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Boule de suif de Guy de Maupassant. Anesthetic. Boule de Suif est paru dans Les Soires du Mdan en 1880 et assura la clbrit de Maupassant. Prefrontal Cortex Damage. L'histoire se droule pendant la guerre de 1870, en plein hiver et dbute par le repli des troupes franaises et l'envahissement de Rouen par les prussiens. Tattoo Anesthetic. C'est bord d'une diligence tire par six chevaux que l'hrone, baptise par l'auteur Boule de suif et neuf autres personnes s'enfuient vers Dieppe. Internment Ireland. Il y a l un couple de commerants, deux couples de la bourgeoisie et de la noblesse, deux religieuses, un dmocrate, et Boule de suif, une femme galante, dont la prsence soulve la mfiance, l’indignation ou la curiosit.
Le voyage s’annonce difficile, le froid est vif. Tattoo. La neige ralentit la progression de la diligence. Electrical. Les voyageurs ont faim. Tattoo. Seule, Boule de Suif a pens emporter des provisions qu’elle partage volontiers avec ses compagnons de voyage. Cars. Ceux-ci n’hsitent pas alors oublier provisoirement leurs prjugs pour bnficier de la gnrosit de la passagre.
Le soir, la diligence s’arrte pour une tape l’auberge de Ttes. Tattoo Anesthetic. Celle-ci est occupe par les Prussiens. Ireland. L’officier prussien interdit la diligence de repartir tant que Boule de suif na pas accepté ses avances. Tattoo. Avant le souper elle est appele le rejoindre mais refuse. Definition. Bonapartiste, elle n’accepte pas de coucher avec l'ennemi. Tattoo. Les passagers restent bloqus la journe l'auberge et ralisent que l'officier prussien ne les laissera partir que lorsque Boule de suif se sera offerte lui.
Chacun y va alors de son argument pour convaincre la jeune femme d’accepter de se sacrifier. Prefrontal Cortex Damage. Elle passe la nuit avec l'officier et ils partent au petit matin. Anesthetic. Tous se sont fait prparer des petits plats sauf Boule de Suif qui n'a pas eu le temps. Prefrontal Damage. Quand arrive l’heure du repas, les voyageurs se rgalent mais personne ne partagera son repas avec Boule de Suif. Tattoo. Elle n’aura droit qu’au mpris de la part de cette micro-société bien pensante, qu’elle a nourrie puis libre. La femme, une de celles appeles galantes, tait clbre par son embonpoint prcoce qui lui avait valu le surnom de Boule de suif. Cortex Damage. Petite, ronde de partout, grasse lard, avec des doigts bouffis, trangls aux phalanges, pareils des chapelets de courtes saucisses, avec une peau luisante et tendue, une gorge norme qui saillait sous sa robe, elle restait cependant apptissante et courue, tant sa fracheur faisait plaisir voir. Tattoo Anesthetic. Sa figure tait une pomme rouge, un bouton de pivoine prt fleurir; et l-dedans s'ouvraient, en haut, deux yeux noirs magnifiques, ombrags de grands cils pais qui mettaient une ombre dedans; en bas, une bouche charmante, troite, humide pour le baiser, meuble de quenottes luisantes et microscopiques. On Oedipus Sophocles. Elle tait de plus, disait-on, pleine de qualits inapprciables. Tattoo Anesthetic. Elle en sortit d'abord une petite assiette de faence, une fine timbale en argent, puis une vaste terrine dans laquelle deux poulets entiers, tout dcoups, avaient confit sous leur gele; et l'on apercevait encore dans le panier d'autres bonnes choses enveloppes, des pts, des fruits, des friandises, les provisions prpares pour un voyage de trois jours, afin de ne point toucher la cuisine des auberges. Quatre goulots de bouteilles passaient entre les paquets de nourriture.
Elle prit une aile de poulet et, dlicatement, se mit la manger avec un de ces petits pains qu'on appelle Rgence en Normandie. Electrical Essay. Tous les regards taient tendus vers elle. Tattoo. Puis l'odeur se rpandit, largissant les narines, faisant venir aux bouches une salive abondante avec une contraction douloureuse de la mchoire sous les oreilles. A Citation Apa. Le mpris des dames pour cette fille devenait froce, comme une envie de la tuer ou de la jeter en bas de la voiture, dans la neige, elle, sa timbale, son panier et ses provisions. Mais au bout de dix minutes elle reparut, soufflant, rouge suffoquer, exaspre.
Elle balbutiait: Oh la canaille! la canaille! Tous s'empressaient pour savoir, mais elle ne dit rien; et, comme le comte insistait, elle rpondit avec une grande dignit: Non, cela ne vous regarde pas, je ne peux pas parler. Anesthetic. Alors on Poverty in the Third World, s'assit autour d'une haute soupire d'o sortait un parfum de choux. Anesthetic. Malgr cette alerte, le souper fut gai. Cars Essay. Le cidre tait bon, le mnage Loiseau et les bonnes soeurs en prirent, par conomie. Tattoo Anesthetic. Les autres demandrent du vin; Cornudet rclama de la bire. Internment Ireland. Il avait une faon particulire de dboucher la bouteille, de faire mousser le liquide, de le considrer en penchant le verre, qu'il levait ensuite entre la lampe et son oeil pour bien apprcier la couleur.
Quand il buvait, sa grande barbe, qui avait gard la nuance de son breuvage aim, semblait tressaillir de tendresse; ses yeux louchaient pour ne point perdre de vue sa chope, et il avait l'air de remplir l'unique fonction pour laquelle il tait n. Tattoo. On et dit qu'il tablissait en son esprit un rapprochement et comme une affinit entre les deux grandes passions qui occupaient toute sa vie: le Pale-Ale et la Rvolution; et assurment il ne pouvait dguster l'un sans songer l'autre. Of Mice And Men The Great. Aussitt rentre, elle monta chez elle et ne reparut plus. L'inquitude tait extrme. Tattoo. Qu'allait-elle faire? Si elle rsistait, quel embarras! L'heure du dner sonna; on definition, l'attendit en vain. Tattoo. M. Prefrontal. Follenvie, entrant alors, annona que Mlle Rousset se sentait indispose, et qu'on pouvait se mettre table. Anesthetic. Tout le monde dressa l'oreille. Internment. Le comte s'approcha de l'aubergiste, et, tout bas: Ca y est? - Oui.
Par convenance. Anesthetic. il ne dit rien ses compagnons, mais il leur fit seulement un lger signe de la tte. Electrical Essay. Aussitt un grand soupir de soulagement sortit de toutes les poitrines, une allgresse parut sur les visages. Tattoo Anesthetic. Loiseau cria: Saperlipopette! je paye du champagne si l'on en trouve dans l'tablissement - et Mme Loiseau eut une angoisse lorsque le patron revint avec quatre bouteilles aux mains. Definition Exceptionalism. Chacun tait devenu subitement communicatif et bruyant; une joie grillarde emplissait les coeurs. Le comte parut s'apercevoir que Mme Carr-Lamadon tait charmante, le manufacturier fit des compliments la comtesse. Tattoo Anesthetic. La conversation fut vive, enjoue, pleine de traits. Definition Exceptionalism. Le lendemain, un clair soleil d'hiver rendait la neige blouissante. Tattoo. La diligence, attele enfin, attendait devant la porte, tandis qu'une arme de pigeons blancs, rengorgs dans leurs plumes paisses, avec un oeil rose, tach, au milieu, d'un point noir, se promenaient gravement entre les jambes des six chevaux, et cherchaient leur vie dans le crottin fumant qu'ils parpillaient. Rex By. On n'attendait plus que Boule de suif. Tattoo. Elle parut. Elle semblait un peu trouble, honteuse, et elle s'avana timidement vers ses compagnons, qui, tous, d'un mme mouvement, se dtournrent comme s'ils ne l'avaient pas aperue.
Le comte prit avec dignit le bras de sa femme et l'loigna de ce contact impur. Poverty Third Essay. La grosse fille s'arrta, stupfaite; alors, ramassant tout son courage, elle aborda la femme du manufacturier d'un bonjour, Madame humblement murmur. Tattoo Anesthetic. L'autre fit de la tte seule un petit salut impertinent qu'elle accompagna d'un regard de vertu outrage. Rex By. Tout le monde semblait affair, et l'on se tenait loin d'elle comme si elle et apport une infection dans ses jupes. Tattoo Anesthetic. Puis on of mice the great depression, se prcipita vers la voiture o elle arriva seule, la dernire, et reprit en silence la place qu'elle avait occupe pendant la premire partie de la route. Amour sacr de la patrie, Conduis, soutiens, nos bras vengeurs, Libert, libert chrie, Combats avec tes dfenseurs! Une Vie de Maupassant , étude de Philippe Bonneu (Editions Bréal) Dictionnaire des Grandes Oeuvres de la Littérature française , Jean-Pierre de Beaumarchais, Daniel Couty ( Editions larousse) Kléber Haedens Une Histoire de la Littérature française , Grasset 1970. Tattoo Anesthetic. Le Robert des Grands Ecrivains de langue française. Electrical And Conventional Cars Essay. Achetez des livres à propos de maupassant une vie chez l'un de nos partenaires. Tattoo Anesthetic. Retrouvez les grands moments. Electrical And Conventional Essay. du Festival de Cannes Molière, ce grand peintre de l'homme tel qu'il est. Shakespeare seul a enfanté une humanité aussi large et aussi vivante.
Emile Zola, 1881. Tattoo. Aujourd'hui, maman est morte. Sports High. Ou peut-être hier, je ne sais pas. Tattoo Anesthetic. J'ai reçu un télégramme de l'asile : Mère décédée. Create Apa. Enterrement demain. Tattoo. Sentiments distingués. Reasons To Abandon Sports In American High. Cela ne veut rien dire. Tattoo. C'était peut-être hier. Eradicate World Essay. mais il y a au monde une chose sainte et sublime, c'est l'union de deux de ces êtres si imparfaits et si affreux.
On est souvent trompé en amour, souvent blessé et souvent malheureux; mais on tattoo, aime, et quand on a citation, est sur le bord de sa tombe, on tattoo anesthetic, se retourne pour regarder en arrière et on definition, se dit : j'ai souffert souvent, je me suis trompé quelquefois, mais j'ai aimé. Tattoo Anesthetic. C'est moi qui ai vécu, et non pas un être factice créé par mon orgueil et mon ennui. Eradicate Third. Alfred de Musset. Tattoo Anesthetic. Dcouvrez sur aLaLettre un rsum de Candide de Voltaire.
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Psychosocial interventions for anesthetic people with both severe mental illness and of mice and men the great, substance misuse. Michelle Cleary, Research Unit, Rozelle Hospital, Sydney South West Area Health Service (Eastern Zone),, P.O. Anesthetic? Box 1, Rozelle, NSW 2039, Australia. Michelle Cleary [email@example.com]. University of Sydney, Discipline of definition, Psychological Medicine, Sydney, Australia Search for tattoo anesthetic more papers by Eradicate Poverty World Essay this author. The Children's Hospital at tattoo anesthetic Westmead, Centre for and Conventional Cars Kidney Research, Westmead, NSW, Australia Search for more papers by tattoo this author. South African Medical Research Council, South African Cochrane Centre, Tygerberg, South Africa Search for Rex by more papers by tattoo anesthetic this author. University of exceptionalism, Sydney, Sydney, Australia Search for tattoo anesthetic more papers by to Abandon in American Essay this author. First published: 23 January 2008 Editorial Group: Cochrane Schizophrenia Group DOI: 10.1002/14651858.CD001088.pub2 View/save citation Cited by (CrossRef): 30 articles Check for updates. Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. To assess the tattoo anesthetic effects of Electrical Cars, psychosocial interventions for substance reduction in people with a serious mental illness.
For this update (2007) we searched the tattoo anesthetic Cochrane Schizophrenia Group Trials Register (May 2006) which is a citation based on tattoo anesthetic regular searches of the great, major databases. We included all randomised controlled trials (RCTs) comparing psychosocial interventions for tattoo anesthetic substance misuse with standard care in the great people with serious mental illness. We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on tattoo a random effects model. We calculated numbers needed to World Essay treat/harm (NNT/NNH) where data were homogeneous. Tattoo Anesthetic? For continuous data, we calculated weighted mean differences (WMD) again based on on Oedipus Sophocles a random effects model.
Evaluation of long-term integrated care included 4 RCTs (total n=735). Tattoo? We found no significant difference on measures of and men the great depression, substance use (n=85, 1 RCT, RR 0.89 CI 0.6 to 1.3) or loss to anesthetic treatment (n=603, 3 RCTs, RR 1.09 CI 0.8 to Electrical Cars Essay 1.5). For the non-integrated intensive case management trials (4 RCTs, total n=151) we also found no significant difference for loss (n=134, 3 RCTs, RR 1.35 CI 0.8 to anesthetic 2.2). And Conventional Cars? Motivational interviewing plus cognitive behavioural therapy (3 RCTs, total n=276) did not reveal any advantage for retaining participants (n=36, 1 RCT, RR lost to tattoo treatment 0.50 CI 0.1 to depression 5.0) or for relapse (n=36, 1 RCT, RR 0.58 CI 0.3 to tattoo 1.1), and Essay on Oedipus Sophocles, no benefit for tattoo anesthetic reducing substance use (n=119, 1 RCT, RR 0.19 CI -0.2 to 0.6). Of Mice The Great? Cognitive behavioural therapy alone (4 trials, total n=260) showed fewer participants lost from treatment (n=260, 4 RCTs, p=0.02, RR 0.61 CI 0.4 to anesthetic 0.9). Definition Exceptionalism? No benefits were observed on measures of lessening cannabis use (n=47, 1 RCT, RR 1.30 CI 0.8 to 2.2) or on anesthetic the number of participants using substances (alcohol; n=46, 1 RCT, RR 5.88 CI 0.8 to Sponsoring High Schools Essay 44.0, drugs; n=46, 1 RCT, RR 2.02 CI 0.9 to tattoo anesthetic 4.8) and Essay on Oedipus Sophocles, no differences were observed on tattoo anesthetic measures of a citation apa, mental state (n=105, 1 RCT, RR 0.52 CI -0.8 to 1.8). Tattoo Anesthetic? We found no advantage for a citation motivational interviewing alone (5 trials, total n=338) in tattoo reducing 'lost to evaluation' (n=338, 5 RCTs, RR 0.96 CI 0.6 to on Oedipus Rex by 1.5) compared with treatment as usual, although significantly more participants in tattoo the motivational interviewing group reported for their first aftercare appointment (n=93, 1 RCT, RR 0.69 CI 0.5 to exceptionalism 0.9, NNT 4 CI 3 to anesthetic 12). Definition Exceptionalism? Some differences were observed in anesthetic abstaining from in the Essay, alcohol favouring treatment (n=28, 1 RCT, RR 0.36 CI 0.2 to tattoo anesthetic 0.8, NNT 2 CI 2 to depression 5), but not other substances (n=89, 1 RCT, RR -0.07 CI -0.6 to anesthetic 0.4) and create apa, no differences were observed in tattoo anesthetic mental state (n=30, 1 RCT, WMD -4.20 CI -18.7 to 10.3). Exceptionalism? Finally, we found no significant differences for tattoo anesthetic skills training in the numbers lost to treatment by 12 months (n=94, 2 RCTs, RR 0.70 CI 0.4 to 1.1).
We included 25 RCTs and to Abandon Sponsoring Sports in American Essay, found no compelling evidence to support any one psychosocial treatment over another to tattoo reduce substance use (or improve mental state) by of mice and men people with serious mental illnesses. Anesthetic? Furthermore, methodological difficulties exist which hinder pooling and Electrical and Conventional Cars Essay, interpreting results; high drop out anesthetic, rates, varying fidelity of Cars, interventions, varying outcome measures, settings and samples and comparison groups may have received higher levels of anesthetic, treatment than standard care. Further studies are required which address these concerns and Essay on Oedipus Rex by, improve the evidence in anesthetic this important area. Interventions psychosociales chez les patients présentant à la fois un trouble mental sévère et un abus de substances. Chez les patients atteints de troubles mentaux sévères, un abus de substances, même léger, peut entraîner des effets dommageables. Évaluer les effets des interventions psychosociales visant à réduire la consommation de substances chez les patients atteints de troubles mentaux graves. Stratégie de recherche documentaire. Pour cette mise à jour (2007), nous avons consulté le registre des essais du groupe Cochrane sur la schizophrénie (mai 2006), issu de recherches régulières dans les principales bases de données. Nous avons inclus tous les essais contrôlés randomisés (ECR) comparant des interventions psychosociales ciblant l'abus de substances à des soins standard chez des patients atteints de troubles mentaux graves. Les données ont été extraites de manière indépendante. Pour les données dichotomiques, nous avons calculé les risques relatifs (RR) et leurs intervalles de confiance (IC) à 95 % sur la base de l'intention de traiter à l'aide d'un modèle à effets aléatoires.
Lorsque les données étaient homogènes, nous avons calculé le nombre de sujets à traiter pour observer un bénéfice/effet nuisible du traitement (NST/NNN). Third? Pour les données continues, nous avons calculé les différences moyennes pondérées (DMP), également sur la base d'un modèle à effets aléatoires. 4 ECR évaluaient des soins intégrés à long terme (n total = 735). Aucune différence significative n'était observée concernant les mesures de la consommation de substances (n = 85, 1 ECR, RR de 0,89, IC entre 0,6 et 1,3) ou de sortie d'étude (n = 603, 3 ECR, RR de 1,09, IC entre 0,8 et 1,5). Tattoo? Pour les essais portant sur une gestion de cas non intégrée intensive (4 ECR, n total = 151), aucune différence significative n'était observée en termes de sortie d'étude (n = 134, 3 ECR, RR de 1,35, IC entre 0,8 et 2,2). La technique d'entrevue motivationnelle + thérapie cognitivo-comportementale (3 ECR, n total = 276) ne présentaient aucun avantage en termes de rétention des participants (n = 36, 1 ECR, RR de sortie d'étude de 0,50, IC entre 0,1 et 5,0) ou de rechutes (n = 36, 1 ECR, RR de 0,58, IC entre 0,3 et 1,1), et aucun bénéfice en termes de réduction de la consommation de substances (n = 119, 1 ECR, RR de 0,19, IC entre -0,2 et 0,6). Eradicate Poverty In The Third Essay? La thérapie cognitivo-comportementale seule (4 essais, n total = 260) était associée à une sortie d'étude inférieure (n = 260, 4 ECR, p = 0,02, RR de 0,61, IC entre 0,4 et 0,9). Tattoo? Aucun bénéfice n'était observé concernant les mesures de la réduction de la consommation de cannabis (n = 47, 1 ECR, RR de 1,30, IC entre 0,8 et 2,2) ou le nombre de participants consommant des substances (alcool ; n = 46, 1 ECR, RR de 5,88, IC entre 0,8 et 44,0, drogues ; n = 46, 1 ECR, RR de 2,02, IC entre 0,9 et 4,8) et aucune différence n'était observée concernant les mesures de l'état mental (n = 105, 1 ECR, RR de 0,52, IC entre -0,8 et 1,8). World Essay? Nous n'avons identifié aucun avantage de la technique d'entrevue motivationnelle seule (5 essais, n total = 338) pour réduire la perte à l'évaluation (n = 338, 5 ECR, RR de 0,96, IC entre 0,6 et 1,5) par rapport au traitement habituel, mais un nombre significativement supérieur de participants du groupe de la technique d'entrevue motivationnelle se présentaient à leur premier rendez-vous de suivi (n = 93, 1 ECR, RR de 0,69, IC entre 0,5 et 0,9, NST de 4, IC entre 3 et 12). Anesthetic? Certaines différences (favorables au traitement) étaient observées concernant l'abstinence d'alcool (n = 28, 1 ECR, RR de 0,36, IC entre 0,2 et 0,8, NST de 2, IC entre 2 et 5), mais pas des autres substances (n = 89, 1 ECR, RR de -0,07, IC entre -0,6 et 0,4), et aucune différence n'était observée concernant l'état mental (n = 30, 1 ECR, DMP de -4,20, IC entre -18,7 et 10,3). Enfin, nous n'avons identifié aucune différence significative pour la formation comportementale en termes de nombre de patients perdus de vue dans les 12 mois (n = 94, 2 ECR, RR de 0,70, IC entre 0,4 et 1,1).
Nous avons inclus 25 ECR et n'avons identifié aucune preuve solide permettant de recommander un traitement psychosocial par rapport à un autre pour réduire la consommation de substances (ou améliorer l'état mental) chez les patients atteints de troubles mentaux graves. Of Mice And Men The Great Depression? En outre, certaines difficultés méthodologiques limitent le regroupement et l'interprétation des résultats ; les taux élevés de sortie d'étude, la fiabilité variable des interventions, les différentes mesures de résultats, environnements et échantillons utilisés, et le fait que les groupes témoins pourraient avoir reçu un niveau de traitement supérieur aux soins standard. D'autres études sont nécessaires afin de surmonter ces problèmes et d'améliorer la qualité des preuves dans ce domaine important. Psychosocial interventions for tattoo anesthetic people with both severe mental illness and Essay on Oedipus Rex by, substance misuse. Dual diagnosis is the anesthetic name often given to people who have a severe mental health problem and of mice and men depression, a drug and/or alcohol problem as well. While the number of tattoo anesthetic, people with these problems varies, in some urban areas it can be over Eradicate World, 50% of all those with mental health difficulties. Although individuals may feel they are self-medicating when using these substances, drugs and alcohol can have a detrimental effect on the symptoms of their illness, the anesthetic way their medication works and their interaction with the create a citation wider world. Tattoo? They can also make people more vulnerable to exceptionalism suicide, hepatitis, HIV and homelessness, and tattoo anesthetic, can cause them to Electrical and Conventional Cars Essay be aggressive or to tattoo anesthetic do something that moves them into create a citation the criminal justice system. People who have a substance abuse problem but no mental health problem can be helped by a variety of tattoo, interventions that look at their motivation for Electrical and Conventional Cars change (motivational interviewing - MI), how to tattoo adapt their behaviour by improving coping strategies (cognitive behavioural therapy - CBT), a supportive approach similar to the one used by Alcoholics Anonymous and on Oedipus, skills training.
These are all examples of tattoo, psychosocial interventions. However, using these interventions on people with mental health problems is more complex, because it is definition exceptionalism unclear whether the intervention for anesthetic the substance abuse should be offered with that for the mental health problem and definition, whether the tattoo anesthetic same team should be responsible for both (integrated intervention). This review attempts to assess all trials using psychosocial interventions compared to care as usual where they are used to create help those who have a substance abuse problem and a severe mental illness. Twenty-five studies were identified containing a total of 2478 people. They were all in tattoo the United States, Australia or the United Kingdom. Eradicate World Essay? Two were based in tattoo anesthetic a hospital, 19 in the community, two in to Abandon Sponsoring in American hospital and anesthetic, the community and Electrical Cars Essay, two in tattoo anesthetic the community and in jail. Reasons To Abandon Sports In American High Schools? They used different psychosocial interventions, with four trials using integrated models of care, four using non-integrated, three combining MI and tattoo anesthetic, CBT, four using CBT, five using MI and of mice and men the great depression, two using skills training. Trials lasted from three months to tattoo three years. No trial showed any definitive difference between the psychosocial intervention and Essay on Oedipus, the usual treatment, although the anesthetic difference in in the World Essay the study designs made it difficult to tattoo compare one trial to exceptionalism another. There are also problems caused by high dropout rates, differences in tattoo anesthetic the outcome measures and definition, dependability in anesthetic the way psychological interventions were used.
To allow more thorough assessment of whether psychosocial interventions work for Essay people with substance abuse problems and tattoo anesthetic, severe mental illnesses, more quality trials are needed which address these problems. (Plain language summary prepared for a citation this review by Janey Antoniou of tattoo, RETHINK, UK www.rethink.org) Interventions psychosociales chez les patients présentant à la fois un trouble mental sévère et un abus de substances. Interventions psychosociales chez les patients présentant à la fois un trouble mental sévère et un abus de substances. Double diagnostic est une expression souvent utilisée pour désigner les patients présentant à la fois un problème de santé mentale sévère et un problème de consommation de drogues/alcool. Le nombre de personnes affectées varie mais peut dépasser 50 % des patients atteints de problèmes de santé mentale dans certaines zones urbaines. Bien que les patients puissent avoir l'impression de recourir à l'automédication lorsqu'ils utilisent ces substances, les drogues et l'alcool peuvent avoir un effet dommageable sur les symptômes de leur maladie, l'efficacité de leurs médicaments et leur interaction avec le monde extérieur.Ces substances peuvent également rendre les patients plus vulnérables au suicide, à l'hépatite, au VIH et à la clochardisation et peuvent les rendre agressifs ou les pousser à commettre des actes relevant de la justice pénale. Les sujets présentant des problèmes d'abus de substances mais pas de problèmes de santé mentale peuvent être pris en charge au moyen de diverses interventions ciblant leur désir de changement (technique d'entrevue motivationnelle - TEM), la modification de leur comportement en améliorant leurs stratégies d'adaptation (thérapie cognitivo-comportementale - TCC), une approche de soutien similaire à celle utilisée par Alcooliques Anonymes et une formation comportementale.
Tous les exemples mentionnés sont des interventions psychosociales. Eradicate In The Third? Néanmoins, l'utilisation de ces interventions chez des patients atteints de problèmes de santé mentale est plus complexe car l'on ignore si l'intervention ciblant l'abus de substances devrait être proposée en même temps que celle ciblant les problèmes de santé mentale, et si les deux traitements devraient être pris en charge par la même équipe (intervention intégrée). L'objectif de cette revue est d'évaluer tous les essais utilisant des interventions psychosociales par rapport à des soins habituels pour aider les patients présentant des problèmes d'abus de substances et des troubles mentaux sévères. Tattoo Anesthetic? Vingt-cinq études portant sur un total de 2 478 patients ont été identifiées. Toutes avaient été menées aux États-Unis, en Australie ou au Royaume-Uni. Sophocles? Deux étaient menées en milieu hospitalier, 19 en milieu communautaire, deux en milieux hospitalier et communautaire, et deux en milieux communautaire et carcéral. Elles utilisaient différentes interventions psychosociales : quatre essais utilisaient des modèles de soins intégrés, quatre des modèles non intégrés, trois combinaient une TEM et une TCC, quatre utilisaient une TCC, cinq utilisaient une TEM et deux avaient recours à une formation comportementale.La durée des essais était comprise entre trois mois et trois ans. Aucun essai ne rapportait de différence notable entre l'intervention psychosociale et le traitement habituel, mais les différents plans d'étude utilisés rendaient les comparaisons difficiles.
Des taux élevés de sortie d’étude, des différences en termes de mesures de résultats utilisées et des problèmes de fiabilité concernant l'utilisation des interventions psychologiques étaient également observés. D'autres essais de qualité sont nécessaires afin d'aborder ces problèmes et de permettre une évaluation plus exhaustive de l'efficacité des interventions psychosociales chez les patients présentant des problèmes d'abus de substances et des troubles mentaux sévères. (Résumé simplifié préparé pour cette revue par Janey Antoniou de RETHINK, UK www.rethink.org). Notes de traduction. Traduit par: French Cochrane Centre 1st November, 2012.
Traduction financée par: Instituts de Recherche en Sant#xfffd; du Canada, Minist#xfffd;re de la Sant#xfffd; et des Services Sociaux du Qu#xfffd;bec, Fonds de recherche du Qu#xfffd;bec Sant#xfffd; et Institut National d'Excellence en Sant#xfffd; et en Services Sociaux. Copyright 2010 The Cochrane Collaboration. Tattoo? Published by John Wiley Sons, Ltd. Article first published online: 23 January 2008. Glenn E Hunt, Nandi Siegfried, Kirsten Morley, Thiagarajan Sitharthan, Michelle Cleary. Article first published online: 3 Oct 2013 | DOI: 10.1002/14651858.CD001088.pub3. Michelle Cleary, Glenn E Hunt, Sandra L Matheson, Nandi Siegfried, Garry Walter. Article first published online: 23 Jan 2008 | DOI: 10.1002/14651858.CD001088.pub2.
DP Jeffery, A Ley, S McLaren, N Siegfried. Article first published online: 24 Apr 2000 | DOI: 10.1002/14651858.CD001088. 1 Marie L. Electrical Cars? D. Anesthetic? Østergaard , Merete Nordentoft , Carsten Hjorthøj , Associations between substance use disorders and exceptionalism, suicide or suicide attempts in tattoo anesthetic people with mental illness: a Danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personal, Addiction , 2017 Wiley Online Library 2 Marina Dieterich , Claire B Irving , Hanna Bergman , Mariam A Khokhar , Bert Park , Max Marshall , Marina Dieterich , Cochrane Database of Eradicate Poverty in the Third World, Systematic Reviews, 2017 Wiley Online Library 3 Leon Sawh , David Smelson , Practical Strategies and Tools to tattoo Promote Treatment Engagement, 2017 , 133 CrossRef 4 Halima A. Essay On Oedipus? N. Ketwaru , Annette E. Anesthetic? Bonebakker , Arjen Neven , Geïntegreerd behandelen bij een dubbele diagnose, Verslaving , 2016 , 12 , 1, 33 CrossRef 5 Stephanie Dugdale , Jonathan Ward , Jan Hernen , Sarah Elison , Glyn Davies , Daniel Donkor , Using the Behavior Change Technique Taxonomy v1 to Electrical and Conventional Essay conceptualize the tattoo anesthetic clinical content of exceptionalism, Breaking Free Online: a computer-assisted therapy program for anesthetic substance use disorders, Substance Abuse Treatment, Prevention, and Policy , 2016 , 11 , 1 CrossRef 6 Wenyuan Yin , Lin Pang , Xiaobin Cao , Jennifer M. McGoogan , Michael Liu , Congbin Zhang , Zhijun Li , Jianhua Li , Keming Rou , Factors associated with depression and anxiety among patients attending community-based methadone maintenance treatment in China, Addiction , 2015 , 110 , 51 Wiley Online Library 7 Maarten Smeerdijk , René Keet , Lieuwe de Haan , Christine Barrowclough , Don Linszen , Gerard Schippers , Feasibility of Cars Essay, teaching motivational interviewing to parents of anesthetic, young adults with recent-onset schizophrenia and co-occurring cannabis use, Journal of Electrical and Conventional Cars Essay, Substance Abuse Treatment , 2014 , 46 , 3, 340 CrossRef 8 Da Li , Man C. M. Anesthetic? Tsui , G. Electrical And Conventional Cars? Yuan , G. Zhang , Hector W. Tattoo? H. Tsang , Measuring Perceived Rehabilitation Needs of a citation apa, People with Schizophrenia in Mainland China, Administration and Policy in tattoo anesthetic Mental Health and Essay Rex by, Mental Health Services Research , 2014 , 41 , 5, 636 CrossRef 9 Kevin Madigan , Daria Brennan , Elizabeth Lawlor , Niall Turner , Anthony Kinsella , John J. Tattoo Anesthetic? O'Connor , Vincent Russell , John L. Exceptionalism? Waddington , Eadbhard O'Callaghan , A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness, Schizophrenia Research , 2013 , 143 , 1, 138 CrossRef 10 Glenn E Hunt , Nandi Siegfried , Kirsten Morley , Thiagarajan Sitharthan , Michelle Cleary , Glenn E Hunt , Cochrane Database of anesthetic, Systematic Reviews, 2013 Wiley Online Library 11 Lorenzo Burti , Loretta Berti , Elena Bonfioli , Irene Fiorini , Improving Mental Health Care, 2013 , 114 CrossRef 12 Michelle Cleary , Nandi Siegfried , Debra Jackson , Glenn E. On Oedipus Sophocles? Hunt , Making a difference with research: Measuring the tattoo anesthetic impact of mental health research, International Journal of Eradicate Third World, Mental Health Nursing , 2013 , 22 , 2, 103 Wiley Online Library 13 Jaime Delgadillo , Stuart Gore , Dawn Jessop , Scott Payne , Paula Singleton , Simon Gilbody , Acceptability of anesthetic, mental health screening in routine addictions treatment, General Hospital Psychiatry , 2012 , 34 , 4, 415 CrossRef 14 Richard Edwards , Ruth Guy , Mark Bartholomew , Rosie Buckland , Reflecting on and men depression the delivery of a structured alcohol and drug group in a medium-secure forensic unit, Advances in anesthetic Dual Diagnosis , 2011 , 4 , 4, 180 CrossRef 15 Filippo Passetti , Colin Drummond , Substance Abuse Disorders, 2011 , 147 CrossRef 16 Alicia Picken , Nicholas Tarrier , Trauma and create a citation apa, comorbid posttraumatic stress disorder in individuals with schizophrenia and tattoo anesthetic, substance abuse, Comprehensive Psychiatry , 2011 , 52 , 5, 490 CrossRef 17 Jon D. And Conventional Cars? Kassel , Adrienne J. Anesthetic? Heinz , Daniel P. Evatt , Ashley R. Braun , Addictive Disorders in Medical Populations, 2010 , 541 CrossRef 18 Marina Dieterich , Claire B Irving , Bert Park , Max Marshall , Marina Dieterich , Cochrane Database of Systematic Reviews, 2010 Wiley Online Library 19 Cynthia L. Rowe , Multidimensional Family Therapy: Addressing Co-occurring Substance Abuse and Other Problems Among Adolescents with Comprehensive Family-based Treatment, Child and Reasons to Abandon Sports in American Schools Essay, Adolescent Psychiatric Clinics of tattoo, North America , 2010 , 19 , 3, 563 CrossRef 20 Fiona Lobbana , Christine Barrowclough , Sophie Jeffery , Sandra Bucci , Katherine Taylor , Sara Mallinson , Mike Fitzsimmons , Max Marshall , Understanding factors influencing substance use in definition exceptionalism people with recent onset psychosis: A qualitative study, Social Science Medicine , 2010 , 70 , 8, 1141 CrossRef. 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Two IELTS health essays – focus on the question. In this lesson I give you two different essays to read and download about health and tattoo the future. Why? They answer two different questions. The aim is to draw your attention to a very common mistake of writing generally about a topic and not answering the question itself. Different questions need different answers! Read the questions – read the IELTS health essays. Read through these two questions and and men the great then the two essays. Tattoo Anesthetic? Which one is which?
Can you match the essay to the question? Much of the language is the same and I use similar “ideas”. But you should see that in definition exceptionalism, each case I make sure my essay is structured to the question. Despite advances in medicine and improved access to anesthetic, healthcare, the overall level of health is falling in many countries. A Citation Apa? Why is this happening and what can be done to solve this problem? Despite advances in medicine there are concerns that certain diseases such as diabetes are increasing and some people believe future generations will face greater problems with health and die younger than we do today. What is your opinion?
It is undoubtedly the tattoo case that medical science has improved dramatically in Poverty World, recent years. Unfortunately, however, this has not always led to anesthetic, an improvement in standards of and Conventional, health because of tattoo anesthetic, modern diets. Part of the solution to this problem must be to Electrical Cars Essay, improve health education among the young. The principal reason why general standards of tattoo anesthetic, health are decreasing is because young people in particular are not eating healthily enough. Indeed, many experts have established that the current obesity epidemic among the young is directly related to the rise in diabetes, which is one of the on Oedipus Rex by Sophocles leading causes of ill-health nowadays. Most evidence suggests that the diet of many youngsters is largely composed of convenience and tattoo junk foods that contain extremely high levels of Electrical and Conventional Essay, sugar and harmful food additives. Anesthetic? This diet, which lacks essential forms of nutrition such as vitamins, is the create apa root of the problem and the cause of many health problems today. The most effective method of tattoo anesthetic, addressing this problem is almost certainly to provide better health education in schools.
The main reason for this is that young people need to be told at a young age what the long-term effects of a poor diet can be and the most effective forum for this is Electrical Cars Essay school. If, for example, a child has lessons on the need for a well-balanced diet in biology classes and does a research project on tattoo, what types of food provide the Essay on Oedipus Sophocles best nutrition, then they will almost certainly learn healthy eating habits which will protect them later in life. This is anesthetic a case where prevention is stronger than cure. My conclusion is that while falling standards of general health caused by poor diets is a concern, the problem can solved if we prevent it at source by providing appropriate health education. There is no question that medicine has progressed dramatically over the last century, but this does not mean that all our medical problems have been solved. A Citation? Indeed, my belief is that the average life span in the Western world may actually fall in anesthetic, the 21st century. This is in contrast to Third World Essay, the situation in developing countries where I expect health provision to improve and longevity to increase. The main reason why overall health may become worse in tattoo anesthetic, the industrialised nations of the West relates to modern lifestyles there. This is partly because we now take less exercise than ever than before and our diet is much less healthy and create a citation there is tattoo anesthetic already evidence that this has led to an obesity epidemic in many countries.
Many experts are predicting that this is going to Cars Essay, have a serious impact on their health in old age. So, for tattoo anesthetic example, a child of today who grows up a diet on convenience food, rich in sugar and Reasons Sponsoring Sports in American High Schools full of additives, and who does take regular exercise may only live to be 65, whereas current life expectancy is around 80. The situation in the developing world is, however, quite different and overall health is likely to improve. This is tattoo anesthetic because there are currently serious problems with access to healthcare and the quality of healthcare in these countries. For instance, in some places there is and Conventional Cars Essay no local hospital or the local hospital lacks the appropriate treatment for preventable diseases such as cholera. That is likely to tattoo, change in the future as the overall economy and create a citation infrastructure improves in these countries. My conclusion is tattoo therefore a mixed one. While it is on Oedipus Sophocles true that people may face greater problems with their health in the future, this only applies to industrialised nations and not to the developing world where life expectancy may increase. The first essay was question 1 and the second question 2. I hope you got that right. Here is tattoo how you can learn to answer the Eradicate Third question in your essays:
think carefully about the question – don’t just focus on the topic, look for tattoo anesthetic the task – the bit of the question that tells you what to write. To Abandon Sports High? Do you need an opinion? Do you have to agree? Do you have to find a solution? Nearly all the time the words are quite clear, you just have to look for them. structure the essay according to the question – think about how you are going to use your two body paragraphs. Are they going to say the same thing in two different ways (I agree because x and I agree because y) or are they going to make different points (this is the problem and this is the solution) focus on question and outline the point of view/opinion in the introduction provide an answer to the question in tattoo, the conclusion. Concentrate on the question when you structure your essay – think body paragraphs. Ask yourself what the question is asking you to do and how you will structure your answer – in particular how are you going to use your two main body paragraphs.You really, really don’t need to learn different models of essay.
Much easier I believe just to read the question and deicide how you are going to use each paragraph. The first question asks me to explain why a problem is happening (why health is getting worse) and what I think the solution is. Reasons Sponsoring Sports High Essay? This means my answer must contain an explanation of the tattoo anesthetic problem and a solution. For me, the logical way to definition exceptionalism, organise this essay is to use one body paragraph for the explanation and the other for the solution. Para 1 – this is why the problem is anesthetic happening. Para 2 – this is how we can solve it. The second question asks me for my opinion about what will happen in the future.
Will people be more healthy and will they live longer? There are perhaps more ways of answering this question. Of Mice The Great Depression? The main idea though is the same in each case – you need to find a logical way of using your two body paragraphs. The main possibilities are: para 1 – I think it is true for this reason. Para 2 – I think it is true for another reason. or the BB essay.
Para 1 – I don’t think it is true for this reason. Para 2 – I don’t think it is true for another reason. or the AB essay. Para 1 – I think it is true up to tattoo anesthetic, a point/sometimes. Para 2 – I think that it is not true some other times. Get the introduction and definition conclusion right.
When you are writing you want to focus on tattoo anesthetic, the question in Sponsoring Sports High Schools Essay, both your introduction and conclusion. You don’t want to anesthetic, waste too much time writing introductions. But you still need to write them carefully. In your introduction you need to Sports in American High Schools Essay, identify the question and show show the examiner your “point of view” or how you are going to answer the question. The conclusion works in the same way. This is where you give your final answer to the question. To do that you need to identify the question and write a clear answer to the question in your conclusion . Now download the complete IELTS health essays. I hope you will see now that the two questions are quite different and tattoo need different answers. If you read through my two essays again, you will see that while the ideas and language are similar, the structure and introduction and create conclusion are quite different. A useful exercise is of course try to write the essays yourself.
The main reason I post these essays in lesson form is to help you write for yourself. This time around, why not write both essays? To see how it can be done, take a look at Zara’s essay added as a comment to this lesson on essay structure. I just can’t promise to comment on it! Get more help with IELTS preparation on the main pages of tattoo anesthetic, my site. Keep up with me on Facebook - all the updates and even more advice there. Or just get all my free lessons by email. 8 Responses to Two IELTS health essays – focus on the question.
Here’s my response to Question 1. Please provide your valuable feedback. Over the past few years, people are increasingly faced with health related problems irrespective of the advancements in the medical field. In my opinion, a great number of these complications are associated with the Reasons to Abandon Sponsoring Schools unhealthy life style. Health of the public can only tattoo anesthetic, be improved if they are educated about healthy ways of exceptionalism, living and safe eating. The most significant reason why there is tattoo a decline in Electrical Cars, health standards of many nations is that majority of people have adopted an unhealthy approach to life. This harmful attitude accounts for bad choices in food like processed foods or eating out at fast food restaurants. As a result increased consumption of food, which consists of high glycaemic index, makes people lazy and tattoo anesthetic prohibits them from taking regular exercise. This diet accompanied with lack of physical activity is the Sponsoring in American Schools Essay root cause of increasing health problems among the present generation.
This situation can be improved if an awareness is created among public especially youngsters about making healthy choices in life. In order to educate young people about nutritious and anesthetic natural foods, schools should teach subjects relating to diet and nutrition. This fundamental knowledge about the long-term effects of meal intake would make youngsters cognisant of their choices and a citation encourage them to opt for the natural ingredients instead of processed or packaged meals. In addition, schools should make health and physical education compulsory for all students so that they participate in games and activities. It will allow them to keep fit and thus avoid diseases resulting from physical inactivity. In conclusion, people’s inclination towards inadequate style of tattoo, living is causing serious concerns for health. However, this issue can be effectively handled if public especially younger generation is empowered by providing adequate health education. Another good essay. Well-structured and coherent. A couple of quick notes. You seem quite fond of Essay on Oedipus Rex by Sophocles, “show-off” words.
This can be a dangerous habit. The more complex the word, the more likely it is to go wrong – unusual words are unusual for a reason – we don’t use them that much or we use them in only specific circumstances. That is the point behind my series on the AWL – those are the words we actually do use. Here “advancements” doesn’t exist and “cognisant” is a very unusual choice. i’d go for tattoo anesthetic “aware” – even though you have used “awareness” slightly earlier. The other point is that you have a slight problem with articles – who doesn’t! They are one of the Essay on Oedipus Rex by peskiest bits of English grammar that trip up even very level people like you. Read your first para again, can you see any mistakes? If you can, that tells me you aren’t checking in the right way. You need an error check list where you check for certain types of anesthetic, mistakes.
What is on that checklist will vary from person to person, but I’d suggest that articles is one bit of grammar that should be on everyone’s list. Sorry for the late response, the time difference between Manchester and Melbourne is huge. I think i mentioned earlier that articles is a major area i need to improve. Can you suggest me any good website or any other source which could be used to Essay on Oedipus Rex by, work on this area? Yes i think i’ve a bad habit of trying to write unnecessarily complex words. Thanks for pointing out and I am working on this and pushing myself to write simpler as per your instructions. In the first paragraph, i think ‘the’ is not required with ‘advancement’ and ‘unhealthy lifestyle’. Do you think that starting the second body paragraph with a phrase like ‘this situation’ is acceptable or should it be changed with some other simple sentence like ‘Overall level of health can only be improved if …’?
Is there any harm in using the phrase from the essay topic at tattoo any stage? Can i download this lesson.? Could you kindly provide me with your feed back on my reply for question 2? The tremendous progress in apa, the medical field, within the recent three decades is tattoo anesthetic undeniable, but on the contrary, it is still seems that overall health level is declining, and the average life length is decreasing. While I agree on the first point, I still believe that the second one is unpredictable to some extent.
Primarily todays’ lifestyle in regards to long working hours, and increasing numbers of working mothers, in Reasons to Abandon High Essay, addition to, the enormous dependency on fast and preserved food; which will obviously increase the health problems, and even create new types of them. For example, the average child those days spend most of tattoo anesthetic, his free times playing electronic games, and Essay on Oedipus Sophocles consuming fatty food, which is usually working mothers rely on; not mentioning the tattoo huge amounts of sugary products including candies, chips and canned drinks. The probability of this child having obesity problem is high, in addition to, the risk of getting high blood pressure or debate on Rex by, the future. On the other hand, science is becoming more advance than ever, and most governments do not hesitate to allocate a decent portion of their budgets on the medical field. For instance, the United States is tattoo anesthetic dedicating fair amounts of its health budget on fighting diseases like: cancer, Aids, diabetes, and even obesity ; and the agenda are in continues increase. This leads to Reasons to Abandon Sports High Schools Essay, remarkable advance in the health sector in tattoo, general, and on extending human’s life span in particular. To conclude, it can be said that although the remarkable decline on the health quality, there is still hope that some solution could be found to maintain or even prolong the Eradicate Poverty in the Third average age of future generation.
Could you post this in the forum please. Then there is tattoo anesthetic a goodish chance that someone would look at it. In your 2ed essay, you wrote ” than ever than before” and “grows up a diet”. Is it right to say ” than ever before” and “grows up with a diet”?
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Essay: Evaluating compliance to Surviving Sepsis Campaign (SSC) resuscitation bundles in tattoo, hospitals across the UK and Electrical and Conventional Essay implications for nursing practice: An Extended Literature Review. This literature review aims to anesthetic, evaluate hospitals’, and more particularly nurses’ capacity to comply with Surviving Sepsis Campaign (SSC) sepsis resuscitation bundles across the UK, as SSC guidelines have proven to increase sepsis survival rates when implemented properly. Using LibrarySearch, a methodical review of the existing literature was performed. A variety of health related databases and journals were searched and Boolean logic was applied to specific search terms (Lobiondo-Wood and Haber, 2014). Eight relevant articles were then appraised for quality and Eradicate Poverty in the World Essay the findings discussed. Tattoo! A lack of resources such as equipment and supplies, lack of appropriate referrals due to the great, poor SSC education of tattoo anesthetic medical and Reasons to Abandon Sponsoring Sports in American Schools Essay nursing staff, and anesthetic the inconsistent use of SSC guidelines are all associated to with generally poor compliance with SSC sepsis resuscitation bundles in the UK.
Overall, the of mice and men the great, extent of hospitals’ compliance to anesthetic, SSC sepsis resuscitation bundles depends on the availability of the resources and equipment, education of exceptionalism medical and nursing staff, and consistent use of the SSC guidelines. Importantly, eight articles evidence that SSC awareness by medical and nursing staff plays a vital role in overall compliance. Chapter 1: Introduction. Hart (1998, p. 26) defines a literature review as a summary and ‘critical analysis of relevant available’ studies related to tattoo anesthetic, the chosen topic being reviewed. A literature review can aid in improving nursing practice in particular, by identifying themes and causation around a given issue in the field of nursing (Moule and Goodman, 2014). And Conventional! Hence, it is critical to anesthetic, gather evidence-based information through a literature review of the and Conventional Cars, latest available research to help improve one’s practice and anesthetic make decisions that is based on the best available evidence (Aveyard, 2014). Florence Nightingale (1860) emphasised that nurses are knowledgeable when it comes to patients’ care.
Therefore, in the nursing profession there is no way to stop learning, but instead there are ways to update what has been learned from the past according to present conditions, and to gain new insights in order to provide the best available evidence-based practice to patients’ care (NMC, 2010; CRD, 2007). Moreover, it is the responsibility of a nurse to learn new information concerning his or her patients and the environment he or she directly works in, in order to be prepared for a citation, new challenges and changes in delivering evidence-based nursing care to patients (Spencer, 2011). The next chapter will briefly discuss the background and anesthetic rationale of the focus question of this literature review, which is: ‘To what extent can hospitals in the UK comply with SSC resuscitation bundles, and what are the Electrical Cars Essay, implications for nursing practice’? The following chapter will outline the methodology of research, including how relevant literature was searched, tabulated, and anesthetic analysed, and how the three themes emerged from the chosen articles (Parahoo, 2006). This is followed by the discussion and analysis of themes that arose from the chosen articles, and the implications and recommendations for nursing practice.
Lastly, conclusions drawn from the chosen articles reviewed will be made. Chapter 2: Background and Rationale. 2.1 What is Sepsis? Sepsis is the reaction of the body to an infection, meaning that the ‘body attacks its own organs and tissues’ as defined by UK Sepsis Trust Organisation (2014). Sepsis was previously known as septicaemia or blood poisoning (Bone, 1991). It starts from an uncomplicated infection that develops into severe sepsis, wherein the infection becomes associated with organ dysfunction and leads to an increased risk of death (Mackenzie and Lever, 2007). According to the UK Sepsis Trust Organization (2014), sepsis can quickly lead to shock, multi-organ dysfunction and Essay on Oedipus Sophocles eventually results in death if the sepsis is not detected immediately and not treated promptly.
Sepsis is one of the primary reasons of death worldwide. This is tattoo anesthetic, why Surviving Sepsis Campaign guidelines have been introduced worldwide. 2.2 Surviving Sepsis Campaign (SSC) sepsis resuscitation bundles. In 2004, Dellinger et al. launched Surviving Sepsis Campaign (SSC) international guidelines in Poverty Third World Essay, the United States for the management of severe sepsis as an effort to reduce the mortality rate associated with sepsis (Dellinger et al., 2004a). It encompasses the creation of evidence-based guidelines sponsored and anesthetic endorsed by 11 international organisations. Electrical And Conventional Cars! It was revised in 2008 and the latest revision was in 2013. Subsequently, numerous research studies worldwide had proven its success in reducing mortality rates. The SSC guidelines are composed of 3-hour, 6-hour, and 24-hour resuscitation bundles for managing severe sepsis and tattoo anesthetic septic shock (Dellinger et al., 2013c), which need to be delivered within a certain timeframe immediately following the to Abandon Sports in American High Essay, identification of sepsis symptoms.
These bundles are a group of three or more elements of care specifically related to the disease, that when implemented together will improve patient outcomes (Surviving Sepsis Organization, 2014b; Institute for Healthcare Improvement, 2014; Dellinger et al., 2013c; Daniels et al., 2011). 2.3 SSC guidelines and United Kingdom. In 2005, the United Kingdom launched the SSC guidelines in an attempt to reduce the tattoo anesthetic, sepsis mortality rate in Essay Rex by Sophocles, the UK (Bray and Murphy, 2006). The National Institute for Health and tattoo anesthetic Clinical Excellence (NICE) (2007) recommended to carry out a set of observations or vital signs systematically using the Early Warning Score (EWS) and the SSC resuscitation bundles (Dellinger et al., 2013c) for management of severe sepsis and septic shock. These are currently recommended on a national scale to address the Essay Rex by Sophocles, issue. However, despite of the anesthetic, introduction of the campaign a decade ago, the mortality rate in UK remains unacceptably high, ‘There are 102,000 cases of sepsis arise annually, 36,800 deaths every year as a result of severe sepsis’ (Daniels et al., 2011, p. 508). ‘Putting this into perspective, lung cancer (the biggest killer after cardiovascular disease) claims just fewer than 35,000 lives per year, bowel cancer 15,000 and breast cancer 9,000? (Richards, 2013, p. Create Apa! 3).
Hence, it is tattoo anesthetic, important to identify the limitations to compliance and determine how medical and nursing staff can best help patients survive sepsis (NPSA, 2007). In any hospital setting, there are different patients with many different kinds of illnesses, and nurses play a vital role in Eradicate Poverty in the Third, ensuring that patients receive the best and most appropriate possible care, thus preventing patients’ deterioration (Aitken et al., 2011). Moreover, rapid diagnosis and treatment saves lives when done as quickly as possible (Parliamentary and Health Service Ombudsman, 2013). Thus, the aim of this literature review is to evaluate hospitals’ compliance to SSC sepsis resuscitation bundles across the UK as well as to identify the role of the nurse in tattoo anesthetic, helping to improve overall SSC compliance (Surviving Sepsis Organization, 2014a). The following focus question was formulated to address the abovementioned concerns and to guide the literature search of definition this review: ‘To what extent can hospitals in tattoo anesthetic, the UK comply with SSC resuscitation bundles, and what are the implications for nursing practice’? The next chapter will discuss in further detail the methodology used for conducting research in and men depression, order to address the most appropriately respond to this question.
Chapter 3: Methodology. This chapter will discuss the selection criteria, search strategy, and the search outcome of the literature search. How and why the tattoo anesthetic, articles were chosen to definition, be included in this literature review will be explained. 3.1 Selection Criteria. The inclusion and exclusion criteria were determined using the Population, Intervention, Comparison or Comparator and Outcome (PICO) tool. The PICO acronym is anesthetic, used to articulate the research question and structure the search strategy (CRD, 2007; Higgins and Green, 2008; Whitlock et al., 2010). Studies evaluating compliance to create apa, the Surviving Sepsis Campaign (SSC) sepsis resuscitation bundles across hospitals in the United Kingdom (UK) were considered. Tattoo Anesthetic! Hospital settings allow for a wider sample in evaluating nursing and medical staff’s adherence to definition, the guidelines of the SSC rather than in specialist clinics or GPs settings. Articles focusing on adult hospital settings across the United Kingdom, and written in the English language were included. Studies evaluating the use of sepsis resuscitation bundles in paediatric and maternity settings were excluded, as these are less relevant to the adult field of nursing, and paediatrics and maternity wards require different interventions for the treatment of sepsis recommended by the SSC. Many studies started within different timeframes in different places when the SSC guidelines had been introduced worldwide; hence, studies outside United Kingdom were excluded.
The literature review focuses solely on the UK, since it is easier to recognise the limitations of the sepsis care bundles when evaluating sample populations in one country rather than across many countries. Studies assessing the compliance to the Surviving Sepsis Campaign guidelines (Dellinger et al., 2013c) comprising severe sepsis, septic shock resuscitation care bundles and tattoo anesthetic early goal directed therapy (EGDT) were included, as these are elements of the Reasons to Abandon Sports in American Schools Essay, established bundles and interventions used to manage patients with severe sepsis and septic shock in the UK (Surviving Sepsis Organization, 2014b). Studies assessing severe sepsis and septic shock cases without using the recommendation of SSC guidelines were excluded, as this paper aims to identify issues and determine possible reasons as to why and tattoo how non-compliance is occurring despite the proven effectiveness of sepsis resuscitation bundles under the Surviving Sepsis Campaign (Daniels et al., 2011). As the United Kingdom launched its Surviving Sepsis Campaign in 2005 (Bray and Essay on Oedipus Rex by Murphy, 2006), only studies assessing compliance to the SSC guidelines to tattoo, address severe sepsis and septic shock in the UK from 2005 onward were included in this literature review. Studies evaluating the of mice the great depression, relationships between awareness, resources, and compliance to the SSC sepsis resuscitation bundles, as well as correlative evidence of decreasing mortality rates associated with compliance in sepsis were included. 3.1.4 Study Design. Due to the nature of the focus question, which is to evaluate the tattoo anesthetic, compliance to the SSC sepsis resuscitation bundles, quantitative studies were included that include prospective observational studies, retrospective cohort studies, questionnaires, and surveys. The focus of this paper is across the United Kingdom in order to establish general determining factors regarding the limitations, barriers, and solutions for successful implementation of SSC sepsis resuscitation bundles (Surviving Sepsis Organization, 2014a). Case reports and case series were excluded because they tend to focus on one case study, which is more likely to be very specific and less widely applicable than evidence across a more random sample population (Jolley, 2013).
The SSC guidelines were published in 2004, hence, publication dates from the years 2004 to December 2014 were included, and dates before 2004 and beyond 2014 were excluded from this literature search. In terms of hospital studies in the UK, only articles published between 2005 and 2014 were included, since the SSC guidelines were launched in the UK in Electrical and Conventional Essay, 2005. 3.2 Search Strategy. After establishing the focus question this paper aims to answer, the first step was to identify the necessary databases for accessing a wide range of data sources in the Internet (Younger, 2004). University librarians’ assistance was sought to access different e-journals. Upon learning the ways to access databases, the researcher used a range of databases from the tattoo anesthetic, LibrarySearch engine. LibrarySearch is the University’s search and retrieval tool designed to search for databases and Essay e-journals. This search was performed to reduce bias of the anesthetic, review, and to retrieve articles containing the search terms used. Minimising bias was endeavored by using many appropriate databases to broaden the Eradicate Poverty in the Third World, selection criteria (Newell and Burnard, 2006).
A worldwide search was not included, as only the population of the anesthetic, United Kingdom was relevant to the research question and only articles written or translated in Electrical and Conventional, English were considered for review in the study. However, this risk bias, resources for translating articles are not accessible (Khan et al., 2003). Jolley (2013) explains how accessing a wide-range databases aids in acquiring the best and most current research articles. The chosen databases used in this literature search are the British Nursing Index, Internurse, Medline (Ovid), Pubmed, SAGE journals, and Wiley Online Library. Anesthetic! The British Nursing Index was chosen because this database covers all aspects of nursing from 1994 to to Abandon High Essay, present, which meets the anesthetic, inclusion criteria for articles from 2004 to 2014. Internurse database was chosen, as it is the UK’s largest collection of nursing journals. Furthermore, as the to Abandon in American, UK is home of the British Journal of Nursing, the journal was used for its main focus on research conducted in UK.
The Medline and Pubmed databases were included, as these two cover academic journals from medical, nursing and health care publications. Wiley online library was used since it provides over 4 million articles from across different countries that include the United Kingdom. Anesthetic! Lastly, the SAGE online journal database was included, as it is the world’s independent academic and professional publisher of over 560 journals (SAGE Publications, 2014). After selecting databases, the next step was to decide which search terms were to be used in accessing literature that would provide the most appropriate evidence for the research question. The following are the search terms that were used: UK, surviving sepsis campaign, compliance, severe sepsis, nurses, impact, and Electrical Cars Essay implementation. To increase the search sensitivity, Boolean logic was applied using the tattoo, words ‘AND,’ ‘OR’ and ‘NOT’ (Khan et al., 2003). 3.3 Search Outcome. This section will describe which databases successfully produced relevant results based on the search terms and selection criteria. A Citation Apa! It will further illustrate the number of articles retrieved, and of the tattoo anesthetic, articles retrieved, which were identified as the most relevant to the focus question.
This literature search took place between October and December 2014. Using the Search Scope in LibrarySearch engine, six databases were selected to gather articles by applying various search terms relevant to the focus question of this paper. Definition Exceptionalism! University journal archives and online access privileges, such as subscribing for a free 14-day trial were also used to obtain relevant literature. Initially, the first group search terms used were ‘Surviving Sepsis Campaign,’ ‘compliance’ ‘AND’, ‘impact,’ and ‘UK’. From these search terms, 694 items resulted, with different material types, any year, and any language type (Figure 1). This was then narrowed down from tattoo, 694 to 3 items by applying the selection criteria wherein the Essay Rex by Sophocles, publication date range of the retrievable articles was limited to anesthetic, filter inclusion of only literature relevant for the review, given that Surviving Sepsis Campaign guidelines were first published in 2004. Therefore, only articles published between 1st January 2004 and 31st December 2014 were considered in order to Essay on Oedipus Rex by Sophocles, filter the tattoo anesthetic, most current available evidence. Moreover, English language type, and articles as the Essay, material type were chosen (Figure 2). The next group of tattoo anesthetic search terms used were ‘Surviving Sepsis Campaign,’ ‘AND’, ‘nurses’ and Rex by ‘UK.’ From these search terms, 4 articles were chosen as the tattoo, most relevant to the focus question. Furthermore, from these 4 articles retrieved using the selection criteria as shown in Figure 3, these were narrowed down from 4 to Cars Essay, 1 article, as the other 3 were not research articles. ‘Severe sepsis,’ ‘guidelines,’ ‘AND’, ‘nurses’ and ‘UK’ were the tattoo anesthetic, third group of search terms used in create a citation apa, the LibrarySearch engine that resulted in 69 articles (Table 4).
To filter results to match the most relevant criteria of the focus question of this review, the subject was refined to ‘Great Britain,’ hence the search was narrowed down from 69 to 2 articles (Table 5). Finally, the following search terms: ‘Surviving Sepsis Campaign,’ ‘AND’, and ‘UK’ were used to find further literature, which resulted in 1,295 items (Figure 6). A collection of journals ‘ namely: Intensive Critical Care Journal, Journal of Clinical Nursing, and Nursing Critical Care Journal ‘ were chosen to narrow down the anesthetic, search from 1,295 to 6 articles (Figure 7). In total, 12 articles were retrieved utilizing the search terms relevant to the focus question. These were then evaluated for relevant titles and abstracts. A Citation Apa! Two of the articles retrieved had no full text access and the other two articles were duplicated using different search terms (Khan et al., 2003). The eight articles were tabulated that met the selection criteria. The reviewer found that seven articles have used additional and often overlapping sepsis research studies as references.
For example, 6 articles referenced Gao et al. (2005), 1 referenced Simmond et al. (2007), and 1 referenced Robson et al. (2007) which were also helpful in tattoo anesthetic, determining the academic legitimacy and relevance of the articles (Polit and Beck, 2006; Whittaker and Williamson, 2011). In order to minimise bias, Glasziou et al. Reasons Sports High! (2001) suggest having a second reviewer, however this was not feasible in this literature review. Finally, quantitative research was included as it relates to the focus question of the review, which is to evaluate the compliance to the SSC sepsis resuscitation bundles as recommended by Dellinger et al. (2013c). Evaluation is primarily conducted with the use of quantitative targets and measurements (Coughlan, Cronin and Ryan, 2007). Ultimately, eight articles were included in this literature review. These eight articles are primary articles, published in United Kingdom between 2005 and 2011.
All of these studies concern hospitals’ implementation and compliance to the ‘sepsis resuscitation bundles adapted from the Surviving Sepsis Campaign’ (Dellinger et al., 2013c; Surviving Sepsis Organization, 2014a; Surviving Sepsis Organization, 2014b), particularly for anesthetic, adult patients identified as having sepsis in the UK. 3.4 Critical Appraisal Skills Programme (CASP) and Hierarchy of Evidence. Reviewing research is a ‘mechanism used to provide feedback for improvement’ as noted by Polit and Beck (2006). After articles were selected, a CASP framework was chosen to critically appraise each article according to its validity, credibility, and implication to to Abandon Sports in American, practice by following the Case-control and Cohort Studies Appraisal Checklists (CASP, 2013). This helped the reviewer to scrutinise the tattoo, individual work and to create apa, underline the strengths and weaknesses of each article in order to tattoo anesthetic, identify the best examples of evidence-based practice (Coughlan, Cronin and Ryan, 2007). The Canadian Task Force on Periodic Health Examination in late 1979 was the first to disseminate the Electrical Cars, Hierarchy of Evidence, until which point different, hierarchies had been established and used (The Canadian Task Force on anesthetic, the Periodic Health Examination, 1979; Evans, 2003). Hierarchy of Evidence is of mice depression, a tool used in determining the effectiveness, appropriateness, and feasibility of evidence (Evans, 2003). It additionally identifies evidence in order to rank the tattoo anesthetic, articles according to the research method most relevant to the focus question. Of the eight articles, five articles employ cohort studies and the other three articles use case-controlled studies.
All of the articles chosen were published in the United Kingdom and are peer-reviewed. The Systematic Review is the highest level of definition hierarchy, followed by anesthetic the Random Controlled Trial (RCT) as the second level of evidence. All of the articles collected within this study are ranked level three according to the Hierarchy of Evidence because the methods used are Cohort Studies and Case-controlled Studies. 3.5 Themes for analysis. The next step after determining the appropriate literature for this review was an analysis of the literature. Of Mice And Men Depression! Upon undertaking the analysis, three themes have been identified: equipment and supply limitations, a lack of appropriate referrals due to poor education of tattoo anesthetic medical staff and nurses on SSC sepsis resuscitation bundles, and the inconsistent use of Essay Rex by SSC sepsis resuscitation bundles from anesthetic, hospital to hospital. The following chapter critically discusses the three themes that emerged from the literature analysis of the eight selected articles, as well as the implications for the field of nursing as related to the SSC. Chapter 4: Literature Analysis. This literature analysis will critically consider the eight articles in order to judge the exceptionalism, strengths, weaknesses, and anesthetic the significance of each study (Burns and Grove, 2009) in addressing the research question: ‘To what extent can hospitals in the UK comply with SSC resuscitation bundles, and what are the implications for nursing practice’? The first theme that emerged from the literature analysis will be examined below.
4.1 Resource limitations. Compliance with the SSC sepsis resuscitation bundles requires that serum lactate be obtained and Essay on Oedipus Rex by Sophocles that this is measured using an tattoo Arterial Blood Gas (ABG) machine (Dellinger et al., 2013c). Of Mice The Great Depression! Other requirements include the use of an ultrasound scan for Central Venous Pressure (CVP) insertion; blood cultures to be sent to tattoo, Pathology before starting antibiotics; crystalloid or colloid intravenous fluid challenge, and resuscitative medicines such as steroids, vasopressors and inotropic therapy (Dellinger et al., 2013c). However, five of the articles reviewed evidence that this necessary equipment is on Oedipus Rex by, lacking in a number of hospitals in the UK. 4.1.1 Equipment and medication. Three of the research articles specify that in some cases there has been lack of necessary resources that are used to meet compliance to the SSC sepsis resuscitation bundles. This not only anesthetic limits the ability of depression medical and nursing staff to manage sepsis, but it also limits the reviewer’s ability to anesthetic, evaluate compliance with the SSC sepsis resuscitation bundles. Gao et al.’s (2005) study aligns with previous studies that demonstrate how compliance with evidence-based SSC sepsis resuscitation bundles significantly reduces mortality. The study comprises ‘101 consecutive adult patients with severe sepsis and septic shock on and men the great, medical or surgical wards, or in tattoo, accident and emergency areas at two acute National Health Service (NHS) Trust Teaching hospitals in England’ (Gao et al., 2005, p. R764). The findings evidence poor ward care in Essay Rex by Sophocles, critically ill patients, evidencing that eight percent of patients had no oxygen administrated, fourteen percent had no IV access, and fourteen percent of patients ‘had no observation monitoring of blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, urine output, or conscious level’ (Gao et al., 2005, p. R766). Since the aim of Gao et al.’s (2005) study is to tattoo, assess the relationship between compliance with SSC guidelines and a decreased sepsis mortality rate, reasons for non-compliance are beyond the Reasons Sports Essay, scope of this study.
However, the authors importantly note that the hospital’s resource limitation led to tattoo, a deviation from the SSC sepsis resuscitation bundle ‘in the short term’ (Gao et al., 2005, p. R764). This includes limited ‘ultrasound-guided access, training and staffing that prevented the safe and early placement of central venous catheters outside the of mice and men the great, critical care environment’ (Gao et al., 2005, p. R766). The ultrasound-guided access is anesthetic, essential to insert the CVP, therefore even if the staff has the knowledge to create a citation, comply with SSC guidelines, with limited resources available, compliance is not possible. In hospitals such as these two NHS Trust Teaching hospitals, resource limitations forced the staff to tattoo, deviate from ‘the benchmark for persistent hypotension despite fluid resuscitation, adapting a target haemoglobin of Electrical and Conventional Cars Essay 7 to 9 g/dl and/or vasopressors but exluding the requirement to tattoo anesthetic, achieve a target of 8mmHg and ScVO2 of’ 70% central venous pressure’ (Gao et al., 2005, p. R768). Similarly, McNeill, Dixon and Jenkins’ (2008) study highlights the issue of on Oedipus Sophocles resource limitations. McNeill, Dixon and tattoo Jenkins, (2008) investigates the implementation of the 6-hour resuscitation care bundle as advocated by Dellinger et al. (2004) in 265 Acute Medicine Units (AMUs) in the United Kingdom. The research methodology is Eradicate in the Third, a questionnaire with 10 questions about the delivery of the 6-hour SSC sepsis resuscitation bundle, sent to anesthetic, each of the participating AMUs.
The data was collected and a citation apa tabulated per percentage by region. Tattoo! Thirty-five percent of the 162 respondents claimed to have implemented the 6-hour sepsis resuscitation bundle in their own hospital, although seventy-one percent had access to create apa, outreach teams, and only forty percent had enhanced care beds. Anesthetic! Moreover, ‘the minimum facilities to comply with the create a citation, 6-hour resuscitation bundle were the tattoo anesthetic, availability of exceptionalism enhanced care beds, ability to anesthetic, measure arterial blood gas lactate, measure CVP and to Reasons Schools, administer inotropes’ (McNeill, Dixon and Jenkins, 2008, p. 164). These minimum facilities varied in different regions in UK. The findings of McNeill, Dixon and Jenkins’, (2008) study identified that only six hospitals had successfully implemented the complete sepsis resuscitation bundle and tattoo anesthetic that thirty-five percent AMUs claimed to have implemented the SSC guidelines despite eighty-eight percent of AMUs lacking the definition exceptionalism, minimum facilities to comply. Tattoo! Although resource availability is not the main focus of either of the abovementioned studies, this emphasis on limitations indicates that the extent to which a hospital can comply with the SSC sepsis resuscitation bundles depends largely on the resources available. McNeill, Dixon and Jenkins, (2008) results indicate that in contrast to exceptionalism, the evidence of resources limitations presented by Gao et al.’s (2005) study, it is apparently possible to comply even when there is a lack of resources. Tattoo Anesthetic! However, the of mice and men depression, respondents’ claims based on anesthetic, the questionnaire alone are unverifiable, as the results were based on participant’s subjective responses. McNeill, Dixon and Jenkins (2008) have no way of proving that the depression, participants responses are honest, although they do suggest that clinical audits to be conducted for future studies. Nevertheless, McNeill, Dixon and Jenkins’ (2008) study identifies the importance of the facilities needed to effectively deliver the 6-hour sepsis resuscitation bundle across AMUs in tattoo anesthetic, UK, and finds that resources are lacking overall.
This includes sixty percent with no access to enhanced care beds, and only twelve percent of AMUs having the minimum facilities available to fully comply with SSC guidelines. Baldwin et al.’s (2007) audit in Kent determines compliance with the 6-hour sepsis resuscitation bundle according to appropriate referrals between nurses and relevant medical staff. It finds that even where communication was adequate between nurses and doctors, ‘there were instances when the Rex by, appropriate antibiotics was out of stock in A#038;E’ (Baldwin et al., 2007, p. 255) particularly with a shortage of the antibiotic Tazocin. It is evident therefore, that compliance with the SSC guidelines not only requires that one follow all of the elements of the sepsis resuscitation bundle, but also that nursing staff monitor and communicate the need for essential medicine supplies more frequently. 4.1.2 Financial resources. Another significant resource limitation relating to SSC compliance is the financial capacity of a given hospital. Gao et al. (2005, p. R765) state that ‘severe sepsis is expensive, such as in USA average cost per is $22,100’. Anesthetic! Even ‘in an age of Third World financial austerity,’ Page et al. (2011, p. Tattoo Anesthetic! 314) suggest on one hand, that a sticker and poster program could provide an affordable means of ensuring universal SSC compliance. And Men The Great! Robson, Beavis and Spittle (2007) on the other hand, suggest that there should be funds for nurse education and training as solutions to ensure compliance.
Regardless of which authors are more justified in their claims, both suggestions are made in reaction to tattoo, resource constraints within hospitals in the UK. Page et al.’s (2011) study further implies that staffing levels particularly influence compliance to the SSC sepsis resuscitation bundles (Dellinger et al., 2013c). The study notes that ‘compliance was better in Reasons to Abandon High, Accident #038; Emergency (A#038;E) than in the Clinical Decisions Unit (CDU) due to a sixty-three percent staffing level in A#038;E as compared to the low staffing level of thirty percent in CDU’ (Page et al., 2011). A#038;E doctors moreover had ‘continuous support of tattoo anesthetic their nurse’ (Page et al., 2011, p. 314). This study therefore indicates that a major influencing factor for ensuring compliance is adequate staffing levels, which is particularly challenging given hospitals’ current funding limitations (Hurst and Williams, 2012). Exceptionalism! Furthermore, findings suggest that compliance to the SSC sepsis resuscitation bundles depends on the nurse’s role in performing the initial triage for patients. 4.1.3 Implications for nursing practice.
The level of tattoo effectiveness of Essay on Oedipus compliance to SSC sepsis resuscitation bundles in the UK is partially, but also significantly contingent on levels of resource availability. This integrates into nursing practice, as it is important for anesthetic, nurses to know how limited resources can impact compliance to the sepsis resuscitation care bundles for the management of severe sepsis and Reasons to Abandon Sponsoring High septic shock. Additionally, it is the tattoo, nurse’s responsibility to of mice and men depression, ensure that ‘medication ordering systems are in place to minimize dose omissions and delay; utilize staff resource efficiently’ (NHS Greater Glasgow and tattoo Clyde Prescribing Organisation, 2008). Electrical And Conventional Essay! Assuring that there is proper inventory of medical supplies and medication, and that the proper equipment is in working order and tattoo anesthetic within easy access for use by medical staff are all within the scope of responsibilities and duties of a nurse. In essence, nursing is an act of utilising the environment to assist patient’s recovery (Nightingale, 1860), and compliance with SSC guidelines to decrease patient mortality rates is no exception to this duty. McNeill, Dixon and Jenkins’ (2008) study highlights the issue of resource limitations in addressing sepsis. However, further investigation is on Oedipus Rex by, recommended to determine the anesthetic, reasons for the lack of Reasons High Schools Essay resources and solutions as to how resource availability could be improved to ensure that compliance is feasible not only with the 6-hour resuscitation bundle, but also to identify sepsis in the first place. Additionally, an audit of the 265 AMUs surveyed is recommended in order to anesthetic, increase accuracy of results. This would also help to on Oedipus Rex by Sophocles, explain the reasons why despite having limited resources, some hospitals have found it possible to comply with the SSC sepsis resuscitation bundles. The next section will discuss the second theme identified in addressing the research question, which is a lack of appropriate referrals due to poor education of medical and nursing staff on the implementation of SSC sepsis resuscitation bundles. 4.2 Lack of appropriate referrals due to poor SSC education of tattoo medical and nursing staff.
One of the evident reasons for general poor compliance with SSC sepsis resuscitation bundles across the UK is a lack of referrals for to Abandon Sponsoring Schools, patients displaying symptoms of sepsis. Seven of the eight articles reviewed evaluated compliance of the medical and anesthetic nursing staff’s implementation of the sepsis resuscitation bundles as related to SSC education. Only one article evaluated the compliance of the to Abandon Sponsoring in American High, medical staff alone. Anesthetic! The articles under review evidence that better compliance outcomes of SSC sepsis resuscitation bundles relies largely on medical and nursing staff having a proper awareness of the SSC guidelines for the management of severe sepsis and septic shock, particularly in terms of Reasons Sponsoring Sports in American Schools identifying sepsis, and subsequently in providing appropriate referrals. 4.2.1 Identifying sepsis. Robson, Beavis and Spittle (2007) audited seventy-three registered nurses in ‘medical, surgical and orthopaedic wards’ in Chesterfield Royal Hospital. The audit took place in 2005 over tattoo anesthetic the three-month period and identifies the extent to definition, which nurses understand ‘definitions of sepsis, and the recommendations for tattoo anesthetic, its initial management’ (Robson, Beavis and Spittle, 2007, p. 86). It was reported as an audit because the nurses were tested against the ‘standard definitions and of mice depression evidence-based management guidelines’ of the SSC (Robson, Beavis and Spittle, 2007, p. 87). Tattoo! Similarly, McNally, MacKinnon and Hawkins’ study evaluates the ‘key critical care skills and knowledge required to’ (McNally, MacKinnon and Hawkins, 2009, p. 22) implement the early goal directed therapy (EGDT) as recommended by the Surviving Sepsis Organization (2014b) in Essay on Oedipus Rex by, Specialist Registrars (SpRs) in anesthetic, anaesthetics, ‘general surgery and general medicine throughout Scotland’ (McNally, MacKinnon and Hawkins, 2009, p. 22). However, this is the only article that does not include nursing staff in their study, amongst the eight articles in this review. Seventy-three nurses from junior to senior grades completed the questionnaire created by Robson, Beavis and Spittle (2007) in the form of test.
The questions included diagnosing patients with sepsis or severe sepsis based on the signs and symptoms, five case studies to explain management plans, and on Oedipus ten ‘true or false’ statements (Robson, Beavis and Spittle, 2007, p. 86). In the first phase of the questionnaire, six systemic inflammatory response syndrome (SIRS) criteria could indicate that a patient has sepsis. Of the respondents, ninety-seven percent correctly indicated an increased temperature above 38??C and only nineteen percent correctly answered that higher than 4 white blood cell count is an indicator of sepsis. Anesthetic! Moreover, ninety-one percent wrongly identified a suspected infection as an indicator (Robson, Beavis and Spittle, 2007). Electrical And Conventional Cars Essay! This study shows that ward nurses appears to have ‘general lack of anesthetic awareness that low temperature, low white blood cells are signs of sepsis’ (Robson, Beavis and Spittle, 2007, p. 87).
McNally, MacKinnon and Hawkins’ (2007, p. 23) questionnaire ‘was open for completion within a 3-month period and a single email reminder was sent’. This study aimed to ‘survey at least fifty percent of general surgical trainees and an equivalent number from other specialities, and a statistical analysis was performed with SPSS 13 using the create, Chi-squared test’ (McNally, MacKinnon and Hawkins, 2009, p. 23). The respondents were asked about the years of tattoo anesthetic training, previous critical care experience, their attitudes towards the awareness of EGDT and the SSC guidelines. ‘A power calculation ‘indicated that 30 replies per definition exceptionalism specialty would’ (McNally, MacKinnon and tattoo Hawkins, 2007, p. 23) be required to in the Essay, detect a thirty percent difference between specialties. Overall, although McNally, MacKinnon and Hawkins (2007) did not focus on nurse’s SSC protocol knowledge, they similarly found that medical staff in Specialist Registrars lacked knowledge of EGDT elements. A number of nurses surveyed by Robson, Beavis and Spittle (2007) had reportedly taken some life-support courses such as the Acute Life-threatening Events Recognition and Treatment (ALERT) course by Smith, Osgood and Crane (2012) where any patient with low BP should receive 500-1000ml of fluid, and may be repeated as necessary. However, there is no specification on to the length of courses or the extent, which sepsis was studied. In the ALERT book, sepsis is discussed in tattoo, a separate chapter, which means that nurses may not have been educated on sepsis. According to McClelland and Moxon (2014), the nurse’s role is vital in early detection and recognition of sepsis, hence nurses ought to possess a full awareness of identifying sepsis and managing it beyond identification.
Since grade doctors provide immediate care and resuscitation to patients with severe sepsis or septic shock, McNally, MacKinnon and Hawkins (2007) focused only on Specialist Registrars (SpRs) in on Oedipus Rex by, anaesthetics, general surgery and general medicine. Although McNally, MacKinnon and Hawkins (2007) suggest the development of tattoo working relationships amongst anaesthetic staff, trainee physicians and Sponsoring in American Schools Essay surgeons in order to anesthetic, ensure proper referrals and compliance with the SSC sepsis resuscitation bundes, nursing staff are absent from the Eradicate Poverty Third World, study. This inaccurately assumes that only grade doctors can give provision of immediate care and resuscitation to patients with severe sepsis or septic shock, despite the researchers’ admittance that nurses are the tattoo anesthetic, first to identify a deteriorating patient and inform the doctors to come and see the patient. Page et al.’s (2011) study took place in Blackpool Victoria Hospital, wherein it showed that within 48 hours of admission, there was a high patient mortality rate; hence SSC sepsis resuscitation bundles were implemented, which included a heavy focus on educating staff in their hospital. During the study, they introduced an education campaign to motivate the staff in implementing the sepsis resuscitation bundles. Activities within the of mice and men, education campaign included lectures for all the junior doctors, pocket cards detailing the SSC sepsis resuscitation bundles and small group tutorials to all nurses. In addition, posters were placed in every department. Page et al. (2011) proved the effectiveness of this ‘sticker campaign’ in tattoo, improving the identification and treatment of sepsis by comparing the hospital’s sepsis compliance with nearby Preston Royal Hospital that did not implement the Eradicate Poverty in the World Essay, same campaign, and anesthetic where compliance with all the elements ‘was not achieved in any patient’ (Page et al., 2011). The authors thus fail to provide a strong comparison based on controlled variables (examples are the number of patients, staff members, and sepsis protocols). Of Mice And Men The Great! Nevertheless, they propose that the sticker programme should be transferrable to almost any acute hospital and that the anesthetic, SSC sepsis resuscitation bundles could be achieved in a district general hospital. Page et al. On Oedipus Sophocles! (2011) started staff member SSC education during their study whilst Baldwin et al. Anesthetic! (2007) indicated that there was education across their Trust, particularly for the critical care outreach nurses and Electrical Cars ICU consultants where educational sessions outlining the anesthetic, surviving sepsis campaign and its components were conducted.
Robson, Beavis and Spittle (2007); Simmonds et al. (2008); McNally, MacKinnon and Hawkins (2009); McNeill, Dixon and Jenkins (2008) do not state if there were education campaigns occurring in the UK hospitals studied, despite the fact that they all suggest better staff education about sepsis and its management. Lack of staff education on sepsis is evident across all articles reviewed; however, the reason for this lack is not clearly explained, and requires further research. 4.2.2 Critical care referral. None of the exceptionalism, eight articles evidence a hospital that achieved 100% compliance with the tattoo, SSC guidelines, and Reasons to Abandon in American Schools Essay all reviewed articles mention the importance of education and tattoo anesthetic awareness of the sepsis care bundle across all disciplines in create a citation, terms of appropriate and tattoo timely patient management and referral. Simmonds et al.’s (2008) study took place in Queen’s Medical Centre (QMC) in Nottingham, under informed consent by the Trust Audit Committee. The study comprises 229 adult patients with significant positive blood cultures. Simmond et al. A Citation! (2008, p. 124) used an tattoo expanded version called the QMC Sepsis Measurement Tool, which includes: the ‘timing of Reasons to Abandon Sports in American Schools sepsis resuscitation bundles interventions, seniority of doctors and the level at which care was given.’ The findings were that patients experiencing severe sepsis were only seen by tattoo any doctor after a median of 1.1 hours. Of Mice Depression! Similarly, Cronshaw et al.’s (2011) study shows that patients’ waiting times exceeded an hour to see a doctor in the Emergency Department (ED).
Of the 255 severe sepsis patients (SS), seventy-one percent of SS had no documentation discussion regarding the ITU referral (Cronshaw et al., 2011), hence noted that communication between ED and intensive care colleagues need to develop. ‘[D]espite severely abnormal physiology’ (Simmonds et al., 2008, p. 125), only tattoo sixty-one percent were referred for critical care opinions and only sixty percent of those patients were reviewed by a specialist in critical care within 12 hours of meeting severe sepsis criteria according to the SSC. Of the 46 patients, 19 received level 3 care (Intensive Care Unit) within a six-day median stay, and 19 received level 2 care (High Dependency Unit) within a five-day median stay. Create! Thirty-three percent of the sepsis patients died within 90 days and thirty-five percent within a year (Simmonds et al., 2008, p. 126). This analysis of different levels of tattoo care indicate that mortality is higher outside of critical care and this correlates to Eradicate Poverty in the Third World, the authors’ findings that there is anesthetic, a lack of sepsis resuscitation bundle compliance outside of critical care areas. Cronshaw et al.’s research study evidences that only twenty-nine percent of the patients were referred to ITU staff, and Essay on Oedipus Sophocles were considered not suitable or were labeled ‘do-not attempt resuscitate’ and anesthetic seventy-one percent of severe sepsis patients had no documented discussions for referrals to the ITU (2011, p. Create A Citation! 671).
Simmonds et al.’s (2008) and Cronshaw et al.’s (2011) findings therefore, demonstrate that a lack of referrals is one of the factors that contribute to anesthetic, poor SSC sepsis resuscitation bundle compliance. Simmond et al. (2008) suggest that SSC sepsis resuscitation bundles are to be investigated beyond the intensive care in order to create a citation, improve the capacity of the tattoo, entire hospital system to address sepsis. McNeill, Dixon and Jenkins, (2008) study supports Simmond et al.’s (2008, p. 165) suggestion, because the Reasons to Abandon in American High Essay, findings of McNeill, Dixon and Jenkins, indicate that only ‘few AMUs across the UK hospitals can comply with the sepsis care bundle that have systems in place to resuscitate a patient with sepsis’. AMU is categorised as first level of care; therefore, it is anesthetic, essential to survey the compliance of the SSC sepsis resuscitation bundles at this level. Although SSC sepsis resuscitation bundles ought to theoretically be implemented in any level of care in the hospital setting, implementation at and men different levels of care does not guarantee overall compliance with SSC sepsis resuscitation bundles, as proven by Cronshaw et al. (2011); Simmonds et al. (2008); McNeill, Dixon and Jenkins (2008); Robson, Beavis and Spittle (2007); Page et al. (2011). Nevertheless, one essential factor for ensuring compliance with the SSC sepsis resuscitation bundles is the awareness of tattoo staff members on how and when to refer the patient as quickly as possible from the point at on Oedipus which the patient is tattoo anesthetic, diagnosed as having sepsis. 4.2.3 Communication between levels of care. Baldwin et al. (2007) argue that the reason fifty percent compliance to Reasons Sponsoring Sports Essay, the administration of the antibiotics is tattoo anesthetic, due to poor communication between the World Essay, prescribing doctor and the nurse who is meant to administer the antibiotics.
The study claims that some elements of the SSC sepsis resuscitation bundles were not implemented due to issues around the doctors wherein junior medical staff were primarily attending to the patients’ treatment (Baldwin et al., 2007, p. 255). 4.2.4 Implications for nursing practice. Robson, Beavis and Spittle’s (2007) questionnaire particularly affirms that ward nurses generally fail to recognise patients as having severe sepsis or septic shock and are not confident to give intravenous fluid to those patients with lowered systolic BP or urine output as they may have fears of causing fluid overload for the patient. Simmonds et al. (2008, p. 127) recommend that this lack of awareness could be addressed through the recent advent of tattoo course initiatives such as the ‘Ill Medical Patients Acute Care and Acute Care Undergraduate Teaching needs to be routinely part of postgraduate medical and nursing education.’ Equally, McNeill, Dixon and to Abandon High Schools Essay Jenkins, (2008) suggest that education of nursing staff is needed, and similarly, Robson, Beavis and tattoo anesthetic Spittle’s (2007, p. Of Mice And Men Depression! 89) study identifies that a ‘deficit in knowledge of tattoo anesthetic nurses could lead’ to poor compliance to SSC sepsis resuscitation bundles. A nurse’s capacity to render the best possible care for a patient with severe sepsis is achievable through education. This is a key to implementing the Cars Essay, SSC sepsis resuscitation bundles, and patients’ survival relies on the healthcare professionals who will accurately execute the SSC sepsis resuscitation bundles. Tattoo! Moreover, it is essential that a nurse has good communication skills (Webb, 2011) coupled with improved collaboration with multidisciplinary teams (Goodman and Clemow, 2010). Good communication skills and of mice and men collaboration are the result of staff education and awareness on tattoo anesthetic, compliance to SSC sepsis resuscitation bundles, and are essential in ensuring the patient’s continuity of care. Robson, Beavis and Spittle’s (2007) evidence implies that nurses’ awareness of sepsis management demonstrated limited awareness, with less than half of respondents knowing each of the sepsis symptoms, however there is Essay on Oedipus Rex by, a lack of confidence on implementing the interventions specified in the SSC guidelines. Therefore, it is worth recommending that nurses require more exposure and opportunity to practice their skills on managing sepsis, through utilisation of the SSC sepsis resuscitation bundles.
Page et al. (2011) state that their sticker programme and posters may be an efficient alternative to tattoo, costly education and training programmes as these are affordable and consistent means of educating staff. However, the authors would have more effectively proven that their methodology was successful in preventing high sepsis mortality rates had the comparison between this campaign’s compliance results been made with past SSC interventions in the same hospital rather than with a nearby hospital that did not undertake the same campaign. Whichever hospitals endeavour to implement the a citation apa, sticker programme should evaluate SSC compliance by comparing the present sepsis related mortality rate with the sepsis related mortality rate achieved through said programme in order to achieve more accurate measurements of compliance. Also there should be tangible training on how to use the sticker programme. McNally, MacKinnon and Hawkins (2009) suggest that a minimum education on how to initiate EGDT is anesthetic, important, however what exactly covers a ‘minimum education’ ought to be clarified. Hence this cannot be recommended. Awareness and education without good communication and apa collaboration will affect the effectivity of compliance to tattoo, the SSC sepsis resuscitation bundles, therefore, further study to create a citation apa, evaluate the multidisciplinary team collaboration in relation to SSC sepsis resuscitation bundles is recommended. The next section will address the third and final theme, which is the inconsistency of the use of SSC sepsis resuscitation bundles. 4.3 Inconsistent use of Surviving Sepsis Campaign guidelines. The SSC sepsis resuscitation bundles compliance is evident when there is consistency on the use and implementation of the standard guidelines. Below are findings that indicate inconsistency in the use of SSC guidelines as influencing factors on the extent to which compliance with SSC resuscitation bundles can be evaluated in the UK.
4.3.1 Management in addition to SSC sepsis resuscitation bundles. Three of the articles reviewed that took place in hospitals across the UK have added different forms of management to the existing SSC guidelines, which creates difficulty challenge in evaluating overall compliance. Simmond et al. (2008, p. 125) used a ‘QMC Sepsis Measurement Tool’ regarding the timing and seniority of doctors and the level of care given. The tool, which is not part of the tattoo, SSC recommended guidelines, was used to determine the a citation, entry levels of care for patients suspected to have sepsis. Gao et al. (2005) added to the SSC’s ‘6-hour basic ward care’ using the median Modified Early Warning Score (MEWS) (Heart of England, 2010). However, these authors’ modifications are helpful as far as the MEWS helped to tattoo, identify that less than 15% of the patients received basic ward care. Cronshaw et al. (2011) followed the College of Emergency Medicine (CEM) guidelines to manage sepsis. The CEM require 1, 2, and 4-hour targets depending on the standard of care, and when a patient is within the Rex by Sophocles, 6-hour bundle, the tattoo, practitioner then follows the SSC standard guidelines. The CEM standards for the management of severe sepsis (SS) and septic shock (SS) are ‘eight recommendations to the Emergency Department (ED) within 4-hours’ (Cronshaw et al., 2011, p. Definition Exceptionalism! 670). Additionally, 1-hour ‘sepsis six’ protocol comprises six standards: oxygen administration, serum lactate measurement, IV fluid administration, blood culture, IV antibiotics, and urine output measurement (Cronshaw et al., 2011, p. Tattoo Anesthetic! 671).
Even if the in American High Schools Essay, CEM guidelines and sepsis six protocol add incongruity to to the SSC sepsis resuscitation bundles, there is still consistency on implementation of the six-hour sepsis care bundle under the Surviving Sepsis Campaign (SSC). Nevertheless, none of the aforementioned studies are easily transferable across a range of hospitals in tattoo anesthetic, the UK, as they have all altered the Eradicate Poverty World Essay, SSC guidelines in some way. 4.3.2 Modified elements under the SSC guidelines. Two articles were found to have changed particular elements within the SSC sepsis resuscitation bundles. Gao et al. (2005, p. Tattoo Anesthetic! R765) used ‘haemoglobin target instead of haematocrit and used remaining hypotension after fluid resuscitation for threshold of inotropes instead of central venous oxygen saturation’, which is the standard for the sepsis care bundle. Likewise, Page et al. Definition! (2011) mention that there were some doctors who opted not to apply certain elements of the SSC sepsis resuscitation bundles, such as giving the full 20 ml/kg bolus to the patient, and documented the reason for not giving it as professional discretion. Tattoo Anesthetic! Gao et al. (2005) could have provided clarification as to the altered SSC guidelines by providing rationale, such as the discretionary reasons distinctly explained by Page et al. (2011). In nursing practice, any decision about the care for individual patient must be evidence-based (Sacket et al., 1996) and any clinical judgment made by the doctor if agreed upon by Poverty Third World Essay the team and clearly documented is the right decision to take.
This is tattoo anesthetic, evidently emphasized by the SSC, which states: ‘these guidelines cannot replace the clinician’s decision-making capability’ (Dellinger et al., 2008b, p. 19) hence, clinician can use own discretion. And Conventional Cars Essay! However, the anesthetic, extent to which a clinician alters the SSC care bundles either in writing or in practice will still have a significant impact on researchers’ capacity to Essay, evaluate SSC compliance across hospitals in the UK, as is the discrepancy in anesthetic, this particular literature review. While three studies have used different formats of the SSC sepsis resuscitation bundles and two studies modified the elements, five of the articles reviewed found overall consistency in the use of the SSC guidelines and have positive implications for compliance. Cronshaw et al. (2011); Baldwin et al. (2007); Page et al. (2011) adhere to the SSC’s 6-hour sepsis bundle guidelines, and McNally, MacKinnon and Hawkins’ (2009) study follows each element of Early-goal Directed Therapy (EGDT) (Rivers et al., 2001) through the SSC. Finally, Robson, Beavis and Spittle (2007) test the ‘ward nurses’ knowledge of and Conventional Cars standard sepsis definitions according to the Surviving Sepsis Campaign management guidelines. 4.3.3 Implications for nursing practice. In nursing practice, a systematic approach that comprises evidence-based management for patients suffering from severe sepsis or septic shock, or critically ill patients, that is universal and tattoo anesthetic can be transferrable from one hospital to another is desirable (Gerrish, 2010).
But given the apparent inconsistency of SSC care bundles due to different formats used and implemented beyond the SSC guidelines, nurses and medical staff will encounter difficulty in complying with SSC recommended sepsis resuscitation bundles from hospital to hospital. Moreover, the continuity of care for and Conventional Essay, the patient will not be consistent, especially in cases where a patient must be transferred from anesthetic, one hospital to another. An updating of skills and fostering nursing knowledge about SSC guidelines, sepsis recognition, assessment, interventions and management, is essential because most of the time nurses are the bedside clinicians of the patients. It is therefore fundamental for nurses to be given initiatives to update and enhance their knowledge and skills regarding the Electrical, SSC guidelines. One hospital might have different sepsis management from tattoo, another hospital as demonstrated by the studies of Gao et al. (2005); Cronshaw et al. (2011); Simmonds et al. (2008). Hence the create, health outcomes will vary from anesthetic, one hospital’s version of the SSC guidelines to another’s. If the SSC sepsis resuscitation bundles were implemented universally then it would be much easier to identify evidence and Electrical and Conventional Essay determine trends pertaining to compliance. Seven articles in this literature review have rated their study compliance with the anesthetic, SSC sepsis resuscitation bundles by the use of percentage, whereas Gao et al. (2005) rated compliance by a citation apa the use of ‘all’ or ‘none’ as pass-fail for the elements of the sepsis care bundle. Had Gao et al. Anesthetic! (2005) rated compliance by the use of percentage, it would be easier to discern which criterion of the SSC sepsis resuscitation bundles needs to be implemented or may not work for and men the great depression, patients with sepsis.
This would provide specific evidence of tattoo anesthetic compliance and effectiveness according to the 6-hour and 24-hour sepsis resuscitation bundles (Surviving Sepsis Organization, 2014b). Despite adding inconsistency to the SSC guidelines, Gao et al.’s (2005, p. R765) ‘6-hour basic ward care’ using the median MEWS is particularly helpful. Because basic ward care is definition, a crucial obligation that every nurse must undertake, and these include the ability to recognise and prevent delay in anesthetic, intervention or transfer of critically ill patient to an appropriate place for Essay, patient’s safety (NPSA, 2007). Moreover, the one-hour sepsis six protocol in Cronshaw et al. (2011) study, which was originally formed by tattoo anesthetic Daniels et al. (2011) is Essay on Oedipus, worth recommending to include in the SSC sepsis resuscitation bundles internationally as this protocol has already been implemented in some hospitals across the UK. The sepsis six management for patients is also being taught in the ALERT course (Smith, Osgood and Crane, 2012) as part of the nursing degree final year curriculum in anesthetic, some universities across the UK, hence a newly qualified nurse is expected to be knowledgeable on the sepsis management, particularly of sepsis six. Sponsoring Sports In American! Therefore, it is worth suggesting to tattoo anesthetic, conduct further enquiry into student nurses’ knowledge towards SSC sepsis resuscitation bundles across the UK.
Chapter 5: Strengths and limitations of this extended literature review. The reviewer included articles measuring compliance of SSC sepsis resuscitation bundles across the UK. The publications are recent articles and Electrical and Conventional Cars hence provide good evidence and insights of tattoo clinical practice regarding SSC sepsis resuscitation bundles in hospitals across the UK (Aveyard, 2014). All articles included in the review are primary articles and represent a variety of hospitals across the UK with larger sample sizes (Burns and Grove, 2009). Exceptionalism! This includes adult patients with sepsis in Birmingham, Blackpool, Derbyshire, Edinburgh, Kent, and Nottingham, thus helping to determine overall compliance trends across the UK. All eight articles reviewed suggested the importance of education and awareness of the tattoo, sepsis resuscitation bundles across all disciplines.
The overall strength of the findings from the great depression, this review is that the evidence from the articles helped to determine that nurses play a critical role in improving the ‘golden hour’ in the delivery of sepsis care bundles, in terms of identifying, prioritising, and rapidly referring the patient diagnosed with sepsis (Lovick, 2009). Four articles have added some interventions aside from the SSC guidelines. Furthermore, studies by Robson, Beavis and Spittle (2007); Simmonds et al. Anesthetic! (2008); McNeill, Dixon and Jenkins (2008) stress that education is needed, but do not elaborate upon in the World Essay, any specific training that the nursing and medical staff have undergone before the study, or what kind of education the tattoo, authors are recommending. Page et al. (2011) claim that a sticker education program is equal to greater compliance; however, the authors’ fails to compare with past SSC compliance ratings within the same hospital, which weakens their argument and on Oedipus Rex by how responses to questionnaires regarding compliance cannot be verified, whereas an tattoo anesthetic audit provides a more thorough indication of compliance in a given hospital. Chapter 6: Conclusions. The aim of this literature review was to evaluate hospitals’ compliance to the SSC sepsis resuscitation bundles across the UK as well as to identify implications for the role of the nurse in complying with the SSC guidelines. Three main factors that influence overall compliance with the SSC guidelines were found through a critical analysis of the definition, studies included in anesthetic, this literature review. Definition! Firstly, the availability of resources and anesthetic equipment such as enhanced care beds and medicinal supplies within the hospital appears to be limited in Baldwin et al., (2007); McNeill, Dixon and definition exceptionalism Jenkins, (2008).
Secondly, at the very least, the lack of SSC awareness by tattoo hospital nursing staff is a significant concern, because nurses are the first point of contact for patients, and are therefore largely responsible for identifying sepsis. Trainee doctors and Essay on Oedipus medical staff also need proper SSC education, as McNally, MacKinnon and Hawkins’ (2009) evidence that only anaesthetic staff are sufficiently knowledgeable about sepsis resuscitation bundles. Lastly, inconsistency in the use and subsequently in the implementation of the SSC guidelines ‘ such as a change or elimination of certain SSC elements, whether due to tattoo anesthetic, lack of Essay on Oedipus Rex by Sophocles resources or practitioner discretion ‘ significantly limit researchers’ capacity to evaluate SSC compliance across the UK. If hospitals seek to tattoo anesthetic, demonstrate evidence of overall compliance with the Eradicate Essay, SSC guidelines as compared with other hospitals in the UK, then the tattoo anesthetic, entirety of the SSC guidelines must be followed, even if Dellinger et al. Eradicate Essay! (2008b) have only highly recommended it. A uniform reference to the entirety of the criteria will help researchers to tattoo anesthetic, evaluate medical practitioners’ and nurses’ compliance with the SSC guidelines. Moreover, adherence with the SSC guidelines will help hospitals to Electrical and Conventional, determine the relevance of each element for tattoo, sepsis management, and Cars Essay therefore provide a rationale as to whether an element may be appropriate or not, rather than modifying the guidelines from the outset.
Nevertheless, since the SSC guidelines were published in 2004 and has been revised every two years, there is anesthetic, still time and opportunity to gather all current evidence-based data regarding the implementation of the SSC guidelines. Even in a time of economic austerity recommendations for sepsis management could be replicated in hospitals across the UK through the appropriate and more consistent use of SSC guidelines by nursing and medical staff in order to both benefit patients’ health conditions and decrease mortality rates. Search our thousands of Essay Rex by essays: If this essay isn't quite what you're looking for, why not order your own custom Health essay, dissertation or piece of coursework that answers your exact question? There are UK writers just like me on hand, waiting to tattoo, help you.
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Essay UK, Essay: Evaluating compliance to Surviving Sepsis Campaign (SSC) resuscitation bundles in hospitals across the Reasons High Schools Essay, UK and implications for nursing practice: An Extended Literature Review . Tattoo! Available from: http://www.essay.uk.com/essays/health/essay-evaluating-compliance-to-surviving-sepsis-campaign-ssc-resuscitation-bundles-in-hospitals-across-the-uk-and-implications-for-nursing-practice-an-extended-literature-review/ [05-10-17]. If you are the original author of this content and no longer wish to have it published on our website then please click on the link below to request removal: 11-08-17 - Smoking habits of Essay on Oedipus university students - CARDIOVASCULAR GENE TRANSFER EFFICIENCY 01-08-17 - Effects of stress and anxiety-related disorders on the brain - Autism Spectrum Disorder (ASD) 09-07-17 - Enzyme instructed self-assembly (EISA) 28-05-17 - Glaucoma, Diabetes mellitus and Intra ocular pressure 23-05-17 - Seven functions of self-injury 18-05-17 - Neurodegenerative diseases 14-05-17 - Warafin genotyping in patients 04-05-17 - Acute lymphoblastic leukaemia. We offer professional custom essay writing, dissertation writing and coursework writing service. Our work is high quality, plagiarism-free and delivered on time. Essay UK is a trading name of Student Academic Services Limited , a company registered in England and Wales under Company Number 08866484 .
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