Police Brutality in NYC - 1424 Words

Police Brutality in NYC Police brutality is the use of excessive physical force, including beating citizens with hands or batons, or using guns, and even lethal weapons. For the vast majority of citizens, this is something they never have experienced. Many police officers go their entire careers without ever having to draw their weapon or even engage in a serious physical confrontation in order to protect themselves or the public from an offender. A very small percentage of law enforcement officials, however are guilty of using excessive force against suspects without reason to do so. Police hold the responsibility of protecting the citizens of the communities they serve. They play an important role in keeping our†¦show more content†¦His mother said that her son required staples in his head and arm. Jatiek Reed, the nineteen year old Bronx resident, who has suffered from constant headaches and nightmares since then, announced he was requesting a special prosecutor to investigate. Reed’s att orney said the Bronx district attorney’s office wasn’t capable of investigating because its close relationship with police. The officers involved have been placed on desk duty and their guns and shields have been removed while the New York Police Department investigated, according to US News Online in 02/09/2012 and AP Regional State Report-New York City, 02/01/2012. Many police killings receive little mention in the media. Therefore, the topic usually goes unnoticed by general public until an incident hits home or a major tragedy occurs. According to recent statistics by October 22nd Coalition to Stop Police Brutality, 21 people were killed by New York police throughout 2012, averaging two killings per month. It increased the previous year’s sum by seven fatalities. The same statistic shows that nearly 90 percent of those killed were Black or Hispanic. Last year’s victims of police shooting varied in age: Antwoine White, 17 years old, was killed in Bushwick, Brooklyn, on January 29; Ramarley Graham, 18 years old, was slain in his own Bronx bathroom just four days later.Show MoreRelatedEssay On Police Brutality1123 Words   |  5 PagesPolice brutality is the lavish physical assault or verbal assault during police procedures which can involve interrogating or apprehending a suspect. Police brutality originated from the labor worker strikes in the 1800’s through the 1900’s. The violent brutal act of these officers usually formed around the lower socioeconomic class. Since then police brutality has hit an all-time high in the 21st century. In New York alone there has been reportedly over 72 police brutality reports some reportsRead MorePolice Brutality : A Social Problem1548 Words   |  7 PagesPolice brutality is a social problem faced in many communities around the world. Focusing on North America, the problems and central focuses on police brutality stem from racism and the excessiv e abuse of power. Police brutality is defined as unmerited, excessive and aggressive abuse, police brutality is a phenomenon that causes irreparable harm to its victims. The abuse may be physical or psychological, and the victims can feel the effects of this abuse for a lifetime. These effects include notRead MorePolice Brutality1192 Words   |  5 PagesPolice brutality is one of the most severe human rights violations in the United States, and it occurs in many communities. Police officers have one of the hardest jobs out there. They have to maintain public order, prevent, and identify crime. Throughout history, the police community has been exposed by brutality in one way or another. Violence by law enforcement officers in the United States is one of the most serious human rights violations in the country. Police officers have engaged in unjustifiedRead MorePolice Brutality And Its Effect On Society1742 Words   |  7 Pagesyourself, what Police Brutality defines itself as? â⠂¬Å"Police Brutality is when an officer using more force than necessary to control a situation.† (Smith). Police Brutality occurs with OC spray, batons, stun guns, or handguns. But Police Brutality can also be seen with a use of threats or intimidation. In today’s world, we see plenty of stories all over social media, the news shows live broadcasts on protesters against the Police and excessive force. If you stop and look around, most of the Police BrutalityRead MoreRoles Of Bill De Blasio1136 Words   |  5 Pages Bill de Blasio is the current Mayor and Mayor incumbent of New York City running under the Democratic Party with alliance to third party Working Families Party gaining de Blasio cross endorsement of both parties. Responsibilities of the Mayor in NYC are wider than other cities. Major cities use a strong mayor form of mayor-council government, which makes the appropriate ‘check’ or restriction that City Councils often have on their Mayor very weak as opposed to a weak mayor form which restricts theRead More Police Brutality Essay1359 Words   |  6 Pages Police Brutality When one thinks of police misconduct many not too distant stories might go through our heads. Most adults will remember how they felt when they saw the brutal beating of Rodney King on their local news station; or the outrage they experienced when they heard that the evidence in the OJ Simpson trial had been tampered with. But thanks to new guidelines, procedures and even civilian groups who now â€Å"police† the police, instances of police misconduct may soon start seeing a declineRead MoreOpinion Essay On Hockey Game1221 Words   |  5 Pagesunderstanding of the issue of racism. They touched on the controversial topic of police brutality by interviewing four of the NBA’s most prominent players, one of them being LeBron James, an arguable candidate for the best player of all time. The latter delivered a stirring, eloquent speech, about police brutality in America, and the specific manner in which, to quote directly â€Å"black and brown bodies† are targeted by the police. James’ public speech is one that understands the manner in which white privilegeRead MoreThe Black Lives Matter Movement1356 Words   |  6 Pagesto administer change. To clarify, Black Lives Matter was started as a result of shooting death of Trayvon Martin, but even though the slogan using the movements name is used mostly in protest of police brutality, it was not developed to combat brutality of African-Americans by police. Combating brutality is listed nowhere on the movement’s official webpage. While the slogan has become popular, the true purpose for creation of Black Lives Matter or its core beliefs are based elsewhere. Next, theRead MoreEssay on The Criminal Population and African Americans1105 Words   |  5 Pagesare targeted more often by police officers than whites; they are also most often the recipients of police brutality (TLC, 2011). Even though there may not be an actual act of racial profiling, if a person or group of people feel they are being treated differently because of race then the problem exists (Toth et al, 2008). The belief of mistreatment strongly affects the relations between the minorities, in this case African Americans, and the police (Toth et al, 2008). Police may perceive African AmericansRead MoreThe Black Panther Party And The Civil Rights Movement1732 Words   |  7 Pagesorganization to ever exist. Founded by Bobby Seale and Huey Newton, the party began in October 1966 in Oakland, California. The BPP’s original purpose was to protect fellow citizens against police brutality in African-American neighborhoods. Marked by social service programs, internal conflicts, clashes with police, and revolutionary rhetoric, the group was a result of the development of the Civil Rights Movement that had already been in place for about a decade before the group existed. At the time

Final Film Critique Essay - 2458 Words

Final Film Critique Richard Hogan ENG 225: Introduction to Film October 25, 2011 Final Film Critique Introduction The movie, The Shawshank Redemption (1994), is based on a character Andy Dufresne. Andy is a young and successful banker who is sent to Shawshank Prison for murdering his wife and her secret lover. His life is changed drastically upon being convicted and being sent to prison. He is sent to prison to serve a life term. Over the 20-years in prison, Andy retains optimism and eventually earns the respect of his fellow inmates. He becomes friends with Red, and they both comfort and empathize with each other while in prison. The story has a strong message of hope, spirit, determination, courage, and desire.†¦show more content†¦In the film’s final scene the two meet up and are free from their life of isolation, law, hate, and racism. The film has some additional storytelling that I would like to discuss. The Shawshank Redemption is done in chronological order, but there are some parts when the characters flash back to earlier times in their live so you can understa nd what is happening in the film. This is done so the viewer still has an easy way to follow the movie. The characters of the film face both internal and external conflict. The internal conflict is should I continue this life when I know I am innocent, and the external conflict is from the prison, the prisoners, and the prison staff. The film does contain symbolism. An example of the symbolism is when the warden learns of his fate and his last judgment by reading the morning newspaper of himself and the prison being corrupt. Additionally, symbolism is used with the holy bible the warden reads; when he finds the hammer that Andy uses to dig out of the prison. There is a passage from Exodus that is used to symbolize the warden’s salvation and Andy’s escape. Also, there is a metaphor that I remember and it happens when the librarian (Brooks Hatlen) is freed from jail and he takes his own life. At the same time he hangs himself his bird (Jake) fly’s away an d is freed. The metaphor is that the librarian is free of his lifelong nightmare of being told whatShow MoreRelatedWeek 5- Final Film Critique1421 Words   |  6 PagesWeek 5 – Final Film Critique Byron Phillips ENG 225 Introduction to Film Instructor Hayes 11 May 2015 FINAL FILM CRITIQUE There’s no doubt that Star Wars is one of the most impactful films of all time, having changed the movie-making game ever since it premiered in 1977. It quickly became a global phenomenon and has accumulated some of the most passionate fans in the universe. Star Wars: Episode IV - A New Hope is a great example to use in order to illustrate the properties discussed throughoutRead MoreFinal Film Critique: Crash (2004)2178 Words   |  9 PagesFinal Film Critique: Crash (2004) Jay Dennis ENG 225 Introduction to Film Instructor: Cicely Young April 13, 2014 Final Film Critique Draft: Crash (2004) There are many different critical elements and artistic aspects to examine when analyzing and critiquing any film. In 2004 Paul Haggis wrote and directed the award winning drama Crash about various intertwining experiences involving racial relations and the socioeconomic status levels of the diverse cast of characters. This film addressesRead MoreFinal Film Critique Paper: Hangover Part Iii1014 Words   |  5 PagesFinal Film Critique Paper: Hangover Part III Barbara Kordell English 225: Introduction to Film Instructor: Michael ODonnell May 27, 2013 Final Film Critique: Hangover Part III I have chosen the Hangover 3, directed by Todd Phillips, to critique; it seems to be a very humorous movie from just watching this one clip. This movie is in the genre of comedy, it is being called the epic final of the â€Å"Wolf Pack†. Since the Hangover III does not get released until May 23, 2013 I will base myRead MoreEng 225 Week 5 Film Critique Final Paper836 Words   |  4 PagesENG 225 Week 5 Film Critique Final Paper Click Link Below To Buy: http://hwcampus.com/shop/eng-225/eng-225-week-5-film-critique-final-paper/ Or Visit www.hwcampus.com ENG 225 Week 5 Film Critique Final Paper Focus of the Final Film Critique Throughout this course, you have been compiling a blog and writing essays that analyze various elements of film such as theme, cinematic techniques, and genre. It is now time to combine those elements into a comprehensive analysis of one movieRead MoreEng 225 Week 3 Final Film Critique Outline791 Words   |  4 PagesIntroduction To Film 11/3/2012 I chose to critique the film â€Å"The Elephant Man† it is an iconic filmmaking endeavor. Director David Lynch shows the sadness and the scariness of deformities onto the audience in a way that touches your heart and leaves you with a sense of sadness and will also leave a tear in your eye. Most of the people who have watched this film are touched and completely changes the way they view crippled, weak, and deformed people in this world. The start of this film begins withRead MoreEng 225 Week 5 Film Critique Final Paper New831 Words   |  4 PagesENG 225 Week 5 Film Critique Final Paper NEW To Buy This material Click below link http://www.uoptutors.com/eng-225-ash/eng-225-week-5-film-critique-final-paper-new Focus of the Final Film Critique Throughout this course, you have been compiling a blog and writing essays that analyze various elements of film such as theme, cinematic techniques, and genre. It is now time to combine those elements into a comprehensive analysis of one movie. You will be completing this assignment in two stages:Read MoreCritique of the Movie Tinker Tailor Solider Spy850 Words   |  3 PagesTinker Tailor Soldier Spy: Critique of a Movie Review Introduction Oscar Season, so dubbed by Hollywood executives and the media covering their world, is quickly approaching. Within the illustrious group of nominees are those featured in the beautifully made cerebral film, Tinker Tailor Soldier Spy. The film, which is a jewel of cinematic effort, is very much the opposite of todays often-found shallow comedies or horror films. This film, in its grasp, includes so much of that which oughtRead MoreFilm Critique (the Blind Side)1392 Words   |  6 PagesWeek Five Individual Film Critique Neil A. Burgheimer HUM/150 Week Five Individual Film Critique This week for the final film critique I chose to review The Blind Side (2009). In this film Sandra Bullock plays Leigh Anne Tuohy, a successful interior designer. Her husband Sean Tuohy played by Tim McGraw is the owner of over 85 fast food franchises including Taco Bell, Kentucky Fried Chicken, Pizza Hut, and Long John Silver’s. In the film Leigh Anne takes a boy named Michael â€Å"Big Mike† Oher intoRead MoreHow Have The Texts You Studied Explored Social Values?1243 Words   |  5 PagesBernard Shaw Pretty Woman – Garry Marshall (dir. 1990) The romantic comedy, Pretty Woman (1990), is a film directed by Garry Marshall and is an appropriation on the play Pygmalion, a satire written by George Bernard Shaw (1912). Although both of these texts explore social values that were significant in the twentieth century, Shaw’s play is considerably more critiquing in comparison to the film as he reflects his stance on social class through the plot and his use of language. Pretty Woman and PygmalionRead MoreEvaluation Of A Project And Discuss Aspects Of The Film1440 Words   |  6 PagesThis Critique will be going over five different aspects, I will be covering the roles adopted during the project by each group member, I will present an argument on one aspect of the project that I believe was strong, and I will be identifying aspects of my project that I think could have been strengthened and how these could have been changed to improve the work. I will also be providing a rationale for the final cut of the project and discus s how the peer review did or did not help in the development

The Use of Intraosseous Vascular Access Free Essays

The Use of Intraosseous Vascular Access Table of Contents Title Page†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. We will write a custom essay sample on The Use of Intraosseous Vascular Access or any similar topic only for you Order Now 3 Body of Paper†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 Plan†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 Do†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 Check†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Act†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Research to Support Change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Change Theory†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 20 Timeline†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 22 Executive Summary First introduced by Drinker and colleges in 1922, intraosseous (IO) vascular access was a method used during World War II for accessing the non-collapsible venous plexuses within the bone marrow cavity to provide access to a patient’s systemic circulation. This method later fell out of use after the development of intravenous catheters. Then during the 1980s IO vascular access was again introduced as a rapid way of gaining vascular access for swift fluid infusion particularly during resuscitation attempts of pediatric patients. (Tay Hafeez, 2011) Plan-Being by implementing a policy for the use of IO vascular access within the Emergency Department of Hays Medical Center (HMC) for critically ill patients. This would expedite critically ill and severely injured patients in receiving the intravenous fluids and medications. Currently there is no policy in place for the placement of IO devices as opposed to peripheral intravenous catheters, or central venous catheters. However, if there was a policy in place the staff would know when it was appropriate to insert an IO device, as opposed to having to make a difficult decision based on personal judgment. Do- Create a group of physicians and nurses to write a policy outlining when it is appropriate for the placement of an IO device compared to traditional techniques for gaining venous access. Once the policy has been written implement its use within HMC’s ED. Check- Keep a careful record of when an IO device is placed, in accordance to the new policy. Monitor the outcomes of these patients. Evaluate the effectiveness of the new policy and determine if any changes need to be made. Act- Based on the information obtained during the check phase of this project, management will determine whether the policy will be continued, improved, or discontinued. The Use of Intraosseous Vascular Access in Critically Ill Patients The origin of the intraosseous cavity as an access sight to the circulatory system was originally discovered during World War II. Medical personnel during this time used an IO route to resuscitate patients suffering from hemorrhagic shock. It was first documented in medical journals by Drinker and colleges in 1922. It was later rediscovered by American pediatrician James Orlowski. During his time working in India, Orlowski observed medical personnel during a cholera epidemic using IO access to save patients in whom IV cannulation was impossible and who might have died without access. He later wrote about his experiences in a paper entitled, My Kingdom for an Intravenous Line. Wayne, 2006) Since Dr. Orlowski brought the use of IO access in pediatrics back into the medical spotlight, the implications for its use within the adult population were soon being addressed. In 2005, the American Heart Association stated in its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that â€Å"IO cannulation was appropriate to provide access to the non-collapsible venous plexus found in the bone ma rrow space, thus enabling drug delivery similar to that achieved by central venous access. (American Heart Association) Intravenous access can mean the difference between life and death when dealing with critically ill patients. IV access means that patients can receive fluids, blood products, and life-saving medications. During situations when time is precious, and access is critical is not when nurses should be making their fifth attempt at a peripheral intravenous catherization (PIV). It also shouldn’t be when chest compressions are stopped, so that the doctor can try for a central venous line (CVL). The average time necessary for PIV catherization is reported to add up to 2. 5-13 minutes and sometimes even up to 30 minutes in patients with difficult to access peripheral veins. (Leidel, Chlodwig Bogner, 2009) This is one of many reasons why it is imperative to have a policy in place so that the staff knows that IO access should be a go to option rather than a last resort. There are very few contraindications when it comes to the placement of an IO device. However, to untrained medical personnel the thought of having to place an IO device is very daunting. I didn’t realize until this semester that it is within the scope of practice for a RN to place an IO device, but it is absolutely is! â€Å"It is the position of the Infusion Nurses Society that a qualified RN, who is proficient in infusion therapy and who has been appropriately trained for the procedure, may insert, maintain, and remove intraosseous access devices. † (â€Å"The role of,† 2009) There is also the fact that of having to explain the procedure to the patient and the patient’s family. The fear of needles is a real one. The thought of an intramuscular injection can send certain patients into a full blown panic attack. So the thought of actually having their bone pierced with a needle is a frightening one. Thankfully most patients who are critically ill enough to necessitate the placement of an IO device are unconscious. In cases where patients are not unconscious, an IO device can be placed with minimal discomfort if proper anesthetic techniques are used. These techniques should be taught along with placement so that nursing staff is aware of how to place an IO with minimal discomfort to the patient. It needs to be noted that â€Å"the pain associated with insertion of the EZ-IO needle is similar to that associated with insertion of a large peripheral intravenous needle and may be alleviate with infusion of lidocaine solution. † (Luck, Haines Mull, 2010) Unlike PIVs and CVLs, IO access can be obtained from multiple sites with less chance of being unsuccessful. The locations include: proximal tibia, distal to the tibial tuberosity, distal end of the radial bone in the upper imb, proximal metaphysis of the humerus, distal tibia, proximal to the medial malleolus, distal femur, above the femur plateau, the sternum, and also the calcaneus (Tay Hafeez, 2011). However, IO access is typically obtained via the proximal tibia or proximal metaphysis of the humerus. There are currently three different ways to gain IO access. The first and oldest way is a manual insertion of the IO device. In this way the device is placed using the force applied by the clinician, and is done in a rot ating motion. The second technique is the use of an impact device. In this case, a spring-loaded IO device is to insert the needle into the bone using direct force. The last technique is a powered drill. The small, handheld device drills the IO needle into the bone with a high-speed rotating motion. Plan To implement a policy within the Emergency Department at Hays Medical Center that clearly outlines when the placement of an intraosseous access device should be used as opposed to more traditional techniques for gaining venous access. A committee would be assembled to look at the research on IO placement. This committee would consist of three physicians and three nurses, and will be given three months to write a policy for the department. This committee will determine in which situations an IO should be placed. The American Heart Association guidelines for intraosseous vascular access should play a major role in this decision. Once criteria has been chosen a checklist will be created that can be hung on the walls of the trauma rooms and handed out to staff. This checklist will aide in helping the staff to be able to more quickly determine in which situations placement of an IO is within the department’s policy. The appointed committee would also be in charge of deciding on which type of IO device the department should use. They will research the availability of the device chosen and what the cost will be to stock the department which the device. Do Once the research is gathered, the assigned research committee will reassemble to compose the policy that will become implemented within the Emergency Department. After the policy has been written, a mandatory unit meeting will be called to introduce the new policy and answer any questions that the staff might have. During this meeting, a demonstration will be given on the correct technique for IO placement, depending on which type of device is chosen during the planning phase. After the demonstration the staff will then be asked to practice placing IO devices using practice bones. One member of the department will then be voted upon to keep track of which patients coming through the department have IO devices placed. They will keep track of for the next six months. The data collected will include any outcomes that the patient experiences, good or bad, in regards to their IO placement. Check The member of the department will look at the data collected from the outcomes of patients who had IO devices placed within the ED in the last six months. This data will then be taken back to the originally assigned committee. The committee will be responsible for analyzing the data. They will look at the outcomes and determine if changes need to be made to the original policy. They will also look at the outcomes to determine if there need to be changes made in the placement technique used by the department. For example, is the rate of successful placement higher or lower when done via the humerus verses the tibia? Or is there a problem with post procedural infection? Should the technique be changed from aseptic to sterile? Etc†¦ They will also ask staff within the department to fill out a survey indicating their comfort level in placing IO devices. Act Depending upon the findings of the committee they can either be decided to leave the policy in place, as is. The committee could find that the policy needs to be altered and then reviewed in another six months’ time to see if the changes were effective. Or they could find that within the ED at Hays Medical Center IO devices for venous access should not be used although the review of literature will prove why this outcome is highly unlikely. Research to Support Change An article published in the Journal of Emergency Medicine, collaborated by three different physicians who work in Emergency Departments in Philadelphia talks about the technical side of intraosseous access. The article states that â€Å"intraosseous vascular access is indicated in the critically ill patient of any age when rapid and timely access via the intravascular route cannot be established or has failed. The article goes on to list conditions in which this might occur, including: cardiopulmonary arrest, shock, sepsis, major traumatic injuries, extensive burns or edema, and status epilepticus. (Luck, Haines Mull, 2010) Indications may also include obese patients on who multiple PIV attempts have failed. Because studies have shown that IO infusions have the same o nset of action, as that of intravenous infusions the authors recommend that the dose used for IV fluids and medications should remain unchanged when using the IO route. They go one to state that other studies have shown that the results of several different blood test values drawn from bone marrow aspirates are comparable to those taken from venous samples. These include blood gas analysis, blood group typing, and electrolyte, drug, and hemoglobin levels. (Luck, Haines Mull, 2010) The authors also talk about the relatively few contraindications for IO insertion. These include a fracture to the bone that the IO device is to be placed, an extremity with a vascular injury, placement to an area with an overlying skin infection or burn. IO insertion is also contraindication in patients with certain conditions that make their bones fragile such as osteogenesis imperfect and osteoporosis. The last contraindication is a new IO insertion where another IO needle may have recently been placed. This is because the opening left by the last needle can cause fluids to extravasate. In their research of other studies, the authors found that success rates for IO insertion vary between 75%-100%, and successful infusion achieved within 30-120 seconds in the majority of cases. Luck, Haines Mull, 2010) The most common complication was found to be extravasation of blood, fluids, and drugs into the soft tissues surrounding the site, but this occurred less than 1% of the time. With a 0. 6% chance of incidence, the most serious adverse complication was osteomyelitis. However, this was attributed to prolonged infusion. For this reason, it is recommended that the IO need be replaced by either a PIV or a CVL once the patient has stabilize d and no longer than 24 hours after IO placement. (Luck, Haines Mull, 2010) This article concluded that the use of IO access devices is a safe, reliable, and timely way of attaining vascular access. Although vital for critically ill and injured patients, it is also a technique that can be applied in non-emergent cases where multiple attempts at peripheral and central IV access has been unsuccessful. (Luck, Haines Mull, 2010) In a study conducted by physicians at the University of Medicine Berlin’s Department of Emergency Medicine, they looked at ten consecutive adult patients who each received an IO device and also a CVC placement during a resuscitation situation. The results showed that the success rate on first attempt was 90% for IO access versus 69% for CVC placement. They also found that the mean time required for the IO access procedure was significantly shorter, 1-3 minutes, compared to the mean CVC placement time of 4-17 minutes. While conducting this study, one IO cannulation failed â€Å"due to operator mishandling by not selecting the correct insertion site at the proximal humerus. (Leidel, Chlodwig Bogner, 2009) The physicians of this study also noted that four CVC cannulations failed on the first attempt at insertion and had to be reattempted. The study then went on to state that the failed placement of one IO cannulation was the only complication regarding the IO devices placed. There was â€Å"no malposition, dislodgment, bleeding, compartment syndrome, arterial puncture, haeatothorax, pneumothorax, venous thrombosis, and vascular access related infection observed. † (Leidel, Chlodwig Bogner, 2009) In conclusion the researchers go on to state â€Å"IO vascular access is a safe, reliable, rapid option in the acute setting of adult patients under resuscitation with inaccessible peripheral veins in the emergency department†¦ Therefore, a change in practice from CVC to immediate IO access for the initial emergency resuscitation should be strongly considered as a reasonable bridging technique to increase patient’s safety in the emergency department. † (Leidel, Chlodwig Bogner, 2009) Another study found was performed by physicians and researchers in the Department of Emergency Medicine of Singapore General hospital. It is a large urban hospital that handles nearly 120,000 patients annually. 9% of these patients are priority 1 patients, or patients that need resuscitation. The inclusion criteria for this study were â€Å"patients who presented to the ED with age greater than 16 years or 40kg body weight requiring intravenous fluids or medication and in whom an intravenous line could not be established in two attempts or 90 seconds. They also had to be seriously ill or injured and meet at least one or more of the following: altered mental status, respiratory compromise, haemodynamic instability, or cardiac arrest. (Ngo, Oh, Chen, Yong Yong, 2009) The study ran from March 1, 2006 through July 30, 2007. During this time 24 patients were met the qualifications for this study. Of all the IO cannulations, only three attempts failed on the first attempt. No failures were recorded on the second attempt. The researchers also did a comparison between junior operators and senior operators and found that t here were no disparity regarding success rates between the groups, they both had a 100% success rate. The average insertion time for both groups was approximately five seconds. Ngo, Oh, Chen, Yong Yong, 2009) There were only two complications regarding the insertion of an IO device with this study. The first was when an operator’s glove was caught on the need during insertion. However, this could have been prevented if the operator was holding the drill properly. The other complication noted was that of extravasation of fluid at an insertion site. This is the most common type of complication, and is seen when the need is misplaced or there is an excessive amount of movement during or after the insertion. Ngo, Oh, Chen, Yong Yong, 2009) The results of this study concluded that â€Å"the EZ-Io is a feasible, useful and fast alternative mode of venous access especially in the resuscitation of patients with no venous access or when conventional intravenous access fails. Flow r ates may be improved by the use of pressure bags. Complications encountered such as extravasation of fluid and gloves being caught in the drill device can be easily prevented. † (Ngo, Oh, Chen, Yong Yong, 2009) The third research article was a prospective, observational study conducted by researchers in the Department of Emergency Medicine at Singapore General Hospital in Singapore. The study was conducted on a convenience sample of 25 medical students, physicians and nursing staff. They were recruited to secure intraosseous access using the EZ-IO powered drill device. Unlike the previous two studies they only need to secure access on a plastic bone model rather than a live patient. (Ong, Ngo Wijaya, 2009) The study participants were allowed multiple attempts in placement with the aim of ensuring success in placement. Their placement times were measured by an independent observer with a stopwatch, from the time the participant placed the need set into the driver and attempted to insert the needle with the ES-IO into the plastic bone. The participants then recorded their perception on the difficulty of insertion using a visual analog scale with 0 representing very easy and 10 representing very difficult placement. (Ong, Ngo Wijaya, 2009) The results showed 96% success rate for placement. Twenty-three of the 25 participants only required one attempt at place the IO device, and only one participant was unsuccessful at securing placement of the device. This failure was attributed to â€Å"unfamiliarity with the equipment and procedure, and hesitating beyond the allocated time given for insertion. † (Ong, Ngo Wijaya, 2009) The results of this study also showed that the mean placement time was 13. 9 seconds. The researchers also found that 87% of their participants reported that using the EZ-IO was easier compared to intravenous cannula. Ong, Ngo Wijaya, 2009) The researchers of this study concluded that â€Å"the I/O access device (EZ-IO) evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department. (Ong, Ngo Wijaya, 2009) The next piece of research was a randomized trial conducted by Dr. Reades from Methodist Hospital System, in Dallas, TX, Dr. St udnek from Carolinas Medical Center and the Center for Prehospital Medicine, Charlotte, NC, S. Vandeventer from Mecklenburg EMS Agency, Charlotte, NC, and Dr. Garrett from Baylor Healthcare Systems, Department of Emergency Medicine, Baylor University Medical Center, and Dallas, TX. The purpose of this study was to determine whether the tibial or humeral placement site was more effective for intraosseous placement during out-of-hospital cardiac arrest. â€Å"All patients eligible for inclusion in this study had their first attempt at vascular access randomized to one of 3 locations: proximal tibial intraosseous, proximal humeral intraosseous or peripheral intravenous. (Reades, Studnek, Vandeventer Garrett, 2011) Randomized note cards were distributed to the paramedic staff at the beginning of their shifts, and told them which access site was to be initially used if they came had a patient who met the inclusion criteria. There were two outcomes that were being monitored in this study. The first was a first-attempt success at the assigned method of vascular access. This qualifi ed in one of two ways, either as an initial success or an overall success. The second measured outcome was the â€Å"total number of attempts required for successful vascular access, time to successful vascular access, time to first ACLS medication, and total volume of fluid infused during resuscitation. † (Reades, Studnek, Vandeventer Garrett, 2011) Overall there were 182 patients randomized to one of the 3 vascular access methods. Fifty-one patients had humeral IO placements, 67 had PIV placements, and 64 had tibial IO placements. The results showed that first-attempt success was greatest in patients randomized to tibial IO access at 91%, compared to both humeral IO access at 51% and PIV access at 43%. The result of the secondary outcome was also significantly shorter in patients with tibial IO access. These patients had their devices in place and ready to use in an average of 4. 6 minutes. Those assigned to the humeral IO access site averaged a 7. 0 minute placement time, which was also the same time for a PIV access site. (Reades, Studnek, Vandeventer Garrett, 2011) This study demonstrated that there is a significant different in the frequency of first-attempt success when placing tibial IO access devices as opposed to humeral IO access devices or even PIV catheters. The researchers go on to state that the â€Å"results from this study may help stakeholders such as EMS medical directors choose the most appropriate site for first-attempt vascular access†¦Ã¢â‚¬  (Reades, Studnek, Vandeventer Garrett, 2011) The last article was a consortium on intraosseous vascular access in healthcare practice, published in a journal entitled critical care nurse. It too outlined the history of IO access, dating back to World War II. It discussed the clinical considerations for the use of IO access, and the clinical situations in which IO access should be considered. It went on to talk about the types of IO devices and how they’re used. It mentioned the contraindications for IO use, and also the possible complications. All of the aforementioned material was consistent with research already discussed. This article lends credibility in support of change because it discusses the education and training needed to implement IO device use in the clinical setting. It states that â€Å"to insert and maintain an intraosseous device in a patient, the clinician must demonstrate adequate knowledge and psychomotor skill competency in the procedure. (Phillips, Brown, Campbell, Miller, Proehl Young-berg, 2010) The article then went on to discuss the economic considerations that must be looked at when considering implementing an IO insertion policy. It states that â€Å"the cost of intraosseous devices and needles should be compared with the cost of central catheter kits, ultrasound evaluation, and human resources required for their insertion. † ( Phillips, Brown, Campbell, Miller, Proehl Young-berg, 2010) The authors also note that â€Å"the economic factors must be weighed along with potential complications of therapeutic strategies should be considered. (Phillips, Brown, Campbell, Miller, Proehl Young-berg, 2010) This article also brings to light the issue of risk management and patient safety. In this day and age where liability concerns continue to drive clinical decisions, it is important to note that delays in treatments are often cited as the cause of injury leading to malpractice claims. If there is an evidenced based option to safely and quickly provide fluid and drug resuscitation, when vascular access is not readily attainable, then it needs to be closely looked at. After reviewing the data the Consortium on Intraosseous Vascular Access in Healthcare Practice reached eight consensuses: 1. Intraosseous vascular access should be considered as an alternative to peripheral or central intravenous access in a variety of health care settings, including intensive care units, high acuity/progressive care units, general medical units, preprocedure surgical settings where lack of vascular access can delay surgery, and chronic care and long-term care settings, when an increase in patient morbidity or mortality is possible. . Intraosseous vascular access should be considered as part of an algorithm for patients treated by rapid response teams in whom vascular access is difficult or delayed. 3. A new algorithm that includes the intraosseous route should be developed for assessing the appropriate route of vascular access. 4. For patients not requiring placement of central catheters either for long-term vascular access or hemodynamic monitoring, intraosseous ac cess should be considered as the first alternative to failed peripheral intravenous access. 5. Techniques of intraosseous catheter placement and infusion administration should be a standard part of the medical school and nursing school curriculum. 6. In evaluating the economic implications of adopting intraosseous technology, the following should be considered: the expense of diagnostic tools to guide and confirm placement, the cost of human resources, the known and unknown risks to patient safety, and the cost of complications related to delayed treatment. 7. Organizational policies, procedures, and protocols that establish the responsibility of insertion, maintenance, and removal of intra-osseous access devices should be developed. . Further research should be conducted on, but not limited to, the safety and efficacy of use of intraosseous access in all practice settings, its economic impact on patient care, and to support the use of intraosseous access in all health care settings. Change Theory The change theory focused upon in this paper is Gordon Lippitt’s Theory o f Planned changed. According Lippitt, â€Å"Planned change or ‘neomobilistic’ change is defined as a conscious, planned effort which moves a system, an organization, or an individual in a new direction. This theory is applies because it can be applied at an individual, group, and institutional level. The basis for Lippitt’s theory of change is center around an agent for change. This agent should be a person skilled in the changed wanted to apply. It is this person who is in charge of planning for the change, initiates the change, and is credited for the accomplishment of change. Lippitt’s theory is centered around 7 phases of change. His phases are not set in stone, and there is no time frame on how long each phase should last. There should be a fluid movement back and forth between these seven phases. The first step is identification and diagnosis of the problem. In this case, the problem is HMC not having a firm policy in place recommending when the use of IO access devices should be implemented. The second step is the change agent assessing the client systems motivation and capacity for change. In this case, myself being the change agent, I would talk with the administrators of the ED department and determine if they agreed with my assessment for a policy to be implemented. The third step would be the initiator assesses his or her ability in helping the situation. In this case this flows back to the first step, because I saw the need for change and felt that I was equipped with the skills needed to bring about such a change. The fourth step is the change agent then chooses an appropriate role in the phase. In this case, I would choose to be part of the policy committee who is responsible for researching. The fifth step states that the change agent may be actively involved in the implementation of change, serve as an expert in fathering and providing data, or function as a liaison within the organization. I feel like in this case, I would function as a liaison within the policy making committee. The sixth step consists of maintenance of change. This involved the â€Å"Do† portion of the plan for change. This is where the decisions made by the policy are provided to the department, and the employees become responsible for implementing and maintaining the new policy. The final step is termination of the helping relationship. This step is accomplished when all parts of the PDCA plan have been completed. (Ziegler, 2005) Conclusion In a day and age where medical technology is advancing, the research about IO access devices proves that newer technologies are not always the best for a positive outcome. IO access applications have great potential in patients who are critically ill, injured, or are incapable of having PIV or CVL access. The fact that IO access is fast, reliable, and safe proves that competent placement of IO devices is a medical technique that all Emergency Departments should have in their repertoire. References (2009). The role of the registered nurse in the insertion of intraosseous access devices. Journal of infusion nursing,  32(4), 187-188. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112(24):57-66. Leidel, B. Chlodwig, K. , Bogner, V. (2009). Is the intraosseous access route fast and efficacious compared to conventional central venous catherization in adult patients under resuscitation in the emergency department? a prospective observational pilot study. Patient safety in surgery,  3(24), doi: 10. 1186/1754-9493-3-24 Luck, R. , Haines, C. , Mul l, C. (2010). Intraosseous access. The journal of emergency medicine,  39(4), 468-475. Ngo, A. , Oh, J. , Chen, Y. , Yong, D. , Yong, D. (2009). Intraosseous vascular access in adults using the ez-io in an emergency department. International journal of emergency medicine,2(3), 155-160. oi: 10. 1007/s12245-009-0116-9 Ong, M. , Ngo, A. , Wijaya, R. (2009). An observational, prospective study to determine the ease of vascular access in adults using a novel intraosseous access device. Annals of the academy of medicine, singapore,  38(2), 121-124. Phillips, L. , Brown, L. , Campbell, T. , Miller, J. , Proehl, J. , Young-berg, B. (2010). Recommendations for the use of intraosseous vascular access for emergent and no emergent situations in various health care settings: A consensus paper. Critical Care Nurse,  30(6), e1-e7. Reades, R. , Studnek, J. , Vandeventer, S. , Garrett, J. (2011). Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial. Annals of Emergency Medicine,  58(6), 509-516. Tay, E. T. , Hafeez, W. (2011). Intraosseous access. In R. Kulkarni (Ed. ),  Medscape reference: Drugs, disease procedures. Retrieved from http://emedicine. medscape. com/article/80431-overview Wayne, M. (2006). Adult intraosseous access: an idea whose time has come. Israeli journal of emergency medicine,  6(2), 41-45. Ziegler, S. (2005). Theory-directed nursing practice. (2 ed. , p. 204). New York, NY: Springer Publishing Company, Inc. Timeline for Change 1/20-11/27Researched the benefits of having a policy about intraosseous access within the ED at HMC 11/28Spoke with the Director of Nursing for the ED and the Director of Emergency Medicine about my research findings 12/1A committee of three physicians and three nurses is assembled to draft a preliminary policy regarding intraosseous access 12/1-3/1The committee is given three months to compose their policy 3/2-3/10The policy is given to the Director of Nursing and Director of Emergency Medicine, who present it to the board of directors for approval 3/15A mandatory staff meeting is held outlining the new policy and answering any questions or concerns the staff has 3/16-9/16The new policy is put into effect and data is collected 9/16-10/16The original committee will analyze the data, and changes are made as needed. 10/20The final committee approved policy is present to the Director of Nursing and Director of Emergency Medicine 11/1The Director of Nursing and Director of Emergency Medicine, take the final recommendations for the policy to the hospital board of directors for approval How to cite The Use of Intraosseous Vascular Access, Essay examples

Comparison of Trade Rivalries Essay Example For Students

Comparison of Trade Rivalries Essay The German-Great Britain trade rivalry like the U.S.-Japan trade rivalry involved a rising power cutting into the trade ofan already dominant trading power. There were several causes of the German-Great Britain trade rivalry according to Hoffman. The first was Germans industrys zeal in procuring new contracts and expanding markets. They did this by fulfilling contracts even if they were very small and constantly trying to stay up with market demand. Second, Germans had a knowledge of languages that the English firms lacked. Third, German industry was aided by their government. In contrast Great Britain did not even supply consular assistance in helping develop markets in British colonies. Fourth, British trade was hurt bythe conservatism of British manufacturers who were unwilling to develop new markets or hold onto those it already possessed. These four factors are just some of the factors that helped German industry grow and rival that of Great Britain. These four factors are all very similar to the Japan-U.S. trade rivalry. Japan like Germany was able to catch up to the U. S. because the U.S. was large and arrogant and refused to believe it could face competition from Japan. Like Britain, U.S. industry believed that they could hold onto markets and would not face competition. British and U. S. industry were startled by the fast rate of growth and industrialization that allowed Germany and Japan to transform themselves quickly into trading rivals. This fast rate of growth also caused friction between both sets of countries. Relations between Germany and Great Britain were damaged as they bickered over markets in particular colonies in Africa . This is similar to the friction between the U.S. and Japan unfair trading practices and closed markets. Both the U. S. and Great Britain in response to losing markets toyed with the idea of economic nationalism and tariffs. As Britain lost markets to Germany many in Britain felt that Britain should adopt tariffs on goods while others known as the free traders believed that a free trade would benefit Britain by creating markets. This split between Tariff Reformers and Free Traders is similar to the split in the U. S. between those in favor of free trade and those opposed to it. Germanys grab for new markets in the 1890s through commercial treaties such as the 1891 treaty with Austria-Hungry is similar to both the United States and Japans free trade zones with neighboring countries using treaties such as ASEAN and NAFTA. The German-Great Britain trade rivalry is different then the U. S.-Japan trade rivalry because a large sector of Japans market for selling goods is the United States who it is competing against; this was not true of Germany. Both Britain and Germany were competing for markets outside of both their countries. Also the trade rivalry between Japan and the United States did not involve a fight over colonies. Trade rivalries between rising and dominant powers change little over time. The German-British trade rivalry and the Japan U.S. rivalry were very similar in their causes, effects, and the solutions that both sets of governments used to overcome their trading rival.Category: Miscellaneous