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write my assignment 5542

Sime, Inc., refines gasoline and sells it through its own Sime Gas Stations. On the basis of market research, Sime determines that 60% of the overall gasoline market consists of “service-oriented customers”, i.e. medium- to high-income individuals who are willing to pay a higher price for gas if the gas stations can provide excellent customer service, such as a clean facility, a convenience store, friendly employees, a quick turnaround, the ability to pay by credit card, and high-octane premium gasoline. The remaining 40% of the overall market are “price shoppers” who look to buy the cheapest gasoline available. Sime’s strategy is to focus on the 60% of service-oriented customers. Sime’s balanced scorecard for 2014 follows. For brevity, the initiatives taken under each objective are omitted.

 

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write my assignment 30432

Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.

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                                         Introduction/PICOT Question

Pain is the most common complaint of people who present to the emergency department (ED).  It is estimated that 75% of all patients use the ED for pain related complaints (Bergman, 2012).  Patient satisfaction survey results emphasize the importance of adequate pain management (Bergman, 2012). With this in mind, nurses have a responsibility to evaluate, assess, and be advocates for a patient’s pain control.  Studies have shown when an ED department has pain management protocols and delegates these to the nurses there is a reduction in patient’s pain (Hadorn, Comte, Foucault, Morin, & Hugli, 2016).  Discovering patient expectations for pain management allows healthcare workers and patients to understand each other.  Once understanding has taken place, we can evaluate essential questions related to the patient’s pain management.  As healthcare workers are we expected to base pain management protocols solely on self-reported pain by the patient?  If so then an important question to answer is: When patients present with pain in the ED, how does a nurses’ perception of the pain influence the level of pain management the patient receives? 

Evidence-Based Practice

              Currently, in the ED I work in pain guidelines and protocols are in place for the nurse to initiate as needed.  Hadorn et al. (2016) state, “guidelines or protocols are generally used to facilitate the transfer of compelling evidence into clinical practice” (p. 81).  This evidence-based pain management protocol is available for the nurse to initiate based on the patient’s self-reported pain, nursing assessment, and observational data.  At times, nurses evaluate pain based on vital signs, facial expressions such as grimacing, restlessness, self-report, and chief complaint (Hazelett, Powell, & Androulakakis, 2002).  In our organization, the policies and procedures for pain management support the adoption of evidence-based practices.  By using the set protocol for pain, nurses are better able to treat pain promptly.  Nurses have a crucial role in delivering evidence-based healthcare in order to have the best outcomes and treatments for their patients (Majid et al., 2011).

Barriers

       Studies noted a barrier to effective pain management is the nurses’ perception of the individual.  Some patients frequent the ED over exaggerating or making up complaints to seek pain medications (Hazelett et al., 2002).  This repetitive drug seeking over time creates a barrier to compassionate care.  The ED is a vulnerable place for drug abuse, especially by patients attempting to get narcotics or other pain medications (Bergman, 2012). 

Emergency department nurses and staff have a culture within their units that influence everyday practices.  There is often a vast age range in the nursing staff which highlights differences in work ethic, attitudes, and professionalism.  The culture of our ED hinders the initiation of evidence-based practices due to stressed out, overworked, and underappreciated nurses.  With this in mind, it is vital that as an organization we provide opportunities for nurses to have adequate rest and find ways to show appreciation for all their hard work.

             Proper access and initiation of the pain management protocol increases the likelihood of adequate pain control for patients.  By discovering the expectations of patients and barriers to providing appropriate care we can eliminate miscommunication regarding pain control. 

References

Bergman, C. (2012). Emergency nurses’ perceived barriers to demonstrating caring when managing adult patients’ pain. Journal of Emergency Nursing, 38(3), 218-225. http://dx.doi.org/10.1016/j.jen.2010.09.017 

Hadorn, F., Comte, P., Foucault, E., Morin, D., & Hugli, O. (2016). Task-shifting using a pain management protocol in an emergency care service: Nurses’ perception through the eye of the roger’s diffusion of innovation theory. Pain Management Nursing, 17(1), 80-87. http://dx.doi.org/10.1016/j.pmn.2015.08.002

Hazelett, S., Powell, C., & Androulakakis, V. (2002). Patients’ behavior at the time of injury: Effect on nurses’ perception of pain level and subsequent treatment. Pain Management Nursing, 3(1), 28-35. http://dx.doi.org/10.1053/jpmn.2002.29012

Majid, S., Foo, S., Luyt, B., Zhang, X., Thong, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. http://dx.doi.org/10.3163/1536-5050.99.3.010

 

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write my assignment 18877

***Need help on the extra optional part on the bottom of the page. The main part of the problem and the graph is solved. The extra optional part is based on the answer and the context of Q2. The answer for Q2 is in the attached picture. Work and Hooke’s Law

Q2.

You recently bought a compound bow and you decide to investigate its “spring like” properties to determine the initial launch speed of your arrows. You decide that the easiest way to measure the force required to displace the bowstring is to hang the bow from the ceiling and then pull down on the bowstring while standing on a scale. By drawing a free body diagram, you can find the relation between the force exerted by the bow string Fbow and the normal force from the scale (n). Using your bathroom scale, you collect the following measurements (assume your mass is 80 kg). By plotting the force as function of stretching you hope to estimate the amount of energy you have stored in the bow. You assume 80% of that energy will be given to the arrow (which you have measured to have a mass of M = 0.02 kg).

Extra Optional: If you aim the arrow directly horizontal and shoot at a target a distance X = 30 meters away, how far above or below the bulls-eye (1 meter below the arrow’s release height) will the arrow hit the target? (Neglect the Drag force from the air on the arrow.) [Solve first using variables and then calculate the numerical value.]

Extra Optional: If you aim the arrow directly horizontal and shoot at a target a distance X = 30 meters away, how far above or below the bulls-eye (1 meter below the arrow’s release height) will the arrow hit the target? (Neglect the Drag force from the air on the arrow.) [Solve first using variables and then calculate the numerical value.]

  • Attachment 1
  • Attachment 2

 

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write my assignment 19788

Hi, need to submit a 500 words essay on the topic The First Emperor.

One thing about Zichu was that he was sent as a hostage son of the Zhao Qin because he was not loved. However, Qin Empire kept on attacking Zhao Empire and this made Zichu mistreated in his host country. It was during his stay in Zhao state that Zichu met Lu Buwei and due to pity the latter felt for the former, they came up with a plan of establishing a successor in lady Huayang who was the king’s most fond concubine. However, Lady Huayang was Buwei’s concubine and Buwei impregnated her before presenting her to Zichu. Therefore, emperor Zheng was neither the son of the king nor the son of Zechu the Prince but the son to the famous merchant Lu Buwei.

According to the stories, Qin’s Court was a very democratic court. This court executed wrong doers like the assassinators. The court ruled a death sentence on the assassinators who tried to assassinate the king. In the court, the men in the court were not allowed to carry weapons. However, the court did not have better measures to ensure that the king was safe while in the court.

From the story of assassination, Crown Prince Dan from Yan State organized an assassination to get rid of Qin Shihaung. Jing Ke was to go for the mission accompanied by Qin Wuyang in the year 227 BC. Qin Wuyand was a fearful man so he didn’t execute his duty of presenting a gift to Qin Zheng. Jing Ke tried executing his goal of getting rid of Qin Zheng but didn’t make it and instead the two of them failed in the assassination and were to be killed later on and the Yan state fell a victim of the Qin State and conquered. Gao Jianli who was an ally of Jing Ke had the urge to avenge his friend’s death. Being the famous lute player and taking advantage of summon by King Zheng to play the lute, he felt he had a good opportunity. Gao Jianli failed in his assassination attempt and later faced execution.

Sima

 

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