Malnutrition in Older Hospitalised Patients

Malnutrition in Older Hospitalised Patients Malnutrition has significantly increased in the ageing population resulting in a major health problem in the United Kingdom and is a cause and consequence of ill health. This essay will seek to critique three research papers based on Malnutrition in older hospitalised patient. It will include evaluation of strengths, limitations of the research and a reflection on how the researched was undertaken. Evidence has shown that malnutrition cost the National Health Service around thirteen billons a year resulting in one of the highest spend in health care (British Association for Parenteral and Enteral Nutrition, 2009).Dunne (2009) also states that one in five people ranging from 65 and over will be affected by malnutrition by the year 2020. Malnutrition is therefore â€Å"a state in which a deficiency of nutrients such as energy, protein, vitamins, and mineral causes measurable adverse effects on body composition function or clinical outcome† (National Institute for health and Clinical Excellence, 2006). In light of the information above, this had stimulated an interest to conduct a research to analyse what is being done and what can be done to reduce the prevalence of malnutrition in older patient. Whilst out in placement, I witness nutrition fell low on the list of nursing priorities of care, not by choice but nurses have so many tasks to complete in a given day. I observe both nurses and health care assistant struggled to cope during meal times and expressed their frustration on the subject on few occasion. Also looking at it from a professional stand point, malnutrition can affect every system in the body leading patients to become vulnerable to illness. This can lead to complication and in the worst case death, it also increases patient’s length of stay in hospital and readmission of patients to hospital. It is vital that information that is used to address malnutrition is extracted from evidence based sources as this aims to provide care in a suitable and efficient way to patient (Craig Smyth, 2007). I used critical appraisal skills programme to analyse my research paper as this model helped me to ascertain the relevance and importance a particular research topic relates to practice as well as conduct a systematic review of the article .It assess whether the three research paper was worth reading and helped me to make sense of the qualitative information (Cutcliffe Ward, 2007). I obtained my three research paper by using search engine such as CINAHL, INTERNURSE and PUBMED. I searched CINAHL (2007 to 2013), INTERNURSE (2005 to 2013) and PUBMED (2007 to 2013) for articles published in English. The search strategy will be explained in details in the reflection section part of the essay and will be demonstrated in Table 1 and Table 2. Table three comprises of the three research which can be found in the appendix. Reflection is seen as an important aspect of nursing, as it improves the quality of care we give to patient as well as it can enhance practice and greater competence. Ghaye, Gillespie and Lillyman (2000) point out that, reflection is a central part of experiential learning and the improvement of practical knowledge. I have chosen to use Rolfe et al model over John’s model because it gave me a better understanding in comparison with John model. It consists of three simple questions which are what, so what and now what. This helped me to organise my thought process. In the next sections of the essay two tables will be shown to depict my search strategy along with the critical appraisal of the three research paper. SEARCH STRATEGY Table 1. Inclusion and exclusion criteria Table 2. Identifying and selecting relevant articles The first research paper was written by Angela Dickinson, Carol Welch, Laurie Ager, entitled No longer hungry in hospital: Improving the hospital mealtime experience for older people through action research, published in the year 2007. The title reflected the content of the research and was clear, specific and concise. It seeks to draw the reader attention to the exact area of study conducted. Marshall (2005) states that a research article should accurately and succinctly reflect the content of the work allowing the reader to be stimulated by the content. This is important as a title that is long and ambiguous can lead to misunderstanding and somewhat misleading. The abstract was excellent, in that it was succinct, containing no jargon and clearly written in a coherent manner that gave a satisfactory overview of the study. It was able to stand on its own as it includes brief summary of the Aims and objectives of the research, the background surrounding the study, the methods used, results collated, the conclusion and the relevance to clinical practice. Paratoo, (2006) points out that the information provided in an abstracts should aids readers to decide whether to obtain the entire article or not. Although evidence shown that ethical approval was granted, no mention of consent of the subjects taken part in the research as in accordance with the Nursing and midwifery council code of professional conduct (2008) which states that consent should be obtained before undertaking any task. Also the authors stipulated that they were unaware of other studies available that addresses meal time care in the way they have carried out the research. A more thorough search could have been conducted to rule out this assumption as this research paper might just be adding to knowledge and understanding already available or it could have been compared and contrasted to better understand the issue or to establish new truths The second research paper was written by Heaven, B, Bamford, C, May, C and Moynihan P entitled Food work and feeding assistance on hospital ward and published in the year 2012. The Authors gave a timely overview into the prevalence of malnutrition in the introduction extracted from reputable sources and demonstrate a good critiquing ability by identifying a gap in a previous related study of which they concluded that little is recounted on the practicalities of the provision of food in hospital and how feeding assistance is seen alongside other nursing priorities which lead them to justified their rationale for undertaking the research. Wigen (2003) states that an introduction should illuminate the rational for the research and highlight any previous research that was conducted on the similar topic. The Authors used a qualitative paradigm research that made it straight forward to follow and was applicable for the intended research. Methods such as interview and focus group was utilised to investigate malnutrition in older hospitalised patient. They provide evidences illustrating that interviews, allowed them to get close to their subject to glean information and to clarify questions that were not fully understand. The focus group they find helped them create an atmosphere where discussion and brain storming can occur to establish the problems surrounding malnutrition in older hospitalised patient and finding measures that can help to resolve the problem. Ellis (2010) suggests that the relationship between the researcher and the researched is part of the research process and is essential to gain the insider perspective that qualitative research seeks to pursue. In addition qualitative research is more suited for nursing as it can focus more on the care a patient receive as well a s their experiences (Jolley , 2010). The author took ethical issues into consideration as appropriate measures were put in place to obtain consent and prevent physical harm, hunger, discomfort or psychological suffering by not carrying out observation on feeding assistance. Ellis, 2010 highlights that ethics should saturate all that nurses do in the delivery of health and social care. However the implication of using method such as interviews can sometimes be hard to replicate as people tend to give their views, attitude, ideals ,pre-existing ideas and their beliefs which does not necessary explains the point to why malnutrition does occur (Ellis, 2010). In addition, they can be take up vast amount of time and can be expensive (Jolley, 2010). The third research paper was written by Vanderwee, K, Clays, E, Bocquaert, I, Verhaeghe, S, Lardennois, M, Gobert, M and Defloor, T, entitled Malnutrition and Nutrition care practices in hospital wards for older people, published in the year 2010. This research was conducted in a hospital ward for older people in Belgium. Although the research was not conducted in the UK, this paper gave insights that suggest that malnutrition in older hospitalised patient is not only a reoccurring problem in the UK but a wide spread problem. The sample selection process was adequately described, stating the intended process of the research by using precision in information provided such as, the time period the research was carried out, the age restriction of patient involved in the research process. Consent was also obtained and adhered as specified by the Department of health (2009) which states that consent must be given unless stated or proven otherwise that they do not have the mental capacity to do so. The authors did an exceptional job in the discussion by highlighting information that was already known about the topic extracted from a wide range of credible evidence based sources that support the importance of nutrition. It contains the findings of the research which identify a balance argument into the meaning of the result and provide recommendation that was developed from the finding. Lastly, it highlights some thought-provoking lines of enquiry for future studies to be undertaken to tackle the problem and to extend knowledge of malnutrition in older hospitalised patient. . The limitation of this study indicates that the authors use a cross sectional study where all information of nutrition status and nutritional care practices of the ward was collated at the same time. Hence, no casual connection could be identified and patients and health care professionals could not express their views on malnutrition, leading to results that could not be quantified. (ref give reason as to why quantitative study)The author or researcher could have carried out a longitudinal study to research and analyse the impact that malnutrition has on older hospitalised patient .Ref (back up the benefits of longitudinal study) . Collectively, these three research paper provide concrete evidence on the prevalence of Malnutrition and the dire consequent it has on the aging population and Health Service. They mention the benefits that can be derived from the prevention of malnutrition and practical steps that need to put in place to help tack malnutrition extracted from NICE guidelines (2006). A general consensus among the authors of the respective paper that for true progress to be achieve in preventing malnutrition all health professional needs to understands the pervasiveness of malnutrition in hospital and the effect patient nutrition care may have on whole clinical outcome. Lastly they conclude that nutrition intervention greatly improved clinical outcome and reduce cost of care, predominantly in patient 65 years of age and above and challenge health care professional to address the barriers and change the paradigm of nutrition care. However, authors from one of the research paper went as far as to say that health professional have often failed to prioritise understanding the enormity of malnutrition in their respective hospital and the impact on cost and quality of care and was backed up by the Bapen ,2009 ) that states that nurses are at time removes from the task of assisting patient at meal time and has been delegated to less qualified staff which further strengthen the notion that mealtime care is unskilled and not important. My first challenge in conducting a research was to identify a topic or area of interest. This was obtained by looking at websites such as Royal College of Nursing, talking with my lecturers, students and staffs on placement as well as reflecting on issues that I was personally interested in. After Collating all the information, I sift through interests, experiences and ideas that had been discussed eventually leading me to conduct a research on Malnutrition and consolidated by the use of the Rolfe et al reflective model. I undertake my research by using a selection of different sources such as Cinahl, internurse, PubMed, Cochrane library but instantaneously found out using these data base on their own can produce a wide variety of information. The search strategies was very instrumental as it helped me to effectively narrow my search down to a manageable number and furthermore it was less time consuming .The search strategy includes Boolean operator, key words that encapsulate malnutrition , peer reviewed and limiters of inclusion and exclusion outline in table 1 and table 2 . For example, when I type malnutrition into Cinahl without using the search strategy I obtained an exhaustive result of 6461. I did another search this time with a more specific aim and objective of a topic and the usage of the different search strategy which includes peer reviewed article , date restrictions (2007- 2013) which eliminate old article , key words (malnutrition and nutrition, hospital and older people) this refined my search down to 11 papers. My aim is to obtained three paper for my research ,so I read through the abstract eliminating paper that had no relevance to my chosen topic . I also found that the Abstract was a good indicator to identify relevant keywords to help with my search. I was now short of one paper so I check the Cochrane library which did not produce any relevant article followed by PubMed which produced 112389 at first. I included my search strategy using key words such as malnutrition, older people, hospital, feeding and a time period of 5 years, this further reduced my number down to 10 hits .I also examine the abstract with a critical eye and scan through literature to find the appropriate research articles. Although I did not use wild card and truncation I know the importance of their uses and I am quite positive they will come in handy in the future. Part of the aim of this assignment was to gain information and understanding of malnutrition in older hospitalised patient by examining the evidence that is already available and seek to find new knowledge on what can be done to reduce malnutrition among the target group. This has put me in good stead as I have gain tremendous amount of insight into the evidence I found from the three research article as well information glean from books and journals that can be applied into practice. For example It was interesting to read nutrition now 2007, who took on a proactive approach in dealing with malnutrition by educating all members of the multidisplinary team to better understand the primacy of good nutritional care and the pivotal role they play in providing it and also implementing ways to work effectively as a team to eliminate the problem of malnutrition. Age concern (2006) also implemented seven steps to end the scandal of malnutrition in hospital, evidence was also shown how variou s hospital took on the initiative, saw a significant improvement in their quest to reduce malnutrition in their hospitals. The ultimate key is to systematically recognise patients who are malnourished or at risk and quickly intervene (Dunne, 2009) The implication of the research papers showed that although research had been carried out and the accessibility of validated screening tools malnutrition still continues to go unnoticed and untreated in many older hospitalised patients (Bapen, 2009). As a student nurse it is important that refection is part of my daily routine as this can enhance my effectiveness as an individual that enhances the quality of care I give to patient. I identify that malnutrition is every one responsibility and requires the collaboration of a multidisplinary team to leverage success in tackling malnutrition and that preventing malnutrition is a pivotal role in my nursing practice Undertaking this assignment I was able to identify my shortfall and limitation and has taught me effectively ways to conduct a search and access academically evidence based resources. This illustrated to me the importance of not taking information at face value but adhering to the correct procedure to obtain articles and examining articles with a critical and analytical mind to decide the credibility of the article. As the profession Nursing, cannot agree to any research at face value and need to be able to ascertain strengths and limitations of the research when evaluating the information available on the research topic (Ryan et al 2007). Conclusion To above information has demonstrated APPENDIX Table 3 Research studies critically appraised REFERENCES

Stoics :: essays research papers

Stoicism was a group of philosophers in the First Century who made laws that they thought should be followed by the citizens of Rome. Two of these laws were the concepts of rationality and nature. Marcus Aurelius was the Emperor of Rome at the time and he also the most known Stoic. His concepts were vital to the survival of the Stoics.   Ã‚  Ã‚  Ã‚  Ã‚  The concept of rationality is what tells a human being what’s right and wrong and what should be done and what is good for the human and the state by thinking. â€Å"the reason also, in respect which we are rational beings, is common: if this is so, common also is the reason which commands us what to do, and what not to do; if this is so, there is a common law also; if this is so, we are fellow citizens; if this is so, we are members of some political community; if this is so, the world is in manner of a state.†(1) Marcus Aurelius says here that the citizens who are ration beings as a part of the whole political spectrum, should combine to make he world one state. He wants the world to join as one state and governed by one, the people are all part of the same political system, so they should join together.   Ã‚  Ã‚  Ã‚  Ã‚  In his Meditations Aurelius talks about every action having a purpose. â€Å"Let no act be done without a purpose, nor otherwise than according to the perfect principles of art.†(2) He says here that the reason we have is because everything we do has a purpose. The purposes are there because they are the unwritten rules of art. These rules are abided because they just happen. The art sets its own rules through the purposes of the acts that are done. No act should be done if it does not follow the rules of art. Yet, the rules of are made by the act’s purposes. This meaning everything has a reason why it is done and the purposes are legitimate.   Ã‚  Ã‚  Ã‚  Ã‚  A man’s life does not become worse unless he makes it worse. â€Å"That which does not make his life worse, nor does it harm him either from without or with in.†(3) In this quote, Aurileus tells the Stoics that the things that don’t harm him won’t make his life worse inside or outside including the soul. This meaning that a person should do what they feel is right, because it will not hurt them physically or mentally.

The Life and History of Craig Kielburger

Craig Kielburger is best known for being a famous Canadian activist for the rights of children. Kielburger is the founder of â€Å"Free the Children† and co-founder of â€Å"Me to We†. In 1995, Kielburger was twelve years old at the time when he saw a headline in the Toronto Star that read â€Å"Battled Child Labour, Boy, 12, Murdered. † The story was about a young Pakistani boy who was forced into bonded labour in a carpet factory at the age of four, and became an international figurehead for the fight against child labour by the age of twelve, but was brutally murdered in 1995.After Craig read this article, he began to research child labour, showed this particular article to his classmates and formed a group called â€Å"Twelve-Twelve-Year-Olds† which formed to â€Å"Free the Children†. This organization become international with 45 participating countries to help the world become a better place. In today's society, Craig's point of view can be im plemented by following in his footsteps to help and try making the world a better place and continuing to support his success with the organization he created, and realizing that you can make a difference if you believe in the fight that you want to stand up for.Craig Kielburger would be considered a pro-natalist point of view because in order to make a difference in the world, you need a lot of help to make the change and it starts by going small and growing big like Kielburger did with Free the Children. The more people that are involved, the greater the chances will be to make the change in society.Personally, I think that Kielburger’s idea with free the children can help solve the problem with this issue of child labour because he is trying to send the message out that child labour is wrong and no child show be forced to work and that children should be allowed to be children by playing, learning, and having fun. By Craig Kielburger and everyone that is in the organizatio n are making a difference in society for the children and hopefully murdering of children decreases as well as decreasing child labour in the whole world overall.

Guilt and Innocence in The Last Night of the World

Guilt and Innocence in 'The Last Night of the World' In Ray Bradburys The Last Night of the World, a husband and wife realize that they and all the adults they know have been having identical dreams: that tonight will be the last night of the world. They find themselves surprisingly calm as they discuss why the world is ending, how they feel about it, and what they should do with their remaining time. The story was originally published in Esquire magazine in 1951 and is available for free on Esquires website. Acceptance The story takes place in the early years of the Cold War and in the first months of the Korean War, in a climate of fear over ominous new threats like the hydrogen or atom bomb and germ warfare. So our characters are surprised to find that their end wont be as dramatic or violent as they have always expected. Rather, it will be more like the closing of a book, and things [will] stop here on Earth. Once the characters stop thinking about how the Earth will end, a sense of calm acceptance overtakes them. Though the husband concedes that the end sometimes frightens him, he also notes that sometimes he is more peaceful than frightened. His wife, too, notes that [y]ou dont get too excited when things are logical. Other people seem to be reacting the same way. For instance, the husband reports that when he informed his co-worker, Stan, that they had had the same dream, Stan didnt seem surprised. He relaxed, in fact. The calmness seems to come, in part, from a conviction that the outcome is inevitable. There is no use struggling against something that cant be changed. But it also comes from an awareness that no one will be exempted. Theyve all had the dream, they all know its true, and theyre all in this together. Like Always The story touches briefly on some of humanitys bellicose propensities, like the bombs and germ warfare mentioned above and the bombers on their course both ways across the ocean tonight thatll never see land again. The characters consider these weapons in an effort to answer the question, Do we deserve this? The husband reasons, We havent been too bad, have we? But the wife responds: No, nor enormously good. I suppose thats the trouble. We havent been very much of anything except us, while a big part of the world was busy being lots of quite awful things. Her comments seem particularly trenchant given that the story was written less than six years after the end of World War II. At a time when people were still reeling from the war and wondering if there was more they could have done, her words could be construed, in part, as a comment on concentration camps and other atrocities of the war. But the story makes clear that the end of the world isnt about guilt or innocence, deserving or not deserving. As the husband explains, things just didnt work out. Even when the wife says, Nothing else but this could have happened from the way weve lived, theres no feeling of regret or guilt. Theres no sense that people could have behaved any way other than the way they have. And in fact, the wifes turning off the faucet at the end of the story shows exactly how hard it is to change behavior. If youre someone looking for absolution which it seems reasonable to imagine our characters are the idea that things just didnt work out might be comforting. But if youre someone who believes in free will and personal responsibility, you might be troubled by the message here. The husband and wife take comfort in the fact that they and everyone else will spend their last evening more or less like any other evening. In other words, like always. The wife even says thats something to be proud of, and the husband concludes that behaving like always shows [w]ere not all bad. The things the husband will miss are his family and everyday pleasures like a glass of cool water. That is, his immediate world is whats important to him, and in his immediate world, he hasnt been too bad. To behave like always is to continue to take pleasure in that immediate world, and like everyone else, thats how they choose to spend their final night. There is some beauty in that, but ironically, behaving like always is also exactly what has kept humanity from being enormously good.

HMS Nelson in World War II

HMS Nelson in World War II HMS Nelson (pennant number 28) was a Nelson-class battleship that entered service with the Royal Navy in 1927. One of two ships of its class, Nelsons design was a result of the limitations imposed by the Washington Naval Treaty. This resulted in the entirety of its main armament of 16-inch guns mounted forward of the battleships superstructure. During World War II, Nelson saw extensive service in the Atlantic and Mediterranean as well as aided in supporting troops ashore after D-Day. The battleships final wartime service occurred in the Indian Ocean where it aided the Allied advance across Southeast Asia. Origins HMS Nelson  can trace its origins to the days after World War I. Following the conflict  the Royal Navy began designing its future classes of warships with the lessons learned during the war in mind. Having taken losses among its battlecruiser forces at  Jutland, efforts were made to emphasize firepower and improved armor over speed. Pushing forward, planners created the new G3 battlecruiser design which would mount 16 guns and have top speed of 32 knots. These would be joined by the N3 battleships carrying 18 guns and capable of 23 knots. Both designs were intended to compete with warships being planned by the United States and Japan. With the specter of a new naval arms race looming, leaders gathered in late 1921 and produced the  Washington Naval Treaty. The worlds first modern disarmament agreement, the treaty limited fleet size by establishing a tonnage ratio between Great Britain, the United States, Japan, France, and Italy. Additionally, it restricted future battleships to 35,000 tons and 16 guns. Given the need to defend a far flung empire, the Royal Navy successfully negotiated the tonnage limit to exclude weight from fuel and boiler feed water. Despite this, the four planned G3 battlecruisers and four N3 battleships still exceeded the treaty limitations and the the designs were cancelled. A similar fate befell the U.S. Navys  Lexington-class battlecruisers and  South Dakota-class battleships. Design In an effort to create a new battleship that met the required criteria, British planners settled on a radical design which placed all of the ships main guns forward of the superstructure. Mounting three triple turrets, the new design saw A and X turrets mounted on the main deck, while B turret was in a raised (superfiring) position between them. This approach aided in reducing displacement as it limited the area of the ship requiring heavy armor. While a novel approach, A and B turrets often caused damage to equipment on the weather deck when firing forward and X turret routinely shattered the windows on the bridge when firing too far abaft. HMS Nelson in the years before World War II. Public Domain Drawing from the G3 design, the new types secondary guns were clustered aft. Unlike every British battleship since HMS Dreadnought (1906), the new class did not possess four propellers and instead employed only two. These were powered by eight Yarrow boilers generating around 45,000 shaft horsepower. The use of two propellers and a smaller power plant was done in an effort to save weight. As a result, there were worries that the new class would sacrifice speed. To compensate, the Admiralty utilized an extremely hydrodynamically efficient hull form to maximize the vessels speed.  In a further attempt to reduce displacement, an all or nothing approach to armor was used with areas either being heavily protected or not protected at all.  This method had been utilized earlier on the five classes that comprised the US Navys Standard-type battleships (Nevada-,  Pennsylvania-,  New Mexico-,  Tennessee-, and Colorado-classes). Those protected sections of the ship utilized an internal, inclined armor belt to increase the relative width of the belt to a striking projectile. Mounted aft, the ships tall superstructure was triangular in plan and largely built of lightweight materials. Construction and Early Career The lead ship of this new class, HMS Nelson, was laid down at Armstrong-Whitworth in Newcastle on December 28, 1922. Named for the hero of Trafalgar, Vice Admiral Lord Horatio Nelson, the ship was launched September 3, 1925. The ship was completed over the next two years and joined the fleet on August 15, 1927. It was joined by its sister ship, HMS Rodney in November. Made flagship of the Home Fleet, Nelson largely served in British waters. In 1931, the ships crew took part in the Invergordon Mutiny. The following year saw Nelsons anti-aircraft armament upgraded. In January 1934, the ship struck Hamiltons Reef, outside Portsmouth while en route to maneuvers in the West Indies. As the 1930s passed, Nelson was further modified as its fire control systems were improved, additional armor installed, and more anti-aircraft guns mounted aboard. HMS Nelson (28) Overview:Nation: Great BritainType: BattleshipShipyard: Armstrong-Whitworth, NewcastleLaid Down: December 28, 1922Launched: September 3, 1925Commissioned: August 15, 1927Fate: Scrapped, March 1949Specifications:Displacement: 34,490 tonsLength: 710 ft.Beam: 106 ft.Draft: 33 ft.Speed: 23.5 knotsComplement: 1,361 menArmament:Guns (1945)9 Ãâ€" BL 16-in. Mk I guns (3 Ãâ€" 3)12 Ãâ€" BL 6 in. Mk XXII guns (6 Ãâ€" 2)6 Ãâ€" QF 4.7 in. anti-aircraft guns (6 Ãâ€" 1)48 Ãâ€" QF 2-pdr AA (6 octuple mounts)16 Ãâ€" 40 mm anti-aircraft guns (4 Ãâ€" 4)61 Ãâ€" 20 mm anti-aircraft guns World War II Arrives When World War II began in September 1939, Nelson was at Scapa Flow with the Home Fleet. Later that month, Nelson was attacked by German bombers while escorting the damaged submarine HMS Spearfish back to port. The following month, Nelson and Rodney put to sea to intercept the German battlecruiser Gneisenau but were unsuccessful. Following the loss of HMS Royal Oak to a German U-boat at Scapa Flow, both Nelson-class battleships were re-based to Loch Ewe in Scotland. On December 4, while entering Loch Ewe, Nelson struck a magnetic mine that had been laid by U-31. Causing extensive damage and flooding, the explosion forced the ship to be taken to the yard for repairs. Nelson was not available for service until August 1940. While in the yard, Nelson received several upgrades including the addition of a Type 284 radar. After supporting Operation Claymore in Norway on March 2, 1941, the ship began protecting convoys during the Battle of the Atlantic. In June, Nelson was assigned to Force H and began operating from Gibraltar. Serving in the Mediterranean, it aided in protecting Allied convoys. On September 27, 1941, Nelson was hit by an Italian torpedo during an air attack forcing it to return to Britain for repairs. Completed in May 1942, it rejoined Force H as flagship three months later. In this role it supported efforts to resupply Malta. Amphibious Support As American forces began to gather in the region, Nelson provided support for the Operation Torch landings in November 1942. Remaining in the Mediterranean as part of Force H, it aided in blocking supplies from reaching Axis troops in North Africa. With the successful conclusion of fighting in Tunisia, Nelson joined other Allied naval vessels in aiding the invasion of Sicily in July 1943. This was followed by providing naval gunfire support for the Allied landings at Salerno, Italy in early September. HMS Nelson at Mers-el-Kebir during Operation Torch, 1942. Public Domain On September 28, General Dwight D. Eisenhower met with Italian Field Marshal Pietro Badoglio aboard Nelson while the ship was anchored at Malta. During this time, the leaders signed a detailed version of Italys armistice with the Allies. With the end of major naval operations in the Mediterranean, Nelson received orders to return home for an overhaul. This saw a further enhancement of its anti-aircraft defenses. Rejoining the fleet, Nelson was initially held in reserve during the D-Day landings. Ordered forward, it arrived off Gold Beach on June 11, 1944, and began providing naval gunfire support to British troops ashore. Remaining on station for a week, Nelson fired around 1,000 16 shells at German targets. Departing for Portsmouth on June 18, the battleship detonated two mines while en route. While one exploded approximately fifty yards to starboard, the other detonated beneath the forward hull causing considerable damage. Though the forward part of the ship experienced flooding, Nelson was able to limp into port. Final Service After assessing the damage, the Royal Navy elected to send Nelson to the Philadelphia Naval Yard for repairs. Joining westbound convoy UC 27 on June 23, it arrived in the Delaware Bay on July 4. Entering dry dock, work began to repair the damage caused by the mines. While there, the Royal Navy determined that Nelsons next assignment would be to the Indian Ocean. As a result, an extensive refit was conducted which saw the ventilation system improved, new radar systems installed, and additional anti-aircraft guns mounted. Leaving Philadelphia in January 1945, Nelson returned to Britain in preparation for deployment to the Far East. HMS Nelson (left) with HMS Rodney, undated. Public Domain Joining the British Eastern Fleet at Trincomalee, Ceylon, Nelson became the flagship of Vice Admiral W.T.C. Walkers Force 63. Over the next three months, the battleship operated off the Malayan Peninsula. During this time, Force 63 conducted air attacks and shore bombardments against Japanese positions in the region. With the Japanese surrender, Nelson sailed for George Town, Penang (Malaysia). Arriving, Rear Admiral Uozomi came aboard to surrender his forces. Moving south, Nelson entered Singapore Harbor on September 10 becoming the first British battleship to arrive there since the islands fall in 1942. Returning to Britain in November, Nelson served as flagship of the Home Fleet until being moved into a training role the following July. Placed in reserve status in September 1947, the battleship later served as a bombing target in the Firth of Forth. In March 1948, Nelson was sold for scrapping. Arriving at Inverkeithing the following year, the scrapping process began

Electronic Medical Record Article Example | Topics and Well Written Essays - 250 words

Electronic Medical Record - Article Example (Himmelstein, Wright, & Woolhandler, 2009; Hoffman, 2009) Without proper standardized treatment of the electronic material, particularly print outs, which are produced by the EMR software systems such as NextGen, implementation of this technology appears to be highly complex and even unrealistic to some extent. Certain experts and clinicians have identified some key challenges with EMR. Many clinicians criticize that EMR set the limits of the scope of interaction/dialog between doctor and patient. The system of inducting readymade templates and hectic custom template making processes time and again prove to be insufficient for recording the different types of patients’ complaints. Moreover, if there are no standard set rules for at least the basic construct of an EMR system, state-wise adaptability within the American federal system will be hampered since programmers will not be able to decide which templates and feedback mechanisms must be changed from one state to another (Greenhalgh et al, 2009). Hence, the international bodies s uch as EU are trying to implement standards to the EMR systems so that the hard copies of patient records can be used for legal and insurance purposes as well. Without preset and uniform standards, goals such as establishing national level networks of healthcare services and systems cannot be achieved (Hoffman, 2009). â€Å"In a move to streamline medical records, Medicare officials have detailed plans to standardize medical files so they can be stored and delivered in comprehensive electronic files. Announced by the Centers for Medicare & Medicaid Services (CMS), the proposed standards are aimed at helping release $19 billion in federal stimulus funds. The standards are expected to be developed over a period of several months.† Hence, the delay and difference of opinions regarding EMR implementation cannot be solved without uniformity of at least the presentation tools related to an EMR software program. Next, if

Importance of an entrepreneurial leader Assignment

Importance of an entrepreneurial leader - Assignment Example Entrepreneurial leaders have the drive to be successful and their flexibility leads to adaptability. Entrepreneurial leaders are result-oriented and have high levels of enthusiasm that ensures full commitment to the goals and objectives of the organization. The role of an entrepreneurial leader is different from other leader roles since they are take personal responsibility of the growth of the organization. Their roles are different from other leader roles since they continuously search for new opportunities that will lead to innovative products and ideas rather than ensuring the success of the already established products and ideas. The entrepreneurial leader will assemble and coordinate resources towards attainment of organizational goals and will take personal responsibility for the failures of the team and utilize such challenges in ensuring the organization attains its objective. Unlike other leader roles, an entrepreneurial leader plays the role of a risk-taker through investi ng in new and innovative ideas that will enhance the growth potential of the organization. An entrepreneurial leader role is different from other leaders since an entrepreneur is a change catalyst and champions creative. An entrepreneurial leader is important in an organization since he continuously searches for new opportunities and ensures creativity that ultimately leads to new and innovative products and ideas. The entrepreneurial leader roles are different from other leader roles since he or she is a risk-taker and acts as a change champion.