Providing Safety Measures within Schools Essay Example for Free

Providing Safety Measures within Schools Essay School violence is not just a recent tragedy. In fact, the earliest known United States (U. S. ) school shooting called â€Å"Pontiac’s Rebellion School Massacre† took place on July 26, 1764 in Pennsylvania (Wikipedia). These ill-fated events are products of many different factors such as bullying, revenge, and even mental issues. Unfortunately, school violence has become a more prevalent occurrence in society today. However, because of the unknown and rather unexpected motives of the perpetrators, an end to school violence cannot, in all actuality, happen. Certainly, there are procedures available to prevent occurring violence. Through the use of increased screening and safety measures, school violence can be greatly diminished, improve the quality of the nation’s education, and restore faith in administrators. School violence has plagued many areas of not only the U. S. , but also other parts of the world. However, a number of the worst attacks have occurred right here in the U. S. , Columbine High School, for example. April 20, 1999 marked the date of fifteen deaths at Columbine High School in Littleton, Colorado. Two teenage shooters took the lives of fourteen students and one teacher (Listverse). This school tragedy led to an increased emphasis on security at schools across the U. S. (SFGate). The April 16, 2007 shooting at Virginia Tech claimed the lives of thirty-three victims and was named the deadliest shooting by a single gunman in U. S. history. Bath School in Michigan fell victim to forty-five deaths and was given the title of the deadliest mass school murder in U. S. history (Listverse). In recent history, Connecticut unfortunately experienced a shooting of its own at Sandy Hook Elementary where twenty-eight young children and adults were victim to a deranged gunman on December 14, 2012 (The Inquisitr). But certainly, we cannot forget the February 27, 2012 shooting at Chardon High School that rocked Ohio (SFGate). More and more schools around the nation are stepping up school safety measures to ensure the security of students. Undoubtedly, the most commonly selected safety measure is limited or controlled access to the school in such ways as to lock and monitor school doors. Metal detectors, security cameras, and limited social networking access are more commonly being used to monitor and restrict student and visitor behaviors (U. S. Department of Education). Monitoring and supervising common areas such as the cafeteria, gym, hallways, and parking lot is a significant safety measure usually practiced by schools (NASPonline). School resource officers, guards, and unarmed law enforcement officers may not always need to be present, but should always be available. Staff members should monitor all guests by greeting each and every person who comes to the door. Counselors and psychologists should always be available to students so that they know they have someone to trust and be able to anonymously report suspicious activity (Gumbrecht; NASPonline). Crisis plans and preparedness training should be accessible for all staff members along with threat assessment procedures. The promotion of obedience of school rules and a safe school environment should be present at all times for the safety of the students (NASPonline). Schools should conduct regular drills such as intruder, weather, and fire for student awareness (Gumbrecht). A responsible and safe school always includes school-community partnerships and school safety incident data to keep the public informed about new procedures (NASPonline). There are a number of structural prevention suggestions available. The most frequently used structural methods are locked doors and security systems. However, more advanced structural preventions exist: single, prominent entryways for guests and students to enter; reduced landscaping to eliminate hiding spots; shifted restrooms away from entryways; moved major mechanical and electrical systems; keyless entry systems for staff and faculty; and elaborate announcement systems for drills and instructions (Gumbrecht). Panic buttons are available for $5,000 and operate on single police dispatch lines that send all available units to the school in case of an emergency. The buttons can be located in each individual classroom or in different regions of the schools. These structural suggestions come at a price but are well worth the investments (Scott). Because of the seemingly reoccurring school violence trend, many school districts have contemplated active shooter training and arming teachers. Even though this might seem like a good idea, there may very well be negative consequences. Instead, most school administrators opt for the more common school entry policies and emergency manuals for all staff. Newer safety ideas are being introduced into school districts such as Mohawk, Ellwood, and Shenango in Pennsylvania. These districts installed computerized systems that scan the driver’s licenses of all visitors to identify anyone convicted of crimes against children (New Castle News). Administrators have many accessible guidelines for communicating with students, their parents, and the public. Conversations with students should be developmentally appropriate and include guidelines for violence. Administrators should keep in mind the cultures, traditions, religion, and family values of students and keep the focus on normal routines and activities. Parents should be made aware of all violence conversations with students. The children must know that schools are safe places and there is a difference between reporting and tattling, they must be observant and report what they see. Students must also realize that every so often, people commit wrong acts, but violence is never a solution. Open communication between parents and their children is key; the students should know to stay away from weapons. Also, the school staff must stress the understanding of possibility versus probability; students should always know that they are safe in school. These guidelines are important for administrators to convey to their student body and public (NASPonline). Without a doubt, school violence has made national headlines. In December, the NRA announced the National School Shield Program. They have issued â€Å"a report on how they believe schools can prevent further gun violence† (Gumbrecht). The NRA will present policy proposals and resources to law enforcement, lawmakers, school officials, and the public. Because there is declining support for strict gun regulations, law enforcement officials will prepare armed guards that state and local officials will alter (Sperry and Wallace). A higher percent of high schools and middle schools require drug testing for athletes and extracurricular activities; badges and picture identifications for students and teachers; random dog sniffs and contraband sweeps; and security cameras for monitoring the school building and surrounding premises. 84 percent of high schools, 73 percent of middle schools, and 51 percent of elementary schools use security cameras for surveillance. A higher percent of high schools and middle schools have electronic emergency notification systems and structured, anonymous threat reporting systems. A lower percent of high schools control access to buildings during school hours, prohibit cell phone usage and text messaging, and require uniforms (U. S. Department of Education). Unfortunately, school violence is on the rise. Children should not have to be afraid to go to school in fear of experiencing a fateful attack. By no means can there ever be assumptions made that attacks cannot happen just anywhere; no area is completely immune to violence. The public cannot be naive. As much as the thought of an attack is hard to comprehend, the possibility must always be in the back of the mind. There are countless ways to be prepared; school administrators just need to take action. Through the use of increased screening and safety measures, school violence can be greatly diminished, improve the quality of the nation’s education, and restore faith in administrators

Essay --

The question I chose to focus on is question seven, â€Å"How Should Families be Involved in Assessment† (Nation Association for the Education of Young Children [NAEYC], 2003, p. 13). It is important to understand how to incorporate the families of the children being assessed into the assessment process. Whether the assessment is merely routine, or is being done out of concern for the child’s development, it is my belief that the parents should be involved. Rous et al. (2007) affirms this belief by defining assessment as â€Å"†¦a shared experience between families and professionals in which information and ideas are exchanged to benefit a child’s growth and development.† Involving the families in the assessment process requires three basic steps. The first step in involving the family of a child being assessed is to notify the family before assessment begins. When a parent (or parents) enrolls their child in a childcare program, they are entrusting the caretakers with the task of knowing what is best for their child. Discovering that may require assessment. NAEYC and the National Association of Early Childhood Specialist in State Departments of Education [NAECS/SDE] (2003) note that â€Å"to assess [a] young [child’s] strengths, progress, and needs, use of assessment methods should†¦[be] inclusive of families.† Essentially, in order to properly assess a child, the families knowledge and input is required (NAEYC & NAECS/SDE, 2003). Once the family has been notified, the second step should take place. The family should be made aware that their involvement in the assessment process is important for their child’s overall development (Rous et al., 2007). Rous et al. (2007) notes that â€Å"the role of family as the child’s first and most significant teac... ...ssed, which is step one. Step two is revealed when the parents and the teacher have a conference to discuss what steps can be taken to improve Tyler’s progress. Lastly, step three occurs when the teacher gathers evidence to show the parents their child’s marked improvement in skills he once struggled in. Involving the parents in their child’s assessment is incredibly important. As a teacher, it shows concern for the child’s overall wellbeing and concern for the parents involvement in their child’s development. While it is important to involve the parents, it is much more important in how a teacher or caregiver does this. With the three steps of informing the parents of assessment, encouraging the parents to participate, and showing the parents the final outcome of the assessment, a teacher or caregiver is able to involve the parents in a meaningful and helpful way. Essay -- The question I chose to focus on is question seven, â€Å"How Should Families be Involved in Assessment† (Nation Association for the Education of Young Children [NAEYC], 2003, p. 13). It is important to understand how to incorporate the families of the children being assessed into the assessment process. Whether the assessment is merely routine, or is being done out of concern for the child’s development, it is my belief that the parents should be involved. Rous et al. (2007) affirms this belief by defining assessment as â€Å"†¦a shared experience between families and professionals in which information and ideas are exchanged to benefit a child’s growth and development.† Involving the families in the assessment process requires three basic steps. The first step in involving the family of a child being assessed is to notify the family before assessment begins. When a parent (or parents) enrolls their child in a childcare program, they are entrusting the caretakers with the task of knowing what is best for their child. Discovering that may require assessment. NAEYC and the National Association of Early Childhood Specialist in State Departments of Education [NAECS/SDE] (2003) note that â€Å"to assess [a] young [child’s] strengths, progress, and needs, use of assessment methods should†¦[be] inclusive of families.† Essentially, in order to properly assess a child, the families knowledge and input is required (NAEYC & NAECS/SDE, 2003). Once the family has been notified, the second step should take place. The family should be made aware that their involvement in the assessment process is important for their child’s overall development (Rous et al., 2007). Rous et al. (2007) notes that â€Å"the role of family as the child’s first and most significant teac... ...ssed, which is step one. Step two is revealed when the parents and the teacher have a conference to discuss what steps can be taken to improve Tyler’s progress. Lastly, step three occurs when the teacher gathers evidence to show the parents their child’s marked improvement in skills he once struggled in. Involving the parents in their child’s assessment is incredibly important. As a teacher, it shows concern for the child’s overall wellbeing and concern for the parents involvement in their child’s development. While it is important to involve the parents, it is much more important in how a teacher or caregiver does this. With the three steps of informing the parents of assessment, encouraging the parents to participate, and showing the parents the final outcome of the assessment, a teacher or caregiver is able to involve the parents in a meaningful and helpful way.

Road Safety Measures

Introduction- Road Accident is collision between any vehicles (for example car, truck, motorcycle etsectra) or it can be with any pedestrian, animal or the hindrance placed in the middle of the road. The accident occurred could result in many injuries or damage to the property. There are various factors which come into account which can be the reason of accident that is design of the road, driver's impairment and vehicle design which can cause serious and most dangerous types of accidents. This essay is based on the prevention of car accidents on the roads mainly on the streets of Dubai.Defining the Problem- What is the Problem? – The provision of highways are resulting in convenience for the peoples but the main problem which is faced by the government of any country is that the more frequent road accidents which are happening on the highways which results in severe damage in form of man power or infrastructure and mainly it is happening in big cities like UAE or Dubai which are having large road transport. The problem is basically small which is to be handled very carefully by the government; they have taken many measures to stop these huge accidents.Whenever a road accident takes place there is various types of damage which takes place which could be in the form of human beings which is also a victim, infrastructure which is damage to the government and other administration damages which occurs during accident. There is heavy cost to all above types of damages which has to be paid during accident which increase the complication if every day there will hundreds of accidents across the country which would directly affect the economy of the country such as UAE.There is a cost which has to be paid by the victim's family which cause great problem financially, the property is damaged due to the accident which also affect government financially indirectly. There is also some administration cost which will undergo due to the accident. Reason- The main reason behind the accidents which occur so frequently on the roads of UAE is that inattention which is given during driving a car. There would probably lesser amount of accidents if proper attention and rules are followed during traveling. There could be reason related to weather which lso come into effect into the reason behind accident which is of course a natural reason, the fog which causes less appearance of on coming vehicles could result in accidents. The other main reason which can cause massive accident is consumption of alcohol during driving. There are some stats related to the car accidents in UAE- * Mostly 92% men are responsible for the death occurred during accident and only 8% women are responsible. * Accidents at night made up 45% of the total fatalities. * Private vehicles cause 1164 accidents taking a toll of 167 lives. The average ratio of death due to accident in UAE was 1 in every 28 hours. Cause of Accidents- There are four factors which are responsible for these ty pes of road car accidents which are- Equipment Failure- The failure of some equipment inside the machine working of a car resulting into serious car accident is known as Accident due to Equipment Failure. These could be of various types such as failing of break, bursting of tire, tread separations or the problem could occur in steering/suspension. Roadway Design- The accidents which occur due to the irregular design of roads are known as accidents due to Roadway Design.It could occur through hazardous visibility which consists of merging lanes, livestock or pedestrian crossings, crests and troughs etc. The accident also occurs due to the irregular surface of the roads which causes imbalance of the vehicle and results into collision with another vehicle or infrastructure. Poor Roadway Maintenance- Poor roadway maintenance also contributes to some of the car accidents. There could be debris in the way of the road which could create problems for the traveler which is responsibility of local highway department, faded road sign and potholes could be another cause for the major road accident.Driver Behavior- The main and foremost cause is driver's behavior other than three causes discussed above which constitutes only 5% of the cause of the road accidents and 95% depends on this one. Various surveys has been done in which there is a study which comes out to be that only 5% driver's committed their own mistake in the accident and a major of 80 % believe that the other driver should have done something to stop the accident to occur. Current Policy- There are various policies which has been started or being formed for the increasing road accidents on the roads of UAE.There is an immediate need for the adoption of government's policies which could change the face of the accidents in the positive manner. Recently there is a conference been held in Abu Dhabi which was 15th Road Safety conference of four continents under the patronage of the vice president and prime minist er of United Arab of Emirates, Sheikh Mohammed Bin Rashid AL Maktoum. This conference was mainly organized by National Transport Authority (NTA) and with collaboration with other groups such as GRPS, FERSI, TRB and many more.This was the first road safety conference which will going to follow United Nation Assembly resolution A/64/L. 44/Rev1 on safety of roads. The aim to conduct this conference was to follow the path being adopted by the UN assembly resolution and to support the declaration being done in Moscow to improve the safety measures on road. This conference was great platform for the government to adopt the measures which are being adopted and technical methods which are better than their methods could be adopted and being implemented to construct a safe world to live in which is free from ant accident.It was a great platform to debate for road safety issues and to discuss them and the measurement for the improvement of safety measures. There should be organization of futu re events and form a close relationship with transport institutions and the government authorities to work on the topic of road safety which can reduce the number of accidents which took place these days. The conclusion of this conference come out with the understanding that all the participants that is the countries or the nations which have participated in the conference will follow the guidance given by the United Nations on the road safety measures.There should be implementation of the strategic plan such as â€Å"Zero Vision† which is famous in some countries in Europe which should be encouraged by the United Arab of Emirates government as well as the agency under which this project will go should handle it with care. Government' s Reaction- The accidents which are taking place in the UAE region of Arab countries are getting out of the alarming situation so there is a need of taking protective measures by the government to enhance the education related to the safety adop tion during driving to avoid the risk of accident.There are various policies which have been introduced by the UAE government to ensure that there is less number of accidents in the country. There are various system introduced to control the accidents which takes place at the highway like introduction of fine system, black points and application like radars should be installed. So these systems should be discussed in detail to understand their uniqueness System of fine-There is an introduction of fine in various countries for the breaking of traffic rules to control the ongoing accident on the highways or on the street but the fine system which is applied in the United Arab Emirates region is somehow little harsh from other countries because of the diversified atmosphere of that country and the large amount of vehicles running daily from one destination to other. There are more than hundreds of offences which are made under the rule which involves handsome amount of money which is t o be given by the culprit if he/she found guilty of any one of them.There are some examples which could be given to show you how strict is the government of UAE * Not wearing seat belt there is a fine of 100 AED * If there is some change found in the fundamental of engine without permit then a fine of 400 AED * Driving a vehicle which is creating lots of pollution then there is a fine of 300 AED * Driving without number plate then there is fine of 200 AED * Overloading can charge an individual with 200 AED Driving a vehicle which is not having a license from license authority could be charged with a toll of 200 AED. So above points describing fine are some of the fines which have described here very shortly instead they are having a big list of them. The system is introduced with a purpose of reducing the irrelevant trafficking and reduction of accidents which are taking place in the country at the faster rate. Radar System- Various countries are adopting high tech facilities to con trol the rate of accidents which is touching the sky.There are technical gadgets which are available in the market which could detect the speed of a vehicle from few kilometers before which could help in controlling the speeds of the vehicle which is the main reason for the accidents. For example there is radar installed somewhere at the place on highway which used to keep track of the speed of ongoing vehicles and if found some vehicle is running at the speed which too high then the censors of radar will give the indication about it.This system and other various measures which have been initialized by the government have reduced the rate of accidents which were taking place earlier. You will be shocked through the stats that death due to road accidents in Dubai has fallen short by 27 percent in the first nine months of the last year which are the figures being given by the Road and Transport Authority (RTA). There has been loads of effort being given by the UAE ministry of Interior in making the roads safer for the pedestrians and the motorists. Black Points-This system is introduced basically in the UAE in which there are points given on the basis of breaking the rules or committing any mistakes during driving along with the fine being charged. These points collectively if crosses a standard limit which has been specified by the government could result into cancellation of the driving license or could be even worse than that by cancelling the license of the vehicle and taking the vehicle into their custody. So these were few measures which are being taken by the government of UAE at the superior level to prevail UAE as the Best Global cities in the world by 2015.There is a signing of memorandum between Road and Transport Authority (RTA) and the ministry to involve road safety in the top agenda and to increase improving the driving standards and the safety measures which are being took by the people. Alternative Policy- The policies which are been introduced by the government or some of them which are in the line are discussed in the above topics but the help or the measures which an individual could take has its own preferences. There are some policies which could be added in the list of the safety rules can help hem a lot to somehow decrease the accidents being taking place at the highway or on the streets. There should be launching of nation wide campaigns which could help in providing information regarding the road safety measures being adopted and to make people aware of the rules which are being introduced in the rule books. There are around 11551 injuries and simultaneous deaths on the streets of Dubai and there are 17 deaths which took place weekly in Dubai which is quite shocking with the stats.There are websites which conduct online test to test the knowledge of the road laws of the people which have another purpose also which is to make aware people about various laws and protective measures which they can take while driving. There should be formation of different associations which could take part in making the rules of road safety implemented in every part of the country and help the government in reducing the rate of accidents and which should provide various new invented measures which could be implemented and will be helpful in decreasing the rate of accidents, the government should take these type of ideas.There is very sharp division on the speed breakers which are situated on the highways could be placed with the forewarning boards and properly colored which could be seen from a distance but the travelers feel that speed breakers are not necessary on the highways but the villagers which understands the necessity of the breakers for their safety from the fast running vehicles. So these ways we have seen the division of mentality. There should be jurisdictional restriction on speed limit of different types of vehicle which are running like anything on the roads or highways resulting into very bad accidents.There should be some technically installment of the limit of speed which could be set accordingly to the traffic running at that place. The criteria of providing license should be made harsher which could only give chance to the perfect drivers which could provide a better chance of decreasing the accident rate. There should be various level of testing the driving of an individual which result in total inspection of the people that how much they know and is it safer to give them license to drive vehicle. The Non-Governing Organizations (NGOs) should come in front to put extra effort on the safety measures being introduced by the government.There are mechanical failures which could occur in vehicle apart from it there are mainly driver's fault which could result in severe massive accidents resulting into loss of many lives with them. Nowadays people are consuming alcohol and driving vehicle which could result into serious accident so the policy should be made to check the a lcohol consumption which should not be found more than a standard level as set by the government. There are cops which are posted at some place on the highways to check for these types of faults with breath taking machines which indicates if there is overconsumption of alcohol.Sometimes there are accidents which occur due to improper sign boards being placed on the roads. The proper planning of city could make a city free from accident which can be made by taking such types of protective measures such as sidewalks should be made to avoid walking on the roads which could decrease in the road hitting cases in the city, the crossing which is made should be made more uplifted to save pedestrian, there should be the facility for separate lanes for the two wheeler, three wheeler vehicles which can travel in only one row to avoid the risk of accidents.The activities like talking on cell phone, listening to music while driving should be avoided by an individual by themselves which could ser iously harm their lives and is termed as very dangerous. The government should walk through every rural and urban area to educate the people and launch campaign at very big level to involve as many people as it can so that more and more people are being introduced to the new technologies which are rapidly being involved in the traffic rules.There should be collaboration which could be made with other countries to improve the conditions which is at present, more and more conferences should be organized within country to establish a base of road safety and there should be exchange of information and ideas between different people having different mindset which could help in building more ideas regarding safety of the people of the country. The road design is also sometimes responsible for the accidents which should be made properly.In some researches it has been shown that proper design and maintenance, with well designed intersections, proper installation of traffic control devices c ould make significant improvement in the rates of accidents. There should be no mechanical default in the vehicle which is actually 5% of the accidents which take place but there should adequate measures which should be taken by individual like proper wearing of seatbelts, time to time service of the vehicle to avoid any risk during long run and other measures which should be taken by the drivers to drive safely on the highways which is the place of aving maximum risk of accident. The driver which is driving a car should be well educated enough to identify the roadside signboards to minimize human error so that risk of accident from human side decreases as low it can be. Conclusion- The car accidents are taking place at frequent rate in the country like United Arab of Emirate where number of highway are more which increases the rate of accident, the protective measure should be taken by an individual while driving a vehicle which has been introduced in above points.There are various policies which are introduced by the government to decrease the alarming situation of the rate of accidents occurring in UAE. There are stats which are shocking about the deaths of the people occurred during the accidents, these can only be improved when there is an initialization from every person of the nation and if full support is achieved by the government of the country then there are chances to calm down the temperature of the rate of accident occurring at highway. Read more:  http://www. businessteacher. org. uk/free-management-essays/road-accident. php#ixzz2OL0YNSNs

Essay on African Innsurrections on Board Slave Ships

4th January 1610 7:00pm Today, will be a day I will never forget. The day started off as usual, I helped my father in the fields while mom prepared a bag for me to carry with me to the other side of town. I was going to spend some time with my relatives who lived not far from where my family and I lived. It had been the custom for me to visit since my uncle died three months ago and left my aunt and two little cousins. My cousins and I were playing through the woods as we would normally do every day before going to the river to take a bath. After playing, we were heading to the river to take our bath when we stumbled upon a group of men who accused us of stealing from the chief of the village. We denied the accusations and turned in the†¦show more content†¦18th January 1610 8:00am I could see the coast line and the vessel that he guards were speaking about a few days back. I couldn’t believe that this was going to be the last time I would see the land of my birth and my family. We had reached the area where we were shown to the persons purchasing us. They inspected us from head to toe ensuring that they were getting what they were paying for and that we were in good health with no deformities. Once this inspection was over and we passed the test we were placed on board the vessel. On board the vessels we remained shackled and the women and the children were placed separately from us the men. 19th January 1610 6:00pm The condition upon the ship was horrible. It was the worst I had ever seen, the scent was despicable. We were placed tightly together. We were crammed. They made sure to use every inch of the space available. We were placed so close together that a simple thing as turning from side to another became a problem. We laid head to toe and though I wasn’t able to count how many of us there were I knew it was plenty because even the air to breathe was limited. We were stored as cargo the name that we were eventually called aside from Negroes. I couldn’t tell if the women were stored in the same manner, but I assumed so. The vessel was filled to capacity with little or no room left. We were now ready to be taken to the white man country. I lay on the bunk and

The Carolina Wilderness Outfitters Is A Retailer For...

Background The Carolina Wilderness Outfitters is a retailer for outdoor enthusiasts. The company was started in the 1930’s and grew to have a following of consumers from its North Carolina residents within fifty years of growth. The head of internal auditing Sue Ramos initiated an investigation after receiving a Tel Tel report. The call that was noticed was from an ex-employee from the company alleging that there was wrongful termination that had taken place. Ms. Ramos had assumed that the investigation would be completed and she would be able to move on to more pressing matters until new evidence was presented last week showing issues with the accounting for the company. Ms. Ramos did not feel that the allegation made by the caller†¦show more content†¦The details referred to other departments and shed light on more than just age being the reason why Ms. Koster was terminated from the company. Scope The purpose of this investigation is to determine whether or not there is was a financial statement issue within the accounting department of Carolina Wilderness Outfitters. Though the initial investigation is based on another issue regarding the accounting department, there may be more to incident that is an underlying issue. This investigation is predicated by a phone call made to the ethics hotline by Betty Koster alleging that she was wrongfully terminated due to her age and claims discrimination. Approach The Investigation Team Members †¢ Sue Ramos, Head of Internal Auditing †¢ Anthony Payne, Investigator Procedures The investigation team took the following actions during the investigation: †¢ Conducted phone interviews with Betty Koster, Simon Peel, and Mark Tomkin. †¢ Obtained and reviewed notes of phone calls with Betty Koster. †¢ Obtained and reviewed performance evaluations of Betty Koster during her eight-year tenure with the company. †¢ Obtained and reviewed possible journal entries about volume rebates made from within the Accounting Department. Individuals That Were Interviewed: the members of the

The World There Are Many Cultures, And Religions - 1231 Words

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Foot Infection for Body Temperature Regulation- myassignmenthelp

Question: Discuss about theFoot Infection for Body Temperature Regulation. Answer: Introduction The biggest part of the heath profession in health care setting is nurse. They utilise judgements and reasoning for taking decisions in terms of patients care. On the broader scale nursing profession understands intuitive reasoning as the experts hint. Thompson et al., 2010 approximated that nurses that is employed in health centres shall take a mean of single results per 10 min. In patients safety agenda decision making plays a very crucial role (Yang, 2009). This report illustrates clinical reasoning cycle to give a clinical decision regarding diabetic foots infection. This may occur due to acute or chronic skins compromise, outer neuropathy, arterial insufficiency or the mixture of all these. Around 20% of diabetic patients with ulcer in foot may have inadequate peripheral atrial supply, approximately half of them have peripheral neuropathy and about 30% will showcase all. The writer chooses this issue in the present clinical practicum because there are large numbers of clients having foot infection in the heal care settings especially diabetic patients having this problem. Adding to this, patients are exposed to danger situation. The major objective of this paper is to develop a clinical decision utilising the clinical reason cycle. It also illustrates about the essentiality and the appropriate stages to take proper decisions. It will also be supporting the condition which is faced by HAAD after which certain recommendations shall be provided. Diabetic Foot infection Clinical reasoning is said to be as the reasoning that is utilised by the nurses and other staffs to gather cues, information processing, reach to a conclusion of the situation or issue, implement, plan, analyse results, learn and reflect prom the process. During the process it connected the way of thinking in respect to care of patients, ability to think critically and with experience and practice clinical reasoning changes to natural skill. Adding to this, clinical reasoning is a crucial skill since it provides positive results for the clients; empower efficient management in complex situations and bifurcates among things that need instant attention and what not. Writer utilises process of clinical reasoning that is described as dynamic process which moves in clockwise direction begins at 12:00. It is crucial and advantageous cycle in decision making since the nurses can go forward and back before taking action or reaching decision or evaluating the results. It is also essential si nce it contains 8 steps that assist in understanding and work through every step instead of making approximations regarding problems of patients and starting intervention. It also gives a framework for the nurses intervention with sufficient consideration and planning (Levett-Jones et al.2010,p.516:Hoffman 2007). Scene Mr M has an age of 55 years. In his left ankle she was diagnosed with foot infection. In his interrogation with doctor she said that she was knows about the infection. She understood it as a simple wound that will be healed by time. That is why she ignored it for about a week. After few days she noticed that wound got larger, it did not healed and there was severe pain which impaired his movement. Underlining that she is diabetic from past 15 year and having family history of diabetic mellitus. She also had cholesterol. Her doctor suggested her 4 antibiotics and 4 analgesic and swelled left leg at the time of getting admitted. Their plan was to do inspection, swab wound care, dressing and mobilisation. Etiology and Epidemiology of diabetes foot ulcer Diabetes is accumulation of metabolic disease categorised by hyperglycemic outcomes from lack of insulin secretion, action or both. Blurred vision, weight loss, polydipsia and polyuria are the symptoms of Hyperglycemia. Problem of diabetic foot has an influence of the patients lifes quality which may result in depression and decreases movement. It also has financial angle with it (American Diabetes Association, 2014a). Moreover, diabetic foot ulcer is caused by peripheral neuropathy, outer arterial disease that lead to gangrene and necrosis, infection and osteomyelitis (NICE, 2011). Patients Condition Good morning, my name is Noor, I am RN from ED. Today Mr. M was diagnosed with the wound infection at the age of 55. The infection is mild and is present in the left ankle. She visited ER at 23:00 pm. Her condition is that she was hit by the thrown rock at the floor which she hit by mistake. His ankle got ruptured from where continuously blood was coming out for half an hour. He just wrapped it up for the week with a towel without cleaning it up. The wound become painful and the situation got worst as she exclaims it to be the worst pain of his life. She arrived at ER in lot of pain and the legs were swelled. She receives an antibiotic levofloxacin 500 mg and IV and acetaminophen 1000mg IV. Wound got dressed with silver cell and gelonet it was wet, swelled and 1 inches in breadth, 3 inches in length and fresh blood cells release at the time of dressing. Vitals of his like blood pressure was 130/81, temperature 36.1C, oxygen saturation was 99% , his pain score was 5 and she was depressed with his respiratory rate of 20/min. Her blood sugar was 270mg/dl, 4th hurly blood checking was done. Mr. M is in sliding scale utilising insulin aspart 2 unit fixed dose and 2-10 unit unfixed. Her attributes are 71 kg in weight, 163 cm in height and having BMI of 26.72. Mr M labs outcome was ordinary except HDL low 33 mg/dl and LDL high 189 mg/dl. She is under atorvastatin 40 mg and asked for repeating of her lipid profile. She does not have allergy from medicine or food. After receiving the patients hand over from ED nurse, me and my preceptor introduce ourselves to Mr. M and we started the assessment. Formal admission process to the ward was done by us that involved risk assessment, physical assessment and history taking. Information/Cues Review present data Second step of clinical reasoning cycle is to begin reviewing and thinking regarding condition of Mr M. Her temperature is low 36.1 C, pain scale the score is 5 and respiratory rate scores 20/min. Expression on the face of Mr. M suggested that he was depressed. 262 mg/dl was his blood sugar level. She also had the cholesterol medical history. His LDL and HDL was not ovious. New Information Beginning with the assessment , me and my preceptor returned to the patients room to access her. We took her vital sign where his temperature was still low i.e. 36.2C, pain is measured through wong baker it scores 5. Legs elevation was not present and the patients position was bad. For wound culture we do swab. Mr M said I not ok in depression, we looked his blood sugar it is high 277 mg/dl. As she says her highest blood sugar she reached is only 221mg/dl. We understood from the subjective data obtained from him that patient has a very less knowledge regarding his health condition. Recall knowledge In diabetic patients foot is infection is very serious and common issue. Existence of infection understood as occurrence of 2 or more inflammations characteristics. For suggesting that infection, positive swab is enough. Since most of the diabetic foot infection is caused by polymicrobial infection with aerobic Gram-positive cocci and staphylococci. Starting therapy related to antibiotic has to emphasize on these bacteria so that therapy must be narrowed to a particular area. For mild to moderate infection, the effective treatment is usually of 1-2 weeks. Information processing Interpret Analysing the Mr Ms data, the writer collects and accumulates it with careful analysing and application of the knowledge associated with diabetic foot infection. By comparing abnormal with normal helps in understanding the sign and symptoms of Mr M. Beginning with the vital his temperature was normal i.e. 36.2C. The hypothermia range is between 36.5C to 37C. As per Hall JE (2015) hypothermia happens when temperature is from 35C and less. In the Pain score she scores 5 out of 10 in which suggest that she is under moderate pain. Respiratory rate was 22 which was high since normal patient is between 16-20 and hence she was having tachypnea. Blood sugar was still on the upper side i.e. 262. As per Joslin Diabetes Center 2016 the before meal blood sugar for diabetic individuals was 70-130. After meal 180 and at bedtime it was between 90-150. However her HDL was low i.e. 3mg/dl the normal between 40-59mg/dl. Risk of heart diseases is higher in this condition. The LDL high is 189 mg/dl. 10 0-129 mg/dl is between 100-129 mg/dl (Hall JE., 2015). There was still swelling. Discriminate Here writer will narrow down information and flinging which requires excessive attention. Beginning with the temperature it was on the lower side, but my worrying was not about it since it was under normal low. With rest patients depression will decrease and so will the respiratory rate. The pain will come down with medication and the results of the lab will be repeated. My worry was regarding his higher blood sugar level and the wound was still fresh as his legs was still swelled. Taking evidence from the raising sugar level the infection may not reduce and the wound may take longer time to get healed. However the rising amount of glucose level in the blood may result in rigidity and stiffness of the cell walls. Weakening blood circulation of the smaller vessels presents in the injured regions surface and may delay the wound recovery (Jana Nemcova Edita Hinkova., 2013). Relate, and (d) Infer In this part I will make collection and link the cues to collect. To find the linkage among the important complain and concern to make interference on these relationship. Mr Ms swelled leg with pain might be an enhancement of his infection on the effected region. Mr M blood sugar is still on the higher side due to the fact that she did not have meal on time, she had infection as well as she was depressed. Mr M was feeling cool may be the sign of depression. This is due to the fact she has limited amount of knowledge regarding his condition which can be seen that she had little knowledge regarding the wound (Diabetic UK., 2012a). Predict Here the writer requires critical thinking to think regarding Mr M results. If author does not think about the condition then patient condition may not improve. It is predicted that Mr M may develop more infection and can lead to his cognitive impaired eyes due to high sugar levels. Adding to this if his blood sugar level may not increase then it may cause hypoglycemic coma (American Diabetes Association, 2014a). Match Here the author shall discuss regarding one patient who having almost same condition in the previous clinical rotation. There was another diabetic patient Mr X having type 2. She was 65 year old with the assumption of right leg having infection and has reached the whole leg. This patient again developed toe infection and at this time patient was highly careful regarding the infection due to his bad experience regarding the infection. They treated the toe, leg was elevated and the client was taking food at regular time in an appropriate manner. Due to one week of antibiotic course the wound got healed since infection was gone. This also becomes possible due to the fact that she was highly co-operative and hence his course completed in one week. She was obeying all the instructions that were given to him. Doctors were surprised comparing the results of the two cases. For better health and quality of life the first and foremost priority that the patients co-ordinates while treatment is going on (Levett-Jones et al.2010,p.516: Hoffman., 2007). Identify the problem As per the process of nursing defining the issue comes when the assessment is already done. It is also termed as nursing diagnosis. The condition of Mr M starting from first diagnosis to the latest is illustrated. First is that the pain associated with the right legs infection as manifested by high sugar levels in blood, swelling in legs, pain score was 5 and the client said I am not ok. Second is that she had hyperglycemia associated with excessive intake of carbohydrate as said by patient himself that I like pasta and breads, enhanced blood sugar and the wound. Third was the activity associated with effected limbs as said by Mr M that I am very weak how I will do my activity and how will work. Adding to this she was also deficient of knowledge. Establish Goals Moving towards the third step in the process of nursing is planning to have long and short term goals. Before making any action nurses must provide goals to have appropriate plan for care. The short term goal for the patient is to bring the blood sugar level is under 240 in the next 24 hours. Client will be pain free in the next 12 hours. For the long term goals patients will be pain free in the next day until discharge, patients will control his diet after education, patient will have healed wound with no infection and client will be satisfied before getting discharged. Patients will perform daily activity by himself. Take Action The forth step to this is nursing intervention is to achieve the objectives. The intervention must be related with the best care plan. Offered timely opiate pain medication as prescribed and the assessment are done in every 30 minutes. It will let us know that if the dosage is enough to manage the pain. Then teach about non-pharmacological techniques like listening to music, yoga or peaceful environment which will assist patient to be relaxed and he remains in comfort. After that reduce or remove factors which will bring or rise experience of pain (e.g. monotony, fear, fatigue and knowledge lack since these factors will influence his tolerance of pain). Mr M must be educated to ask for pain medication before the pain becomes worst. This shall be done before the pain becomes difficult to manage and handle (Chris Pasero and Margo McCaffery., 2016). Evaluation Last step of this process is to evaluate the whole thing that you did to see if it is fruitful and check whether the entire plan is effective or not. Vitals of Mr M becomes normal, the lipid profile HDL and LDL is within the appropriate range 122mg/dl and HDL 51mg/dl with assistance of proper intake of atorvastatin. Sugar in the blood was 200 mg/dl with proper diet and timely insulin. Patient verbalize" I am comfortable I cannot imagine that pain went"," thank god I can go to work know", "I will do the advice that given to me to avoid such complication. She is now stable the goals is achieved with the co-operation of Mr M. Reflect In this part reflection regarding client condition will be discussed and explained. This condition happened due to my clinical rotation for Advanced Clinical Decision making in nursing in ALMAFRAQ in the surgical ward 2A. With the use of Gibbs cycle of reflection that contain 6 stages that are describing the situation, your feels, analysing, evaluating, concluding and your action plan for reflection about the incidents (Chang Daly, 2012). For a start, I was in 2A ward doing day duty with my preceptor. She assigned with five patients two of them immobile and two contacts. The fifth one is with foot infection that is Mr M who is 55 years old. My preceptor was highly busy on that day since doing documenting, going to OT and collecting blood. Moreover she neglected Mr M but the time she reached her, he was in the very difficult condition. The room was singing IV machine ringing due to the medication finish, she is trying to get out of the bed with effected leg. Mr M was asking and screaming for help. As per my feeling I was surprised having no reaction on my face by looking Mr M not been able to move. I was thinking about the things that happened and put him in terrible condition. I thought that if the preceptor continues to ignore the condition of him then it can be dangerous for him. I evaluated the condition in both good and bad way. Good in the sense that condition of Mr M made me good reactor and made me watchful. Bad part of it was that doctor takes longer time answering to their needs. Patients safety is in danger when one nurse is assigned more than 5-6 patients. Seeing such situation I ran to find the aid in such situation and hence forming a team leader without the help of my preceptor. Units manager called my preceptor for three minutes meeting so as to relax and say her that not to be afraid of while handling the report. Next day units manager thanked the preceptor and gave her two days off. This situation came to an abrupt ending for which me and my preceptor were not ready. We were also worrying about the response we will receive from others. At last everyone was cheerful. This was done by the units manager to let other understand that they must not get afraid of any situation. Same way f thee nurses takes their personal decision rather than asking for help they may save many lives. If in future such incidents arise I will do the same thing where I could use my experience and critical thinking to save patients from any further harm rather than waiting for help. While working in various units I can gain this experience. Clinical errors occur since the nurse neglects the patients. Applying HAAD standers are required for all the RNs in Abu Dhabi to give excellent care to patients. Such competencies are for ensuring safety and security of both RNs and clients. Nurses responsibilities are categorised into 3 categories. First is the class where nurses decide how RN must behave, act or perform. They needed to put appropriate and safety care of each patient. Second one is ethical practice professionalism which describes about understanding of RNs about their job and the code that keeps them independent. Third is the creation of the professionalism that makes RNs to sustain their individual life learning essential for jobs. Gathering the first to the second they will emphasize on behaviour professionalism when the nurse in the last situation fails to safeguard Mr M from harm. The nurses were unable to do their task by applying organised technique (Health Authority of Abu Dhabi., 2009). Recommendation All the patients of diabetes requires a inspection on daily basis if she is in the risk of infection and ulcer. Multidisciplinary expert agrees that it is a foot care pathway for individuals with DM. Referrals at rapid speed is required for managing patients with infection (Diabetes UK., 2012a). A special health card is provided to patients with DM in UAE where they can visit specialist doctors in the imperial college London diabetic centre. More study is needed to make sure that implication of nurses delivering diabetic foot care program in treatment of diabetic foot infections where the hospital lacks trained podiatrist (van Battum P et al., 2011). Conclusion In the concluding remark it can be said that foot infection in diabetic patients is a complicated issue. Such incidents are rising and are costly to the people with DM. Educating people can be an efficient tool which can contribute to changing of behaviour of patient. The selected topic may aid the writer to learn about such situations and practice to enhance critical thinking. Adding to this writer utilised Gibbs cycle to reflect upon Mr M situation that experiences foot infection. At the end the author provides recommendations for future so as to reduce ulceration for patients of diabetes. References American Diabetes Assosition (2014a) Dignosis and classification of diabetes mellitus. Diabetws Care 37 (suppl 1): S81-S90. Doi: 10.2337/diacare.27.2007.S5 Chris Pasero and Margo McCaffery. (2016).Nursing Diagnosis Acute Pain - Nanda NIC NOC.Available: https://nursing-diagnosis-intervention.blogspot.ae/2012/07/nursing-diagnosis-acute-pain-nanda- nic.html. Last accessed 15th March 2016. Chang, E. Daly, J. (2012). Transitions in Nursing: Preparing for Professional Practice. 3rd Edition. Elsevier. Australia. Diabetic UK (2012a) Putting Feet First: Transforming Foot Care Service in diabetes http//bit.ly/ZdhpbO (accessed 15 February 2016). Hall JE. Body Temperature Regulation and Fever.Guyton and Hall Textbook of Medical Physiology. 13th ed. Saunders; 2015 Jun 03. Chapter 74, 911-922. Health Authority of Abu Dhabi. (2009). Health Authority - Abu Dhabi Monitor RNS competences domains. Retrieved 21 Feb 2016. Jana Nemcova Edita Hinkova. (2013). The efficacy of diabetic foot care education.Journal of Clinical nursing. 23 (1), p877-881. Doi: 10.1111/jocn.12290 Joslin Diabetes Center. (2016).Goals for Blood Glucose Control.Available: https://www.joslin.org/info/Goals-for-Blood-Glucose-Control.html. Last accessed 15th March 2016. Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., Hickey, N. (2010). The five rights of clinical reasoning: an educational model to enhance nursing student ability to identify and manage clinically at risk patients. Nurse Education Today. Lipsky BA, Berendt AR, Cornia PB et al (2012) 2012 Infection Disease Society of American clinical practice guideline for the diagnosis and treatment of diabetic foot infection. Clinical Infection Disease 54(12): 132-73. National Institution of Health Care Excellence (2011) Inpatient management od diabetic foot problem. NICE Clinical guideline 119. https://bit/1C2HB7Z(accessed 29 Feb 2016) Thompson, C., N. Cullum, D. McCaughan, T. Sheldon and P. Raynor. 2010. "Nurses, Information Use, and Clinical Decision Making- The Real World Potential for Evidence-Based Decision in Nursing." Evidence Based Nursing 7(3): 68- 72 Van Battum P, Schaper N, Prompers L, et al. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet Med 2011; 28:199205. Yang, H. 2009. The Effects of improving Representatives Design on Nurse Risks Assessment: A Comparison of Written Case Simulations and Physicals Simulations'. PhD Thesis, University of York, York, UK.