Reflection on Task Management in Nursing

Reflection on Task Management in Nursing Description: what happened. Whilst working on a medical ward with a senior staff nurse as a mentor, I identified certain competencies which needed achieving around management of care, and negotiated these with the mentor. Accordingly, the mentor suggested that I take charge of the patient workload we had been allocated for that shift, and both prioritise the care and nursing tasks, and also attend the ward round with the medical teams, providing the nurse liaison and taking the instructions from the consultants in relation to ongoing patient care and case management. Accordingly, I agreed on the prioritisation of patient tasks and allocated the workload to the members of staff in our team, and when the ward rounds began, my mentor and I attended. However, when the doctors communicated with us, they automatically addressed her, and although she turned to me to provide key information, they continued to chiefly communicate with her, and she did not correct this. Subsequently, she took charge of the ward rounds and I remained as an observer. At the end of the ward rounds, it should have been my role to take the instructions given and to implement them in changing care plans and in directing or implementing clinical tasks. However, my mentor continued to take charge of this for the rest of the time, giving me little opportunity to experience this aspect of the role for myself. Feelings There is a great sense of responsibility associated with management tasks, which extends beyond being responsible for individual patients to being responsible for a group of patients, and for the actions of some staff allocated to their care. I felt very strongly motivated towards achieving management competencies, but also very nervous and concerned that I would do this effectively without compromising patient care. I felt that I was achieving well under supervision until the ward rounds, where the mentor ‘took over’ and did not discuss why she had done this. I then felt as if I was unable to fulfil my competencies, and that I must have failed in some way because she did not allow me to continue in the role. Evaluation It was very positive to take charge of some management tasks and to complete these effectively. In particular, other staff responded well to me taking on this responsibility (in liaison with my mentor), and this positive feedback gave me more confidence to continue in this role. However, the way that my mentor just stepped in and took charge during the ward rounds undermined my confidence and was very challenging to deal with. I felt that I should have been more assertive at this point, but did not feel I had the confidence to do this. Analysis The acquisition of the complex skills associated with the staff nurse role have always been problematic (Gerrish, 2000). However, the literature seems to suggest that nurses are learning to perform this role in a rather haphazard manner,in the light of what they perceive to be inadequate preparation and lack of support (Gerrish, 2000). Bradshaw (1998) suggests that this is partly because nursing competency is only vaguely and broadly defined, which means that preparation and assessment of competency is both haphazard and unstructured. This also suggests there may be a potential safety hazard for both patient and nurse (Bradshaw, 1998). This would certainly seem to be the case here, where the inability to fully engage with management roles does not support the student in becoming competent. Baillie (1999) in an action research study of the topic found that preparation of students for their management role as staff nurses benefits from being closely linked to practical experience, with clear learning outcomes and supportive clinical staff. In this instance, staff were generally supportive, and clear learning outcomes set, but the mentor failed to follow through to meet these outcomes completely. This may have been because the mentor felt that there was a risk to patient care and safety, but this was not communicated to the student and there may have been other ways in which this could have been managed. However, there may be other reasons for this occurrence. Cahill (1996) in a small study found there to be a type of ward culture that not only separates those with knowledge from those who need to learn, but also reinforces the position of the student through both covert and overt mechanisms of control. If such a finding were applicable in this case, then it would suggest that the mentor may have been (consciously or subconsciously) reasserting her own authority and position of power and greater knowledge. The position of student nurses may also be such that they adhere to these cultural practices in order to ensure they receive a favourable report at the end of the placement (Cahill, 1996). Lofmark and Wikblad (2001), in a study of facilitating and obstructing factors for development of learning in clinical practice, found that responsibility and independence, opportunities to practise different tasks, and receiving feedback were facilitating factors for learning. In this case, it w ould appear that responsibility was offered, but not fully, and it is problematic to see how a student can achieve true independence whilst being supervised. In Lofmark and Wikblad’s (2001) study, other perceived promoting factors included perceptions of control of the situation and understanding of the total picture. Here it would have been useful perhaps if the staff nurse had explained to the student why she retained control and why she did not follow through on her promise to allow the student to take charge. Such behaviour was found in the Lofmark and Wikblad study to be one of the obstructing factors to learning, where the nurses as supervisors did not rely on the students. Other obstructing factors were supervision that lacked continuity and lack of opportunities to practise Lofmark and Wikblad, 2001). Perception of their own insufficiency and low self-reliance were drawbacks for some students (Lofmark and Wikblad, 2001), which is also true in this reflection, but these perceptions seem to be linked to the ways in which mentors and other staff perceive and interact with students. It also appears that the NMC Code of Conduct (2004) works both to support students here but also restricts their opportunities to engage in practice, due to the need to primarily protect and support the wellbeing of the patients. Conclusion The learning that has taken place here is vitally important for continued functioning and the acquisition of confidence as a staff nurse in future. Not only do ward cultures play a large part in student experiences, but relationships are the fundamental component of how nurses function in their environment. Some aspects of the nurse-mentor relationship, while perceived as challenging, may be necessary or inevitable, and it has not become clear to me through this reflection how this can be changed, other than to raise these issues honestly with mentors during initial and mid-point interviews to acknowledge them and how they will affect the learning experience. Action Plan Explore dimensions of the nurse-mentor relationship further Raise issues of independence, power and control during initial placement interviews. Seek out ways to develop management competencies through a variety of mechanisms and experiences. Identify communication issues and potential means of addressing them. Engage in more management activities, daily, until other staff members gain trust in my ability to fulfil these roles. Attend all ward rounds to gain confidence in this area. Engage in future cycles of reflection. References Baillie, M. (1999) Preparing adult branch students for their management role as staff nurses: an action research project. Journal of Nursing Management 7 (4), 225–234. Bradshaw, A. (1998) Defining competency in nursing: an analytical review. Journal of Clinical Nursing 7 (2), 103–111. Cahill, H.A. (1996) A qualitative analysis of student nurses experiences of mentorship Journal of Advanced Nursing 24 (4), 791–799. Gerrish, K. (2000) Still fumbling along? A comparative study of the newly qualified nurses perception of the transition from student to qualified nurse Journal of Advanced Nursing 32 (2), 473–480. LÃ ¶fmark,A. Wikblad, K. (2001) Facilitating and obstructing factors for development of learning in clinical practice: a student perspective Journal of Advanced Nursing 34 (1), 43–50. Nursing and Midwifery Council. (2004). The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics . London. Nursing and Midwifery Council.

Bank of America Corp Essay

Bank of America Corporation supplies banking and non-banking financial services and products to individual customers and small and medium enterprises (SMEs) in the form of retail banking, larger corporations and government of the United States and even to international arena. The bank generates the savings accounts, money market savings accounts, checking accounts from the deposits segment. The Global Card services segment allows the US consumers with business cards, consumer lending and international debit card services. The Home Loans and Insurance segment offers it consumers with products and services related to real estate such as mortgage and home equity loans. The Global banking segment gives commercial loans, leasing, short-term loans, capital management and treasury solutions. The Global Markets solution provides advisory services, custody services and securities clearing. The bank’s Global Wealth and Investment Management segment caters to estate management, brokerage services, credit and banking expertise. The profit margin for the bank was 7. 05 percent in the past year. Bank of America has a $1. 5 trillion goal for community development lending focusing on affordable housing, SMEs, consumer financing and economic development in general. Global Consumer and Small Business Banking is the largest segment of the bank and focuses mostly on credit card issuance and consumer banking. This division has over 6200 retail branches and over 18700 ATMs over the US. The bank is also a member of Global ATM alliance- initiative taken by many banks to that enable the customers to use the ATM or check card with no fees. The organization also supplies its employees to buy hybrid vehicles and has an eco-friendly tower in Manhattan and even gives mortgage loan breaks to consumers whose homes pass as being energy efficient. The bank has even donated money for the health centers in Massachusetts and to the homeless shelters in Miami. JP Morgan Chase and Company: JP Morgan Chase provides a variety of financial services across the globe. There is the Investment bank segment for corporate strategy and structure, capital raising in equity and debt markets, risk management and provides the financial institutions, governments and corporations with institutional investors. There is Commercial banking segment that does lending, treasury services, cash management, trade and whole sale cards to SMEs and multinational companies. The Asset management segment provides wealth and investment management services to institutions as well as retail investors. Global investment management in equities, real estate, hedge funds, fixed income, money market instruments and banking deposits are also offered by the bank. The company has Retail financing services segment that caters to retail banking for the consumer through checking and savings accounts, mortgages, home equity and business loans and online banking and telephone banking. The Card Services segment provides the credit cards and keeps track of the credit payments processes. The profit margin for the latest fiscal year has been 19. 52 percent. Its consumer functions involve more than 3000 branches, 8500 ATMs and 270 mortgage offices. JP Morgan and Chase fared well compared to its peer in the credit crunch of 2007 and even though investment banking unit suffered and the bank even increased its loan reserves losses by $4. 3 billion. And even then the net income of the bank was 25 percent due to the growth in strong earnings of the bank’s credit card and commercial banking units. After the survival of the bank in such a tough scenario it has proven the effectiveness with which it has been offering the diverse array of financial services businesses. Citigroup and Inc: The company has two distinct segments: Citicorp and Citi Holdings. Citicorp is the global bank for the businesses plus the consumers and is divided into two main businesses namely: Regional consumer banking and institutional clients group. The regional consumer banking provides the conventional services of retail banking, cards and commercial banking on small-scale in North America, Latin America, Europe, Asia, the Middle East, and Africa. Catering to the securities and banking services such as investment banking, advisory services, lending, debt and equity sales, foreign exchange, institutional brokerage and treasury and trade solutions is the institutional clients group. Whereas the segment Citi Holdings has three businesses to look at: brokerage and asset management, local consumer lending and special asset pool. The brokerage and asset management division in a joint venture with Morgan and Stanley and provides retail brokerage and asset management services. The local consumer lending provides mortgage loans, personal loans, student loans, commercial real estate loans and even western European card. The special asset pool is a portfolio of securities, loans and other assets. The profit margin for the latest year has been negative 0. 84 percent. Citigroup is the sixteenth largest political campaign donator in the US according to Centre for Responsive politics. Citigroup even obtained naming rights as Citi Field to the home ballpark of the New Major League Baseball team in 2009. Recommendation: After research of the three banks, Citigroup has been the one to be involved in many scandals; ranging from financing Enron and alleged money laundering facilitation and even conducting biased research on the customers. Citigroup even disrupted the European bond market by selling a large amount of bonds and then buying them back a cheaper price. The organization has also been alleged of stealing money from its customers especially the poor and the recently deceased with an improper â€Å"sweep† feature in its computers. Hence it can be said that Citigroup has to go a long way in clearing its image with the consumers because now with the internet, they’re aware of everything and already Citigroup faces a lot of competition from its competitors. Reference: Winkler, Rolfe (August 21, 2009). â€Å"Big banks still hold regulators hostage†. Reuters, via Forbes. com (Retrieved August 21, 2010)

TLE cooking session

Follow the instructions of the teacher. 2. Stay with your group and avoid going to the other groups. 3. Assign each task to every member. 4. Prepare the materials and ingredients needed. 5. Wash your hands before cooking. 6. Wear apron and for the girls, they should tie their hair. 7. Handle the sharp materials with care to avoid accidents. 8. Clean your place after cooking. 9. use the materials according to Its functions. 10. Turn off faucets and stoves when not used.TOCINO Ingredients: 3 lbs boneless pork shoulder rost cup lemon-lime soda (sprite or 7 up) 1/3 cup of soy sauce 2 cups brown sugar 1 h cups pineapple juice h ketchup 1 tablespoon garlic, minced 2 tablespoons of salt 1 teaspoon of black pepper Procedures: 1 . Cut h Inch slices of pork shoulder and place In a one gallon zip-lock plastic bag. 2. In a separate bowl, mix the rest of the ingredients and then add to the meat. Seal the bag, while trying to remove excess air. Let the pork cure Inside the refrigerator for 4-5 day s, turning the bag over every day. . After curing, you can either cook the meat or portion them off Into smaller bags and freeze. 4. To cook the Toclno, add a little water, marinade and a few slices of meat to a skillet. Over medium heat, let the liquid boll off and then fry the meat for a couple of minutes to carmellze It. Make sure not to burn the meat. PICKLED VEGGIES WITH CHILLIES white radish 3 carrots 3 chillies 2 cups vinegar sugar 1. 1 lbs salt 1 OF2 1 . Slice the carrots and radish vertically. (finger size) 2. Slice the chillies diagonally. 3.Put all the vegetable in a container. 4. Add some salt and leave it for 5 minutes. 5. Squeeze the vegetables to release its mixtures. 6. Rinse it with water. 7. Put sugar and boil it. 8. Cool it off for 5 minutes. MANGO JAM Mango ascorbic acid water 1. Prepare the materials and the ingredients. 2. Slice the Mango. 3. Mix the Mango, sugar, and water. 4. After mixing, boil it and add 2 tablespoons of ascorbic acid. 5. Mix it until it bec omes sticky and golden brown. 6. After 20-15 minutes, get it and it is ready to serve.

Could Napoleon Dynamite Have Aspergers - 558 Words

It was hard for me to watch this movie and separate Napoleon’s behaviors from his friends and family members. Many of the things he does and says are like those of the people around him. His overall weirdness was not behavior that I immediately would have identified as Asperger’s, rather someone who is simply a little odd. However, as I continued to watch the movie I was able to find certain examples that could be red flags for Asperger’s. From the very beginning of the movie, it seemed like Napoleon never opened his eyes. They are open just enough to be squinting, and they are rarely directed to be looking at a person. Asperger’s typically come with poor eye contact in social situations, and Napoleon definitely has this characteristic. Even when he is talking directly to someone, he doesn’t have the comfort level to look them in the eye. The second thing is that he is very uncoordinated. He is able to play tetherball, but just barely because he hits it with different amounts of power and so is constantly jumping out of the way. When he goes out to feed Tina the llama, he is awkward about getting the food through the fence to her, and then flings it on the ground in front of her with his fork. He also has an awkward walk that gets especially odd when he runs and is very uncoordinated. The third characteristic that is typical of people with Asperger’s is a lack of interest in the feelings and emotio ns of others. Napoleon makes comments to people that most of us wouldn’t