About Vipers, Family Viperidae

Vipers (Viperidae) are a group of snakes known for their long fangs and venomous bite. Vipers include true vipers, bush vipers, rattlesnakes, pit vipers, adders and night adders. Venomous Fangs The fangs of vipers are long and hollow and enable the snake to inject venom into animals that it bites. Venom is produced by and stored in glands located at the back of the snakes upper jaw. When the snakes mouth is closed, the fangs recede into a thin membrane and fold against the roof of the snakes mouth. When a viper bites its victim, the bones of the jaw rotate and flex so that the mouth opens at a wide gape angle and the fangs unfold at the last moment. When the snake bites down, muscles that encase the venom glands contract, squeezing venom out through ducts in the fangs and into their prey. Types of Venom Several different types of venom are produced by the various species of vipers. Proteases consist of enzymes that break down proteins. These enzymes cause a variety of effects in bite victims including pain, swelling, bleeding, necrosis, and disruption of the clotting system. Elapid venoms contain neurotoxins. These substances disable prey by disabling muscle control and causing paralysis. Proteolytic venoms contain neurotoxins to immobilize prey as well as enzymes that break down molecules in the victims body. Head Shape Vipers have a triangular-shaped head. This shape accommodates the venom glands at the back of the jaw. Most vipers are slender to stout-bodied snakes with a short tail. Most species have eyes with elliptical pupils that can open wide or close down very narrowly. This enables the snakes to see in a wide range of light conditions. Some vipers have keeled scales—scales with a ridge in their center—while others have smooth scales. 26 Types There are currently about 26 species of vipers that are considered vulnerable, endangered or critically endangered. Some of the rarest vipers include the golden lancehead and the Mt. Bulgar viper. Like most snakes, vipers appear not to care for young after hatching. Most species of vipers give birth to live young but there are a few species that lay eggs. Vipers occur in terrestrial habitats throughout North, Central and South America as well as in Africa, Europe, and Asia. There are no vipers native to Madagascar or Australia. They prefer terrestrial and arboreal habitats. The range of vipers extends further north and further south than any other group of snakes. Vipers feed on a variety of small animal prey including small mammals and birds. Classification Vipers belong to the snake family. Snakes are among the most recently evolved of the main reptile lineages alive today. Their evolutionary history remains somewhat murky, though—their delicate skeletons do not preserve well and as a result, few fossil remains of ancient snakes have been recovered. The earliest known snake is Lapparentophis defense which is estimated to have lived about 130 million years ago, during the early Cretaceous. The viper family includes about 265 species. Vipers are classified into one of four groups: Azemiopinae: Feas viperCausinae: night addersCrotalinae: pit vipersViperinae: true vipers The Viperinae, also known as the Old World vipers, are short and stocky snakes. They have a wide, triangular head and rough, keeled scales. Their coloration is dull or cryptic providing them with good camouflage. Most members of this group give birth to live young. Pit vipers are distinct from other vipers due to a pair of heat-sensitive pits located on either side their face between the eyes and nostrils. Pit vipers include the worlds largest viper, the bushmaster, a snake native to Central and South American rainforests. The bushmaster can grow as long as 10 feet. Copperhead snakes are also pit vipers. Of all vipers, the rattlesnakes are among the most easily recognized. Rattlesnakes have a rattle-like structure at the end of their tail formed out of old layers of the terminal scale that do not fall off when the snake molts. When shaken, the rattle serves as a warning signal to other animals.

Essay on Buddhism - 3689 Words

Buddhism nbsp;nbsp;nbsp;nbsp;nbsp;In reading this account on Buddhism, the goal is, for you (the reader) to understand a fascinating belief system, that has been around since before Christ ever set foot on this earth. This will provide a connection to the minds and hearts of the people who live and die in this sacred world, so that an understanding may be arroused and ultimatly give an acceptance as well as a clear path to minister to these people. The most important aspect of reaching out to people of other cults or religions could possibly be an understanding and common ground with your neighbor. Therefore, knowing Buddhism and learning about it will help give you a stepping stone in you mission on spreading the gospel of†¦show more content†¦He did these things for six or seven years in order, so he believed, to attain truth. One day while on his pilgrimage of enlightenment he came to the realization that his life as an ascetic was of no greater value than that of his previous exi stence as a prince. His self-torturing acts were then viewed by him as vain and fruitless, just as a life with worldly pleasures would be described as. Once he discovered the importance of the â€Å"middle way†, (the way to truth, which averts both worldly pleasures and extreme austerities) he abandoned his life of extreme austerities and moved on in his search for truth. (Mead 30) Later on in his life, it is not certain exactly when, Gautama sat under a particular fig tree in Gaya, which now is christened the Bodhi-tree. Gautama sat at the foot of that tree and meditated, he meditated until he became enlightened. At the point of enlightenment he discovered the â€Å"Four Noble Truths†, which became the focal point of his teachings, and of his Buddhist philosophy. This marked perhaps the most important point in his spiritual journey, where he became the Buddha or â€Å"the Enlightened One†. With his newly found title as the Buddha he decided to set out and share the enlightenment he experienced and the â€Å"Four Noble Truths† to all who would be willing to receiveShow MoreRelatedBuddhism : Buddhism And Buddhism1009 Words   |  5 Pages Zen Buddhism isn’t exactly a â€Å"religion†, but a way of living. It creates peace within the human mind that allows one to grow, develop and look at the world more positively. Originating in China in 650 C.E., Zen Buddhism is a combination between Indian Mahayana Buddhism and Taoism. Mahayana Buddhism promotes bodhisattva, which is practicing the way of life in the direction of Buddha. Taoism is a religion developed by Lao-tzu, a Taoist philosopher, and focuses on obtaining long life and good fortuneRead MoreBuddhism, Buddhism And Buddhism1371 Words   |  6 PagesBuddhism is one of the largest religions in the world that started in India. Later spreading to China,Burma,Japan , Tibet and other parts of south east Asia. Buddhism is a religion that Is concentrated on spiritualism than religious teachings. Established by the buddha, one must obtain their own spiritual awakening, or nirvana through meditation. There are three main branches of Buddhism Theravada Buddhism , Mahayana Buddhism and Tantric Buddhism. About 2,500 years ago, Prince SiddharthaRead MoreBuddhism : Buddhism And Buddhism982 Words   |  4 PagesBuddhism is a philosophy that is often viewed as a religion and dates back to approximately 6th century B.C.E. Buddhism originated in the Indian subcontinent by a man known as Siddhartha Gautama. The original language of Buddhism is often debated as some scholars believe that it was first practiced in Pali while other believe it was first spoken in Sanskrit. The practice of Buddhism first spread to China in the 2nd century A.C.E and was translated to Mandarin in 3rd century A.C.E. Today, there areRead MoreRelics Of Buddhism And Buddhism847 Words   |  4 PagesRelics are thought to be present in Buddhism since the 5th Century B.C.E, when the original Buddha, Siddhartha Gautama, was said to have lived, and Buddhism itself was a new religion. They continue today as sacred objects of worship. Relics that are as old as Buddhism itself are said to exist and still be wo rshipped. Although the idea of relics may seem contradictory to many of Buddhist beliefs, they actually do resonate with many ideals of Buddhist teachings and practices. To see whether relicsRead MoreBuddhism : The Philosophy Of Buddhism1198 Words   |  5 Pagesnever be one true answer. The theory I mostly identify with is the philosophy of Buddhism, its teachings, and the importance of meditation. Some people would argue that Buddhism is a religion not a philosophy, and vice versa, but nonetheless the Buddha has an idea of self in our current life. Buddhism teaches us that life is, and full of suffering and that nothing in life is eternal. The ultimate goal of Buddhism is Nirvana, which means liberation from the constant cycle of life and death, andRead MoreThe Teachings Of Buddhism And Buddhism939 Words   |  4 Pagesfamous religion icon of all time the Buddhism. Many people became followers of this very wise man we know as the Buddha. Buddhism is based on the teaching of Siddhartha Gautama, Buddha, who was born in the Ganges River Valley, the foot of the Himalayas. The Buddha led people in meditation and enlightenment to the next level. Philosophers such as Santideva and Thich Nhat Hanh, have led the life to follow the Buddhism ways and live their day to day life off of it. Buddhism gave them the enlightenment toRead MoreThe Religion Of Buddhism And Buddhism1730 Words   |  7 Pageslife. The religion of Buddhism is one of these that had this effect when it began to spread from India where it originated, to many Asian countries especially China where it would have the biggest impact. In China, Buddhism would take root and would grow to become a popular religion in the country much like the other major religions of China, Confucianism and Taoism, which together with Buddhism would later be known as the â€Å"Three Teachings†. Additionally, at some point Buddhism would began to loseRead MoreReligion Of Buddhism : Buddhism963 Words   |  4 Pagesinterested in the religion of Buddhism. After I watched Oprah Winfrey’s television series, Belief Buddhism has become something I wished to look into on a deeper level. Therefore, On October 9, 2016, I visited Wesleyan college East Asian studies facilities to participate in their Sunday meeting of Practice and Talk. During this hour and a half meeting, individuals who are exploring Buddhism wil l learn the surface practice of Buddhism more specifically shin Buddhism. Shin Buddhism or the teachings of ShinranRead MoreBuddhism, Buddhism And The World Essay1999 Words   |  8 PagesBuddhism is the fourth largest religion in the world, with more than 5 million believers in the world. Buddhism is a kind of religion and law that contains various traditions, beliefs, and spiritual practices. Buddhism from India, between the sixth and fourth centuries BC, and gradually spread to Asia. Although Buddhism originated in India, China has many believers in the dissemination and contribution. Chinese Buddhism began in the Han Dynasty and became the most powerful in the Tang Dynasty. WithRead MoreBuddhism : The Popularity Of Buddhism1306 Words   |  6 PagesBuddhism Culture in China Instructor Dr. Jack Name: Zhoudongxue Zhang Student #: 100311725 Date: 26/11/2015 The Popularity of Buddhism in China Buddhism is one of the most popular religions in the world. The Pew Research Center reports that nearly 488 million people practice Buddhism, which represents 7% to 8% of the world’s entire population. Buddhism is mainly practiced in the Asia-Pacific region with approximately 481,290,000 Buddhists, which means 99% of Buddhists live in Asia-Pacific

English Language Practice Ordering at a Restaurant

Knowing how to order food at a restaurant is an important task for any beginner-level English learner. Here are two short dialogues to help you learn common questions and answers used at restaurants. Dining at a Restaurant Alone This dialogue  includes most of the basic questions youll need to know when going to a restaurant alone. Practice it with a friend. Waitperson: Hi. How are you doing this afternoon? Customer (you): Fine, thank you. Can I see a menu, please? Waitperson:  Certainly, here you are. Customer: Thank you. Whats todays special? Waitperson: Grilled tuna and cheese on rye. Customer: That sounds good. Ill have that. Waitperson: Would you like something to drink? Customer: Yes, Id like a coke. Waitperson: Thank you. (returning with the food) Here you are. Enjoy your meal! Customer: Thank you. Waitperson: Can I get you anything else? Customer: No thanks. Id like the check, please. Waitperson: Thatll be $14.95. Customer: Here you are. Keep the change! Waitperson: Thank you! Have a good day! Customer: Goodbye. At a Restaurant With Friends Next, use this dialogue to practice speaking at a restaurant when eating with friends. The dialogue includes questions to help you choose  what to eat. For this role-play, youll need three people instead of two. Kevin: The spaghetti looks really good. Alice: It is! I had it the last time I was here. Peter: How is the pizza, Alice? Alice: Its good, but I think the pasta is better. What would you recommend? Waitperson: Id recommend the lasagna. Its excellent! Alice: That sounds great. Ill have that. Waitperson:  Fine. Would you like an appetizer? Alice: No, lasagna is more than enough for me! Kevin: I think Ill have the lasagna as well. Waitperson: Right. Thats two lasagnas. Would you care for an appetizer? Kevin: Yes, Ill take the calamari. Peter: Oh, that sounds good! I cant decide between the chicken marsala and grilled fish. Waitperson: The fish is fresh, so Id recommend that. Peter: Great. Ill have the fish. Id also like a salad. Waitperson:  What would you like to drink? Kevin: Ill have water. Alice: Id like a beer. Peter: Ill take a glass of red wine. Waitperson:  Thank you. Ill get the drinks and the appetizers. Kevin:  Thank you.   Key Vocabulary and Phrases Here are some key  phrases used to discuss food in a restaurant when ordering and deciding on what to eat: Could I have  a menu, please?Here you are.Enjoy your meal!Would you like ...Can I get you anything else?Id like the check, please.Thatll be ...Have a good day!The spaghetti/steak/chicken looks good.How is the pizza/fish/beer?What would you recommend?Id like my steak rare/medium/well done.Are there any nuts/peanuts? My child has allergies.Do you have any vegetarian dishes?Could I have a glass of water, please?Could you tell me where the restroom is?Id recommend the lasagna/steak/pizza.Would you care for an appetizer/a beer/a cocktail?Id like to  have a beer/steak/glass of wine.

The Ends Justify the Means - 1113 Words

The violence shown in the film Mississippi Burning displays one of the most inhumane images. It shows the unconditional hatred by the Caucasian Americans toward the African American people living in Jessup County. Throughout the film, it is suggested by Agent Anderson (a fictional FBI agent) that those involved in the investigation of three missing children needed to use more guttural tactics. This is often referred to as a â€Å"do whatever it takes† philosophy. In the film however, Agent Ward is particularly against using such tactics and avidly tries to avoid using them. Agent Anderson finally wins the argument between them and the more aggressive technique eventually prevails. The question that looms however is whether or not it is†¦show more content†¦The minority in this way, will always be persecuted, they will always be slaves to the opinion of the majority. Despite all of this, I do not believe Thoreau would embody a â€Å"do whatever it takes† philosophy. He does advocate civil disobedience, via refusal to follow certain laws or protesting, but in no way does he believe that one should rise up against the government with force to overcome injustice. Martin Luther King Jr. was greatly influenced by Henry David Thoreau and it is shown through their theories and ideas such as imprisonment. Both King and Thoreau spent nights in jail in order to protests a particular idea or belief, for Thoreau it was slavery, for King it was segregation. Mississippi Burning, the film that so brutally depicts the actions of the Ku Klux Klan in the South, actually takes place in the Neshoba County of Mississippi. While the film makes loose ties to the actual event, many of the specific details were altered in order to better make the film. The statements that I will include are those that coincide with reality. Three civil-rights activists: James Cheney, Michael Schwerner and Andrew Goodman; were charged with a false speeding violation an d were taken to prison for a total of eight hours. The police department working in accordance with the Klan released the three advocates andShow MoreRelatedDoes The Ends Justify The Means?1597 Words   |  7 PagesDoes the Ends Justify the Means? To answer questions such as ‘Does the Ends Justify the Means?’ is complex. Should we unconditionally accept this doctrine? I believe this cannot be answered unequivocally yes or no because it will depend on the situation and the role in which this concept is being considered. This essay will explain the doctrine of the ends justifies the means while showing examples of both positive and negative application outcomes. This should allow readers to gain a better understandingRead MoreDoes The End Justify The Means?951 Words   |  4 Pageshave heard of the question, â€Å"does the end justify the means?†, but what does it mean? This question can be answered on both sides as yes it does justify and no it does not justify the means. It all depends on the situation in hand. Were the steps to achieve the end good or bad? If the steps to the end were good then it justifies but if it was bad then it does not justify. So the answer to the question would be depending on the means to get there and the end results. There had been many incidentsRead MoreDoes the End Justify the Means1267 Words   |  6 Pages The end justifies the means The end justifies the means is an expression that is often used in society to validate or excuse distasteful and objectionable actions undertaken by its people. In effect, the phrase is a justification for dispensing with all morality and principle in the passage towards a successful conclusion. The Greek writer Sophocles wrote in Electra 409 BC â€Å"the end excuses any evil. This was a thought later considered, by the Roman poet Ovid, ‘the result justifies the deedRead MoreDoes the End Justify the Means?739 Words   |  3 Pagesresponse to the question, Does the end justify the means? Give examples of when the ends justifies the means and when it doesnt. Post your response as a reply to this topic. Read others responses and feel free to comment on others threads and have an open discussion. The ends justifying the means is extremely difficult to generalize. The answer is much more complex than a simple yes or no. Quite often, if not most of the time, the end does not justify the means. But sometimes it can happen. ARead MoreDo the Ends Justify the Means?1115 Words   |  5 PagesRobert Sasson Final Paper ENG 2800 12-09-09 Do the Ends Justify the Means? Literature is often a vehicle for social commentary. Two works of literature that express criticism of practices in the society in which they were written are Niccolo Machiavelli’s Mandragola and the Gospel According to Saint Matthew. In his satirical comedy, Machiavelli indirectly criticizes the hypocritical practices of the Catholic Church; however, JesusRead MoreDo the Ends Ever Justify the Means?1295 Words   |  6 PagesDo the Ends Ever Justify the Means? When I first heard about the book The Immortal Life of Henrietta Lacks, I thought it was just a reading assignment when I was in high school that I had to complete for a grade. As I began reading I became particularly interested in Henrietta Lacks and the HeLa cells. In The Immortal Life of Henrietta Lacks, Rebecca Skloot talks about Henrietta Lacks and how her cells were taken without her permission, and how her family suffered afterwards. Skloot shows howRead MoreWhen the Ends Justify the Means in Machiavelli ´s The Prince Essay788 Words   |  4 PagesWhen the Ends Justify the Means It is commonly believed by both lay people and political philosophers alike that an authoritative figure is good and just so long as he or she acts in accordance with various virtues. If the actions of a ruler are tailored toward the common good of the people rather than himself, then that ruler is worthy of occupying the status of authority. By acting in accordance with social and ethical norms, the ruler is deemed worthy of respect and authority. Niccolà ² MachiavelliRead More Social Influence Research - Do the Ends Justify the Means? Essay865 Words   |  4 PagesSocial Influence Research - Do the Ends Justify the Means? To what extent does the importance of social influence research, justify the methods used in its investigation? The debate about ethics in psychology focuses on two areas: protection of participants and benefiting society. This is a double obligation dilemma as if some psychologists are not allowed to do certain experiments because of ethical restraints; this can cause problems with validity. In social psychologyRead MoreMorality And The Moral Theories1137 Words   |  5 PagesMeaning of the phrases ï ¿ ½the ends justifies the means’ The phrase ï ¿ ½the ends justifies the means’ is a very popular in many fields and is also used in our day to day living. However, it is more used when talking about morality issues whereby it means that the morality of an action or behavior depends entirely on the result of that action and not the behavior or action itself. This is phrase that can be viewed different by proponent of different moral theories. A consequentialist theorist will agreeRead MoreAssessment of a Statement Essay1102 Words   |  5 Pagesâ€Å"the end justifies the means† is not morally defensible. It will explore the implications of the statement itself, the rudiments of the social contract, the principles of Machiavelli and solid empirical evidence. The belief that the end entirely justifies the means is merely an extreme version of the commonly held belief that moral considerations cannot apply to the means except in relation to ends, or that the latter have a moral priority. Gandhi wrote, â€Å"The means may

The Public Facilities Privacy Security Act - 1755 Words

In March 2016, a â€Å"bathroom bill,† entitled the Public Facilities Privacy Security Act was introduced in North Carolina and signed into law by Governor Pat McCrory. Commonly referred to as â€Å"HB2,† or House Bill 2, this law states that within government buildings, like schools, an individual must use the restroom or changing facility that matches the sex listed on their birth certificate. For transgender individuals, this presents a problem, as their birth sex and the gender with which they identify do not match. Several other states, including South Dakota, Florida, Tennessee, and Wisconsin have introduced similar bills. Although these forms of legislature may seem of concern to only a minority, it should ultimately concern anyone who†¦show more content†¦Spokespeople for other North Carolina police departments have made similar statements (Michaels). Even if such a thing were plausible, how would one determine whether or not to allow a particular pers on into the restroom? Consider, for a moment, people who are gender non-conforming. These individuals are comfortable with their biological sex, male or female, but choose to present themselves in a way that is not typical of or expected for their gender. For example, a female may shirk feminine gender roles and dress in a way that is considered â€Å"masculine.† Now imagine a scenario in which such an individual wants to use the women’s restroom. They do not look as is expected for a female, but they are female nonetheless. Would a law enforcement officer request they present some form of ID or even their birth certificate? Would there be someone on standby to examine bathroom goer’s genitals, or check their DNA to ensure they have the correct chromosomes? On the other hand, there are many cases in which a transgender person is virtually indistinguishable from a non-transgender person, and this says nothing of intersex people who fall outside of the sex binary. The fact of the matter is that gender and sex are often blurred lines. In those cases, the only way to be certain the person entering the restroom was of the proper sex would be through the use of the extreme and

Healthcare Practice and Policy Considerations-Samples for Students

Question: Demonstrates how the Gibb's reflective cycle helped an understanding of self and alternative view. Answer: Introduction The critical analysis of any issue or event through reflection cycle is helpful in increasing knowledge and understanding of the professional practice in aspects of behaviour and values in the healthcare and determines how behaviour will change in the future. It provide an insight into a particular incident that contribute to personality development and aids in ensuring continuous learning and role improvement. In the similar way, the analysis of the healthcare issue through reflective cycle helped to gain an insight into the importance of issue and uncertainties around healthcare practice and policy considerations. The incident took place during the second year of the placement while working at the surgical ward. During the wound examination, the doctor examined the wound without washing the hands with soap or alcohol. It was astonishing and surprising for healthcare professionals to exhibit such a malpractice in this profession, as hand hygiene is the simplest activity for cross-infection reduction. The five moments of hand hygiene also reduces the infection rates by cleaning hands in the right way and time. Therefore, in the next section, analysis of this incident through Gibbs reflection cycle will be done followed by uncertainty of health practice or policy and actions required to enhance hand hygiene in professional health practice. Gibbs reflection cycle Incident The incident occurred during the second year of my nursing placement. I was assigned to work in the surgical ward and under the supervision of my senior. My mentor instructed me to take care of a seventy-year old man. The patient had undergone abdominal surgery and was instructed for wound dressing removal for the doctor to examine during the round off. I removed the wound dressing under his guidance through a non-touch procedure. I cleaned the wound as instructed. At that moment, my mentor was called for visiting another patient and was advised to stay with the patient until the doctor come for the visit. The doctor was busy examining another patient and to my surprise, I noticed that doctor came straight to my patient and started examining his wound. Before examining my patients wound, the doctor without using alcohol or soap wash. I also noticed that doctors sleeves were long and concerned cuff contamination with the wound. At that time, I thought of what to do or say to the doctor by summoning courage, I realized that it was too late as the doctor was already examining my patient. Feelings This incident alarmed me. It is expected that being a healthcare professional, he would wash his hands with soap or alcohol before examining the patient. However, it did not happen and was astonished by the incident. I felt intimidated that as he is a doctor, he would be more experienced as compared to a nursing student. I did not want to embarrass him and kept quiet. I did not confront the doctor in front of the patient, as it would concern the patient. However, I gathered some courage and later spoke to my senior about this incident. He suggested that he would talk to the doctor about the whole incident. My mentor took and spoke to the doctor aside. My mentor asked the doctor that whether he had washed his hands before examining the patient. He looked shocked and was alarmed. He said that he had a busy schedule and missed it. Finally, my mentor discussed the five moments of hand hygiene and he assured my mentor that he will wash his hands before touching any patient in the future Evaluation This incident was shocking for me. It was also surprising for me. I regret that I would have acted before the doctor examined the patient. However, by the time, I had summoned courage; the doctor already examined the patient. However, I was pleased that the doctor responded in a positive manner when my mentor confronted him. He was empathetic when my mentor provided feedback and I have observed that he had changed his practice after the incident happened. I have also learned the importance of assertiveness with my colleagues and most importantly the five moments of hand hygiene for best health practice. Analysis Hand hygiene is the most important factor to prevent hospital related infection rates and cross-contamination. According to World Health Organization (WHO), one in 25 patients who are admitted in hospital suffer from hospital borne infections. Even the healthcare professionals are at risk for infection as they are in continuous contact with the patients. This prevention of infections is important in medical setting. It safeguards the patients and ensures highest quality of care in the healthcare. The improvement of hand hygiene is important to prevent and reduce the spread of hospital-associated infections. Recent guidelines provided by the Department of Australian Commission on Quality and Safety in Health Care (ACSQHC) states the maximization of implementation of hand hygiene practices. The Nursing and Midwifery Council Code of Professional Conduct, (Section 8), states that nurses have the responsibility to identify the risk and try to minimize to safeguard patient safety and deliv er highest quality of care. This statement greatly implies in this incident as the patient was under the supervision of my mentor. Moreover, for a student nurse, it is important to apply this hand hygiene practice in daily practice and has the responsibility to make others aware of it (Sickbert-Bennett et al. 2016). Apart from hand hygiene, assertiveness is also important for the nursing profession. Nurses should work schematically for problem solving by unveiling constraints for effective nursing and in improving quality of care. For effective communication, one has to behave assertively and prevent barriers to assertiveness among the nurses. As the doctor was experienced than me, I was unable to challenge his practice and as a result, endangered the patient safety. This is the reason, assertive skills are important in nursing for effective communication and risk in healthcare settings. Action Plan In the future, I will try to develop my assertiveness working with my colleagues that would ensure the patient safety and highest quality of care. It is my goal to make my colleagues aware of the importance of five moments of hand hygiene to provide the best quality of care and in ensuring patient safety. In my next nursing placement, I will make a goal to enhance my learning to achieve assertive skills and work in collaboration in ensuring patient safety (Howatson-Jones 2016). Hand Hygiene Policy and health practice After the incident, I wanted to gain an insight into the evidence-based practices and policy considerations regarding five moments of hand hygiene. For this, I have gone through various peer-reviewed journals for literature review to understand the uncertainties in hand hygiene practices and policies related to hand hygiene. According to Centres for Disease Control and Prevention (CDC), practicing of hand hygiene is the simplest and effective way to prevent germs and infections by eradicating resistant antibiotics that are difficult to mitigate (Shinde and Mohite 2014). According to Salmon et al. (2015) the healthcare professionals should perform five moments of hand hygiene to prevent hospital associated infections spread and chances of cross-contamination. According to World Health Organization (WHO), patient-care activities transmit bacteria to the healthcare professionals during wound-care, respiratory tract, intravascular catheter care (White et al. 2015). During these activities, there are possibilities of healthcare professionals to get infected with patient body fluids and secretions or during clean contact like patients temperature, pulse or blood pressure. Various microorganisms come in contact after patient visit are Clostridium difficile, MRSA, Klebsiellaspp., Staphylococcus aureus,or gram-ne gative bacteria. Contact with contaminated surfaces can also cause spread of infection. Hospitals also have hand hygiene policies that are important to guide the employees for hand hygiene (Mumford et al. 2014). However, I personally feel that it is not possible to imply these policies in a healthcare organization. At the professional level, this issue of hand hygiene requires high degree of compliance to make changes in the organization to reduce infection rates. According to a recent report by CDC, one in 25 patients get infected with healthcare-associated infection during the hospital stay that add up to 722,000 total infection cases in a year. Out of this number, around 75,000 patients die due to infections as clinicians neglect the basic practice of hand hygiene to prevent infection spread (White et al. 2015). The five moments of hand hygiene is an effective hand hygiene way as outlined by WHO. These are performing hand hygiene before contacting a patient, before any aseptic task, after exposure to bodily fluids and after patient contact and after being in contact with the patient and contaminated surroundings. At the personal level, I think that these hand hygiene policies can only work when people show adherence to hand hygiene practices on a daily basis. According to WHO guidelines, an estimated 50% to 60% of people show adherence to these five moments of hand hygiene. However, this non-compliance to hand hygiene is unintentional (Kwok, Callard and McLaws 2015). In a study conducted by New South Wales (NSW) and Australian Institute of Health and Welfare (AIHW) the clinicians and nursing staffs work under extreme demanding and stressful conditions and as a result, miss it (Kwok, Harris and McLaws 2017). In another study conducted by White et al. (2015) it highlighted the fact that one potential reason for hand hygiene non-compliance is that the target (pathogen) is visible. At the professional level, I feel that healthcare professionals do not realize the spread of infections by the carrying pathogens in their hands and pass to others. They are unable to understand how the pathogens are transmitted from contaminated hands to other patients when it may result in few days or months. Cost of time is another reason for their non-compliance to hand hygiene. A practice that is altruistic in nature makes them feel burdened to perform the task and nothing is there to reap the benefit (Srigley et al. 2015). In NSW Health, the Hand Hygiene Policy outlines the policies that minimize the risk of infection and prevent healthcare associated infections (Allegranzi et al. 2013). The policy sets out that medical staffs should perform hand hygiene by using soap and use of alcohol-based wash. In healthcare organizations, hand-washing facilities and Alcohol-based hand rubs (ABHR) should be available for all clinicians, medical staffs and visitors. There should be strict surveillance over the practice of good hand hygiene (Ellingson 2017). At the personal and professional level, I think this is possible through clinical audit in healthcare organizations on a monthly basis to reduce the rates of HAIs. Action plan to enhance the professional health practice Clinical auditing is the most effective action plan that can help to increase compliance to hand hygiene and in improving the quality of healthcare (Sickbert-Bennett et al. 2016). It is a clinical process that is well established and set out principles for the evidence-based practices. This clinical auditing will measure the compliance of hand hygiene by the clinicians and medical staffs. Clinical auditing is a measure of clinical governance where it provides opportunities for organizational change and hand hygiene adherence. It is an improvement process in the safety and quality of healthcare that outlines recommendations for compliance and behaviour change in reducing HAIs (Macinga et al. 2013). This can be performed through processing of outcome data after clinical audit measuring the hand hygiene compliance. The focused interviews and questionnaire obtained from the medical staffs and clinicians would help to evaluate the awareness among them regarding the infection control and adherence to hand hygiene. The evaluation of the interviews and questionnaires would help to determine the targeted group for behaviour change, its management and the potential barriers that hinder compliances. At the personal level, medical staffs and clinicians should understand the issue of hand hygiene that ensure patient safety and quality of healthcare. While working with patients, they should perform the five moments of hand hygiene at specific moments wither by alcohol wash or hand washing with soap. According to WHO, alcohol hand rub is the most easiest and effective method to perform hand hygiene on a daily basis in the healthcare delivery (Rawles 2014). However, it is also stated that hand rubs are not affordable and not available in many countries as said by WHO. Therefore, it is important to improve the affordability and accessibility of the hand rubs in saving lives while working in public and private collaboration. These issues are important to address to inculcate the practice of hand hygiene among the healthcare staffs. At the personal level, I think, creating awareness is the best way to help to increase compliance to hand hygiene. Hand hygiene programs can help to create awareness and act as a common platform to share the knowledge in promoting compliance and enhancing healthcare staffs to use hand hygiene products in their daily routine (McInnes et al. 2014). There is also need to assess the availability and accessibility of hand hygiene products in all parts of healthcare organization. Direct observation can also be done as it is regarded as a gold standard process that provide information about staff compliance to thoroug hness of cleaning and their behaviour towards the hand hygiene issue. Conclusion This incident made me realize that I should have acted at the right time. After looking back, I realized that I should have acted sooner and warned the doctor to wash his hands before examining the patient. I realize that I have put the patient safety at risk by not acting at the tight time. After a brief conversation with my mentor, I realize that I have to develop assertive skills and confidence to stand for the rightful thing. I have to challenge the wrong practice even if they are my seniors keeping in mind the safety and well-being of the patients at the forefront. I realize that I need to be understanding and supportive towards my colleagues keeping in mind the pressure and demand of the nursing profession. At the same time, it is my responsibility to ensure patient safety and in minimizing the client risk. 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Macinga, D.R., Edmonds, S.L., Campbell, E., Shumaker, D.J. and Arbogast, J.W., 2013. Efficacy of novel alcohol-based hand rub products at typical in-use volumes.Infection Control Hospital Epidemiology,34(3), pp.299-301. McInnes, E., Phillips, R., Middleton, S. and Gould, D., 2014. A qualitative study of senior hospital managers views on current and innovative strategies to improve hand hygiene.BMC infectious diseases,14(1), p.611. Mumford, V., Greenfield, D., Hogden, A., Debono, D., Gospodarevskaya, E., Forde, K., Westbrook, J. and Braithwaite, J., 2014. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals.BMJ open,4(9), p.e005284. Rawles, Z., 2014.Essential Knowledge and Skills for Healthcare Assistants. CRC Press. Salmon, S., Pittet, D., Sax, H. and McLaws, M.L., 2015. The My five moments for hand hygieneconcept for the overcrowded setting in resource-limited healthcare systems.Journal of Hospital Infection,91(2), pp.95-99. Shinde, M.B. and Mohite, V.R., 2014. A study to assess knowledge, attitude and practices of five moments of hand hygiene among nursing staff and students at a tertiary care hospital at Karad.International Journal of Science and Research,3(2), pp.311-321. Sickbert-Bennett, E.E., DiBiase, L.M., Willis, T.M.S., Wolak, E.S., Weber, D.J. and Rutala, W.A., 2016. Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices.Emerging infectious diseases,22(9), p.1628. Srigley, J.A., Corace, K., Hargadon, D.P., Yu, D., MacDonald, T., Fabrigar, L. and Garber, G., 2015. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review.Journal of Hospital Infection,91(3), pp.202-210. White, K.M., Jimmieson, N.L., Graves, N., Barnett, A., Cockshaw, W., Gee, P., Page, K., Campbell, M., Martin, E., Brain, D. and Paterson, D., 2015. Key beliefs of hospital nurses hand-hygiene behaviour: protecting your peers and needing effective reminders.Health Promotion Journal of Australia,26(1), pp.74-78. White, K.M., Jimmieson, N.L., Obst, P.L., Graves, N., Barnett, A., Cockshaw, W., Gee, P., Haneman, L., Page, K., Campbell, M. and Martin, E., 2015. Using a theory of planned behaviour framework to explore hand hygiene beliefs at the 5 critical moments among Australian hospital-based nurses.BMC health services research,15(1), p.59. White, K.M., Starfelt, L.C., Jimmieson, N.L., Campbell, M., Graves, N., Barnett, A.G., Cockshaw, W., Gee, P., Page, K., Martin, E. and Brain, D., 2015. Understanding the determinants of Australian hospital nurses hand hygiene decisions following the implementation of a national hand hygiene initiative.Health education research,30(6), pp.959-970.

Tall Like The Tree by Delaney Gibson free essay sample

Delaney Gibson is an established independent singer-songwriter who has been recognized for songs such as â€Å"La Di Da,† â€Å"Better Version of Me, and â€Å"Chicago.† With two other full length albums to her name, she has proven that you do not have to be a huge celebrity to be a dynamic artist. With her debut and sophomore efforts, she creatively intertwined top forty pop which held strong on a singer-songwriter base. Her third album, Tall Like The Tree, which is set for release to the general public later this month (fans who backed her PledgeMusic campaign received advanced copies) shows that Delaney is still at the forefront of what she is doing and truly a mastermind. She plays with emotions throughout tracks touching on what seems to be anger, love, loss, and love again. Her powerful vocal range fits smoothly within the theatrical like production Joshua Bartholomew brings to the table. After nearly four years between albums, she shows the most growth on â€Å"Lions,† a powerful ballad that talks about the viscous state of mankind. We will write a custom essay sample on Tall Like The Tree by Delaney Gibson or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Songs like, â€Å"Be,† â€Å"Give Up The Ghost,† and â€Å"When We Were Young† provide the energy it requires to make a Delaney Gibson album complete. To me, her vocals resemble the likes of Jewel on the song, â€Å"Your Heart Is My Home.† Overall, this album is one masterpiece Delaney should be very proud of. Music lovers worldwide should rush to listen to this collection as I promise, you will relate to at least one song on this record. Tall Like The Tree is truth, and rightfully shows Delaney will continue to grow â€Å"tall like the tree† for many years to come.