Impact of the Institute of Medicine on Nursing Practice Essay Example for Free

Impact of the Institute of Medicine on Nursing Practice Essay Impact of the Institute of Medicine on Nursing Practice, Education and Leadership The Institute of Medicine of the National Academics in Conjunction with the Robert Wood Johnson Foundation launched a campaign to provide solutions in response to the need for evaluating and alteration of the nursing profession. Future needs of our growing population from diverse cultures and demographics dictate the need for registered nurses to adapt and transform in response to advances in health care. This is done by promoting health with most favorable, efficient patient outcomes centered on patient care. The limitation of nursing practices today prevents nurses from effectively responding to the continuously evolving, rapidly changing, health care system which compromises patient safety and optimal outcomes. The IOM and RWJF determined four key messages in their discussions. Nurses should practice to their full potential regarding education and training. Higher levels of education and training should be attained through an improved and seamless academic program. Nurses should play an important role along with medical doctors and other health care professionals in reforming health care. Health care informatics and data collection need improvement to facilitate development of policy and efficient workforce planning. These suggested reforms will certainly impact nursing education, nursing practice, and the nurse’s role as a leader ( IOM, 2011). The foundation of the IOM’s report is to restructure nursing roles to become more efficient, cost effective, and adaptable in response to the growing population and technological advances seen in health care. Education is the key to preparing nurses for the new roles and responsibilities they will encounter. The expanded roles and expectations of the nurse call for educational reform as well. Incorporation of competencies at the educational level include leadership, basic health policy, evidence based care, quality improvement, and systems thinking ( IOM, 2011). The goal of the IOM is to increase the  number of nurses with Bachelors Degrees to eighty percent by the year 2020. Some bariers to this goal are as follows. There is a shortage of faculty, placement for students to perform clinical duties is limited, lack of competent programs to prepare nurses for higher degrees and technological advaces in patient care, and lack of workforce planning. Workforce planning is the competence of an organization to meet emerging needs. Educational institutions are not meeting these needs due to cost and qualified fculty (Wikipedia, 2014). As a result clinical experience is imperitive for fulfilling educational needs. The advent of the Affordable Care Act of 2010 endorses a shift from treatment of patients in an acute care setting to focusing on management and prevention of chronic illness. There is evidence based practice to suggest a more holistic approach which involving patient and family centerd care is more effective in treating patients rather than the hospital or healthcare model (Holmes, 2011). Due to this new model the IOM encourages nurses to advance education to the fullest extent, continue and maintain education to develop new competencies, and reform nursing school curriculum to meet these new patient care delivery models (Holmes, 2011). The IOM suggests that it is imperitive that nurses are able to practice to the full extent of their education and training ( IOM, 2011). As the population grows, physicians will not be able to perform at a competent level and provide complete patient care without a substantial number of nurses. Reliance on nurses is necessary to reform the health care system. Barriers such as regultatory restrictions regarding scope of practice, professional resistance by physicians, and insurance company reimbursment pactices hinder RNâ⠂¬â„¢s and Advanced Practice Nurse’s from practicing to the full extent of their education and compromise patient outcomes (Richard Ridge, 2011). Autonomy is an issue in some states regarding APN’s role. Some states require physician oversight to diagnose, treat, prescribe, or make referrals. Compensation for services is also an concern. Independent insurance providers, Medicaid, and Medicare compensate APN’s at reduced rates or not at all and may not cover prescribed prescriptions unless a physician signs off. Professional resistance is also an problem. The Scope of Practice Partnership lobbies against state expansion of the APN’s role stating they lack medical education, clinical knowledge and cognitive and technical skills which are acquired only in medical school ( IOM, 2011). These restrictions make it difficult to meet the demands of patient care. Outdated insurance practices also pose an obstacle by restricting insurance reimbursement to APN’s. Some recommendations to remove these barriers include conforming scope of practice regulations from state to a national level. Enlighten medical doctors on the future of health care and the need for autonomous APN’s. Providing information about successful patient outcomes as well as the decrease in hospital readmissions may sway the opinion of doctors regarding APN practice. Include Medicare and private insurance coverage of APN’s. Refer to evidence based practices to justify coverage. In order to institute IOM’s reform it is imperative the role of the nurse also transition into that of a leader. The development of leadership skills should be instilled at every level of nursing education and clinical mileu. The educational curriculum needs to incorproate theory and business practices, exposure to political dynamics, and management of multifocal relationships to ensure competency in high level collaborative skills (O’Grady, 2011). We will be responsible for assessing and implementing change in patient centered care systems which requires full partnership with other disciplines to reform policy. It is time for nurses to shape policy rather than conforming to it. As the population grows, and demographics shift to include a vast number of geriatric patients, the need for health care reform is imperative to provide optimal patient care. The IOM’s report recognizes the integral role nurses play in our healthcare system. The IOM suggests changes in areas such as education, leadership, and scope of practice to safegaurd the future of healthcare. Implementing these suggestions will transform the role of the nurse into a competent leader who is responsible for health policy change, and an educator to patients, family, and community. It is time we take responsibility for change rather than accept it for what it is. References Holmes, A. M. (2011, April). Future of nursing special: Transforming education. Nursing Management, 42. 34-38. Retrieved October 16, 2014, from Lippincott Nursing Center: http://www.nursingcenter.com/lnc/pdfjournal?AID=1150962an=00006247-201104000-00008Journal_ID=Issue_ID= IOM (Institute of Medicine). (2011, October 05). The future of nursing: Leading change, advancing health. Retrieved from http://iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx OGrady T. P. (May, 2011). Future of nursing special: Leadership at all levels. Nursing Management,42. 32-37. Retrieved October 19, 2014, from Lippincott Nursing Center: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=1163290 Ridge, R. (2011, June). Future of nursing special: Practicing to potential. Nursing Management, 42.32-37. Retrieved October 16, 2014, from Lippincott Nursing Center: http://www.nursingcenter.com/lnc/pdfjournal?AID=1176058an=00006247-201106000-00008Journal_ID=Issue_ID= Wikipedia, The Free Encyclopedia. (2014, September 27). Retrieved October 19, 2014, from Workforce planning: http://en.wikipedia.org/w/index.php?title=Workforce_planningoldid=627275816

Causes of Underage Drinking Essay -- Alcohol Drinking Binge Essays

Causes of Underage Drinking Today, many teenagers experience different things in the world. Whether it is their first date or first day in high school, teens are always eager to try something different or new. One of the things that teenagers try is drinking alcohol. Unfortunately, underage drinkers often abuse alcohol. In this paper, I will try to shed some light on some of the reasons why teenagers drink alcohol at such premature age. The causes of underage drinking include peer pressure, family problems, low self-esteem, and of course curiosity. Must students who enter college in the United States are about eighteen years of age. They find a new kind of freedom on college campuses away from the supervisory eyes of their parents being away from home gives these students the freedom to make their own decisions regarding school, their finances, and their social lives. Some students feel that they finally can do what ever they want including drinking alcohol even though they perfectly know that the drinking age in many states, including Texas, is twenty-one. According to Dr. Richard Yoast, Ama’s director of the office alcohol and other drug abuse, says that 80 percent of students have consumed more than a few sips of alcohol by the time they finish high school. â€Å"Among youth 12 to 20, an estimated 10.1 million used alcohol,† he says. â€Å"Of these, 6.8million were binge drinkers and 2.1 millions w ere heavy drinkers.† Dr. Yoast continues to illustrate the seriousness of the ...

Consider Pip from Great Expectations and Ralph from Lord of the Flies Essay

Which character do you think gives the most realistic portrayal of childhood? Both of these novels contain depictions of childhood. An important fact to keep aware of is that in Dickens’ portrayal of childhood, there are adults present to mould Pip through his encounters with them, whereas Golding leaves his characters free from any guiding adult hand. Pip’s sister being on â€Å"the rampage† when she felt Joe or Pip had done the slightest thing wrong, is different to Ralph’s experience of childhood on the island as the closest thing he has to an adult guide is Piggy, who whilst undoubtedly more intelligent than the other boys, lacks the respect and authority an adult commands. Pip and Ralph are alike however in their longing for a lack of adults, â€Å"but then the delight of a realized ambition overcame him. In the middle of the scar he stood on his head and grinned at the reversed fat boy. ‘No grown ups!’ † Is what Golding tells us of Ralph, and similarly Dickens’s Pip calls them all â€Å"toadies and humbugs†. Although these views both seem to concur that a lack of adults is definitely a good thing, they do differ somewhat, I do not believe Ralph would go so far as to call all adults â€Å"toadies and humbugs† and this is certainly to do with their different backgrounds. Ralph is a Home Counties lad with a father high up in the navy who knows that the queen has â€Å"a drawer full of maps†, whereas Pip is the adopted son of a blacksmith and although Ralph’s lifestyle may not necessarily have been glamorous, it was much more homely and welcoming than the one Pip enjoys. The two novels are also set over a greatly differing time span. Lord of the Flies lasts perhaps several weeks at the most, whereas Pip’s childhood lasts several years in Great Expectations. Obviously this will play a part in how realistic their childhoods seem as we see no more than the blinking of an eye of Ralph’s, but have a much more in depth viewing of Pip’s. Adults mould Pip throughout his childhood, and the most important adults involved in this are Pumblechook, Mr Wopsle and Pip’s sister. All of these have a tendency to look down on Pip, and it is for that reason that Joe is not included in the list, as he and Pip treat each other like equals. Ralph on the other hand has no guiding force behind him throughout all the time the reader knows him. Whereas Ralph is a very expressive child, he stands on his head and laughs and looks â€Å"golden†, Pip is not, in the early stages of the book, free from the tyranny of his sister. So there is a crucial difference between the two novels in that Ralph and his companions are free to be children without adult ideals being laid upon them, whereas Pip is expected to be a child the way society expects him to be, â€Å"be grateful boy to them which bought you up by hand† being a good example of this. A key aspect of childhood is Fear, fear of the dark, fear of the unknown and fear of adults to name but a few. Both authors work this aspect of childhood into their novels somehow. Dickens does this with Magwitch’s young man â€Å"a boy may lock his door, may be warm in bed, may tuck himself up, may draw the clothes over his head, may think himself comfortable and safe, but that young man will softly creep and creep his way to him and tear him open.† All this to scare Pip into getting him some â€Å"wittles† and it works, from the language in that quote, it is obviously apparent that Dickens had a very good idea of childhood and it’s workings, on of the few things universal to children is that they do think bed to be the ultimate haven. Pip is scared by Magwitch into stealing from his sister, who he is already afraid of, and this is significant in that it shows Dickens had a very good grasp of what childhood was about, and is thus likely to have a very good portrait of childhood in his novel. Possibly even more significant than this is that Pip steals a file from Joe his trusted friend, and this also shows more understanding on Dickens’ part about children, they do not discriminate between close friends and others to the extent older people do. And so we see the counter part to this in Lord of the Flies, when alone and with no adults on the desert island the children feel the need for a fire and steal Piggy’s glasses to light it. Piggy is Ralph’s main ally on the island, and certainly Ralph is Piggy’s only friend, so the situation is much akin to the one in Great Expectations but we do not see the same level of remorse from Ralph. Instead of Pip’s fearful â€Å"I held tight to the leg of the table under the cloth, with both hands, and awaited my fate† in anticipation of any retribution that may be dealt out, all that Golding says of the boys remorse at leaving Piggy blind and helpless is for Ralph to hand them back when done with them, and it is here that it seems as though Golding has a better understanding of children, he appreciates that their consciences are not yet fully developed as they are unable to grasp the implications of what they have done. The fear that grows apparent on the island however is not the same kind of fear as Pip experiences. One of the little-uns complains of â€Å"a beastie†, nonsense is the response he gets from Ralph, and yet â€Å"The vivid horror of this, so possible and nakedly terrifying held them all silent†. And it is here where the crux of the argument begins to form for Dickens’ having the better portrayal of childhood. The Beastie is in fact symbolic of the horror humans will create on the island, and the rest of Golding’s novel is also mostly symbolic, whereas Great Expectations isn’t. The natural reaction for Ralph and company to have is to try and ward of the beastie somehow, and thus the fire begins to become more than simply a rescue beacon. The relationships between characters is also a major part in the views we are offered of childhood. Golding uses the views of others to reveal aspects of the main characters, and so influence how we feel about them, Piggy’s view of Ralph and the others â€Å"Like a crowd of kids -† is supposed to make the reader feel that Piggy is far more mature, and that in turn Ralph is excessively immature, and childlike. Dicken’s however uses Pip’s perspective throughout the novel, and the language he uses differs greatly at the start as compared to the finish for the purposes of showing the transition between child and adult. For example â€Å"I religiously entertained that they had been born on their backs with their hands in their trouser pockets† is clearly not the impression an adult would get from having dead brothers or sisters, and most likely not the way they would describe them. However at the end of the book the language use has progressed to statements such as â€Å"Oh, Joe, you break my heart! Look angry at me, Joe! Strike me, Joe! Tell me of my ingratitude. Don’t be so good to me.† This is a statement the younger Pip would have been incapable of making, ti shows the complex differences in language that Dickens appreciates children use as compared to adults. In Great Expectations Pip is not treated as an adult, he is treated as a particularly worthless child, and as such he forms negative opinions of the adult world he will have to grow into, â€Å"that ass Pumblechook† being just one example of the way Pip views this world, however Dickens also understands that children’s attitudes change very quickly, as does Golding, and so when Pip obtains â€Å"Great Expectations† and Pumblechook starts acting up to him, then he decides that maybe â€Å"Pumblechook was a practical, sensible, good hearted fellow†. This is also shown in Lord of the Flies because although by the end Ralph and Jack are literally at each others throats, when making the fire at the start Ralph finds a log that looks too heavy, but gets the reply of â€Å"Not for the two of us!† And so Golding shows the reader a glimmer of hope that the two may get along well, but they don’t, and this demonstrates the inconsistency of children. Ralph has responsibility for the other boys on the island, and this causes him in many aspects to grow up. Instead of being completely child like and swimming, diving and running about, he gets worked up because the shelters haven’t been made and the other are incapable of concentrating â€Å"And they keep running off. You remember the meeting? How everyone was going to work hard until the shelters were finished?† This is not a very childlike statement, children get frustrated because they don’t get their own way, Ralph is not saying â€Å"I’m the leader and they don’t obey me† but instead worrying that the community is beginning to tear apart, a concern more voiced on tabloid letter pages than children’s conversations. Pip however has no such responsibility, admittedly while he does some chores set him by his sister, or his lessons under Mr Wopsle’s great aunt â€Å"that preposterous female†, he is nowhere near as empowered as Ralph who has been voted to care for a few dozen boys. And so this also affects the childhood of the two we see, while Ralph had the easiest growing up previous to the novel (with his parents) as opposed to Pip’s dead parents and harsh sister, he is given a far more demanding role to play. And the way he deals with it is not very childlike; in fact it comes to eventually represent the way a tired adult may feel, worn down, beginning to despair and wondering why on earth he’s taken the responsibility at all. And this is another key point to consider, Golding’s children are literary metaphors for mankind, whereas Pip, although he teaches the reader about aspects of the human character, is not supposed to be representative of the whole human race, and so more likely to represent childhood better. Yet another fact to remember is that Golding and Dickens were writing in very different times. Dickens was writing in what was the height of Victorian England and was teaching about society in those days. Whereas Golding was writing after the World Wars and so was trying to tell a more global message. So his Ralph is, although a child, not necessarily entirely representative of one. Pip however is forced to be a child by the constraining presence of his sister, Pumblechook and eventually the bond apprenticing him to Joe, all things that represent Victorian society, and yet things that still apply today even if in a different form, such as parental control and discipline and mandatory education. Childhood on Golding’s island is also not really something enjoyed particularly by Ralph and his peers, instead it is the little’uns who are the children, Ralph and the other bigger boys find themselves in the positions of adults simply because they are the biggest ones on the island. Perhaps because they are not completely mature at the time this does not help them deal with the events that happen on the island. There is possibly a case for saying that Pip too, is no ordinary child and has to grow up very fast in his attempts to impress Estella and grows up even more rapidly once he has his expectations laid upon him. However this is most likely a part of his childhood akin to the beginning of school and as this has been a part of life for every child in the last hundred years and more, this is not something that can be argued as not being a part of childhood. And most certainly at the start of the novel Pip is a child plain and simple, with no more worries than his si sters â€Å"rampages. Another aspect of childhood to consider is trust and loyalty. Children are usually trusting unless something happens to make them otherwise. In Lord of the Flies, loyalty is shown by the twin’s and Piggy’s dedication to Ralph and their faith in him to get them through. Ralph however displays a special kind of loyalty, a loyalty to the good side of human nature and a deep trust in fair play. Pip’s trust however is in Joe and his own learning, but the trust is very temporary with Joe, it is more of a mutual agreement to be equals. And Pip is more than happy to trade his oldest friend for some money and a life in London. Here again we see that Dickens understands children are rarely consistent, whereas Golding is trying to use children as a metaphor for something much bigger. To conclude I believe that Pip is by far the better portrayal of childhood. Childhood does not generally involve the lack of adult presence to so huge an extent as it does in Lord of the Flies, however the battles of child against adult and adult society such as are seen in Great Expectations do occur almost universally. I think that some qualities the reader sees in Ralph, such as the headstands, do display the kind of innocent glee a child might express, but other than that Ralph and is peers are all examples of the human race and so representative of those who rule the world, adults, and not of children who merely inhabit it. Golding’s book is a political message of it’s time, whereas Dickens was writing a novel, but his was free from the idealism that contaminates Golding’s work. Dickens’ novel still had a point, but this point was made about the way in which his society worked and in particular his belief that money is a great corrupter. Therefore I believe that Dickens’ Pip is the most realistic portrayal of childhood as he behaves like a child, his expressions and attitudes are all those common to children. Dickens’ also displays a deep understanding of how children work, and this comes across in Pip’s actions. Golding’s children however are only just recognisable as children, they could easily be replaced with full grown adults and still the story would work just as well.

My Career As A Sociology - 1369 Words

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