Acta Anaesthesiologica Scandinavica, 35, 548-52. Brown, A.G., Visram, A.R, Jones, R.D.M., Irwins, M.G., Bacon-Shone, J. Preoperative and postoperative oxygen saturation in the elderly following spinal or general anaesthesia - an audit of current practice. Anaesthesia and Intensive Care , 22, 150-4. Couderc, E., Mauge, F., Duvaldestin, P., Desmonts, J.M. (1977). Comparative results of general and peridural anesthesia for hip surgery in the very old patient. Anesthesie, Analgesie, Reanimation. 34(5), 987-98. Chin-Jung, Lin., Shih-Jung, C., Shou-Chuan, S., Cheng-Hsin , C., Jin-Jin, T. (2012). Discharge Planning. International Journal of Gerontology, 6(4), 237240. Daurka, J., Pastides, P., Lewis, A., Rickman, M., Bircher, M. (2014). Acetabular fractures in patients aged 55 years: a systematic review of the literature. Bone Joint Journal , 96, 157163. Davis, F.M., Woolner, D.F., Frampton, C., Wilkinson, A., Grant, A., Harrison RT, et al. (1987). Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. British Journal of Anaesthesia, 59, 1080-8. Drake, M.T., Clarke, B.L. and Lewiecki, E.M. (2015). The Pathophysiology and Treatment of Osteoporosis. Clinical Therapeutics, 37(8), 1837-50. Durasek, J. (2010). Factors affecting blood loss in total knee arthroplasty patients. Acta Medica Croatica, 64, 20914. Juelsgaard, P., Sand, N.P.R., Felsby, S., Dalsgaard, J., Jakobsen, K.B., Brink, O., et al. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. European Journal of Anaesthesiology, 15(6), 656-63. McKenzie, P.J., Wishart, H.Y., Smith, G. (1984). Long-term outcome after repair of fractured neck of femur; comparison of subarachnoid and general anaesthesia. British Journal of Anaesthesia, 56, 581-4. Moretti, B., Larocca, A.M., Napoli, C., Martinelli, D., Paolillo, L., Cassano M, et al. (2009). Active warming systems to maintain perioperative normrothermia in hip replacement surgery: A therapeutic aid or a vector of infection? Journal of Hospital Infection, 73, 5863. Pesce, V., Speciale, D., Sammarco, G., Patella, S., Spinarelli, A., Patella, V. (2009). Surgical approach to bone healing in osteoporosis. Clinical Cases in mineral and bone metabolism, 6(2), 131135. Raisz, L. (2005). Pathogenesis of osteoporosis: concepts, conflicts, and prospects. Journal of Clinical Investigation, 115(12), 331825. Rozario, L., Sloper, D., Sheridan, M.J. (2008). Supplemental oxygen during moderate sedation and the occurance of clinically significant desaturation during endoscopic procedures. Gastroenterology Nursing, 31, 2815. Sporer, K.A., Tabas, J.A., Tam, R.K., Sellers, K.L., et al. (2006). Do medications affect vital signs in the prehospital treatment of acute decompensated heart failure? Prehospital Emergency Care, 10(1), 41-5. Singh, S., Singh, S. P., Agarwal, J. K. (2012). Anesthesia for bone replacement surgery. Journal of Anaesthesiology Clinical Pharmacology, 28(2), 154161. Valentin, N., Lomholt, B., Jensen, J.S., Hejgaard, N., Kreiner, S. (1986). Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. British Journal of Anaesthesia, 58, 284-91. Acute Care Nursing Questions: 1. Identify factors that determine which healthcare professionals are required to be involved in a health care team? 2. Who should lead the health care team? 3. Who is the most important member of the health care team? 4. What further questions will you need to ask the nurse? 5. List specifically what further assessments you would complete when the patient arrives onto the ward? 6. Clinical Reasoning: Learning to think like a nurse, Frenchs Forests, NSW: Pearson? 7. Using your knowledge and experience of various patient allocation models? Answers: 1. Factors to determine the involvement of health care professionals The health care professionals are involved to determine the care and needs of the service users. The needs vary from patient to patient like diagnosis, emotional, psychological and functional level of the patient (Okuyama, Wagner Bijnen, 2014). This also includes the social, functional status of the patient, treatment type and the preference of them. In addition, needs of care and multidisciplinary team involvement should be changed as per the progression of disease and the symptoms that are present. According to Lgar et al., (2014), the important part is the involvement of multidisciplinary team and information exchange through the communication. The multidisciplinary team members should have the ability of the proper communication so that the patients get proper treatment. All the expertise people should have the utilizing power of the clinical judgement. 2. Leader of the health care team The multidisciplinary team should be led by the case manager. In some cases the care coordinator manages the team (Grol et al., 2013). Each member has individual responsibilities to achieve their job goal. They have some common goals that they need to perform in collaboration (Al-Balushi et al., 2014). According to the fact sheet, the team leader needs to motivate other staffs so that there will fewer difficulties to achieve the goal (MND Australia 2013). He needs to maintain the healthy environment of the caring home. 3. Important member of the health care team Every member of the multidisciplinary team is important to give their best performance and achieve the best outcome. The treatment procedure should be effective and the focus should be given to the patient only. The patient should get efficient and effective treatment. The team members should provide the central focus and care to the patient. They should communicate properly and collaboratively. Salminen et al., (2014) mention that all he member of multidisciplinary team should respect each other and participate in the decision making for the wellbeing of the patient. They need to communicate with the patient on regular basis and make rapport of the patient assessment. The responsibilities of different doctors and staffs are different. For example, the role of Psychologist is different from the physiotherapist. Key issues: Leg injuries and mild head injury due to motor vehicle accident. Admitted for six months Suffering from depression Need long term rehabilitation Health care team involved in treatment Physiotherapist helps to assess and manage the mobility Psychologist helps to stable the mental condition and bring back to normal life Social worker supports patient and his family members to adapt the situation and return to the normal lifestyle The occupational therapist helps Grant Thompson to improve the skills and day to day activities. As the team leader, the treating doctor should take the concern of the patient and the family members of the patient to know their opinion. Rehabilitation unit will help to motivate the treatment procedure of Grant Thompson. They will help to speed up the recovery of Grant Thompson so that he can return to his normal lifestyle as soon as possible. 4. The medication time and the procedure of medication If the patient has any allergic problem or any kind of irritation from a particular food The type of injury and time period of admission The function of drugs and injection, which the nurse does not know 5. List of the necessary and specific patient assessment The nurse should go through the patient history very carefully and examine the patient. The nurse needs to identify that if the patient is able to bear with the treatment procedure. Therefore she must modify the procedure according to the patient needs. The nurse needs to spend more time with the patient to know more details about him and make rapport. The nurse should know about the presence of the systemic diseases, previous hospitalization, allergies, past anaesthetic events, drug or alcohol use, medication and family history. The nurse should discuss the test reports with the patient as the patient has the right to know about the reports (Alomar, 2014). The patient also should not hide anything from the nurse and provide all information to the nurse. Moreover, the nurse needs to know about the psychological, spiritual, physiological and sociological status of the patient. 6. Levett- Jones Clinical Reasoning Cycle Consider the patient situation What current information do you have on this pt.? What new information have you gathered? 37years old male patient faced MVA before six months Pt. is recovering day by day Pt. is depressed Collect Cues/Information What further cues and information would be useful? Why? Pt is a truck driver and faced accident before six months. Recovery time is slow and relies on the wheelchair. However, he can walk for short distance with the help of walker. Process Information What changes do you notice in the cues and information provided? Which changesare significant for this patientand why? What do you think these changes could indicate and why? What could be the outcome of these changes? The health condition of the patient is improving since the last six months. The significant changes are that the patient can walk to cover short distance. The patient is gradually depressed as he is the only earning member in the family and he is hospitalised. The patient needs rehabilitation. The patient got depressed. Establish Goals Describe what you want to happen. Who do you want to be involved and what do you want them to do? In what timeframe? The nurse needs to involve herself in the treatment of the patient so that he can recover soon by following the guidelines and can collaborate with multidisciplinary team. Take Action What nursing actions will you take? What will be your nursing priorities? The nurse needs to consult with the doctor and help the patient in medication and walking. Evaluate Outcomes What do you expect to achieve from the actions have taken? The nurse then needs to take proper action to reduce the problem and needs to observe the patient, if any noticeable changes like improvement or decline happen (Matziou et al., 2014). Reflect on Process and new learning What have you learnt from this exercise? The nurse can learn various things from these evaluated outcomes, which she needs to understand and learn. This clinical reasoning cycle will help the nurse to develop her skills. 7. There are one RN, one EN and three AIN in the ward with me and we work in the afternoon shift. There are total twenty two patients, in which 14 need post operative treatment and 8 need pre operative treatment. To ensure the skills, techniques, experience and knowledge the total patient care model is chosen to discuss the module. Patient allocation model: Total patient care The registered nurse is allocated for the total patient are as she has the registered licence of total patient care. Delany and Golding (2014) mentioned registered nurse as the primary nurse. Two AINs are also appointed with the RN for the help. The RN has various responsibilities to perform like medication, administration and dressing changes. The patient who went for the surgery in morning, are very sensitive. Therefore, they needs to be handled with sensitivity and deserves more caring. The necessary needs of the surgical patients are dressing of the wounded place, provide proper medication and injection. According to Urden, Stacy and Lough (2015), as the type of surgery is different for various patients, therefore the nurses need to provide different care to different patients. The room should be cleaned and well ventilated for the post operative patients. Team nursing A team of three people of RN, EN and AIN is formed for the acute caring of the pre operative patients, who needs to know about the all circumstances of the operation. They will explain the patients about the risks and curing chances of the patients. They need to give proper medication to the patient. The RN should lead the team but as she is busy with the post operative patients therefore, the EN should lead the team and guide the AIN. The team is responsible to handle all the eight patients who are going for the surgery. The team needs to work in collaboration and no one should be ignored (Delany Golding 2014). All the members of the team should input their skills and also can learn new knowledge from the patients. Task allocation There are one RN, one EN and three AIN in the ward with me and we work in the afternoon shift. There are total twenty two patients, in which 14 need post operative treatment and 8 need pre operative treatment. Due to the huge patient load of the pre and post operative patient two teams are made, which include one registered nurse, one enrolled nurse and one AIN. In the other team, there are one RN and two AIN that will handle the pre operative patient. As the AINs do not have the licence of giving antibiotics and performing intravenous access, therefore I and the other RN will handle this. Both the AIN will do the other formalities in case of pre operative patients like filling up the formalities and dress up. In case of post operative patients, the EN will help the other RN that is responsible for the medication and injection and the AIN will take care of dress up and controlling infection. References Al-Balushi, S., Sohal, A. S., Singh, P. J., Al Hajri, A., Al Farsi, Y. M., Al Abri, R. (2014). Readiness factors for lean implementation in healthcare settingsa literature review.Journal of health organization and management,28(2), 135-153. Grol, R., Wensing, M., Eccles, M., Davis, D. (Eds.). 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