Research Korner

Chapter 1: Los Angeles County Childhood Lead Poisoning Prevention Program Parent Lead Knowledge

Introduction     Lead poisoning is one of today’s most common and preventable pediatric health problems (Anderson, Whitwell, Snyder and Besunder, 1999).  Lead is a known neurotoxin that adversely affects children’s behavior and development at levels as low as 10ug/dL, the lowest acceptable level of blood lead concentration established by the Centers for Disease Control in 1991 (CDC, 1991).   The focus of lead poisoning is mainly on young children who live in contaminated environments that ingest significant amounts of lead dust through their hand-to-mouth behavior (Children’s Safety Network, April 1997). Despite efforts to eradicate the problem of childhood lead poisoning, many urban areas continue to be plagued with childhood lead poisoning incidences (Binns and Mehta, 1998).  Estimates are that one child in six suffers from lead poisoning with a total of 3-4 million children affected nationwide (Sum 10); 10% or approximately 2 million of them are preschool children (Sum 16).  As many as 890,000 (8,9%) children in the United States today have levels high enough to affect learning and behavior (Sum 1-CDC, 1997). In California, it is estimated that 0.4% of the population or 130,000 children between the ages of one and five have elevated blood lead levels (California State Auditor, 1999).  Los Angeles has more lead poisoning cases than any other county in California.  It has been estimated that 12.7% of the population or 76,194 children between the ages of one and five have elevated blood lead levels, using the third National Health and Nutrition Examination Survey NHANES III, 1988-1991 (Pirkle et al., 1994).  Since 1991, the Childhood Lead Poisoning Prevention Program (CLPPP) has identified 10,673 children with blood lead levels higher than 10ug/dL, including 4,635 children under the age of six.  This information sets the stage for this graduate project since it reveals that approximately 58.6% of the children lead poisoned in the state of California reside in Los Angeles County (CLPPP HUD Grant, 2000). This study will focus on the development and administration of a survey to assess parents’ knowledge regarding the risk of lead poisoning.  A review of the literature points to a significant gap in lead surveys that are designed to properly assess parents’ knowledge regarding the risk of lead poisoning and lead poisoning prevention, specifically in Los Angeles County.  Traditionally, it has been physicians as a group, not parents, that are most targeted through surveying (Goldman, Demissie, DiStefano, McNally and Rhoads, 1998).  In addition, most studies using questionnaires and surveys are aimed at assessing the prevalence of lead poisoning in children in high-risk populations (Nordin, Rolnick, and Griffin, 1994) or are used to help identify children with elevated blood lead levels, not to test parents (Schaffer, Szilagyi, and Weitzman, 1994). Unfortunately, in the limited studies that have been conducted on the subject, many parents are still unaware of the dangers of lead poisoning.  Major gaps in parental knowledge regarding the risk of lead poisoning and lead poisoning prevention methods still exist.  In one Chicago study titled, ‘What Do Parents Know About Lead Poisoning?’ Mehta and Binns (1998) showed that parents had limited knowledge about ways to prevent lead poisoning and the importance of good nutrition as a preventative measure.  In a second lead related study conducted by Irene Mahon, R.N., M.P.H. (1997) with the Philadelphia Department of Public Health, a questionnaire was developed to assess the knowledge, perceptions, and behaviors of family caregivers of children under the age of eight.  The survey was administered at pediatric clinics in two geographic areas of the city with documented severe and moderate lead poisoning rates.  Results of the study found that caregivers of children in high-risk areas did not mention lead poisoning as a health concern.  Only 15% of the parents in the study had identified lead paint dust as a source of lead poisoning and approximately 49% of the caregivers reported that they “never” or only “sometimes” perform recommended prevention activities. Dalton, Sargent, and Stukel (1996) implemented a behavioral risk factor questionnaire to identify children with elevated blood lead levels.  Parent participants (N = 459) reported that approximately 15% of their children use a pacifier, and that approximately 55% of their children play within one yard of outside of the house, two risk factors found to be associated with elevated blood lead levels in young children.  A large percentage of children were reported as “not always washing their hands before eating” (50.3%) or “after playing outside” (54%).  Further, parents reported that 11.5% of the children put paint chips in their mouth and 14.8% eat dirt or sand (Dalton, Sargent, and Stukel, 1996).             Parents do not have much knowledge of ways to prevent childhood lead poisoning (Mehta and Binns, 1998).  Understanding what parents know about the dangers of lead exposure can be helpful in curtailing the problem of childhood lead poisoning.  Health professionals in the discipline of lead poisoning prevention may use the information derived from parent knowledge surveys to develop appropriate educational and intervention programs that address specific gaps in knowledge and thereby affect a decrease of lead exposure in children. Statement of the Problem   More research is needed using surveys that have been properly designed and tested to assess parents’ knowledge regarding the risk of lead poisoning within specific high-risk populations.  The literature revealed a gap in surveys addressing the association of parental knowledge and lead poisoning in children at high-risk.  Existing surveys did not have the questions needed to address the problem comprehensively and did not have the questions needed to address the problem specifically for Los Angeles.  This study will help ascertain what parents of children at high-risk for lead poisoning know and/or don’t know about lead poisoning and exposure.  A comprehensive survey including questions pertaining to the target population will be designed and pilot-tested at the Watts Health Foundation WIC Clinic in the South Central Los Angeles Community.  At the Watts Health Foundation WIC Clinic at Compton Avenue, there is a critical need for a survey that assesses parents’ knowledge regarding the risk of lead poisoning to help plan and develop more effective educational intervention programs for the community on the subject of lead poisoning prevention. The Watts WIC Clinic is of particular interest to this project since it lies in a Lead Hot Zone and services five zip codes that lie in Lead Hot Zones, including 90011, the area with the highest number of lead poisoning cases, 504, reported to the Los Angeles Childhood Lead Poisoning Prevention Program (CLPPP), to date.  CLPPP also has an invested interest in this project since they currently need a standardized survey to measure parents’ knowledge regarding the risk of lead poisoning.  A standardized survey would be beneficial to all units comprising CLPPP: Epidemiology, Health Education, Case Management, and Environmental Health, as a means to obtain information about what parents know or do not know about the dangers of lead poisoning living in high-risk areas throughout Los Angeles County and as a means to target these populations with effective educational interventions that address the gaps in knowledge that exist.  A standardized survey would also give CLPPP a chance to combine their efforts interdepartmentally to combat the problem of lead poisoning in these high-risk areas.   Purpose of Project             1.                  To query a selected panel of key informants with specific expertise in childhood lead poisoning using the Delphi Method and utilize the information derived for construction of a knowledge instrument.   2.                  To design a standardized instrument for measuring parents’ knowledge regarding the risk of lead poisoning to their children to be utilized by all units at the Los Angeles Department of Health Services, Childhood Lead Poisoning Prevention Program (CLPPP).   3.                  To pilot-test the instrument on a large sample of parents using services at the Watts WIC Clinic situated in a Lead Hot Zone- zip code 90011, in order to determine any knowledge deficits that parents may have regarding the risk of lead poisoning to their children.   4.                  To make recommendations for the development of more effective educational interventions at the Watts WIC Clinic for parents regarding the risk of lead poisoning to their children.     Limitations of the Study   ·         Specific target population investigated may not represent the general population across Lead Hot Zones in LA County.   ·         Individuals participating may report inaccurate information.     Assumptions   Based on the literature review conducted and on informal interviews and observations made by the researcher within the last year working at LA County Childhood Lead Poisoning Prevention Program:   ·         Results will show knowledge deficits in parents regarding the risk of lead poisoning and lead poisoning prevention practices.   ·         Family practices surveyed will reflect problems across Lead Hot Zones throughout the County.   ·         Parents participating in study will answer questions accurately and to the best of their ability.     Definition of Terms     BLL                A BLL refers to a blood lead level, which is the amount of lead concentrated in the blood.  It is measured in micrograms per deciliter (mg/dL).   CDC               Centers for Disease Control   CLPPP           Childhood Lead Poisoning Prevention Program   LEAD HOT   Are determined using Geographic Information Systems- GIS and ZONES              are defined by the percentage of pre-1960 housing, the percentage of children living in poverty, and the number of children living in the area under the age of six.  Specifically, a Lead Hot Zone is a geographic area distinguished by these three characteristics and ranked in the top 25% by these measures.     Methodology Outline   I.                   Querying a Selected Panel of Individuals A.    Interview candidates and select a panel of individuals knowledgeable in Childhood Lead Poisoning. B.     Apply Delphi Method to panel members to help determine what types of questions should be included in the “Lead Poisoning Knowledge Survey”   II.                Development of the “Lead Poisoning Knowledge Survey” A.    Review of the literature B.     Develop rationale for the use of a survey C.     Design the structure of the survey 1.      Conceptualize format 2.      Formulate and design pertinent questions expertly reviewed by panel members 3.      Make appropriate modifications to the lead survey instrument D.    Select thesis committee chairs E.     Obtain human subjects approval   III.             Identify Target Population to Participate in Study   F.      Pinpoint geographical area of lead poisoning concern. G.    Identify locations where target population can be reached H.     Select target population   IV.             Pilot-test the Lead Poisoning Knowledge Survey A.    Pilot-test the Lead Survey on a large sample of parents to see if it reveals knowledge deficits regarding the risk of lead poisoning to their children. 1.      Determine sample size of target population to receive instrument 2.      Determine exactly when they will be targeted B.     Develop plan describing how the Lead Survey will be administered 1.      Develop protocol for administration of the Lead Survey 2.      Mobilize facility staff to help administer the Lead Survey   V.                Analysis of the Data A.    Provide information on parental barriers to levels of knowledge regarding the problem of childhood lead poisoning and lead poisoning prevention practices among the specific target population assessed 1.      Create tables with illustrations of frequency and percentages for each item on questionnaire.   VI.             Discussion of the Results   VII.          Development of Recommendations A.    Make recommendations for improving the design of more effective educational interventions directed at parents using the Watts Health Foundation WIC services at Compton Avenue relative to their child’s risk of lead poisoning     Literature Review     I.          Search Topics   ·         Studies conducted on parent’s knowledge regarding the risk of lead poisoning and lead poisoning prevention methods ·         Surveys implemented on parents to assess their knowledge regarding lead ·         Child and caretaker attributes associated with lead poisoning in children ·         National, State, and Countywide estimates for incidence and prevalence rates  of lead poisoning ·         Sources of lead poisoning ·         Symptoms of lead poisoning ·         Impact of lead poisoning on young children ·         Solutions to the problem of lead poisoning- preventative measures ·         The cultural parameters of childhood lead poisoning ·         Demographic characteristics of children who are lead poisoned ·         Description of target populations affected by lead poisoning ·         Blood lead levels in children in South Central Los Angeles ·         Los Angeles County demographic data ·         Age of housing in Los Angeles County ·         Lead Hot Zones within the County of Los Angeles ·         WIC services within Lead Hot Zones in Los Angeles County ·         Survey design   I.                   Journals   ·         American Journal of Public Health ·         Archives of Environmental Health ·         Archives of Pediatric Adolescent Medicine ·         Health Education Quarterly ·         Journal of American Medical Association ·         Journal of Environmental Health ·         Journal of the National Medical Association ·         Journal of Pediatric Health Care ·         Pediatrics ·         Pediatric Nursing ·         Public Health Nursing ·         Public Health Reports   III.          Other Resources   ·         Alliance to End Childhood Lead Poisoning ·         California Department of Health Services ·         Centers for Disease Control ·         Community based organizations ·         Environmental Protection Agency (EPA) ·         Los Angeles County census tract information ·         Los Angeles County Childhood Lead Poisoning Prevention Program, Epidemiology, Case Management, Health Education, and Environmental units ·         Medline ·         National Health and Nutrition Examination Survey (NHANES III) ·         National Research Council, 1993 ·         Other state and local Childhood Lead Poisoning Prevention Programs ·         U.S. Census ·         U.S. Department of Health and Social Services ·         U.S. Housing and Urban Development     Projected Graduate Project Chapters   I.                   Introduction A.    Statement of the problem B.     Purpose of the project C.     Project Limitations D.    Assumptions E.     Definition of Terms   II.                Review of the Literature   III.             Methodology   IV.             Results   V.                Discussion      References California State Auditor, Bureau of State Audits (April 1999), “Department of Health Services has made little progress in protecting California’s children from Lead poisoning.”  [Internet address]: http://www.bsa.ca.gov/bsa/.   Centers for Disease Control and Prevention. (1991).  Preventing lead poisoning in young children: A statement by the Centers for Disease Control.  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.  DHHS publication no. 5:37-304.   Children’s Safety Network at CSR, Maternal and Child Health Bureau, Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, April 1997.   Dalton, MA, Sargent, JD, Stukel, TA.  Utility of a risk assessment questionnaire in identifying children with lead exposure.  Archives of Pediatric Adolescent Medicine, Vol. 150, p. 197-202.   Goldman, KD, Demissie K, DiStefano, D, Ty, A, McNally, K, Rhoads, GG. (1998).  Childhood lead screening knowledge and practice.  Results of a New Jersey physician survey.  American Journal of Preventative Medicine, Vol. 15, No. 3  p. 228-234.   Mahon, I. (1997).  Caregivers’ knowledge and perceptions of preventing childhood lead poisoning.  Public Health Nursing, Vol. 14, No. 3  p. 169- 182.   Mehta, S, Binns, HJ. (1998).  What do parents know about lead poisoning?  Archives of Pediatric Adolescent Medicine, Vol. 152.  P. 1213-1218.   Nordin, J, Rolnick S, Griffin J. (1994).  Prevalence of excess lead absorption and associated risk factors in children enrolled in a Midwestern health maintenance organization.  Pediatrics, Vol. 93  p. 172-177.    Pirkle, JL, Brody, DJ, Gunter, EW, Kramer, RA, Paschel, DC, Flegal, KM, and Matte, TD. (1994).  The decline of blood lead levels in the United States.  The National Health and Nutrition Examination Survey (NHANES).  Journal of the American Medical Association, Vol. 272  p284-291.   Schaffer, SJ, Szilagyi, PG, Weitzman, M. (1994).  Lead poisoning risk determination in an urban population through the use of a standardized questionnaire.  Pediatrics, Vol. 93, No. 2  p. 159-163.

Chapter 1: Los Angeles County Childhood Lead Poisoning Prevention Program Parent Lead Knowledge

Introduction Lead poisoning is one of today’s most common and preventable pediatric health problems (Anderson, Whitwell, Snyder ...

The Advantages and Disadvantages of Belonging to a Nuclear Family

THE ADVANTAGES AND DISADVANTAGES OF NUCLEAR FAMILY         The Nuclear or biological family is the smallest unit of society that we belong. They consist of father, mother and children who loved and lived together to form a home.  All over the world the nuclear family has been given value and importance that makes a family stand up from problem and opportunities that may come. It is in the family that we can adopt our personality, sense of pride, character formation, identity and social upbringing.  Most of the time family relation formation is dependent in our culture. In Asian countries who have a very close family ties to the highest extent that bonds until up to the point that parents would support their children after their marriage, while in American and European culture most likely they are dependent when reach a certain age. Although family bonding is also being exercise but basically they separate upon maturity of children.       Our family is the one who taught us to learn to walk when we are children and they are the one to help us stand up when we are down. No matter how much our situation they will always be there to support every family members, they are the ones who gave us our physical needs during our childhood and we can depend on them even when we grow old inherently we help them if they ask. They are also the one to encourage us to reach our dreams and they will be there to reach us if we fall, they are the sources of our strength and understanding. Sometimes we live our life and inspiration to dedicate them our achievements but we are ready to accept everyone even if they fail. No amount of hardship is ever enduring if there is a foundation of love and respect that unites the family even more. A family is not just a house that is constructed by marbles and steel but a home that consists of loving and nurturing mother, respectable father and obedient children that strengthens the family relationship. There will come a time that children are going to build the family of their own and children will soon be adults, whatever lessons they have learned from their nuclear family they will soon exercise it in the family of their own. We are the reflection of our nuclear family, a person who has a family that sticks together through thick and thin will basically succeed in life and they will always return in a place that they called “HOME”. A person who has found a home may be blessed with a stable personality while the person who grows without their own family may find it hard to love and be loved simply because they have not found love if they grow lonely but this doesn’t mean they cannot learn to love, it comes naturally inside the family. The nuclear family can express the freedom to live the best life more than the material possession but freedom to choose what is right.         There are times that our Nuclear family has become the one who can destroy our personality for there are parents who lived up to the highest expectation that degrade and belittle their children who have not done well especially in school if they lack the grades expected. Also the children’s competition and jealousy about their parents love.  If we belong to a very irresponsible parents chances are we are poor that we have not given the opportunity to get the basic needs to live, they may experience fighting and beating of parents and children. In some countries including European and African nations who have the most number of family struggles and crimes, there are numerous counts of family and domestic violence especially among children who suffered most from radical and sadistic parents.       There are also forms of degrading and sexual abuse from minors reportedly having traumatic experiences of smacking, and torture brought about by poverty or vices coming from the parents themselves. Some children are neglected to live alone without anything. Mostly they are weak and spirit, always alone even with others and longing to be loved, if children does not found love at home they will seek their companions in the outside world with their peers that may result in tragedy and exploited body and mind.  They tend to escape from the reality that they are force to take illegal activities such as smoking, drinking drugs and early marital relationship that may even worsen their longing for acceptance inside the family. They rebel against each other that destroyed the family even more. This has been the disadvantages of the nuclear unfortunate family that manifested through destructive pattern and negative character development among family members especially among children who may find it hard to understand their situation, but it is there.

The Advantages and Disadvantages of Belonging to a Nuclear Family

THE ADVANTAGES AND DISADVANTAGES OF NUCLEAR FAMILY The Nuclear or biological family is the smallest unit of society that we belo...

SWOT Analysis of Dell Computers Inc.

DELL SWOT ANALYSIS         Dell is one of the largest PC hardware, software and computer peripherals manufacturer based in Round Rock, Texas United States founded by Michael Dell at the age of 19 in 1984. Since then Dell Company has revolutionized the fast pace computer technology that continues to developed and distributed around the world, they have joined the league of the top fortune 500 companies in 1992 Michael Dell being the youngest Chief Executive Officer receiving international recognition and worldwide penetration and distribution recognized as one of the leader in the industry.       During 1995 they have expanded around the world with its worldwide distribution partners in Asia, Australia, Europe and America that generates millions of dollars in sales every single day in their operation that makes this company even more prestigious and dominating. Since then they always belong to the top 10 PC manufacturer around the world because of the continuous demand of the people, Dell has promised its continuous effort to meet its demand. For 27 years of their operation customers has always been satisfied with their products and services.       During the year 1996 onward they continue to expand their manufacturing sites from various countries including China, Brazil and the United States. By the year 2000 they have an average sale of $4million US dollars every day that makes them the number 1 in worldwide sales and production in the year 2001. They have continued to develop various products including giant industry servers, fast laptop, printers, including cell phone and other featured products that correspond to the needs of their customers.        To summarize here is the present Dell SWOT Analysis:       STRENGTH – Being one of the largest distributors and manufacturer, the strength of DELL is their market leadership and distribution control that they have penetrated strategic points and locations that raises the confidence of the people to buy their brand because of its name. The Dell Company’s strength and advantage is that they have strong manufacturing partners, the PC components are made by their suppliers this means that most parts purchased by customers are also included in their gross revenues. If a certain customers would like to assemble a PC rather than buying a new one, Dell can still control the sales and this is their advantage. They have a total control of the specification and parts that also comes from their company manufactured by their suppliers using a generic brand name which is lower than the usual brand.            WEAKNESS – Somehow their strength can also be their weaknesses if certain manufacturing partner has not completed their demand or has not followed certain production specification in certain country there might have been delayed in operation. This happens in 2004 that they have the need to recall about 4.4 million laptop adapters because of the manufacturing problems that it may overheat and may cause fire and shock hazards. This will result in getting a new parts imported from other countries that may add the cost or shipment, although delay in supplies never usually happens only in the occurrence of environmental condition such as typhoon, earthquake, tsunami etc.       OPPORTUNITIES – As long as there is a demand Dell Company will continue to develop the products that the customers want they may even lavish in their production that they can set trends to new standard in various PC products. Also during the year 2004 to 2007 Kevin Rollins being the president of the company has temporarily replaced Michael as the new Chief Executive Officer and Michael Dell remained as the Chairman of the company. Rollins also did a great job employing approximately 50,000 workers worldwide during his term. This change in position makes the company even more powerful since the unification of their great marketing minds will surely lead the company to more success in their future operations. Another opportunity that they can see is the consideration of distribution and expansion of manufacturing sites that they may think about the third world countries that also has a strong demand and has realized the needs for technology.             THREATS – One of the most alarming threats they may have faced is the competition from other giant manufacturers and distributors including IBM and Hewlett Packard who have established outsourcing from other countries that can also create a powerful appeal to customers in terms of services. The entry of the new players is also booming like ASUS, Logitech, A4tech and other small manufacturers are paving its ways to success. There are also various companies that are locally manufacturing various peripherals that have a very competitive price advantage over leading brands that slowly increasing demand from various costumers who prefer low priced products. The constant change in price has also becoming a threat and this is due to inflation and world currency rate from various countries is also one of their disadvantages and threats over the small player.   References: http://content.dell.com/us/en/corp/our-story-company-timeline.aspx                                                                                                                  http://www.ehow.com/facts_5273511_dell-swot-analysis.html                      http://en.wikipedia.org/wiki/Dell

SWOT Analysis of Dell Computers Inc.

DELL SWOT ANALYSIS Dell is one of the largest PC hardware, software and computer peripherals manufacturer based in Round Roc...

Article Critique Marking Criteria

7021NRS - Research Evidence and Clinical Practice   Assessment 1 – Article Critique   Marking Guide   Students will be required to critically appraise ONE article supplied by the course convenor in Week 2/3 using a critical appraisal framework that has been reviewed during the workshops (see page 31 and beyond in the Study Guide). Appraisal of this article will require: - a summary of the method and findings of the article (10 marks) - a critical appraisal of the method and consequent relevance of results (20 marks) - highlighting of the value of this study in relation to practice change (10 marks).   Criterion Possible Mark Obtained Mark Summary of method and findings of article 10   Clear, concise summary of main aspects of method     Clear, concise summary of main aspects of results     Critical Appraisal 20   Information about groups at beginning of study     Information about groups throughout study     Intervention and measurements     Results     Assessment of Value of article 10   Consideration of study sample, interventions and outcomes     Consideration of benefits, harm and costs     Application to patient care     TOTAL 40     Comments: _____________________________________________________________________   _____________________________________________________________________   __________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________         ASSESSMENT Item Assessment Task Length Weighting Total Marks Relevant Learning Outcomes Due Day and Time 1. Article critique 2000 words 40% 40 2. Plan for practice change 3500 words 60% 60 Students are required to submit both assessment items to qualify for a passing grade. Assessment Item 1 – Article Critique: Students will be required to critically appraise ONE article supplied by the course convenor, via the  in Week 2. Students are to use the critical appraisal framework located on pages 30 – 31 of your study guide and titled ‘Critical Appraisal of Studies Assessing Health Care Interventions – Clinical Trials’. Appraisal of this article will require: - a summary of the method and findings of the article (10 marks) - a critical appraisal of the method and consequent relevance of results (using questions 1 – 13 of the critical appraisal framework) (20 marks) - a discussion of the value of this study in relation to practice change (10 marks).

Article Critique Marking Criteria

7021NRS - Research Evidence and Clinical Practice Assessment 1 – Article Critique Marking Guide Students will be requi...

Nurses role in swallowing assessment

INTRODUCTION: The main goal of this assignment is to reflect back on nursing practice area which needs improvement in my country i.e. swallowing assessment. Reflective practice has the broad meaning of being able to look at your own professional behaviour and practice with the intention of improving and developing ( &  1998). I was caring for a patient in who I shall be referring as Tina (80year) to protect her identity and therefore adhere to protecting her confidentiality as laid in (Reference of ) medicine department during my three year training. She was admitted for investigations of weight and difficulty in swallowing (dysphagia).Swallowing is a complex neuromuscular disorder described as having four stages: oral preparatory, oral, pharyngeal and esophageal. Dysphagia disorder results from neurogenic, myogenic, psychogenic or mechanical causes. Swallowing impairment increases with the advancing age and is a major health care problem, especially in nursing homes. I was asked by the registered nurse (RN) of the shift to assist Tina to eat dessert from the general menu. I questioned the nurse’s instruction, but she insisted Tina could swallow and was in fact, had only attention seeking behaviour. I wanted to clarify the patient’s condition and went to the doctor. By the time I came back, the nurse took the dessert from the trolley herself and forcefully spoon-fed the patient and immediately left the place. The patient tried to resist and subsequently started to choke. Tina became cyanosed and needed esophageal suction, the attention of doctor and the administration of oxygen. I suctioned her immediately and administered oxygen.   BODY: , , and  (1995) found that nurses can perform bedside swallowing assessments Feeding often becomes one of the first tasks nurses delegate to less-skilled personnel (, , , & , 1998). CNAs' disagreements may result from their belief that they are the feeding experts. Although dysphagia is diagnosed and treated by a multidisciplinary team including a radiologist, speech therapist, dietician and nurse ( 1983) but  according to  (1999), nurses are the professionals who most often are present at the bedside, particularly at mealtime, and are the first members of the healthcare team to observe signs and symptoms of dysphagia. By recognizing dysphagia early, nurses can help to prevent complications and decrease the number of deaths associated with dysphagia in those who have had a stroke (, 1999). It is duty of RN according to  NATIONAL COMPETENCY STANDARDS that nurse should do a comprehensive and systematic nursing assessment by using her skills.  She should discuss whole information with the other members of team as dysphagia is diagnosed and treated by a multidisciplinary team including a radiologist, speech therapist, dietician and nurse ( 1983). A nurse's complete swallowing assessment should include testing of the four phases of swallowing: the oral preparatory phase, the oral phase, the pharyngeal phase, and the esophageal phase ( & , 1990). Assessment should begins by communicating with the patient or their families if they have had any difficulty in swallowing food and liquids then ask questions such as Do you chock when eating or drinking?, Do you have any problem controlling your saliva?. I will communicate with resident and explain her that I am going to help with the feed. After asking for her choice of food. I will held the spoon up, coaxing her, but she wouldn’t open her mouth and at that time then I will rubb the spoon against her lips, putting a little an applesauce on them. Using these technique nurses can prevent futher complications in elderly patients  The nurse is the person who performed a complete swallowing assessment described assessment of the oral stage in a variety of ways and gathered a data by observation, interview, physical examination and measurement in obtaining a nursing history. It is one liability of the nurse to provide prior information related to treatment options so that elderly patient takes decision (1998 &  1990). Although nurses have an important advocacy role in promoting the autonomy of elderly patient ( 2001). It is well documented in  code of professional conduct. That all registered nurses should respect the patient as an individual; and promote and protect the interests and dignity of patients. The nurse’s bedside assessment of swallowing ability should occur before initiation of feed ( & 1990)   In the end after all my research I came to the conclusion that simple nursing interventions of nurses can effectively prevent dysphagia's most serious complications. After reflecting on the whole scenario I am able to analyse that nurses are primary carer and who performs a complete swallowing assessment and described Now after analyzing the whole situation my action plan is that now I would like give prior information to elderly patient as it is vital that older people receive consistently high standards of care. By improving professional and practical skills I will make an active contribution to slow down the rate of swallowing and provide high standard care to elderly and other patiens and I will also encourage my coworker to follow the same Having awareness and current knowledge of the procedure of feeding being undertaken was invaluable in being able to see that the colleague was making mistake.     Reference:

Nurses role in swallowing assessment

INTRODUCTION: The main goal of this assignment is to reflect back on nursing practice area which needs improvement in my country i.e. swal...

Sample Paper on #research paper | Love difference between amoretti and astrophil and shella

Sample Paper on #research paper | Love difference between amoretti and astrophil and shella

Sample Paper on #research paper | Love difference between amoretti and astrophil and shella i need a six page research paper , you can choo...

RESEARCH PROPOSAL: The Impact of Prosopis Juliflora on Local Desert Plants

RESEARCH PROPOSAL The Impact of Prosopis Juliflora on Local Desert Plants   This paper discusses in detail the research proposal on the impact of P. juliflora (mesquite tree) on local desert plants. In particular, the research will focus on the allelopathic influence of mesquite trees. In this research proposal, the background, context and theme of the study are presented; the objectives of the study and the research statements are formulated. Here, vital concepts, questions and assumptions are stated. Finally, the scope and limitation of the study, methodology to be used and the significance of the research are discussed.   Introduction Mesquite pods are among the earliest known foods of prehistoric man in the new world (Duke, 1983). Pods are made into gruels, which are sometimes fermented to make a mesquite wine. The leaves can be used for forage. The wood is used for parquet floors, furniture, and turnery items, fencepost, pilings, as a substrate for producing single-cell protein, but most of all for fuel. Toasted seeds are added to coffee. The bark is rich in tannin, which is used for roofing. The gum forms an adhesive mucilage, used as an emulsifying agent. Gum is used in confectionary and mending pottery. Roots contain 6–7% tannin, which might discourage Rhizobia. Mesquite juice is cathartic, cyanogenetic, discutient, emetic, stomachic, and vulnerary; it is a folk remedy for catarrh, colds, diarrhea, dysentery, excrescences, eyes, flu, headcold, hoarseness, inflammation, itch, measles, pinkeye, stomachache, sore throat, and wounds (Duke & Wain, 1981). Mesquite flower contains (Per 100 g): 21.0 g protein, 3.2 g fat, 65.8 g total carbohydrate, 15.5 g fiber, 10.0 g ash, 1,310 mg Ca, and 400 mg P. The leaves contain 19.0 g protein, 2.9 g fat, 69.6 g total carbohydrate, total carbohydrate, 21.6 g fiber, 8.5 g ash, 2,080 mg Ca, and 220 g P. Fruits contain 13.9 g protein, 3.0 g fat, 78.3 g total carbohydrate, 27.7 g fiber, and 4.8 g ash. Seeds contain (ZMB) 65.2 g protein, 7.8 g fat, 21.8 g total carbohydrate, 2.8 g fiber, and 5.2 g ash. (FAO, 1981). Another analysis of the fruit shows 14.35% water (hygroscopic), 1.64% oil, 16.36% starch, 30.25% glucose, 0.85% nitrogenous material, 5.81% tannin-like material, 3.5% mineral salts, and 27.24% cellulose. Mesquite gum readily hydrolyses with dilute sulfuric acid to yield L-arabinose and D-galactose and 4-o-methyl-D-glucuronic acid at 4:2:1. Owing to the high content of arabinose, the gum is an excellent source of sugar. Roots contain 6.7% tannin, bark 3–8.4%, and dry wood 0.9%. The alkaloids 5-hydroxytryptamine and tryptamine are reported from this species (Simpson, 1977). P. juliflora have been introduced to Oman for shade, decorative, food for domestic animals and pasture. Vigorous growth, prolific seed production and effective seed dispersal enables P. juliflora to strongly compete with, and to some extent, eliminate native vegetation. P. juliflora may also change the fuel load in plant communities. The changed structure and fire regimes of the habitat is likely to adversely impact on both native vertebrate and invertebrate fauna. P. juliflora was introduced to Salalah in Oman in the mid-seventies. In 20 years, P. juliflora has spread just from a few trees and now occurs throughout the 1 million ha. Mesquite was spread by ruminants which ingest seeds and excrete them in manure. Manure is a common source of fertilizer for agriculture. With high content of hard seed, passage through the digestive system of ruminants acts to scarify seed. Mesquite was found to be well adapted to environment with high moisture such as drainage lines, irrigation canals, bridge inlets and outlets and irrigated farm lands. Mesquite causes many serious problems. It competes with native plants, eventually killing them; large quantities of pods are consumed and excreted in manure as only the pods are palatable to livestock and not the leaves; very high pods production occurs e.g. 3.34 kg per tree ensuring rapid spread, with seedling germination at very high densities forming thickets; and the seeds can be transported long distances by goat and sheep, and by water to favorable sites some distance away. The primary purpose of achievement of Directorate General of Nature Reserves at Ministry of Regional Municipalities, Environment and Water Resources is to protect not only the local wildlife and its components from human activities but also from other organisms including animals and plants. After habitat loss, invasive or exotic species are considered the greatest threat to the preservation of natural resources. Additionally, more than one million acres of Oman land are infested by exotic invasive plant species. Large numbers of exotic plants such as the Prosopis juliflora (mesquite) invade native plants; they compete with, and displace many native species. With this, the researcher finds the necessity to study the harmful impact of mesquite trees on other plants. In this study, P. juliflora’s  allelopathic effects on other plants’ rate of germination and growth in terms of root, shoot and seedling will be determined. Allelopathy in trees and forests is an important health care issue (Coder, 1999). Allelopathy is the chemical modification of the site by an individual to enhance interference effectiveness. Allelopathy also involves the ecological communications between species which can positively or negatively influence growth, behavior, reproduction, and survival of associated species. According to El Fadl (1997), in his investigation of the potential allelopathic effect of P. juliflora on agricultural crop seed germination and seedling growth, aqueous leaf extracts of the tree contain substances that inhibit sorghum, pearl millet and sesame seed germination and retard seedling development when applied at concentrations greater than 5%. However, the crop biomass production increased with increasing amounts of P. juliflora litter in the soil. Based on El fadl’s (1997) study, it is unlikely that P. juliflora produces harmful levels of potentially allelopathic substances, and hence it is suggested that this tree can be successfully intercropped in agroforestry systems. The study showed that the use of P. juliflora in agroforestry has a great potential for rural people in a region very vulnerable to drought and famine. Risk minimisation should not be viewed only through increasing the agricultural crop productivity; even more importantly, the pod production is of paramount importance especially during times of scarcity of fodder and food El Fadl (1997). The study will consider the many benefits of mesquite trees on the ecology. However, it will be necessary to present its other side. This research will be divided into five chapters. In Chapter 1, the nature of the problem, background of the study, research objectives and methodologies will be presented. Chapter 2 will review previous studies on P. juliflora. The third chapter will discuss the methodologies that will be utilized. The fourth chapter will present the result of the experiment. Finally, Chapter 5 will provide significant conclusions and insightful recommendations.  Research Statement General Purpose of the Study Generally, the purpose of the research is to conduct an experimental study on determining the effects of mesquite on local desert trees. The research will also conduct a gene-mapping of mesquite and determine the allelopathic effect of mesquite trees on local desert plants. Research Questions To support the aforementioned fundamental purpose, the research will specifically attempt to answer the following questions: 1.    In general, what are the effects of mesquite trees on local wild life? 2.    Specifically, what are the effects of mesquite trees on local desert trees? 3.    In what way do mesquite trees affect local desert trees? 4.    What are the measures done by Omani authorities in addressing the mesquite problem? Overall Research Aim             The project primarily aims to explore the nature of mesquite trees and to present their benefits as well their harm on the ecology. Objectives             To carry out the overall aim, the following aims will be realized: 1.    Assessment and evaluation of the benefits and harms of mesquite trees on the environment. 2.    Review of related literature on P. juliflora and its allelopathic influence on local desert trees and gene-mapping.  3.    Conducting a laboratory experiment to determine the allelopathic effects of mesquite trees on desert trees. 4.    Generation of significant conclusions and insightful recommendations   Overview of Methodology There are three kinds of research methods, correlational, descriptive and experimental (Walliman and Baiche, 2001). The correlational research refers to studies in which the purpose is to discover relationships between variables through the use of correlational statistics (r). The square of a correlation coefficient yields the explained variance (r-squared). The descriptive research method uses observation and surveys. In this method, it is possible that the study would be cheap and quick. Finally, the experimental method is the only method that can be used to establish cause-and-effect relationships. (Creswell, 1994) In this method, the subjects are split into two or more groups. One group, called the experimental group gets the treatment that the researcher believes will cause something to happen (this treatment is formally called the independent variable). The experimental and control groups are compared on some variable that is presumed to reflect the effects of the treatment, or outcome. This is formally referred to as the dependent variable. The primary source of data will come from the laboratory experiment that will be conducted by the researcher.  The secondary sources of data will come from published articles from science journals, books and related studies on allelopathic influences of P. juliflora and gene-mapping. For this research design, the researcher will gather data, collate published studies from different local and foreign universities and articles from science journals; and make an analysis of the result of the experiment and collected documentary and verbal material.  Afterwards, the researcher will summarize all the information, make a conclusion based on the null hypotheses posited and provide insightful recommendations on addressing the mesquite tree problem. In assessing and evaluating the overall benefits and harm of mesquite trees on Omani environment, the researcher will personally seek pertinent data from the Ministry of Regional Municipalities, Environment and Water Resources. Afterwards, in reviewing the literature, the researcher will gather all relevant literature from libraries and the Internet, organize them according to topic, identify the headings and subheadings, and synthesize the literature. Then, the researcher will identify issues and problems to be addressed in the research. For this study, a laboratory experiment will be conducted. The process will include the test of mesquite tree water extracts on some desert plants in terms of rate and germination percentage and growth rate of root, shoot, and seedling of some desert plants. The researcher will design the experiment processes with the help of the advisor. Finally, with the help of a statistician, the researcher will make the statistical analysis. After gathering the results, a preliminary analysis of the results of the experiment will be conducted. Then the advisor will check the preliminary analysis. Afterwards, the researcher  will conduct detailed analysis of the results.   Objectives for the Experiment 1-    To study the effects of water extracts on the rate and germination percentage of some desert plants. 2-     To study the effects of water extracts on the root growth of some desert plants. 3-    To study the effects of water extracts on the shoot growth of some desert plants. 4-    To study the effects of water extracts on the seedling growth of some desert plants.   Protocol: (Experiment 1) Extract preparation 	<li class="MsoNormal" style="color: black; text-align: justify; line-height: 200%"> 	Root, stem, leaves, 	flowers, fruits, and seeds of Prosopis juliflora are collected.</li> 	<li class="MsoNormal" style="color: black; text-align: justify; line-height: 200%"> 	Five to ten gram of 	plant material are weighted and soaked in 100ml of distilled water for 24h.</li> 	<li class="MsoNormal" style="color: black; text-align: justify; line-height: 200%"> 	Then homogenized and 	filtered using Whatman No.1 filter paper. </li> 	<li class="MsoNormal" style="color: black; text-align: justify; line-height: 200%"> 	Five to ten gram of soil 	sample are collected from under canopy of P.juliflora.</li> 	<li class="MsoNormal" style="color: black; text-align: justify; line-height: 200%"> 	Soils samples are soaked 	in 100 ml distilled water for 24h and after shaking in an electric shaker 	for 30 min, are passed through Wharman No.1 filter paper.  </li> Extract bioassay 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Seeds of each test 	species are scarified.</li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Seeds are surface 	disinfected with 0.52% NaOCl (sodium hypochlorite) solution for 1 min and 	thoroughly washed in sterilized water and then soaked in test solution for 	4h.</li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Distilled water is used 	as control.</li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	The seeds are then 	germinated using sterilized test tube, 20mm in diameter and 180mm long, and 	line with 3.5 ×16 cm strips of Whatman No.1 filter paper folded to form 	channel and 1.5 ml of respective test solution is then added to each test 	tube.  </li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Each treatment is then 	replicated three times with five seeds each. </li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Germination of seeds is 	recorded upon emergence of radical every 24h for 3days.</li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	The rate of germination 	is estimated by using Khan & Unger (1984) index of germination velocity = 	∑G/t, where G = number of seeds germinated at 2-day intervals, t = total 	germination period. The data are subjected to statistical analysis.</li> 	<li class="MsoNormal" style="text-align: justify; line-height: 200%"></li> Scope and Limitation             This study will only cover the allelopathic impact of P. juliflora on desert plants in Oman. The outcome of this study will be limited only to the data gathered from previous studies on mesquite trees and from the primary data gathered from the result of the laboratory experiment that will be conducted by the researcher. As the research was completed in a relatively short period of time other factors and variables are not considered. This might have an impact on the results of the study.   Significance of the Study             This study will be a significant endeavor in promoting awareness on the harmful side of mesquite trees. This study will be helpful to environmentalists for this will present significant findings on the impact of mesquite trees on local desert trees. Moreover, this study will be an important contribution to a body of research concerning allelopathic influences in plants.   References Coder, K. B. (1999) Allelopathy in trees and forests: A selected bibliography. Daniel B. Warnell School of Forest Resources, The University of Georgia. Available at [www.forestry.uga.edu]. Accessed [15/10/03].   Creswell, J.W. (1994) Research design. Qualitative and quantitative approaches. Thousand Oaks, California: Sage. Duke, J. A. (1983) Handbook of Energy Crops. Unpublished El Fadl, M. A. (1997). Management of Prosopis juliflora for use in agroforestry systems in the Sudan. University of Helsinki Tropical Forestry Reports 16,  107. FAO (1980) Genetic resources of tree species in arid and semi-arid areas. Rome. Simpson, B. B., ed. (1977) Mesquite, its biology in two desert scrub ecosystems. Dowden, Hutchinson & Ross, Inc. Stroudsburg, PA.

RESEARCH PROPOSAL: The Impact of Prosopis Juliflora on Local Desert Plants

RESEARCH PROPOSAL The Impact of Prosopis Juliflora on Local Desert Plants This paper discusses in detail the research proposal on t...