The Roper Logan Tierney Model Nursing Essay

The Roper Logan Tierney Model Nursing Essay The aim of this study is to demonstrate the care management that a nurse can provide to a patient who had Laparotomy and mesh repair of incarcerated incisional hernia. It also shows how the Roper- Logan- Tierney Model was utilized in assessing, planning, implementing, and evaluating patients care. The core of this care study is on infection and wound healing management which was identified as the patients main problem. According to NICE (2008), a minimum of 5 out of 100 surgical patients develop infection and that this covers almost a quarter of all infections acquired in a hospital. The patients name was altered to uphold confidentiality (NMC, 2008). In this study, health and social care policies affecting the patient care were also considered. PATIENT PROFILE Mrs P is a 63 years old lady who was admitted due to symptoms of small bowel obstruction like vomiting, bloating and abdominal pain. She lives with her husband in a privately owned house who also has impaired mobility due to stroke. Mrs P weighs 111 kilograms, 5 feet 7 inches tall and body mass index of 38. Previous medical history includes Chronic Kidney Disease Stage 2 (2008), Congestive Cardiac Failure (2007), leg cellulitis (2006), Essential Hypertension (2005), Primary repair of Incisional Hernia (1992), Type 2 Diabetes(1991), Repair of Umbilical Hernia(1985), Total Abdominal Hysterectomy NEC (1979) and Cholecystectomy (1976). After series of examination, she was found to have incarcerated incisional hernia which was repaired with mesh on the emergency list. Post- operatively, she was admitted to ITU for ventilator support and post-op care. When she was stable, she was transferred in the ward and two weeks post- op she developed infection and her abdominal wound dehisced. Patient has to take several medications while in the hospital to help her recover. She had Augmentin (Co- amoxiclav) 625 mg via oral route three times a day, followed by tazocin (Piperacillin with Tazobactam) 4.5 grams intravenously every 8 hours interval, Fragmin (Dalteparin) 7500 units once at 6 pm, senna (7.5mg) two tablets in the evening, bisoprolol 10 mg once daily, furosemide 20 mg daily orally, ramipril 5mg daily orally, amlodipine 10 mg daily oral, paracetamol 1 gram 4-6 hourly oral, domperidone 10mg three times daily orally, insulin Glargine(Lantus) twice a day SC injection, Novorapid three times daily SC injcetion, and oxycodone hydrochloride (oxynorm) 10 milligrams every 4-6 hours orally when needed. PATHOPHYSIOLOGY The development of an surgical site infection depends on contamination of the wound site at the end of a surgical procedure and specifically relates to the pathogenicity and inoculum of microorganisms present, balanced against the hosts immune response(NICE,2006). Typically, wound infection is caused by migration of patients normal flora to the wound site. Another way of surgical site being contaminated is being in contact with contaminated surgical equipments, environment, and hands of staffs. (NICE, 2006). ASSESSMENT The Roper- Logan-Tierney Model of Nursing based on activities of living was used in planning the care of Mrs P which is a widely used model in practice areas in the UK(Roper et al 2000). Maintaining a safe environment Mrs P was alert and orientated however she is diabetic, hypertensive, uses eye glasses and obese. She has an infected wound that is oozing and painful, poorly healed, dehisced, abdominal wound. She has a urinary catheter in situ which can be a potential site of another infection. Communicating Patient can communicate effectively, her primary language is English, can hear and talk without any aids and difficulties, and very conversant but when it comes to her care she tends to stay quiet and just wait for her turn to be look at. Breathing Patient is at risk of developing chest infection due to decreased mobility and respiratory depression due to oxynorm medication. Patient has a respiratory rate of 15 breaths per minute, oxygen saturation of 98% on air, no shortness of breath noted, no signs of respiratory distress and no complaints of pain during breathing. Eating and Drinking Patient claims to have decreased appetite after operation and risk of poor wound healing since although she is obese, she still needs some important nutrients like protein and vitamins like vitamin A,C, and K. Also patient is scared that when she ate, it will cause more pressure to her abdominal wound. Patient is able to eat and drink independently, no complains of difficulty of swallowing, and she is on normal diet. Eliminating Mrs. P has urinary catheter in situ draining adequate amount of urine at present which made her at risk of further infection. She was continent of faeces and uses bedside commode with assistance of two staffs. Because of the pain on her wound when moving and the need of two staffs to help her get out of bed, she keeps refusing her senna tablet and end up opening her bowel on bed. Personal Cleansing and dressing Nurses are the one irrigating and changing her wound dressing. Mrs P is unable to wash and dress herself independently due to her current state of health. Did not have any shower since admission because of her difficulty in mobilising. Controlling body temperature Although Mrs P got an infection, her temperature during assessment was 36.8 degree Celsius, no sweating noted, skin warm to touch, uses only hospital gown and dressing gown to keep her warm during the day, and uses top sheet and one blanket at night. She has limited mobility which predisposed her to poor blood circulation. Mobilising While on bed, Mrs P can turn on her sides but still with assistance of one staff because of her abdominal wound and shes an obese patient. Patient complains of pain on the surgical site when moving and mobilising. Three days before she was being hoisted from bed to chair and back to bed with assistance of 3 staffs but at this time after referral to physiotherapist, she can transfer to chair with assistance of two staffs and use of a zimmer frame. She was able to stand during the transfer and can make 2-3 steps during transfer. Working and playing Patient worked in an office before but had early retirement due to illness. Enjoys knitting and playing with her grandchildren at home. Although she can still do knitting, she cannot run or look after her grandchildren at home in her situation. Expressing sexuality Mrs P is 63 years old, menopause, and still lives with her husband. Her abdominal wound makes her anxious about her body image. Sleeping Patient says shes not able to sleep well due to environment change, pain and sometimes bowel urgencies. Mrs P takes two glasses of milk before bedtime. Death and Dying Mrs P keeps asking about worst thing that could happen to her regarding her present condition. She is worried for her husband when it happens to her first. Patient does not have a will. IDENTIFICATION OF PATIENTS PROBLEM While in the ward, Mrs P was assessed using the RLT Model based on activities of living. From those activities, all problems identified were related to her infected wound that is not healing normally. She has to stay further in the hospital until her infection is dealt with and that her condition will be manageable by primary care. This is a serious problem that if not attended immediately would cause further injury or problems to Mrs P therefore these problems which are related to each other should be the priority and the focus of her care plan. GOALS After nursing interventions, Mrs P will be able to verbalize feelings regarding her condition and understand the course of treatment being done to her. In three to 7 days, patient will be able to mobilize on her own using her zimmer frame and will be infection free. NURSING CARE PLAN PROBLEMS INTERVENTIONS RATIONALE REFERENCES 1.Wound Infection >Monitored patients vital signs. >Assessed wound site daily and documented. >Maintained aseptic technique when changing dressing and irrigation. >Administered antibiotic as prescribed. >Encouraged patient to eat nutritious food and increase fluid intake >Educated patient about wound infection control and prevention. >Infection is frequently linked with pyrexia >As basis for treatment >To prevent further deterioration in wound >Inhibits growth and kill microorganisms >Enhance immune response >To have an idea on how to manage her surgical wound Rico et al, 2002 Shultz et al, 2003 MEP,2008 Colier, 2004 Dealey,2012 NICE, 2006 2. Poor wound healing >Assessed the wound and its surroundings >Monitored blood glucose regularly >Maintained strict infection control measures >Encouraged patient to eat nutritious food and increase fluid intake >Encouraged diversional activities like knitting and reading papers. >Maintained a moist wound environment but not saturated >Managed exudates to ensure that surrounding skin is protected from leakage. >Referred to tissue viability nurse >To assess healing and as basis for treatment. >Associated with delayed wound healing. * need to expand >To prevent further infection >Poor nutrition increases infection risk. * how does protein, calories affects healing, hydration? Link poor healing with nutrition. >To reduce stress caused by pain on the wound surroundings. >Supports wound healing >Exudates can damage surrounding skin and is ideal for bacterial growth >To give advice on appropriate wound dressing for wound healing by secondary intention. Daugherty and Lister, 2004 Patel, 2008 Pratt et al,2007 Dealey, 2012 Augustine and Maier,2003 Shultz et al,2003 Vowden and Vowden, 2002 NICE, 2006 PART 2 HEALTH AND SOCIAL CARE POLICIES The basic principle of NHS is that good healthcare should be available to all, regardless of wealth(NHS website,2011). In order to maintain it, the NHS is regulated by several policies. DH policies are designed to improve on existing arrangements in health and social care, and turn political vision into actions that should benefit staff, patients and the public (DH 2010b). Mrs Ps information are compiled in a folder and kept in a secure place so that only members of the Multi-disciplinary team responsible for her care will be able to access it. It is the responsibility of healthcare professionals to safeguard their patients information and share it only to appropriate individuals (NMC, 2008). Mrs Ps personal information were handled in accordance with Data Protection Act of 1998. According to Mental Capacity Act of 2005, every adult has the right to make his or her decision and must be assumed to have capacity to make them unless it is proved otherwise. Informed consent was taken from Mrs P before any procedures or treatment was given or done. Doctors, anaesthetists and nurses has the responsibility to explain all tests and procedures being carried out on her and made sure she understood why it is being done or given to her. The consent is not valid when the person did not understand intervention (DH, 2009a). The vital signs of Mrs P were kept monitored and documented using the National Early Warning Score (NEWS)Chart. It is a new observation chart (implemented July, 2012) used in the ward where Mrs P was admitted. RCP (2012) says that this is also used as a surveillance system for all patients in hospitals, tracking their clinical condition, alerting the clinical team to any clinical deterioration and triggering a timely clinical response. Another tool used in Mrs Ps ward is the SBAR Tool. It is a structured method for communicating critical information that requires immediate attention or action(NHS Website, 2008). The patient was also assessed using the Waterlow Pressure Ulcer Risk Assessment Tool and Malnutrition Universal Screening Tool(MUST). In the chart it says there that although the later was incorporated to Waterlow, they should be assessed individually to ensure patient needs are addressed and their care was implemented (Waterlow 1985, Revised 2005). This tool helps nurses and other healthcare professionals in identifying what measures and equipment are needed for the care of the patient. NICE (2006) recommends that all hospital inpatients on admission and all outpatients at their first clinic appointment should be screened (weighed, measured and have Body Mass Index (BMI) calculated). Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients. The abdominal wound of Mrs P was also assessed and documented on the Wound Management Chart implemented by the trust. Mrs Ps surgical team decided to leave her dehisced wound open and heal by second intention. The team looking after her prescribed antibiotic, and twice a day irrigation and dressing of her wound. Mrs P was referred to the Tissue Viability Nurses (TVN) for advice on appropriate dressings to be used on her wound as it was planned to heal by secondary intention (NICE, 2012). Another issue to consider in looking after Mrs P was infection control. The fact that she was already infected does not mean healthcare staffs no longer follow Infection control procedures. Infection control should be strictly manifested in order not to aggravate her situation. Hand hygiene is important especially before touching the patients wound to minimise introduction of pathogens and also after changing wound dressings to prevent self and cross- contamination of patient. The WHO (2006), provided Five Moments as to when healthcare professionals should perform hand hygiene. Use of appropriate Personal Protective Equipments (PPE) should also be worn when irrigating and renewing the surgical wound dressing of Mrs P to prevent spread of infection. Guidelines on how to put on PPE and how to take it off were also produced by WHO(2007). Proper disposal of sharps used by Mrs P like needles used for her antibiotic, insulin, and fragmin injection should also be observed. They should be th rown directly to designated sharp bins as uncapped and still assembled (RCN,2011). OVERALL EVALUATION AND CRITIQUE OF FRAMEWORK The nursing process is an orderly method of designing and providing nursing care which are collecting information and assessing the patient, planning care and defining objectives for nursing care, implementing interventions and evaluating results (Uys Habermann, 2005,p.3). Roper et al(2000,p.124) pointed out that assessment which is considered to be the first phase of the nursing process should be done regularly and not only once. Being this the case, the use of Roper- Logan-Tierney (RLT) Model based on Activities of Living is preferred for Mrs Ps case. It does assess the patient needs wholly and can determine the impact of infection and poor wound healing to her identified twelve activities of living as recognized by the model. Using RLT model, an overview of Mrs Ps health status was created and from it prioritization of her needs is easier. This model enabled healthcare professionals to produce a care plan which is unique or aligned to her needs. The author of this care study find this framework to be an ideal model in assessing patient and useful for healthcare professionals as they do not miss out any aspect of care. Looking at the down side of the model, it is a very long process of assessment and it takes time for a healthcare staff to finish all the twelve areas. The author of this study thinks although it is an ideal one that in a ward where Mrs P was confined, there might be an issue in doing this regularly to all patients. It is a very busy ward and if all patients are assessed regularly using this model, problems on other aspect of nursing process will be left untouched and cause additional work to incoming staffs. CONCLUSIONS AND IMPLICATIONS FOR FUTURE PRACTICE Health and social care policies are indeed very important and has a great impact to the healthcare system. It serves as the basis for the trusts in making their own policies and it guides healthcare professionals to their practice. Nurses practice in accordance with the NMC Code, Standards of conduct, performance and ethics for nurses and midwives and other laws and guidelines provided by the British government and different departments or agencies like the Department of Health, National Institute of Clinical Excellence, World Health Organization, etc. After using the Roper-Logan-Tierney Model The care of Mrs P went smoothly during her stay in the hospital. Her post- operative complications have been managed without any major issues. Since the very start, nurses and other members of the MDT reassured her that personal details and all information regarding her care is treated as confidential and that this could only be shared to appropriate people only on her approval. The MDT members based their interventions on the protocol and policies of the trusts which was based on National policies. Mrs Ps problems were managed by the interventions provided in the hospital and was now discharged and back to her home. Long term goals were also taken into account therefore a proper referral to the district nurse was done before she went home.

Pda Connector Case Essay

An additional feature of ConneCtor is its ability to establish wireless links to other ConneCtors for voice and data transfer or to cell phones for voice transfer. For direct data transfer, the product includes an infrared port and also ships with a USB synchronization cradle. In summary, the key features of ConneCtor are: †¢ Instant communication for voice and data †¢ Cell phone, pager, fax and e-mail, and instant messaging †¢ PIM functions †¢ Digital voice recorder †¢ Enabled voice commands †¢ PalmOS application base. The History of the PDA The Personal Digital Assistant (PDA) is basically a hand-held computer. In 1984, the first PDA, the Psion1, was introduced. It could store addresses and phone numbers, keep a calendar, and included a clock and calculator. In 1993, Apple introduced the Newton PDA, which was too bulky, too expensive and had handwriting recognition too inaccurate to be successful. However, the excitement surrounding the Newton hinted that there could be a market for such devices. The broad acceptance of PDA technology then materialized in 1996, when Palm Inc. ame out with the Palm Pilot that featured an elegant user interface and a reliable character-recognition system. By 2001, PDAs had evolved to offer many applications including wireless Internet capabilities, games and music playback. PDAs are designed for very specific tasks and environments: there are custom-built PDAs for amateur astronomers, truck drivers and teachers. In addition, there is specialized software available to fit specific needs; f or example, people in the medical fields can obtain software that lists thousands of drugs with their dosages and interactions. PDA Types The 2001 palm-sized PDA market was mainly composed of two types, each with its own philosophy: (1) the PDA/Palm devices run PalmOS, whose developers sought to make PDAs simple but functional products focusing on Personal Information Management (PIM) tasks; (2) the PDA/Pocket PCs run the more complex operating system, Microsoft Windows CE, which allows these PDAs to offer 1 Source: Marketing Engineering – Lilien and Rangaswamy extensive features. In addition, â€Å"smart† phones are breaking into the PDA world. These wireless application protocol phones extend traditional cell phones with PDA functions such as email and Web access. The original Palm Pilot embodied the PDA/Palm design mission. It provided a simple organizational device, composed of a calendar, an address book and a to-do list with e-mail and Internet access. It also had a character-recognition system that worked for most people. Handspring, Palm’s biggest competitor, introduced snap-on modules to expand the Handspring Visor and allow many applications, including an MP3 player, a web cam and digital camera. These features appealed to the youth market and enabled Handspring to gain considerable market share. In 2001, Palm also offered this same degree of expandability and was able to maintain a market share of more than two thirds; in addition, all of Palm’s close competitors licensed its operating system, PalmOS. Several electronic manufacturers have developed similar devices; for example, Sony introduced Clie as a direct competitor to Palm and Handspring. PocketPCs make up the other group of PDAs, whose manufacturers include Compaq, Hewlett-Packard, Psion and Casio. These hand-held computers come with a large application suite of pocket Windows applications, e. g. , a scaled down version of MS Office. They usually come with more memory than PDA/Palms and with a range of accessories to be added to the devices (e. g. , digital cameras, web ams). However, they are bulkier, heavier and more expensive. In contrast, PDA/Palms perform basic tasks very well and, unlike the PocketPCs, synchronize with non-Windows systems. A new technological thrust in 2001 involved the adoption of wireless technology for the PDA with manufacturers trying to assess if and how to add wireless capabilities. Wireless technology would make synchronization possible without docking, making PDAs true communication tools. AT&T, Nokia and other cellular phone companies have started developing wireless phones with some PDA functions. The PDA Customer As PDA designs have evolved, manufacturers have targeted different segments based on differing lifestyle and business needs. Palm initially captured innovators – people eager to adopt a new gadget. A typical early PDA user was a professional, high-income male. He was over 30 and probably worked in a technology field. Even as of September 2000, 93 percent of PDA users were male, according to IDC, a Massachusetts technology consulting firm. Another major group of users is the mobile professional. Since this group frequently needs access to e-mail and the Internet while away from the office, it is also driving progress on the wireless front. A recent study by the University of California at Berkeley indicated that nearly half of the users had a technical job dealing with computers, and the overwhelming majority of the respondents rated hemselves as technically sophisticated. To attract more mainstream buyers in 2001, companies were working on increasing the usability of the PDA and its general appeal to non business users. For example, the new Claudia Schiffer Palm (sold via her Web site) is supposed to give Palm a sexier image, and Handspring’s Visor line comes in many colors. Palm’s affordable M series ($150) targets college students and other nonprofessional consumers. It is expected that such efforts will eventually open up the largely untapped young consumer and female markets. However in 2001, it appeared unlikely that the bulk of the mainstream population would enthusiastically embrace the PDA. A PDA was still relatively pricey and fairly limited. Handwriting recognition was slow and lacked quality, and keyboard facilities were either non-existent, too big to carry or too small to use. The display screen was too small for most applications other than text display. Internet connections were generally both slow and expensive. In addition, the mainstream market appeared to have little need for many of the more sophisticated features the PDAs were able to offer. PDA Features Given all the available design options, new product entries must make tradeoffs between features. Customers want easy portability, but with more functions the PDA becomes heavier and bulkier. PDA users’ needs are heterogeneous. Those who are looking for a high-tech way to store contact and appointment data may be satisfied with the basic models that cost $200 or less. They also are likely to prefer to keep a PC and cell phone separately rather than having an integrated PDA system that could do both. Users who plan to use the PDA as an extension of a PC by creating and accessing documents, sending e-mail, and doing basic Web surfing, might consider a Pocket-PC in the range of $350–$600. The appendix provides more details on PDA features. Facts about the PDA Market In 2001, many companies participated in the PDA market, bringing in a variety of new products designed to appeal to new audiences. The market was changing and growing rapidly. PDA unit sales totaled 1. 3 million in 1999 and more than doubled, totaling 3. 5 million in 2000 (Source: NPD INTELECT in Business 2. 0).

Eagle Fire Department Staffing Analysis Health And Social Care Essay

The job was the Eagle Fire Department lacks the cognition of whether or non a staffing alteration in 2003 has been effectual in run intoing the demands of community stakeholders by dramatically cut downing the mean clip it takes firemans to â€Å" turnout † for a call for service to an exigency scene. The intent of this research was to find if the staffing theoretical account that the Eagle Fire Department presently employs is effectual in supplying for a sufficient figure of forces when volunteer/paid-on-call employees are out of the community working at their regular occupations and are unavailable to reply exigency calls for service. This undertaking would carry on quantitative research to find to find if the 2003 staffing alteration resulted in a lessening of turnout clip to exigency calls for service by the organisation. The research would uncover a important lessening in turnout clip when the section was staffed with on-premises forces.IntroductionThe Eagle Fire Department is a preponderantly volunteer/paid-on-call municipal fire section located in rural southwesterly Waukesha County, Wisconsin. A sleeping room community to the Milwaukee and Madison, Wisconsin metropolitan countries, Eagle lacked a sufficient degree of staffing during daytime exigency events in the community. To decide this, the community began funding paid-on-premises staffing in 2003. The job is the Eagle Fire Department lacks the cognition of whether or non the staffing alteration in 2003 has been effectual in run intoing the demands of community stakeholders by dramatically cut downing the mean clip it takes firemans to react to an exigency scene. A quantitative survey would necessitate to be conducted to turn to this issue. The intent of this research is to find if the staffing theoretical account that the Eagle Fire Department presently employs is effectual in supplying for a sufficient figure of forces when volunteer/paid-on-call employees are out of the community working at their regular occupations and are unavailable to reply exigency calls for service. If a staffing lack is identified, this research would show the demand for the Town and Village of Eagle to increase staffing beyond what is presently being provided. This undertaking would carry on appraising research to reply the undermentioned inquiries: a. ) what was the turnout clip during responses from 1996 – 2003 prior to the paid-on-premises staffing? B. ) what was the turnout clip during responses from 2003 – 2010 after paid-on-premises staffing was added? c. ) does the information discovered through research demonstrate that the Eagle Fire Department is run intoing province and federal guidelines that govern fire section staffing and response? e. ) Based on these consequences, should the Eagle Fire Department urge staffing alterations to the Town and Village of Eagle boards?Background and SignificanceEagle, Wisconsin is a diverse community located in rural southwesterly Waukesha County, Wisconsin, about 35 stat mis from business district Milwaukee. The community is surrounded by the pristine lands of the Southern Kettle Moraine province wood which is regionally revered for its stat mis upon stat mis of hike, biking and sno wmobiling trails. Because 40 % of Eagle is province Department of Natural Resources or nature conservancy land, the community is stifled by its inability to turn to the West and north and as a consequence, Eagle retains much of its small-town quaintness and capturing entreaty to occupants looking for an flight from the bunco and hustle of large metropolis life. Eagle is 36 square stat mis and is comprised of two separate municipalities: the Town and Village of Eagle, each of which retains full liberty from one another but works together and financess several joint community ventures such as the fire section, library, and park and diversion scheduling. The combined population of the community is 5,471. Like many little southeasterly Wisconsin communities, Eagle is considered a sleeping room community for the Milwaukee metropolitan country as most of the occupants work outside of the community during the twenty-four hours. Eagle is home to many concerns and industries and has a strong touristry base due to the province wood and Old World Wisconsin, which is a â€Å" life museum † tourer attractive force that accurately depicts the history of rural life by securing historical edifices and so traveling them to the museum site. Actors and actresses depict Wisconsin colonist life to funny and frequently baffled invitees. The community is served and protected by the preponderantly volunteer/paid-on-call Eagle Fire Department [ EFD ] , a full-service combination fire section. The section operates out of one fire station that is centrally located within the community and responds to all exigencies within the Town and Village of Eagle, every bit good as common assistance aid to adjacent communities. The Eagle Fire Department protects critical substructure which includes State Highways 59 and 67 every bit good as the Wisconsin and Southern Railroad, each of which bisects and transverses the full community. The section was originally organized in 1927 by a group of husbandmans who saw the demand for a fire section to protect the community. The mission of the organisation did non alter until about 50 old ages subsequently when in the early 1970 ‘s the section began supplying exigency medical services to the community through an ambulance plan. With the execution of exigency medical services, the preparation demands to go a voluntary fireman and exigency medical technician began increasing and the one-year call volume doubled from about 75 to 150 calls. The rank of the organisation remained strong with between 40 – 50 voluntaries on the roll at any given clip. During the 1980 ‘s and 1990 ‘s, province mandated preparation demands continued to increase and lodging developments began to shoot up as available farming area began to slowly lessening. Many more occupants of the community were transposing to work and were non able to volunteer as much clip to the organisation. As a consequence of the needed addition in preparation hours, rank began to easy worsen. In 2003 the organisation reached a hamlets and was holding trouble staffing for exigency calls that occurred during the twenty-four hours. A determination was made to staff the fire station with paid-on-premises firefighter / exigency medical technicians who would work from 6:00 am – 6:00 autopsy Monday through Friday. This staffing agreement allowed at least one individual to reply a call for service while trusting on the voluntaries who were able to react during the twenty-four hours for extra work force. In 2006 the section hired a full-time calling Fire Chief to pull off the twenty-four hours to twenty-four hours operations. The section is still staffed for 12 hours a twenty-four hours with paid-on-premises forces. During the eventide and nighttime hours, the community is entirely protected by its dedicated voluntary work force. Because the current staffing theoretical account still relies so to a great extent on the voluntary work force, it can be highly hard to foretell concern hours staff handiness which complicates the section ‘s ability to efficaciously react to exigency calls for service. There has ne'er been a conclusive survey done to find if the bing staffing theoretical account utilized by the Eagle Fire Department is effectual. As a consequence, the section is powerless to find if it should seek extra support to spread out the bing paid-on-premises plan, hire extra calling firemans, or remain position quo.Literature ReviewThe literature reappraisal for this applied research undertaking focused on reexamining anterior research conducted on staffing preponderantly volunteer/paid-on-call fire sections and ordinances that exist at the province and federal degree that regulate or dictate fire section staffing. Staffing Models Harmonizing to Wilson ( 2009 ) , the stating â€Å" Do more with less † seems to hold been the unofficial slogan of the fire service for more than 200 old ages. Wilson affirms that there will come a clip when firemans will be able to make merely so much before on scene resources are depleted. From fires to EMS calls and everything in between, no affair how a individual looks at it, the fire service is the last line of defence when it comes to a community in an exigency state of affairs. So the outlook of making more with less is non appropriate to this occupation. Varone ( 1995 ) held that surveies have been conducted in respect to firefighter staffing and the increased efficiencies found with the addition of forces staffing but no conclusive surveies have been done to find if there is a correlativity between fireman staffing and on scene incident safety of forces. Varone discovered that informations from the Providence ( RI ) Fire Department staffing survey in 1990 – 1991 showed that reported hurts in the studied firefighting companies decreased from 42 during the control period when staffing was three members per setup [ fire truck ] , to 31 during the survey period when the survey companies were staffed with four members. This represented a 23.8 per centum decrease in hurts. Bay City, Michigan is no alien to cutbacks, holding closed a fire station in 2009 that led the firemans brotherhood and other outraged citizens to proclaim that shuting a fire station would do an addition in response times which would impact the quality of life for all occupants of the metropolis ( Editorial Board, 2011 ) . Harmonizing to the Bay City Times ‘ ( 2011 ) column board, Fire Chief Gregory Michalek told the City Commission that in 2009, the mean response clip was 5 proceedingss and 48 seconds. In 2010, the clip had plummeted about a minute, to 4 proceedingss 43 seconds. The National Fire Protection Association recommends response in less than 6 proceedingss. The betterment in Bay City is even though the quicker response would look to undersell the chief statement that the firemans brotherhood has made in recent old ages whenever metropolis functionaries bring up fire section budget cuts – that fewer Stationss and fewer firemans would be longer delaies until aid arrived at a fire or medical exigency. The Bay City Commission early in January 2010 decided to do lasting a impermanent closing of Station 5 at 1209 E. Smith St. in the Banks country. This was after a argument in 2009 over the shutting in which the firemans brotherhood warned, and occupants worried, approximately predicted longer delaies as fire crews responded to the country. That seemingly has n't happened. Fire crews from the Central Fire Station at 1401 Center Ave. on the East Side and at Station 4, 212 Dean St. , on the West Side each are about three stat mis off from Fire Station 5 ( Editorial Board, 2011 ) . Internationally, Australia utilizes a nationalized voluntary fire system dwelling of over 60,000 voluntaries. These firemans, who respond in the rural countries of the state, supply the first line of defence against the 100s of 1000s of shrub fires that burn yearly. Because volunteer/paid-on-call firemans work in the field because they want to instead than depending on the occupation as a exclusive agency of income, voluntary keeping and occupation satisfaction is paramount ( Rice & A ; Fallon, 2011 ) . Harmonizing to Rice & A ; Fallon ( 2011 ) , unpaid motive can be conceptualized within the model of societal exchange theory – in order for voluntary attempts to be sustained over clip, the wagess to the voluntary must transcend, or at minimal, balance out the costs. The determination to go on volunteering is typically re-evaluated throughout the voluntary ‘s term of office, where appraisals are made about the comparative wagess and costs of their engagement. There must be a delicate balance when measuring staffing in a preponderantly volunteer/paid-on-call section. The demands of the community must be balanced with the keeping involvement within the voluntary corps. An extra factor that assists with voluntary keeping is acknowledgment and recognition. Despite high degrees of service bringing, it has been argued that those working within the exigency services in Australia experience a wide deficiency of acknowledgment. Recognition of voluntaries is of peculiar concern to exigency service bureaus given that organisational surveies repeatedly find that staff often quit in cases where they feel undervalued. Harmonizing to Janke ( 2009 ) and Compton & A ; Graninto ( 2002 ) , staffing strategies are by and large a local issue and are dependent on the frequence of fires, budgetary considerations, the community hazard degree, and the demand for services. Other factors include the population protected, denseness of the population, and the type of constructions protected. In the terminal, staffing degrees may change widely from section to section. Keeping an unfastened duologue with members of the organisation is built-in to the success of any staffing theoretical account alteration. Laws and Standards Governing Fire Department Operations The United States fire service is efficaciously governed by a set of criterions that are established and reviewed every four old ages by the National Fire Protection Association [ NFPA ] . There are legion criterions that exist that govern fire section operations and the minimal figure of firemans that must be present on an exigency scene to prosecute in operations. NFPA 450, the Guide for Emergency Medical Services and Systems, Chapter 5, Section 5.5.2.3.4 provinces, â€Å" most experts agree that four respondents [ at least two trained in advanced cardiac life support ( ACLS ) and two trained in basic life support ( BLS ) ] are the lower limit required to supply ACLS to cardiac apprehension victims † ( National Fire Protection Association, 2009 ) . While it is by and large acknowledged by most fire sections that exigency medical services is the staff of life and butter of their operations, construction fires and incidents necessitating specialized deliverance accomplishments are really dependent on work force. NFPA 1720, the Standard for the Organization and Deployment of Fire Suppression Operations by Volunteer Fire Departments, Chapter 4, Section 4.3.1 provinces that, â€Å" the fire section shall place lower limit staffing demands to guarantee that a sufficient figure of members are available to run safely and efficaciously. † Further, based on NFPA 1720, a matrix has been developed which indicates that the Eagle Fire Department should hold a minimal staff of six firemans respond to the scene within 14 proceedingss of the call for service and be able to run into that standard 80 % of the clip. However, one time on scene, National Fire Protection Association relates that between 19 and 23 forces typically constitute the first-alarm assignment to a confirmed single-family brooding fire, as observed by rating squads. However, non fewer than 24 firemans and two head officers, one or more safety officers, and a rapid intercession squad ( s ) should react to high-hazard tenancies ( schools, infirmaries, nursing places, explosive workss, refineries, high-rise edifices, and other high-life jeopardy or tenancies with big fire possible ) . Not fewer than 16 firemans, one head officer, a safety officer, and a rapid intercession squad should react to medium-hazard tenancies ( flats, offices, mercantile, and industrial tenancies non usually necessitating extended deliverance or firefighting forces ) . Not fewer than 14 firemans, one head officer, a safety officer, and a rapid intercession squad should react to low-hazard tenancies ( one- , two- , or three-family homes and scattered little concerns and industrial tenancies ) . At least 12 firemans, one head officer, a safety officer, and a rapid intercession squad shall react to rural dismaies ( scattered homes, little concerns, and a farm edifice ) ( National Fire Protection Association, 2008 ) . The Occupational Safety and Health Administration [ OSHA ] mandates that two firemans be equipped in full protective equipment with a ego contained take a breathing setup be stationed outside of an environment that is imminently unsafe to life and wellness. Dearly, this is known as the two in/two out regulation which requires a lower limit of four firemans to prosecute in structural firefighting operations. There is an exclusion to this regulation if a life safety jeopardy exists and if firemans moderately believe a deliverance can be made it is allowable to go against this regulation ( Occupational Safety and Health Administration, 2008 ) . At the Wisconsin province degree, there are several steering administrative codifications that affect fire section scene operations. Wisconsin Comm. 30, the Fire Department Safety and Health Standards, do non proclaim a minimal staffing degree for operations straight, instead, the codification references antecedently cited NFPA and OSHA criterions. Based on the literature reappraisal, there is no constituted minimal degree of staffing that must be present expecting a call for service. Rather, systems must be designed such that when a call for service is received, the system responds in an expedient mode within the guidelines established at the province and federal degree.HypothesissThe void hypothesis is that the 2003 staffing alteration of the Eagle Fire Department had no consequence on norm turnout clip. Alternate hypotheses include: ( a ) the staffing alteration in 2003 did hold an consequence on diminishing the norm turnout clip. ( B ) call type ( EMS, Fire, and MVA ) had an consequence, either positive or negative, on the norm turnout clip. ( degree Celsius ) winter months had an consequence, either positive or negative, on the norm turnout clip.MethodologyThe original research for this undertaking was initiated via the cyberspace where a cursory reappraisal of literature related to volunteer staffing both domestically and abroad was sought. Beginnings were so identified in an effort to find what guidelines and criterions exist at the province and federal degree to modulate fire section staffing and response. Eagle Fire Department staff were assigned to roll up and analyse run study statistics for calls for service that the organisation responded to from 1996 – 2010. With the exclusion of 2008 and 2009 calls for service, which were recorded electronically, all informations had to be entered into a database manually, from manus written records. Data sought was the day of the month of the call for service, the twenty-four hours of the hebdomad, the clip the call was dispatched, the clip the first unit responded en path to the call for service, the clip that the first unit arrived on scene, and the figure of forces that responded to the call for service. Because a alteration in staffing occurred in 2003, the information was analyzed to find if the alteration caused a lessening in the norm turnout clip – the elapsed clip between when the call is dispatched by the 911 centre until the clip that the first unit acknowledges en path. The information could be so be analyzed to find if the organisation was run intoing province and federal guidelines with respect to exigency response, if any exist. The dependant variable in this analysis is whether or non the station was staffed at the clip an exigency call for service was dispatched. Several independent variables were identified. First, the type of call for service is of import to find whether or non call fluctuation has an impact in the turnout clip. For this undertaking, calls for service were grouped into three chief classs: Fire, Emergency Medical Services ( EMS ) , and Motor Vehicle Accident ( MVA ) . Calls for service coded as â€Å" EMS † were all calls necessitating exigency medical services, whether it was advanced or basic life support. Calls were coded as â€Å" Fire † if the call for service was fire related such as a edifice fire, field fire, natural gas leak, or other public aid call. Finally, calls were coded as â€Å" MVA † if the call for service was for a motor vehicle accident. Other independent variables identified involved the month that a call for service occurred. This was of import because the conditions could play a important factor in response efficiency when the fire station was unstaffed. For the intent of this survey, the months of November, December, January, February, and March were identified as months that would hold the highest likeliness of snow and icy conditions which would halter the section ‘s ability to react quickly when volunteers/paid-on-call firemans had to react to the fire station to obtain equipment and setup. So that accurate statistics were identified as related entirely to the Town and Village of Eagle, common assistance calls to other organisations were excluded from this survey as they would ‘ve increased the mean response clip well due to the geographic location of the Eagle Fire Department and the distance the section must go to supply aid to other communities. While reacting common assistance to help another bureau, 20 – 30 minute travel times are non uncommon. From the information collected, arrested development analysis was conducted to find if the void hypothesis should be rejected or accepted. Arrested development analysis was chosen because it allows the research worker to show the strength of the relationship between the identified independent variables against the dependent variable of turnout clip. Multicollinearity would be investigated to find if two or more independent variables are extremely correlated. Based on the information gleaned from the survey, consequences would be presented to the Eagle Fire Commission and Town and Village of Eagle boards to inform them whether or non the section ‘s bing staffing theoretical account is effectual, and, if non, urge alterations for the hereafter.ConsequencesThe first research undertaking sought to find the norm turnout clip of respondents prior to the paid-on-premises plan being implemented in 2003. The 2nd research inquiry dovetails on the first and sought to find the mean response clip after the paid-on-premises plan was implemented in 2003. There were 4084 instances, or calls for service, that the Eagle Fire Department responded to 1996 – 2010. From this information, it was determined when the station was and was non staffed. Turnout times were calculated from by deducting the clip the first unit went en path to a call for service from the clip that the call was dispatched. This was known as the TD to ER clip. Based on the information evaluated, it was determined that the Eagle Fire Department ‘s norm turnout clip was 4:02 for all calls for service that occurred 1996 – 2010. However, when the independent variable of staffing is introduced, there was a important decrease in the norm turnout clip to 2:23. When comparing the dependant and independent variables, the r-squared value is.404. Therefore, 40 % of the fluctuation in turnout clip can be explained by the independent variable which is the station being staffed. The incline between the dependant and independent variable of the station being staffed is -1.815. This indicates that when the station was staffed during a call for service, one can anticipate an mean clip turnout clip decrease of 1.815 proceedingss versus when the station was non staffed. Is the relationship between the dependant and independent variable statistically important? The t-score of -52.603 corresponds to a significance degree of 0.00, intending that there is a less than one in 1,000 opportunity that the relationship between turnout clip and the station being staffed is due to error. Insert table 1 here Insert table 2 here Based on these consequences, we can reject the void hypothesis and accept the alternate hypothesis. Staffing does hold an impact on the norm turnout clip of the Eagle Fire Department. There are several other variables that could hold an consequence on the norm turnout clip of the Eagle Fire Department. One illustration that could hold an consequence is the type of call for service that is being responded to. Calls for service such as construction fires or motor vehicle accidents require particular protective cogwheel that must be put on, or donned, prior to go forthing the fire station. Would these types of calls have an impact on turnout times? Harmonizing to the informations analyzed, exigency medical ( EMS ) calls for service were the baseline analyzed at 4.02. Calls affecting â€Å" fire † took somewhat longer to turnout for, with an norm of 4.134. The incline is somewhat different between the dependant and independent variables. For FIRE, the incline is.114 which indicates that when a call for service is related to fire, it takes an extra.114 proceedingss to turn out versus a standard EMS call. The t-score of 2.574 corresponds to a significance degree of 0.010, intending that there is a 10 % opportunity that the relationship between turnout clip and fire calls for service is due to error. Calls for service affecting motor vehicle accidents ( MVA ) took less clip to turnout for, averaging 3.998 proceedingss. For these calls for service, the incline is -.022 which indicates that when a call for service is related to MVA, it takes.022 fewer proceedingss to turn out versus a standard EMS call. The t-score of -.419 corresponds to a significance degree of 0.675, intending that there is a 67.5 % alteration that the relationship between turnout clip and fire calls for service is due to error. Insert table 2 here One other country that could hold an consequence on informations involves the clip of twelvemonth that a call for service is dispatched. Apparently, calls for service that occur in the winter months would hold an impact on unstaffed response times as the volunteer/paid-on-call employees must foremost react to the fire station before reacting to a scene. What impact do these months have on norm turnout clip? For the intents of this undertaking, winter months were considered to be November, December, January, February, and March as these were the months when Wisconsin snow and ice would reasonably impact the section ‘s ability to react in an efficient mode. Based on the information evaluated, it was determined that the Eagle Fire Department ‘s norm turnout clip was 4:00 for calls for service that occurred during these five months from 1996 – 2010. When comparing the dependant and independent variables, the r-squared value is.405. Therefore, 41 % of the fluctuation in turnout clip can be explained by the independent variables which are the clip of twelvemonth ( winter versus non-winter ) that a call for service was received. The incline between the dependant and independent variable of the winter months is varied between -0.092 to 0.073. This indicates that conditions did hold an impact on the norm turnout clip, though the alteration in norm was negligible. Is the relationship between the dependant and independent variable statistically important? The t-score scope identified corresponds to between an 18 % and 62 % opportunity that the relationship between turnout clip and the winter months identified is due to error. Insert table 6 here Insert table 8 here Tolerance and the discrepancy rising prices factor ( VIF ) are two statistical countries that help to set up if multicollinearity exists. A little tolerance value indicates that the variable under consideration is about a perfect additive combination of the independent variables already in the equation and that it should non be added to the arrested development equation. All variables involved in the additive relationship will hold a little tolerance. Some suggest that a tolerance value less than 0.1 should be investigated farther. If a low tolerance value is accompanied by big standard mistakes and nonsignificance, multicollinearity may be an issue. The VIF measures the impact of collinearity among the variables in a arrested development theoretical account. The Variance Inflation Factor ( VIF ) is 1/Tolerance, it is ever greater than or equal to 1. There is no formal VIF value for finding presence of multicollinearity. Valuess of VIF that exceed 10 are frequently regarded as bespea king multicollinearity, but in weaker theoretical accounts values above 2.5 may be a cause for concern. ( Research Consultants, 2010 ) . The consequences of this undertaking revealed that multicollinearity was non an issue. Tolerance was in surplus of 0.900 and VIF was between 1.0 and 2.2 for all independent variables. Insert table 2 here Insert table 8 hereDecisionThe research has revealed that there are no Torahs or criterions necessitating communities to supply paid staffing on premises in their fire Stationss. The National Fire Protection Association, Occupational Health and Safety Administration, and the State of Wisconsin mandate lower limit staffing demands one time on scene of an exigency. The National Fire Protection Association ( NFPA ) recommends that calling fire sections, which are by and large comprised of full-time paid forces, turn out within 60 seconds ( National Fire Protection Association, 2010 ) . There is no known criterion that exists for voluntary or paid-on-call fire sections, nevertheless. Though most people would impute the â€Å" fire section † to merely seting out fires, in most instances 80 % + of all calls for service in an bureau are medical in nature. An unstaffed volunteer/paid-on-call fire section must hold first respondents go to the fire station, obtain the necessary setup, and so react to the exigency scene. In some instances, this oversight in clip is O.K. as the nature of unwellness is minor and lives are non at interest. In other instances, the badness can be much higher and seconds can do the difference between life and decease. In a sudden cardiac apprehension, when a victim ‘s bosom stops all of a sudden whipping, there are merely proceedingss with which bystanders and exigency medical technicians can impact a deliverance. The encephalon needs a changeless supply of O and foods to map. Cerebral hypoxia occurs when there is non adequate O acquiring to the encephalon because the bosom is non pumping any blood throughout the system. Brain cells are highly sensitive to a deficiency of O. Some encephalon cells start deceasing less than 5 proceedingss after their O supply disappears. As a consequence, encephalon hypoxia can quickly do terrible encephalon harm or decease ( Hoch, 2011 ) . Though the literature reappraisal revealed that NFPA 450 does non mandate a minimal figure of respondents present on premises available to react, the criterion does urge at least four people to supply effectual advanced life support attention ( National Fire Protection Association, 2009 ) . The information revealed that the Eagle Fire Department ‘s response clip is an norm of 4:02 when the station is unstaffed. This leaves 58 seconds for an ambulance to make a victim ‘s place to get down supplying resuscitative attention to a sudden cardiac apprehension victim before lasting encephalon harm consequences. With a response country of 36-square stat mis, this can be a daunting challenge. Harmonizing to Compton and Granito ( 2002 ) , fire suppression operations have three basic maps: ( 1 ) deliverance, ( 2 ) work affecting ladder, physical entry, and airing, and ( 3 ) the application of H2O. To raise ladders, ventilate, hunt, and deliverance at the same time takes speedy action by at least four and frequently eight or more firemans, each under the supervising of an officer. If approximately 16 trained firemans are non runing at the scene of a on the job fire within the critical clip period, so dollar loss and hurts are significantly increased as is fire spread. As firefighting tactics were conducted and judged for effectivity, the writers held that five-person companies ( squads ) were 100 % effectual at executing these undertakings in an expeditious mode. Four-person companies were 65 % effectual, and three-person companies were 38 % effectual. Under the current staffing matrix of the Eagle Fire Department, during current staffed periods, the section operates at the two-person company degree whose effectivity as non been measured. When the section is unstaffed, the section typically operates at a three or four-person company though response can significantly detain due to the handiness of volunteer/paid-on-call employees and their single response to the fire station to obtain equipment and setup. In a 2008 study, the Eagle Fire Department concluded that in order to increase staffing to one individual, 24 hours per twenty-four hours, a budget addition of $ 87,000 would be needed to fund this plan, non including capital disbursals needed to upgrade the fire section installation to suit nightlong staffing. In order to supply four fireman / exigency medical technicians on a full-time footing, twenty four hours a twenty-four hours, the section would necessitate to budget about $ 1.5-million yearly for wages and benefits. This would ensue in a 600 % addition of the current operating budget. This option was non financially executable ( Heim, 2008 ) . This undertaking has revealed, nevertheless, that staffing the fire station does supply a touchable benefit of cut downing the norm turnout clip by about half. Though the current staffing matrix merely provides for one exigency respondent, there is a batch that one individual can make at a medical scene or fire until auxiliary staff arrives from the volunteer/paid-on-call ranks. Expanding this plan to twenty four hr coverage would be of important benefit to the community as it would let the section to react efficiently and run into the demands of community stakeholders. The challenge in implementing such a plan will be to procure gross to fund the plan. Expanding coverage would still necessitate an extra $ 87,000 yearly and revenue enhancement levy restrictions would most likely prevent the municipalities from implementing such a plan without seeking a referendum. A 2009 Town of Eagle referendum that was proposed to supply support to staff the paid-on-call plan failed with a 3-1 bord er ( Nixon, 2009 ) . Several restrictions were encountered while carry oning research for this undertaking. First, bing informations keeping policies limit the records kept in storage to the old 15 old ages. Records older than 15 old ages are destroyed. Therefore, information was merely available from 1996 – 2010 which allowed for seven old ages of unstaffed and eight old ages of staffed responses to be evaluated. This disparity may somewhat skew the consequences. Second, the Eagle Fire Department switched despatch bureaus in 2006. It is the despatch bureau ‘s duty to keep accurate records of clip, nevertheless it is acknowledged that during times of heightened call volumes, the starter may non hold been wholly accurate in entering all times. This disparity may somewhat skew the consequences, though the discrepancy is expected to be minimum. Further rating should be done to formalize the consequences of this survey finding if other like-sized fire sections that have undergone staffing alterations which involved transitioning from an unstaffed fire station to one that is staffed have experienced the same decrease in norm turnout clip. Additionally, surveies should be done in volunteer/paid-on-call fire sections to find if on-premises staffing as an consequence on the loss of life and belongings loss as a consequence of fire.

Listening Log - 724 Words

A. Sound of the music: What does the first selection sound like? (How can we describe it in terms of melody, harmony, rhythm, tone color, and form? How is the sound similar to or different from music you are more familiar with?)(2 points) Answer below: The first selection, â€Å"Hotter Than That†, is a very colorful, upbeat presentation of traditional jazz. The tempo is in 4/4 and is played at around 100 beats per minute. Mr. Armstrong moves quickly and widely with the trumpet from high, vibrato tones to low, mellow contradictions. There is the bright addition from a drum-set that keeps the beat up. The Clarinet begins playing at about 45 seconds into the song, which helps to add a mellow opposition to the brassy, crisp sound of the†¦show more content†¦This follows the standard of improvisation. This type of arrangement also adds a lot of excitement and swing, making the listening want to move right along with the beat. C. Compare and contrast: Now compare the first selection with the second. (In what ways are they alike, and how are they different? Refer to the Listening Guides in the textbook.) (3 points) Answer below: The first and second selection both use similar instruments: a trumpet/coronet, a string (guitar) to play bass, a clarinet, and drums. However, the second does not include the addition of vocals. Both arrangements do posses a noticeable swing aspect. The difference in the trumpet and coronet help with the overall mood. The first arrangement uses trumpet and is very brassy and crisp. The coronet in the second selection is much softer in tone and bell-like. Additionally, the rhythm is around 70 beats per minute in the second selection vs. the first arrangement being about 50% faster at around 100 beats per minute. 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