BUSINESS D M Essay Example | Topics and Well Written Essays - 500 words

BUSINESS D M - Essay Example All members of the team also agreed on most fundamental point that selected site should have maximum business potential otherwise no sensible promoter will ever risk their funds in a private venture. While doing strength and weakness analysis of each sites by group members following points emerged for each sites. Strengths Weaknesses Site A Site B Site C Plenty of land available Politically quite suitable site Semi-skilled and unskilled workers are available plenty. Most profitable site for business Professionals will love to live here Skilled professionals are available Plenty of the land available for the project A ‘mid cost’ site Not enough housing facilities Professional staff would not like to move here A lot of amount required to be spent on clean up and sterilization Not having enough business potential Protected wild life site Media is against in selection of this site Political activists oppose this site Road conditions are dismal Parking is an issue at this sit e Transport link would take huge budget The group members agreed after deliberations on the following main criteria/objectives of the hospital project that must be fulfilled while selecting the site and they are listed as per the following. 1.

Living religion is not so much about where we finally arrive, but how Essay

Living religion is not so much about where we finally arrive, but how we move there - Essay Example The Native American Individuals had no plans of worshiping and reverenced when they were bemused by something in life. They continually changed their doctrines guiding their religion to match with the changing environment. Judaism is considered a way of people’s life. It is a living religion, since it is made up of the society, adoration and holidays. The Jewish religion thrived where there was the presence of a Jewish individual. The religious services were lively when the Jews assembled for the purposes of worship. The Judaism holidays enabled the Jews to stay connected through out the year seasons. Buddhism is an antique religious conviction practiced by the Egyptians and the Greeks. Buddhism is a living religious conviction as it is published in books and the internet. The teachings of the Buddha are applicable by the contemporary Buddhists in their daily activities in the society. Individuals still strive to apply the values of the ancient Buddha. Buddhism understands the suffering, which is part of human life contrary to other religions blaming suffering on other causes. Hinduism is the oldest creed in the universe. Its ideologies are based on the facts that everyone garners the fruits of his labor. It is based on the external truth as written in the scriptures. The religion lacks a common founder leading to conflicting ideologies spread by various groups. It is based on Gods’ involvement in the daily activity of an individual. There are several living teachers of Hinduism, hence, it is considered as a primeval living religion. It is a living religion as it evolves to match individual religious demands. Christianity has expanded to increase its number of followers. It treats all its followers as equal and is proof to the miracles, truths, peace and love in its doctrines. Christianity has never changed its religious inceptions or doctrines and is forever in a stable state of evolution. Islam is a living religion as

Compare And Contrast Different Organizational Structures And Culture Commerce Essay

Compare And Contrast Different Organizational Structures And Culture Commerce Essay MasterCard is one of the most common names used by people in USA and the second only in worldwide billings to Visa. In order to answer the question about the position of MasterCard in the world, Leigh Clapham (n.d) announced that: As we examined the company, we felt our strategy and people were fine, so we really focused on culture almost by a process of elimination. We just felt our leadership and our execution could be much better, and culture was really at the heart of that. MasterCards organizational culture is defined as role culture because their employees have passive-defensive behaviors, which often means avoiding personal responsibility and simply attempting to make everything rule-based. (Leigh Clapham, n.d) However, these bureaucracies are very slow to respond to change which means that the Leigh Claphams desire to change behavior and culture in MasterCard is quite hard to achieve. However, role culture brings safety working environment to employees so that they are willing to keep their mind on their work. Microsoft In the past, Microsoft is known as the most successful and biggest technological company under Bill Gates leadership. In 2000, Bill Gates left and Steve Ballmer became the CEO of Microsoft. Under Steve Ballmers leadership, Microsoft went down in many aspects such as stock price, the capabilities of innovation, and especially the organizational culture. The organizational culture in Microsoft is competitive culture (Diane Ravitch, 2012) and also called cannibalistic culture (Paul Thomas). It means that, working in Microsoft, employees always have to take part in an unexpected competition. This internal competition, somehow, has created dysfunction corporate culture that obviously will thwart innovation. Its one of many things that lead Microsoft to Lost Decade (Kurt Eichenwald, 2012). Structure According to Bill Gates (1997), Microsoft has a very flat organization. Microsoft is currently employing 94,000 people which means much larger than MasterCard. In 2011, MasterCard was employing approximately 7000 people. However, likes Microsoft, MasterCard is also defined as a flat organization (?) Outcome 1.3: Discuss the factors which influence individual behavior at work Admittedly, organization is made up by individual and, as a result, individual plays an important role influencing organizational behavior. There are five major factors that influence individual differences in behavior at work: personality; perception; attitude; abilities and skills; conflict, stress and change. The individuals personality is one of the core factors of organizational behavior which obviously affect the whole organization. Personality is considered as the most complicated aspect that can influence an individual behavior in a big way. Family, culture and situation are several personality factors that have impact on an individual. Attitude is a tendency to respond to certain situations. Its also defined as a mental and neural state of readiness, exerting a directive or dynamic influence upon the individuals response to all objects with which is related. That means the managers of an organization have responsibility in order to create a favorable working environment which will enable their employees form a positive attitude. For example, the working environment in Microsoft is known as cannibalistic culture (Paul Thomas) meaning that its too competitive. It leads to result that their employees always have to compete with each other. They would rather beat their colleague than make innovation. Lacking innovation which comes from employees, Microsoft is performing a bad business in recent years. Perception is the way an individual interpret the environmental stimuli. There are also many factors that decide the right perception of an individual. But the most important is that the manager has to create a favorable environment which will help employees perceive them in a positive way. Abilities and skills are judged through the performance of an individual at work. It means that employees can perform well or not depends on his/her abilities and skills can match the job requirement or not. Microsoft is a typical example explains the relationship between skills, abilities and organization. Microsoft is using stack ranking system which was popularized by Jack Welch of GE (Diane Ravitch, 2012). This system enables manager rate their employees from the best to worst and then fail the worst. The worst one is also known as the person who cant match the abilities and skills with the job requirement. If the failed one is doing a terrific job and he knows he is going to get failed, he absolutely perform his work in a positive way. The last factor in five core factors that influence an individual is conflict, stress and change. Working under cannibalistic culture means Microsofts employees always have to work under pressure and stress. The result is that they cant do their best when they deal with problems or have to innovate. Then, they perform the bad work, greatly influence to the organization and Microsoft is now close to financial failure. The knowledge about these responses is determining factors for the organization. Every organization requires a positive behavior from their employees and such behavior is recognized by observation, learning or training. Besides the job, the managers have responsibilities to create a good working environment which, somehow, will influence to employees behavior. Outcome 2.1: Compare the effectiveness of different leadership styles in different organizations Leader plays a vital role for the development and the existence of the organization. Leader helps develop organizations objectives, visions, missions and value. Naturally, organizational culture is created based on its leadership and contrariwise the organizational culture also has impact on shaping and developing leadership. The leader styles could be distinguished into four types: autocratic, democratic, persuasive and, participative. Microsoft under Bill Gates leadership is different with Microsoft under Steve Ballmers leadership because of different leadership between these two CEO. Bill Gates leadership is called autocratic. Gates made all the decisions, large or small. He allowed no middle managers between him and his employees. Gates was Microsofts chief decision maker, chief technologist, chief salesperson, chief dealmaker and chief visionary, all rolled into one. (Robert S. Portfolio, 2004). His leadership styles made the communication between him and subordinates was shown in one-way. He made decision and everyone had to do exactly what he said without questions. It greatly effects on employees work performance. Making all decisions himself means he decides to change Microsofts culture into overbearing culture (Edward Cotton). He also dropped the innovative culture which is built from the contribution or initiative from subordinates. However, his style ensures the fulfillment of the strategies. We cant avo id the excellent business performance of Microsoft under Bill which was a certain part created by his leadership style. In 1993, Microsoft had $3.79 billion in revenues, $953 million in profit, and 14,430 employees. In 2000, revenues soared to $22.96 billion, profits to $9.4 billion, and the headcount to 39,170. Between 1999 and 2000 alone, the company had taken on nearly 8,000 new employees. (Robert S. Portfolio, 2004) When Steve Ballmer became the CEO of Microsoft, he tried to change the organizational culture and encourage innovations by using his leadership style which definitely different from Bill Gates. Steve Ballmer (2012) said: Im really trying to give out the instructions, so that many decisions can be made by people. By saying this, he affirmed that his leadership style is democratic which allow him and followers make the decision together. Robert W. Selander was the CEO of MasterCard for 14 years from 1999 to 2010. Robert W. Selander announced that: I have to be careful about not conveying where Im coming from too early on in the process, because Im looking to get feedback from others. Obviously, his leadership styles can be defined as participative leadership. It helps MasterCard create the innovation culture. Participative leadership enables Robert W. Selander to gather and analyze subordinates ideas and views. It makes all MasterCard decisions seem to be more objective than Microsoft. Under Robert W. Selanders leadership, MasterCard grew and turn into one of the most successful payment company. In 2006, MasterCard sold for $39 in its initial public offering. It closed at $218 on June 25. (Roslyn Courtney, 2010) The organization measures its performance and uses that information to improve products and services. In order to do that, it absolutely needs employees contribution and everything is encouraged and shaped by the leadership. Leaders have responsibilities to ensure that their employees are motivated and guided by their leadership and organizational culture also. In other words, leadership has affected the whole organization including human resources, processes and profits.

Science Experiment to Measure the Dissolved Oxygen Levels Using the HACH Method and CHEMets Test Kit :: Science Scientific Environmental Resources Essays

Science Experiment to Measure the Dissolved Oxygen Levels Using the HACH Method and CHEMets Test Kit Purpose The purpose of my project is to determine if there is any significant difference in dissolved oxygen (DO) levels as measured by the traditional HACH ® method or the newly developed CHEMets ® test kit under typical field conditions. Hypothesis My hypothesis is that there is no significant difference in dissolved oxygen (DO) levels as measured by the traditional HACH ® method or the newly developed CHEMets ® test kit under typical field conditions. Review of Literature "Ours is a watery world, and we, its dominant species, are walking sacks of sea water. The presence of large amounts of liquid water on Earth make our planet unique in the solar system." (Hill, 1992 p. 477) People have recently become more concerned with preserving our earth for future generations. Even the government pitches in to help save our earth by enacting laws to help preserve our natural resources. There is local evidence that improved sewage treatment means improvement in water quality. Monitoring on a national level showed that large investments in point-source pollution control have yielded no statistically significant pattern of improvement in dissolved oxygen levels in water in the last 15 years. It may be that we are only keeping up with the amount of pollution we are producing. (Knopman, 1993) The early biosphere was not pleasant for life because the atmosphere had low levels of oxygen. Photosynthetic bacteria consumed carbon dioxide and produced simple sugars and oxygen which created the oxygen abundant atmosphere in which more advanced life forms could develop. (Brown, 1994) The mystery of how Earth's oxygen levels rose is very complex. Scientists don't agree when or how the oxygen on earth got here, but we know we could not live without it. (Pendick, 1993) Oxygen is crucial for humans to survive. Dissolved oxygen is also crucial for most fish and aquatic organisms to survive. Dissolved oxygen is for them what atmospheric oxygen is for humans. If humans have no oxygen to breathe, they die. The same goes for fish. However, fish get their oxygen from the water, and humans get theirs from the atmosphere. (Mitchell and Stapp, 1992) Different aquatic organisms need different levels of dissolved oxygen to thrive. For example, pike and trout need medium to high levels of dissolved oxygen. Carp and catfish are the exact opposite, needing only low levels of dissolved oxygen.

A business report on Cuba

Cuba has suffered for long due to unsuitable macro economic principles that serve to discourage investors from investing in the country rather than encourage them.   Cuba has also suffered due to restriction of trade with the United States, because of political reasons.   This has adversely affected Cuba's economy, leading to its economic growth, fluctuating over the years.The government interference is also adversely affecting the economy since most of the macroeconomic policies applied are weak.   They are also aimed at benefiting the people who operate business activities in the public sector   at the expense of the private sector.   The government also lacks a clear vision for the future, in terms of economic development and growth goals.1.2 CHAPTER 11.3 IntroductionThis chapter aims at analyzing the general facts about Cuba.   These include a brief history, location, general economy, imports, exports, importing and exporting partners among other facts.   It also ai ms at analyzing the employment levels, source of employment for the majority of the people, goods produced by local industries and other basic facts about Cuba as a country.1.4 An overview of Cuba.Cuba is a country that is located on the Caribbean islands, and is reputed to be the most varied, beautiful and largest of all the islands in the Caribbean.   On its southern side it is bordered by the Caribbean and the Western side, by the Gulf of Mexico.   The northern and eastern side is surrounded by the Atlantic ocean.The main imports for Cuba are machinery, food, chemicals and petroleum.   The importing partners are Venezuela, Canada, China, Spain, Mexico and Italy. The main exports are medical products, sugar, tobacco, nickel, coffee and citrus.   The country also produces agricultural products that include tobacco, sugarcane, coffee, citrus, beans and potatoes.1.5 Problem statementCuba has an unfavorable balance of trade and low level of economic growth.   There are also high levels of unemployment and very low levels of foreign investment.   The government interferes with most business activities.   The political environment is also characterized by low levels of democracy.   This paper aims at analyzing the impact of all these factors on the economic environment for Cuba and recommendations on improving the same.

Critical Incident

Rich & Parker 2001 defines critical incidents as snapshots of something that happens to a patient, their family or healthcare professional. It may be something positive, or it could be a situation where someone has suffered in some way. Reflecting on critical incidents will allow me to explore and analyse incidents and how it has affects me and what I hope to do with these effects in the course of my training towards becoming a registered practitioner. It also gives me the opportunity of changing my way of thinking or practice, as I learn valuable lessons when I reflect on an incident. This helps me to develop self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). On the other hand, Johns 2003 defines reflection as â€Å" being mindful of self, either within or after an experience, as if a window through which the practioners can view and focus self within the context of a particular experience, in order to confront, understand and move towards resolving contradiction between one’s vision and actual practice†. I will be using the Beckwith model of reflection which states clearly that reflection is a tool to deal with challenges that will influence the speed and amplitude of one’s development, to explore these effects in other to understand and learn from this incident, with the hope of improving my practice (Beckwith & Beckwith 2007). The incident I will be reflecting upon occurred while attending a clinical placement in the critical care unit at my placement hospital which for the purpose of this essay will be referred to as X Hospital. Critical Care is the multi-professional healthcare specialty that cares for patients with acute, life-threatening illness or injury, (Sheppard & Wright 2005). Critical care can be provided wherever life is threatened. Critical care provided at the scene of an accident or in an ambulance is basic life support. Basic life support is the emergency treatment of any condition where the brain stops receiving adequate oxygen; it could be a cardiac or respiratory arrest, (Kumar). A cardiac arrest is one where there is no pulse and is unlikely the patient will recover with basic life support alone but advanced life support with a defibrillator is required. It is important to carry out basis life support until defibrillator arrives even after careful assessment one discovers it’s a cardiac arrest, as one usually leads to the other, (Kumar). The importance of recognizing, assessing and reacting to cardiorespiratory arrest is very important. Immediate response increases the chances of a successful outcome, (Davey and Ince). Shostek says critical care in a hospital setting is provided by multi-professional teams of highly experienced and professional personnel who use their unique expertise and ability to interpret important therapeutic information, manage highly sophisticated equipment and provide care that leads to the best outcome for the patient. Patients are usually admitted from the emergency room or surgical area where they are first given care and stabilized to CCU, (NHS Careers). The management of the critically ill patient ranges from eye care(Appendix 1), oral care(Appendix 2), infection control, health and safety issues, tissue viability among other vital issues like care bundles for this high risk group of patients who are dependent these care to maintain integrity and dignity according to trust policy. Suction pumps are also vital in the critical care setting as airway hygiene is impaired in critically ill patients as a result of depressed cough reflex and ineffective mucociliary clearance from sedation, high inspired oxygen concentrations, elevated endotracheal tube cuff pressure, and tracheal mucosal inflammation and damage, (X Hospital Policy). Due to this, care of intubated patients includes tracheal suctioning to facilitate the removal of airway secretions (suction therapy) is carried out on all unconscious patient, as it maintains airway patency and prevents pulmonary infection, (X Hospital Policy). A tube or catheter is passed down inside the endotracheal tube and attached to a suction pump, the size of the catheter must be chosen carefully using a simple formula of doubling the size of ET tube minus 2. One should be careful to suction on withdrawal using a suction pressure that is appropriate. Suction depth varies depending on the size of the trachea tube hence suction can be shallow, pre-measured and deep suctioning. Despite the importance of suctioning some complications like hypoxia, cardiac arrhythmias, hypotension, tracheal trauma, laryngospasm and bronchoconstriction are associated with it. Hence tracheal suctioning of intubated patients should be performed on a when needed basis defined by the quantity of secretions obtained, not at prescribed, set intervals, (X Hospital Policy). The incident I will be reflecting on is about a Twenty-Nine-year-old male admitted to the critical care unit with a closed head injury sustained in a motor vehicle accident. His young wife, parents and other family members faced real fears. Most of the family members had never been inside a critical care unit, and found the array of pumps, tubes, machines, monitors and lines, as well as the rush of staff members overwhelming. Just by looking at them and watching their reaction each time they come visiting was enough to tell me how scared and worried they were of their son’s illness and the environment they were in. I started to wonder what was going on in their minds and was drawn to them not only for this reason but because the patient and his family members were the youngest I ever saw in the unit. I was thinking to myself if they have asked questions or done any research about CCU they will most likely be thinking their son’s situation is hopeless. It is important to label and date all the lines as this helps to know what each is used for and how long it has been in situ for. Also care should be taken when moving patients to ensure the stay in place as it can be very uncomfortable and difficult to reinsert a cannula on a patient as most of them are oeadematous. As I was involved in the care of the patient I had to explain to the wife why her husband was connected to a ventilator and it use. A ventilator is an artificial breathing machine that moves oxygen-enriched air in and out of your lungs. If your lungs have failed and you cannot breathe on your own, you will need to be attached to a ventilator (See appendix 3). Being helped to breathe by a ventilator means that you will usually need to be sedated. Ventilators can offer different levels of breathing assistance. If you only need help breathing for a couple of days, it is likely you will have an endotracheal tube from the ventilator to your mouth or nose. The tube will usually be held in place behind your neck as was the case with my patient. However, if you need help with breathing for more than a few days, you may have a short operation called a tracheostomy. This replaces the tube in your mouth with a shorter tube that is placed directly into your trachea. As well as being more comfortable, a tracheostomy makes it easier to keep your lungs clean, and usually requires less sedation. There are two kinds of ventilators, negative pressure and positive pressure. Negative pressure ventilators are not commonly in use today. In my trust we have only the positive pressure ventilators. Mode of ventilation should be tailored to the needs of the patient. Understanding these settings is important as they may need to be changed quickly. Once my patient’s next of kin fully understood the treatment he was receiving I could see this young lady’s face soften a bit. I later learnt from my conversations with her that their 5years-old daughter, had been in the back seat with him when the accident occurred. She had not slept properly since the incident, expressing that she was afraid he would â€Å"never come home. † She has continually asked her mother and grand parents, â€Å"When is daddy coming back home? † The 5-year-old girl would not enter the parents’ bedroom at home and insisted that the light remain on and has refused to take her bath as her dad always gave her a bath each evening. From this conversation I concluded that this little girl needed to see, touch, smell and be with her dad to understand what had happened. I believe that she needs to be allowed to grieve and participate in the healing process surrounding her dad’s trauma. However, there were barriers, because our institution’s written policy was to not allow anyone under the age of 12 to visit patients even though the majority of published studies evaluating family member presence in surgery have shown the positive effect it has on family members irrespective of their age, (Kingsnorth et al 2010). Some of these benefits included removing the family’s doubt about the patient’s situation and allowing them to see that everything possible is being done in caring for that patient, reducing their anxiety and fear about what is happening to their loved one, maintaining the family need to be together even at this time. In addition, when and if death occurred, families have reported that their presence gave them a sense of closure and facilitated the grief process, (Kingsnorth et al 2010). With this information I spoke with my mentor and she agreed how awful it must be for her and promised to look into it. Three days after the accident, my mentor came to me and said they have come up with something that will help this young family and asked if I wanted to be involved with it, I said yes. We approached our patient’s family about scheduling an educational conference for the family. We agreed to include aunts, uncles, grandparents a young niece and two nephews. There were fears about how the children will handle the information but the adults were advised that, if the children exhibited fear or discomfort, they can be allowed to leave the conference room. At the conference, I sat with the children at the table and provided them with crayons and paper. Drinks and cookies were available. I was glad the atmosphere was gentle, quiet, comfortable and conducive to learning. We began the session by discussing definitions of grief, mourning, loss and coping. The adults agreed that this was the first trauma in the family and were giving the children explanations such as â€Å"God may take him† and â€Å"Dad may never wake up. †It was now time to listen to the children. They were asked to talk about a time when they had been sick. We went over what each part of the anatomy did and how they worked together. The children were asked to draw picture of what they understand of the discussion, drew pictures of lungs, a heart, a brain and a rib cage. When the patient’s daughter drew her Dad, she placed wires and tubes in his organs. At this stage I could see that the little girl now understands what had happened to her Dad. The adults who previously did not fully understand the injury to their son appreciated the education. The patient’s young wife had her eyes full of tears but I saw relief on her face regardless. As the clinical picture becomes clearer, the little girl asked if she could see her dad. All agreed this might be beneficial. Now we were confronted with the hospital policy prohibiting children in the critical care unit. The sisters spoke among themselves. I was praying silently that they can make an exception here. It is believed that every patient should be treated as an individual and critical care involves the care of family members as well (Kingsnorth et al 2010). I was glad when the sister came back and asked the patient’s wife to take her daughter to the ICU door, while all the staffs were informed of the plan. The decision was to allow the young daughter to see her dad and hospital policy was explained again, they all understood and were evidently glad like I was. The daughter entered the unit with wide eyes and stood at her dad’s bedside, where she was told about every tube and its purpose. The little girl took her dad’s hand and cried, as did the entire staff. Except for the hum of ventilators, the unit was quiet as the little girl held hands with her father, stroked his hair, sang him a song and said goodnight with prayers. I savored this moment as I realized it was an important journey in the little girl’s life. As a student I concluded that surely there can be nothing superior to this type of care giving. Through out the lecture I couldn’t help but think that God forbid if this was me or my family member I would hope for a care team as nice and understanding as these ones looking after my family. I imagined if these were my children I sure would want them to understand what is happening and to be able to confront it if they want to and what better way to do this. Following the visit, we were told how the little girl had become more agreeable at home. She says â€Å"I have to keep things in order until Dad comes home. † Making a difference is what care exemplifies, particularly when the art of humanity in a technologically driven healthcare system is advocated, (NHS Careers). I truly agree with this statement. For me the critical environment was a different setting and honestly I believe there can be no other like it. It is a very emotional setting that requires strong willed people yet competent in their jobs as well as having a heart full of love to care for their patient and family members. This is an experience that will stay with me throughout my career and influence me in a positive way as I can clearly understand that delivering quality care goes beyond what is done for the patient but for family members around as well. In my trust eye care is recognized as a basic nursing care procedure required by critically ill patients to prevent complications such as eye infections or injury. This care involves regular eye assessment on each patient in the ward to ensure that all patients receive individualized evidence based eye care which ranges from no action required to hydration treatment with and sterile water to a more complex treatment prescribed by a doctor. If hydration or cleaned care is taken to wipe from the nasal corner outwards starting with the lower lids using a different wipe or gauze each time. If there is an infection the non-infected eye should be cleaned first. Sometimes a bacteria barrier cream may be applied if the doctors deem it necessary, (X Hospital Trust Policy). Appendix 2- Oral Care Similarly, all critical ill patients who are intubated receive individualized evidence based mouth care. All orally intubated patients will have moisture, integrity and cleanliness of all oral surfaces. Intubated patient are especially vulnerable to complications if inadequate oral care is practiced. Also there are many factors that pose as barriers to carrying out effective oral care such as: difficulty to access oral cavity, changes in mucosa and normal bacteria flora of the mouth, immunocompromise and medication, presence of endotracheal tubes, oral suctioning and therapeutic dehydration. Based on the above, assessment is carried out daily using the Eilers assessment guide. Whatever the outcome of this assessment oral care on all critically ill patients on a daily basis involves using a soft tooth brush and toothpaste every 12hours in a circular stroke away from the gums, cleaning the tongue and inside of the cheeks. A through rinse using a syringe and gentle suction to remove secretions thereby minimizing trauma to soft tissues in the mouth. Foam sticks and sterile water can be used in cases of extreme dryness as it’s is effective for moistening oral cavity. Soft paraffin can also be used to prevent lips from cracking. Dentures are usually removed and cared for till when patient needs it, (X Hospital Trust Policy). Appendix 3 – Understanding ventilators settings Tidal volume This is the lung volume representing the normal volume of air displaced between normal inspiration and expiration with no extra effort. Typical values are around 500ml or 7ml/kg. To avoid adverse effects of barotrauma and volutrauma it is recommended to use lower tidal volumes. An initial TV of 5-8 mL/kg of ideal body weight is generally indicated. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2 O. Continuous mandatory ventilation (CMV) Breaths are delivered at preset intervals, regardless of patient effort. This mode is used most often in the paralyzed patient because it can increase the work of breathing if respiratory effort is present. CMV has given way to assist-control (A/C) mode. Many ventilators do not have a true CMV mode and offer A/C instead. Assist-control ventilation The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. With each inspiratory effort, the ventilator delivers a full assisted tidal volume. Spontaneous breathing is not allowed. This mode is better tolerated than CMV in patients with intact respiratory effort. Intermittent mandatory ventilation With intermittent mandatory ventilation (IMV), breaths are delivered at a preset interval, and spontaneous breathing is allowed between ventilator-administered breaths. Spontaneous breathing occurs against the resistance of the airway tubing and ventilator valves, which may be formidable. This mode has given way to synchronous intermittent mandatory ventilation (SIMV). Synchronous intermittent mandatory ventilation The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. Spontaneous breathing is allowed between breaths. These modes are beneficial for patients who require high minute ventilation. Full support reduces oxygen consumption and CO2 production of the respiratory muscles. A potential drawback of A/C ventilation in the patient with obstructive airway disease is worsening of air trapping and breath stacking. Pressure support ventilation For the spontaneously breathing patient, pressure support ventilation (PSV) has been advocated to limit barotrauma and to decrease the work of breathing. Pressure support differs from A/C and IMV in that a level of support pressure is set (not TV) to assist every spontaneous effort. Airway pressure support is maintained until the patient's inspiratory flow falls below a certain cutoff. PSV is frequently the mode of choice in patients whose respiratory failure is not severe and who have an adequate respiratory drive. It can result in improved patient comfort, reduced cardiovascular effects, reduced risk of barotrauma, and improved distribution of gas. CPAP is an acronym for â€Å"continuous positive airway pressure†, a variation of the PAP system. Respiratory rate A respiratory rate (RR) of 8-12 breaths per minute is recommended for patients not requiring hyperventilation for the treatment of toxic or metabolic acidosis, or intracranial injury. High rates allow less time for exhalation, increase mean airway pressure, and cause air trapping in patients with obstructive airway disease. The initial rate may be as low as 5-6 breaths per minute in asthmatic patients when using a permissive hypercapnia technique. Positive end-expiratory pressure Positive end-expiratory pressure (PEEP) is a term used in mechanical ventilation to denote an airway pressure that is kept above atmospheric pressure at the end of the expiratory cycle. The equivalent in a spontaneously breathing patient is CPAP. One obvious beneficial effect of PEEP is to shift lung water from the alveoli to the perivascular interstitial space. It does not decrease the total amount of extravascular lung water. This is of clear benefit in cases of cardiogenic as well as noncardiogenic pulmonary edema. An additional benefit of PEEP in cases of CHF is to decrease venous return to the right side of the heart by increasing intrathoracic pressure. References Amitai, A. and Kulkarni, R. Medscape (2010), Ventilator Management. Available at: http://emedicine. medscape. com/article/810126-overview,assessed on 13/03/11 Beckwith, M. A. R. ; Beckwith, P. T. (2008) â€Å"Reflection or Critical Thinking? : A pedagogical revolution in North American health care education†. Refereed Program of the E-Leader Conference at Krakow, Poland, Chinese American Scholars Association, New York, New York, USA June 2008, Courey, A. J. and Hyzy, R. C. Up to date 19. 1(2010) Over view of mechanical ventilation. Availableat: http://www. uptodate. com/contents/search? earch=ventilators&source=USER_INPUT&searchOffset=assessed on 13/03/2011 Hatfield A, Tronson M, (2009), The Complete Recovery Book, 4th edn. New York: Oxford University Press. Chapter 2, Page 29. Johns, C. (2004) Becoming a Reflective Practitioner, 2nd edn. UK: Blackwell Publishing Ltd. Kingsnorth, J. , O’Connell,K. , Guzzetta, C. E. , Edens, J. C Atabaki, S. Mecherikunnel, A. and Brown, K. (2010) Journal of Emergency Nursing: Family Presence During Trauma Activations and Medical Resuscitations in a Paediatric Emergency Department: An Evidence-Based Practice Project,36/2,pp115 NHS Careers (2009) Operating Department Practice. Available at: http://www. nhscareers. nhs. uk/details/Default. aspx? Id=255 (assessed 11/03/2011) Pirret, M. (2002) Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skills requirements. Intensive and Critical Care Nursing. 18(1) pp. 19-26. Rich, A. and Parker, D. L. (1995) Reflection and critical incident analysis: Ethical and moral implications of their use within nursing and midwifery education, Journal of Advanced Nursing 22(6): 1050-1057 Sheppard, M & Wright, M (2005) Principles and practice of High Dependency Nursing. nd ed. Philadelphia. Bailliere, Tindall Elsevier. The Intensive Care Society (2010) An Introduction to intensive care medicine for junior doctors [Online] Available from: http:/ /www. ics. ac. uk/education/2010_trainee_handbook: Accessed 19 January 2011. Unknown Author (2006) Eye care for critically ill patients, X Hospital Policy. Unknown Author (2006) Mouth care for intubated patients, X Hospital Policy.