The Dark Child

The Dark Child Camara Laye wrote The Dark Child to oppose stereotypes that have become part of western culture. When most westerners think about Africa they think of an undeveloped country that is stricken by poverty and primitive behavior. The dark child is an autobiography of Camara Laye’s youth and his early life growing in to adulthood. Camara Laye grew up in the town of Kouroussa on the inland plain of French Guinea in the Malinke tribe. His father was a well-renounced blacksmith and a man of tradition but he wanted a Western education for his son.Around the center of this book is where Camara Laye describes his initiation into adulthood at about the age of thirteen. He and the other boys sing while they enter the forest where they kneel with closed eyes with a roar of many lions surrounding them. Later he discovers the â€Å"rational† explanations for these frightening events, but he is wise enough to recognize that for the boys who take part in it, the ceremony i s still a true test of courage, and a real division between childhood and adulthood.The actual circumcision comes later, which he describes as â€Å"a really dangerous ordeal, and no game† Upon his return to the village, he is moved to his own hut, separated from his mother and father and he is given new â€Å"men's clothes† with quiet gratitude. This scene closes with Camara turning to his mother to thank her, who he finds standing quietly behind him, smiling at him sadly. Shortly after moving into his hut, Camara leaves at 15 years of age to attend â€Å"Ecole Georges Poiret, now known as the technical college† in Guinea's capital city of Conakry.His mother warns him to â€Å"be careful with strangers† and sends him off on a train to live with his Uncles Sekou and Mamadou in Conakry. In the school, Camara encounters difficult language barriers and a hot, humid climate more severe than his home in Koroussa. In his new school it is evident that it is more colonized. Camara lives the life of a typical college student by studying at school and going home during the breaks. As he experiences the European education, he adopts the culture associated with it.His mother changed the way his hut looks to give it a more European look, which he notices. He is aware of because the changes were making â€Å"the hut more comfortable. † Several years after leaving for Conakry, Camara returns home with his â€Å"proficiency certificate† and an offer from the director of his school to continue his studies through a scholarship, in France. While his uncles and father support and encourage him to take the foreign study opportunity, his mother is forbids him to accept the offer.He decided to accept the offer despite his mother's resistance to the idea, and parts with her and his father all while his mother was shouting insults and pushing him away. She then fell into a heap of tears, turning her anger instead to the European influences. H is father gave him with a map of city transportation of the Paris Metro in France. His father gives him the physical, practical tools for surviving in the city, but with that comes a theoretical compass directing the learning and success of his son. The mixed emotions of fear, excitement, anxiety and sadness cultivate with Camara crying as he goes to exit the plane.

Civil War Reconstruction

America between 1865 and 1876 was very broken and disunited due to the obvious Civil War. There was much effort put in my various powers to put together America again and attain the unity preferably desired by the central governing body. Both the Congress and the Citizenry participated to remedy the discretely disunited states. President Johnson, who took office right after Lincoln against the radical republicans to piece together America, is a perfect example of Congressional effort put into the problem. As for the citizenry putting in effort, the Freedmen’s Bureau and sharecropping both showed a different paradigm of the problem on a level in which the average citizens could assist in unifying America again. Through examples we will soon see exactly how the two entities combined forces of the government and the people to fight for a common goal. After the conclusion of the Civil War with the defeat of the Confederate states, an organization by the name of Freedman’s Bureau was composed to give abandoned or confiscated land to freed African Americans to live on. This land was given to them in the form of grants that were approximately 40 acres, give or take, to live on for three years. After these 3 years, they would be able to purchase the land at a very low price. This organization helped put America together again because it shows the co-op method in which the Congress set up an establishment to give freedom to the black and then the people were readily agreeing to it, not rebelling. This also changed the Citizenry’s view of slaves in a certain way. As the Dread Scott case mentioned that slaved were not people they were property, well, now they were able to purchase land. This meant that since property can not own property and only another person can own property, that people must soon see slaves as reasonably people and not property. Although not revolutionary since segregation was very common amongst both North and South states, there was still a new perspective offered to people to accept slaves as people themselves. This would soon help bring the South and North closer as they would begin to begin in soon the same ideology towards people of different colors and cultures. Another factor important in tying together America was sharecropping, which however was not as good. Sharecropping meant that a squad or family could work independently for a fixed share of crop, around ?. The positive side to this was the fact that there was no expenditure in advance of harvest. The tenant had to share the risks of crop failure or a fall in cotton prices. Blacks believed this to be helpful to them, and since it was the Citizenry who decided upon doing this, we can see that the not only the government, but all the way down to the individual person we can see that citizens would put forth effort to cooperate with the new system of social life considering slavery was no longer an option. Although in the 1870s it became a servitude type instance in which croppers lived on credit until the cotton was sold. This was en route back to a modified adaptation of slavery in this time period. However until then, it was a vital key to show the vast effort put into the bringing together of America. The president also played a vital role in the bringing together of America. President Johnson wanted to reprieve the formerly Confederate states. He believed in organizing a new government and electing new representatives for states. This was contrary to the bringing together of America. Thus his opponent, the Radical Republicans came into action. Their plan was to fully represent the southern states’ government and also used military force to do so. They also passed the Civil Rights Acts to give slaves full rights. They wanted to grant suffrage to freedmen. This political party of republicans showed that the president was overpowered and thus could not disagree otherwise as the republicans fully gained the support of the people in their cause. Because of their success in this, they were able to put together America by the use of military force, which almost always does the job as we can see the Civil War settling any social issues about slavery. The fact that people began to not only include slaves as people, but to give them rights as well was a leap for American men, especially in the South. This was all part of the effort for unity. So as we can see from the efforts of the Radical Republicans and the Freedmen’s Bureau, there is much cooperation between the Citizenry and the Congress in the unity of America pose-Civil War.

Electronic Medical Records

Electronic Medical Records Essay Cynthia Jones Grand Canyon University: HCA 450 November 11, 2012 Electronic Medical Records Essay Medical record keeping has change in the last couple of decades. In the past patients records were kept in a file on paper taking up excessive room. In the past, paper charts were the only means of keeping a patient’s medical diagnoses documented. Some of these charts are still used today in healthcare facilities, however they are slowly being replaced with a more advance method; electronic medical records (EMR’s).This virtual data–information center can serve as a vehicle to promote and to disseminate standardized data definitions and best practices to providers, consumers, and others interested in quality improvement efforts nationally and internationally (Varkey, 2010). The Electronic Medical Records is an advance computerizes medical record system that delivers medical data for physician’s office and hospitals within a matt er of seconds while offering care. This system allows the healthcare staff and physicians to modified, store and retrieves patient’s medical records.Electronic medical records are legible and organized. The Electronic Medical Record (EMR) has been around since the late 1960‘s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosis (NASBHC, 2012). However, it wasn’t until 1972 when the Regenstreif Institute developed the first medical records system. Although it was a great invention, physicians didn’t seek to use it right away.This new system would help physicians improve patients care. Although, $19 billion in stimulus funds have been invested into the Electronic health record (EHRs) another name for EMRs; the Obama administration highly suggested that health car e and hospitals facilities start to digitize patient data and start making better use of the advance technology(Greenemeier, 2010). The health care industry has been slow to adapt to this new system. Although the EMR system is intended to make patients records more accessible for the physicians and staff, still many have not implemented it yet.Given the lack of EMR adoption throughout the health care industry, less than 10 percent of U. S. hospitals have adopted electronic medical records. Cost is the primary reason many have resisted or are unwilling to adopt the EMR system and shortage on staff as well. In a recent interview on November 9, Jessica in human resource at Vineville Internal Medicine, with Dr. Mary Bell Vaughn presiding as the physician over the practice. The practice has been using electronic medical records systems since the practice open in 2002. Dr.Vaughn thought patients and staff needed easy access to their records when needed. Some of her other reasons are as fo llow: †¢ Paperless, Less storage †¢ No physician running around ( Patient info available at finger tips) †¢ Saves time spent with patient †¢ Good for tracking information †¢ Financial Good This system is web based and uses an E-Clinical program through a portal. This system also allows prescriptions to be sent to the local pharmacy as well. Blood work results are also put into the patients charts as well.Recently, the practice took on new patients with paper charts, because their physician retired. In this cause their most recent charts were converted over to EMRs. However those paper charts still exist in a small storage area if further information is needed on the patient. Though the practice implements the EMRs system from the very beginning, the physician and staff are very happy with the system. Most patient information is put into the system via computer on the spot while the patient is telling the nurse or physician what is ailing them.Although there system is a web based system, it has two backup systems in two different locations just in case the systems go down or power outage. The EMR system has had great quality impact on the practice. The patients care has been improve by the system. It allows the physician to track and effectively treat the patient. In some cases if the patient is located at another healthcare facility this system allows them to send information to multiply people for care, no matter where they are. Dr.Vaughn’s practice is already looking into the future to implement sending out text message to patients to inform them of appointments. Patients have access to their care anytime. EMR adoption is slow to be implemented into some practices. Although there is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system will reduce medical errors and help put information in front of researchers This new form of technology is here to stay and the s ooner healthcare facilities start using it the more efficient results they will receive.References Prathibha Varkey (2010). Medical Quality Management, Sudbury, Massachusetts: Jones and Bartlett Publishers. History of the Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org Will Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http://www. scientificamerican. com/article. cfm? id=electronic-health-records Electronic Medical Records Engineering Management Field Project Electronic Medical Records: A Case Study to Improve Patient Safety at Royal Victoria Teaching Hospital By Annie Bittaye Spring Semester, 2009 An EMGT Field Project report submitted to the Engineering Management Program and the Faculty of the Graduate School of The University ofK. ansas in partial fulfillment of the requirements for the degree of Master's of Science )= †¢ , , Tom Bowlin Cotntnittee Member ‘~k Committee Member Date accepted: _ _&-4–_':'†/~,,,,,,†1_-. -Q:;,,.. r5c—-_ _ Table of ContentsTable of Contents †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 List of Figures †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3 List of Tables †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Acknowledgments†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Executive Summary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Background of Royal Victoria Teaching Hospital †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Literature Review †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 Procedure and Methodology †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 Exp erimental Design †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 Survey Procedure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 18 Data Analysis †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 9 Limitations of the study †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 19 Resultsâ⠂¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 20 Reasons why EMR is not being used at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 Benefits and challenges of EMR†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 24 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 0 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 30 Suggestions for Additional Work †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 32 References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 34 Glossary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Appendix †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 36 2 List of Figures Figure 1: Sources of funding, RVTH 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 22 Figure 2: Averages ofEMR functions in order of relevance to work at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 29 List of Tables Table 1: Number of patients seen at RVTH in 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 Table 2: List of Professionals, RVTH 2009 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 0 Table 3: Computer ownership and previous computer training received by the respondents at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 28 Acknowledgments My journey towards my Master's degree was a long and fruitful one. The Engineering Management (EMGT) program has not just exposed me to much information and ideas but also opened a way towards my career path. Thank you to my parents, Ebrima and Lucy who have always been a source of great inspiration and strength to me. They taught me the value ofeducation and their prayers has always been with me.Thanks to my brother, Baboucar who encouraged me to pursue my Master's degree and the never ending support I receive from him. Special thanks to my six year old son, Ebrima for his understanding that I'm at school when I'm not home to read him a bedtime story. I also want to thank all my EMGT instructors especially Professor Herb Tuttle, Dr Tom Bowlin and Ray Dick who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her extreme support and encouragement during the course of my studies.Thanks to the staff at Royal Victoria Teaching hospital for providing me with all the needed information for this project. Last but not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you! Executive Summary Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare quality. Unfortunately, The Gambia government faces a series of health crises including but not limited to HIVIAIDS, malaria, diabetes and tuberculosis.These diseases threaten the lives of thousands of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. The contribution of this field proj ect outlines the benefits of an EMR system at Royal Victoria Teaching Hospital (RVTH) and how it will improve patient safety. This is a descriptive study using interview questionnaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in similar developing countries with advanced systems, but not so advanced as to be at the level of state-of-the ­ art facilities in the U.S. Results from this study indicates the importance of an EMR system at RVTH to facilitate effective and efficient data collection, data entry, information retrieval and report generation. As a catalyst for development, the implementation of an EMR system at RVTH may make it one on the best hospitals in the West African region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and communication of this data.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, drug resistance and treatments) and demographic information about a patient; it provides a comprehensive medical picture and can be used by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care delivery but also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman; Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent faced with many challenges ranging from epidemics, civil wars, and disasters, lacks robust healthcare infrastructure in the form of computerized h ealth care systems. For instance, Ghana has one the best health institutions in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is currently the only institution in the West African sub-region which performs surgery. Due to the quality of outcome, it now receives referrals from most parts of the continent namely the Gambia, Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d' Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which can help improve care delivery in the region. Therefore, the purpose of this study is to examine the potential benefits of EMR and its ultimate contribution to improving healthcare delivery development in less developed countries like The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small country in West Africa, with a population of approximately 1. 5 million. RVTH has been in existence for over 100 years in The Gambia's capita l, Banjul.It used to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian Government decided that it had to reduce its dependency on foreign doctors by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own initiative to take to improve the healthcare of the nation. There are 540 beds in the hospital and the two largest Departments are Pediatrics and Maternity.The biggest â€Å"killer† disease in The Gambia is malaria, with young children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems such as trachoma and cataracts are also major health problems. The following table provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure Inpatient Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1: Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not have any EMR system in place to facilitate patient safety. As noted by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of money. It looks expensive to them and also they are more used to the paper folder†. Currently, information is very fragmented and therefore does very little to help patient safety and consistency in care. Another important issue here is that a large number of these patients are illiterates. To ensure they receive the appropriate treatment, they will have to explain to the physician current medications they are taking etc.This can be a very challenging and fatal to the patient sometimes. The typical paper medical record contains sections including information on demographics, admissions, discharge summaries, progre ss notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most documentation regarding treatment of a patient is written directly in the patient's medical chart. On a given day a patient arrives at the hospital for care, sign in his name and waits anywhere from 30 minutes to six hours o get their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record must wait till it's available. Typically, medical records are transported to the outpatient clinic where the patient would be seen, and then returned to storage center to be filed again. It is necessary for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient moved to the medicine room for treatment. The purpose of this field project is to examine the potential benefits of an EMR system and its ultimate contribution to improving patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. Literature Review The first generation of EMRs was extensions of medical billing systems in large US hospitals. Over the last four decades, they have been used as tools to organize and store medical data. EMRs are widely accepted as important tools to support high quality health care in the US, Europe and other developed countries.Evidence shows that using EMRs that include decision support systems improves quality of care and both reduce medical errors and unnecessary medical investigations (Partners in Health), Experience with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is considerable interest in using medical information systems to support the treatment of HIV and TB in Africa, Latin America, and Asia. In most African countries, healthcare informati on systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time ­ consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical management. Clinicians can easily access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs.Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially unreliable with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the treatment of HIV and TB in Africa.Some examples of EMR use in Africa include: †¢ The Regenstrief Institute in collaboration with Moi University in Kenya developed an EMR for general patient visits to clinics in western Kenya. This system was subsequently modified to support the care of several thousand HIV patients. †¢ Baobab Health Partnership in Malawi has developed an EMR system using innovative, low-power touch-screen PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the Lighthouse clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. [email  protected], an HIV medical information system developed for US patients, has now been deployed in Uganda and is planned for use in other African c ountries and in Latin America. (Partners In Health) A wide-ranging literature review of electronic medical record implementation over the past decade reveals that clinical, workflow, administrative, and revenue enhancement benefits of the EMR outweigh barriers and challenges. Among other key efforts, organizations must train and motivate users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs found that electronic 11 access to clinical infonnation saves time and provides a thorough and efficient way to manage patient information To reap the full benefits of an EMR, organizations must redesign current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following goals: improve quality of care, reduce organizational expense, and produce a data stream for electronic billing. (Dassenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. ( Gaillour) The Computer-based Patient Record Institute's (CPRI) definition concurred with the other researchers, but added that the EMR provides protection of patient and provider confidentiality, has a defined vocabulary and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are unable to offer all of the components defined by the CPRI because †the technology is too complex and too expensive, doctors won't use computers, and standards don't exist. â€Å"(Gaillour) The advantages associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a dollar figure to these advantages; consequently, few organizations have published studies describing the actual costs and benefits attained from implementing EMRs. Bingham) The benefit s associated with CPRs are organized into four categories: clinical, workflow, administrative, and revenue enhancement. Renner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is probably safe to select those that can make the greatest financial difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR include: better access to the chart, improved clinical decision making and disease management, enhanced documentation, simplified patient education, and increased free time to spend with patients, accompanied by improved perception of care and quality of work life. These benefits ultimately result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in today's healthcare systems. It is evident that EMR technology is still a hot topic for discussion when browsing through current healthcare technology and management journals.The following bar riers have kept healthcare leaders discussing EMR technology instead of adopting it: cost, leadership, ROI, vendors keeping up with users' needs, and deficits in the following categories: public policy, standards, security, and a true definition. First of all, cost has kept organizations from implementing EMR systems. These costs can be organized into the following categories: software, hardware, infrastructure development and maintenance, implementation, education, planning, and administration.Software costs include development or purchase, maintenance, and upgrades over time, while hardware costs include purchase of workstations. (Mohr) Infrastructure development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosing meaningful metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, business disruption during transition, employee resistance to change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have raised capital for essential business initiatives such as major building programs, acquiring a physician network, or starting up a managed care organization. This amount of capital is on the same scale as an EMR. Next, Drazen stated that a lack of government support is a major issue holding up EMR implementation.Unfortunately, the federal government does not contribute fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface easily with each other, and databases are not easily developed. Most individual departments within a healthcare system have already invested in computerized patient information systems; however, these systems are isolated and do not communicate well with one another. Getting these systems to interface is one challenge facing EMRs. Data security continues to be an ongoing challenge.Bergman, found that politicians, consumer advocates, and the general public have voiced concerns about risks to the privacy and confidentiality of patient information. However, when compared with the security of the paper chart, the EMR's electronic audit trails and passwords actually improves internal security. The EMR may be more secure for internal breeches of confidentiality, but must also be protected from external breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits: First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensive information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identified have thus far been insurmountable, but the considerable achievements identified in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, â€Å"Success comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. † (p. 114) some organizations that invested in early EMR systems are struggling to show the qualitative benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) â€Å"If the ROI were a function of the information tool itself, the financial benefits would be experienced universally. † (ROI: The White Paper. A Business Case for Electronic Medical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work processes to make full use of the system: Healthcare organizations must first train and motivate their users on how to navigate and operate the EMR tools. To optimally use the EMR, it must be implemented from registration through billing, thus allowing the organization to realize full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to measure the economic value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and competitive advantage. It is even more difficult to allocate necessary resources and commit to institutional change when the paper chart is â€Å"getting the job done,† even if it is not in the most efficient style.However, Carlon, suggests that all providers s hould embmce the EMR to deliver safe medical care. The information in the EMR can reduce medical errors to avoid dangerous, sometimes lethal, mistakes. If organizations can't show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature emphasizes that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Gambia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorized as a non-experimental qualitative study. Initial contacts were made with the Chief Medical Director, Development Officer and the Head of Medical Records at the RVTH to solicit participants for the study. 3. 1. Experimental Design Surv ey approach was used to gather data from healthcare professionals who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A total of 50 surveys containing 15 questions were sent out and 30 of them were returned. The content of the survey designed was open-ended questions based on the following areas: knowledge of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. Other areas include, demographic details of respondents based on profession, length of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists , and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sample size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the subject as well as difficulty in getting volunteers to participate. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants on February 2, 2009. Unfortunately, five medical professionals who were initially contacted to participate in the study later declined to take part due to lack of understanding of the survey questions. As a result, different participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Gambia to facilitate the survey, one of th e administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were requested to fill out the attached survey and return it in a sealed envelope to this person or the chief administrator. After three weeks, on February 23, 2009, a first reminder was mailed asking for their cooperation and the importance of returning the survey. A final reminder was sent out on March 9, 2009, to those who might have forgotten to return the survey. 8 3. 3. Data Analysis The 30 completed surveys were coded, sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. All responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out of the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area involved, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and challenging if more professionals from other hospitals were involved in the study. Secondly, due to cost of air travel between the United States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The inability of participants to respond to some important questions on the survey skewed the data.Finally, due to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed internet or sometimes no connection at all caused the delay in receiving all the responses on time. It was also really difficult to get people to cooperate because the survey was not on their l ist of priorities. 19 4. Results Based on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. Thirty completed surveys were received which included 15 questions.The results from all participants are as follows: The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional distribution of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon Pharmacist Physician Radiologist Midwife Nurse Laboratory Technician Student No Response Total Table 2: List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To analyze this result, key words such as computerized, storage and retrieval, were used to determi ne respondents' understanding of the concept of an EMR system. Subsequently, one-third of respondents (33. 3%) who included these three key words were marked as right. While nine people representing 20% who said it is a mechanism for storing patient medical record on a computer were classified as partially right and approximately half respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified technical elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said adequate trained personnel, and one person indicated the need for money to train staff on EMR. Also availability of adequate infrastructure such as experts to support and train care providers on EMR is very crucial when implementing EMR system.However, more than half resp ondents agreed that enough infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people believed that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents reported there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven reported experts are not available; six stated experts are available but too few to meet the demand and needed training requirement of the healthcare sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed diverse opinions. Nine people said developed countries are helping, 15 responded no. However, six indicated that â€Å"the help given from developed nations are not enough and sometimes electronic devi ces sent to less developed countries like the Gambia are inferior and lack quality†.Still others think â€Å"some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector†. Lastly, seven people reported they have no idea â€Å"if developed nations are helping† and one person did not respond to this question at all. This pie chart below shows the sources of funding and the amounts received for the year 2008. Sources of Funding 2% †¢ Gambia Government †¢ Patient User Charges †¢ Donation Fund †¢ Internally Generated Fund †¢ Global Fund Severe Malaria in African Children FundFigure 1: Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of subvention received monthly or quarterly in advance. However, about 70% of the amount goes towards payment of salaries and allowances to approximately 1,200 staff. Other donations re ceived are in the fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are bulky and can take up costly space.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having immediate access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively searched and used to track, analyze, and/or chart voluminous clinical medical infonnation and processes. They cannot be easily copied or saved off-site.Also physician's orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literature review and results have proven that paper records are costly, cumbersome, misinter preted, easily misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder†.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in terms of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or awareness and fear to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many argue that positive aspects of u sing an EMR system outweigh the challenges. Even though the investments in EMR systems are costly, most argue that over time this outset cost will result in greater savmgs. As well as cost saving, many agree that one advantage of EMR system is that they save space. Instead of keeping huge paper files on patients, all records are kept on computer files. Though someone must store these records in computers, this still represents a small percentage ofthe space required to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obsolete, but they certainly do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care team to coordinate care in terms of monitoring and treating diseases. This helps avoid duplication of testing, prescribing medicines that in combination might be dangerous and the ability for anyone on the medical team to understand the app roaches taken to a condition. A person with complex health issues may see several specialists, and can easily become confused by overlapping or contrary advice.When specialists and primary care doctors use the same system for electronic medical records, then everyone on the team would be aware of all the other team members' actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patient's information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly helpful in emergency situations where a patient cannot answer questions about medical history or allergies due to extreme illness or injury. Generally, doctors are often considered to have th e worst handwriting, though this is just a generalization, unclear writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not rule out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you buy equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the transitional stage where old records haven't yet been converted and doctors don't always know this. Further, training on EMR software adds additional expense in paying people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic medical records is that doctors may have a significant learning curve when these programs are first implemented.A poor 25 typist may a ctually take a long time to input information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor distracted by confusing technology may not be as alert to a patient's symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record systems might be hacked and exploited by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authorized to do so. Misuse of private medical information could create problems for people who have conditions they wish to keep private. Despite these concerns, it appears many hospitals are no w attempting to use EMR systems.It remains unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants believe that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, â€Å"availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick diagnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptability from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. More than half of respondents said the process would be challenging initially, but eventually care providers will accept the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, â€Å"they will change when they see the importance or need for EMR† stated a participant.Others also believe it would be a â€Å"welcome idea†. The adequate protection of patient health record requires limitations at all levels, such as: collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients' interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to maintain patients' privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the surv ey results that effective implementation and utilization ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine length of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on â€Å"practitioners' ability to understand the concepts ofEMR as well as the user friendliness of the software†. Others believe â€Å"for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take longer time (approximately over a year)†. Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16

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Professional Resume and Cover Letter - Essay Example CH2M HLL is a global leader in consulting, design, design-build, operations, and program management where success of turnkey projects is critical part of organizational success. My skills and professional expertise in office management can be judiciously exploited to accelerate the progress of ongoing projects. I strongly believe that role of leaders, managers and the administrators of the organizations have increasingly become more challenging especially when new strategy and policy decisions are introduced in the organizations. As such, I have often undertaken leadership role to ensure effective feedback through participatory approach and helped solve the problems and workplace conflicts. My professional competencies, experience and my desire to acquire more knowledge would help me to become top performer in your company also. My work experience has involved extensive interaction with major clients and public, thereby equipping me with necessary traits of effective verbal communication techniques. I have attaches resume for your kind perusal. My key strength have been my ability to function under limited direction and worked independently using initiative and good judgment. I can assure you that my personal and professional competencies would add value to your organization. I would appreciate an opportunity to discuss the same with you in person and look forward to meeting you. Strong leadership initiatives in performing liaison work for CEO and proven record for excellent office management. Talent for organizing meetings and ensuring effective coordination with different stakeholders for resolving conflicts and promote communication. Highly efficient in managing confidential information and drafting agendas for important meeting and ensuring smooth conduct of the same. Exceptional organizational skills; Leadership initiative in prioritizing

Poetry Explication Essay Example for Free

Poetry Explication Essay Wordsworth is one among the best five poets in English. He wrote many poems and most of them are best known for its treatment of love for nature. â€Å"The Daffodils†, â€Å"Lines Written in Early Spring†, â€Å"To the Cuckoo†, and â€Å"My Heart Leaps Up† are very few of his poems in which the role of nature is predominant. By the close reading of the poems it is obvious that he is an ardent lover of nature. And he has the quality to heal all his deep sufferings by enjoying nature. And he insists his readers that to live in touch with nature and it will cure all their problems. Through his poems he gave such a healing power to nature. In most of his poems he considered nature as a living personality. He is a very sensitive to all changes occurred in nature. I WANTERED LONELY AS A CLOUD (THE DAFFODILS) His poem â€Å"I Wandered Lonely as a Cloud† is one of the most celebrated poem. In which the poet describes about a time when he wandered like a cloud through vales and hills. From the first line of this poem it is clear that the poet feels lonely at the time of writing this poem. Finally he saw a group of daffodils which are â€Å"fluttering and dancing in the breeze†. This is all about the first stanza of this poem. In its second stanza he started describe about the daffodils. The flowers seemed never ending so he compares it with shining stars in the Milky Way. He assumes that he might see ten thousand daffodils at a glance. This shows that the flowers are countless or large in number. And they are â€Å"tossing their heads and sprightly dance†. Here the poet is depressed internally but he tries to find happiness from his surrounding nature. In third stanza he compares the waves of the lake and daffodils. But he says that daffodils have more â€Å"glee† than the â€Å"sparking† lake. And he says that a poet can’t do anything but enjoying it. Even in his loneliness he feels some happiness inside his mind. He says that â€Å"in such a jocunt company† a poet can only enjoy it nothing more than that. He starred at the scene for a long time and he couldn’t understand what he gained by gazing at it. Here he says that nature has a power to attract any man’s attention even if the man is in depressed mood. In its last stanza he describes about what he gained from this experience. He says whenever he feels â€Å"pensive† or â€Å"vacant† this experience fills happiness in the mind of the poet and he started dancing with that flowers. It shows his change of mood after take a look of those flowers. â€Å"They flash upon that inward eye Which is the bliss of solitude; And then my heart with pleasure fills, And dances with the daffodils. † The dancing daffodils have that much influence in the mind of the poet. This experience was capable to heal the inner sufferings of him. From this poem he tries to teach the reader about the importance of man’s connection with nature. Only nature can give utmost pleasure to man than any material possession. MY HEART LEAPS UP (THE RAINBOW) This poem is one of Wordsworth’s widely accepted poems. In which he depicts about his excitements when he saw a rainbow in the sky. This poem is well known because of its simplicity in theme and its treatment of nature. Through this poem he reveals to his readers that how childishly he keeps enjoying nature. He used to see rainbow in the sky from his childhood itself. Now he is a grown up man but still he didn’t lose his spirit towards nature. In short his love for nature is consistent. We can understand it by referring many of his poems. This poem is started with the line â€Å"My heart leaps up when I behold A rainbow in the sky:† From the first line itself he started describing his cheerful experience when he saw a rainbow in the sky. According to him there is no age bound in enjoying nature. He used here present, past and future tenses only to denote his spirit of enjoying the nature. â€Å"So was it when my life began; So is it now I am a man; So be it when I shall grow old,† He says that when he was in his childhood the view of rainbow made the same effect which he feels now, in his manhood. And he wishes to continue like this in his future also. In his mind leading a life without keeping any connection with nature is worse than death. He says that in his future days if he is not capable to enjoy it then â€Å"let me die! †. He can’t think a life without nature because it is everything for him. And through these lines he also shows his consistent love towards nature. His love has same spirit throughout his life. And till his end he wishes to live in nature’s lap. Towards the end of this poem he says that â€Å"The child is father of the man;† which gives a paradoxical meaning here. Commonly we know that man is the father of child. But here he was not talking about its direct meaning. He only means that from the childhood begins manhood. Here the word â€Å"father† means one from whom something begins. The main idea of the poem lies in this line, i.e. , the present is the outcome of past and like this future will be the outcome of present. And in its concluding lines he shows his deep desire to live in connection with nature by enjoying all its varieties. â€Å"And I could wish my days to be Bound each to each by natural piety. † Through these lines he indirectly talks about his immense desire to go back to his childhood. In that age he was very cheerful. Now in his adulthood, because of the bitter experiences of his life, he wishes to attain his childhood once again and he finds that nature is the best mean to achieve it. The themes of â€Å"childhood† and â€Å"nature† are best described through this poem. â€Å"LINES WRITTEN IN EARLY SPRING†: It is a simple, lyric poem. The poet himself said in this poem that he wrote this when he sat under the shade of a group of trees. He was in a relaxing mood at that time and he sat there for a long time by enjoying the music or the sounds from his surroundings. Suddenly the music changes to a melancholy note when he started thinking about humanity. â€Å"In that sweet mood when pleasant thoughts Bring sad thoughts to the mind. † Personally the poet was in a depressed situation at that time. Because of the French Revolution there were problems concerning poverty and society. Moreover he was not take care by his uncle, who was supposed to take care of him since the death of his father, after his graduation. But when he sat under the trees he felt better and slowly it act like a healing balm of his sufferings. But suddenly things have changed. He says that the beautiful sight of nature is a bridge from human soul to god. According to him natural sights are enough to give a perpetual bliss to his mind. â€Å"To her fair works did Nature link The human soul that through me ran;† Through these lines the poet tries to spiritualize nature. He knows that spiritual life is happier than material life. Now his tiresome heart is in search for eternal pleasure. Nature is a perfect creation of god so worshipping it will also give bliss. But the thought of humanity again started disturbing him. And he thinks pathetically about the treatment given to a man by his fellow beings. â€Å"And much it grieved my heart to think What man has made of man. † From these lines he tries to say that all the sufferings of man are only because of the drifting away from nature. According to him nature is the mother of humans. From there only we get complete compensation from all our sufferings. So he indirectly says that men can’t exist without nature. Then he started describing about the flowers in that place. Primrose, periwinkle like flowers are well grown there. After gazing at them he realized that all the flowers are enjoying all their actions even their breathing. From his surroundings he wish acquire some happiness and thus feel an internal bliss. â€Å"The birds around me hopped and played, Their thoughts I cannot measure: But the least motion which they made, It seemed a thrill of pleasure Secondly he started looking at the birds around him. They were â€Å"hopped† and â€Å"played† there. Then he says that he was not able to understand their thoughts but even in their small movements poet could feel â€Å"a thrill of pleasure† in them. Poet’s mind is wounded now. But the pleasant picture of the nature changes his mood and brings happiness slowly. In its fourth stanza he started describing about the trees around him. They were all spreading their leaves to breathe the fresh air. But their also he could see only happiness. He came to a realization that nature itself is blissful. All the creatures which are living in connection with nature are all blessed with peace and happiness. In the final stanza he concludes the poem with an important question that is â€Å"what man has made of man? † He became clear about the fact that drifting away from nature is the cause of all tragedies in human life. This realization ache him very harshly. â€Å"Have I not reason to lament What Man has made of Man? † According to him man himself is only responsible for their sufferings. Throughout the poem the pleasure which he describes is something spiritual or divine and the union of man and nature is also the plan of god. Here it is well expressed the poet’s capacity to spiritualize nature. Thus this poem is all about the relationship between man and nature. â€Å"TO THE CUCKOO†: This poem is one of the best poem in which nature is reflected. Throughout this poem the poet thus the speaker addressing a bird cuckoo. Through this poem the poet welcomes the spring season in the most elegant way. He from his childhood noticed that from the beginning of this season nature seems more beautiful with the â€Å"wandering voice† of the bird cuckoo. And in this poem he indirectly depicting about his belief in supernatural elements and he states that this earth is not only for humans but also for animals, birds, supernatural elements like fairies etc. He starts the poem by calling the bird cuckoo as â€Å"a BLITHE New Comer†. He was attracted by its double fold shouting than anything. The bird is not visible to the poet. So in utter confusion he asks the bird that, â€Å"shall I call thee bird, / Or but a wandering voice? † It also shows his interest to see that bird. In its first stanza he talks about his happiness when he hear the voice of the bird. In his second stanza he describes about when he heard the shouting of the bird cuckoo. When he lied on grass he heard the voice passing through â€Å"hills to hill† but he couldn’t fix the bird and thus the shouting seems to him as a wandering voice. Even he became in confusion that whether the bird is shouting from far away or nearby place. Thus the twofold sound of that bird made him a wanderer. Wordsworth is best known as the poet of eyes and ear. In his third stanza he talks about his pleasure and his experiences after seeing that cuckoo. â€Å"Though babbling only to the Vale, Of Sunshine and of flowers, Thou bringest unto me a tale Of visionary hours. † The valley which was filled with sunshine and flowers seemed more beautiful with the voice of the bird. It gives a feast to his eyes and ears. So it made him to stay there for a long time. It brings happiness to his mind. So whenever he heard its voice his urge to see that bird increases. And in the next stanza he addresses the bird as â€Å"darling of the spring† and he welcomes it to the season. And he says to the bird that the bird is only an invisible thing to him. So he feels that the voice of that bird is something mysteries. Even an unknown sound from nature has profound influence in poet’s mind. That’s why it easily catches the attention of the poet. In its fifth stanza he describes about his childhood. Even in his childhood he wandered a lot to see this bird. He tried to see the bird by following its voice. â€Å"The same whom in my school-boy days I listened to; that Cry Which made me look a thousand ways In bush, and tree, and sky. † He says that even from his boyhood age he was fully attracted by the catching beauty of nature. In his childhood also he used to listen its music but then also he didn’t get a chance to see that bird. The bird stays by hiding itself and through its sweet sound it makes the nature more alive and thus it tries to increase its overall beauty. In his childhood he often searched it â€Å"In bush, tree and sky. † Still he keeps searching it with a hope of success. So these lines also show the theme of hope also. He didn’t tire with his thousands of attempt to see that bird. All his failures made him to search more and more. So by observing nature he got a hope for his future. He believes that one day he will meet the owner of that wandering mysterious voice. In its next two stanzas he depicts about his theme of hope and childhood. Even in his manhood also he is wandering for that bird. He has a spark of hope by the shouting of that bird. He keeps an ardent love towards the bird even if he didn’t see that bird yet. And he says that when he lied on the grass and hear the voice, it made a nostalgic effect  to his mind. He started thinking about his â€Å"golden time†, childhood. From the line, â€Å"And listen, till I do beget That golden time again. † It is obvious that his childhood was full of happiness. That is why he referred it with the word â€Å"golden time†. The music of cuckoo had made this much influence in the mind of the poet. In its final stanza he gives a supernatural power to that bird. He calls it as â€Å"O blessed bird! †. From our childhood itself we heard about the stories of fairies. Fairies are some supernatural elements which help and give happiness to others. So to him the bird cuckoo also like this. It gives intense pleasure to the mind of the people. With its sweet voice it heals the incurable wounds of the mind. In his last stanzas he indirectly depicts about his believe in supernatural elements like fairy. â€Å"O blessed Bird! the earth we pace Again appears to be An unsubstantial, faery place; That is fit home for Thee! † Through this line he says that this world is not only for humans but also for animals and other super natural elements. In his eyes the cuckoo bird is a blessed one because it has the power to heal the inner sorrows of men and it fills eternal bliss in to the mind of the humans. This poem dramatizes the conflict between appearance and reality, particularly as this conflict relates to the central symbol of the poem, the goose fish. The speaker relates the tale of two lovers who encounter a dead fish on the beach after sharing their affection with one another. While looking at the fish, the couple ponders the meaning of this fish. Taken figuratively, the goose fish occupies many roles. As the speaker overlooks the events taking place between two lovers on a beach, he introduces the goose fish as playing the part of an intruder: â€Å"Until they saw†¦ / As though the whole world had found them out, / The goose fish†¦Ã¢â‚¬  (15-17). Shortly after the lovers witness the goose fish, they ponder over what the fish’s big toothy grin â€Å"would express, / So finished a comedian† (30-31). The speaker then expresses the lovers’ thoughts that delegate the fish as an emblem of their passionate love and an optimist of their relationship. Finally, after conveying the numerous roles that the lovers attribute to the fish, the speaker expresses the lovers’ final decision to call the goose fish their patriarch who blesses their union. In reality, the fish can not realistically satisfy these roles because it has died. In this way, the speaker communicates the several roles that the lovers ascribe to the goose fish. However, the poem begins with several oddities that hint to the fact that this poem expresses more than it’s literal words. For example, the poem follows the iambic tetrameter form with each stanza closing in an iambic trimeter line. The form of the poem as well as the speaker’s neutral attitude toward the events that take place create a philosophical and detached tone that suggest that the objects and events within the poem should not be interpreted according to their denotations. Also, the rhetoric of the first line illustrates that the words in that line do not simply describe the beach. The speaker uses long vowel sounds to create the long stretch of beach that the lovers inhabit: â€Å"On the long shore, lit by the moon† (1). The syntax conforms to traditional rules so that the speaker can explicitly narrate the action happening between the two lovers: â€Å"Two lovers suddenly embraced / So that their shadows were as one† (3-4). The lovers share an intimate moment that expresses their love for one another. The vocabulary that the speaker uses such as â€Å"graced,† â€Å"prized,† and â€Å"emparadised† suggests that whenever the couple gets together, they enter their own fantasy dream world that consists of just themselves. In the second stanza, the speaker replaces his long, flowing lines with short, abrupt words to convey the fright that the two lovers experience when an outsider intrudes upon their fantasy world: â€Å"Then, as if shaken by stage-fright / Beneath the hard moon’s bony light,† (10-11). The goose fish, the central symbol of the poem, introduces himself to the pair of lovers. Even though the fish looks deceased, the use of irony that the speaker employs describes the role of the goose fish as an intruder: â€Å"Until they saw, there underfoot, / As though the world had found them out, / The goose fish turning up, though dead, / His hugely grinning head† (15-18). The normal structure of the speaker’s sentence builds up to the suspense of finding out who has trespassed into the lovers’ secret world: â€Å"They stood together on the sand / Embarrassed in each other’s sight / But still conspiring hand in hand,† (12-14). In the third stanza, the speaker describes the importance of the interrupting goose fish on the couple through an iambic trimeter line: â€Å"The only way that could be known / To make a world their own† (26-27). The lovers express astonishment in how a fish has infiltrated their fantasy world. Thus, they try to attribute their own special meaning to the fish to make him a part of their world. The speaker blends the symbols of the moon and the fish to show the merging of the heavenly, or the appearance, with the earthly, or the reality: â€Å"There in the china light he lay, / Most ancient and corrupt and gray† (19-20). As the speaker tells about the fish, he inverts the order of his sentence. The fish’s description follows the introduction of the fish. The speaker reverses his word order to place emphasis on the comparison between the heavenly moon and the earthly goose fish. Descriptive words such as â€Å"fragile† and â€Å"violence† transform the lovers’ dream world into a place of horror because an unwelcome visitor joins them. In the last two stanzas of this poem, the goose fish becomes transformed into three different roles as the lovers attempt to decipher the fish’s true meaning. At first they believe that his â€Å"wide and moony grin† transforms the fish into a comedian (28). The use of the word moony to describe the fish fully joins the symbols of the moon and the fish together. This merge represents the unity of the cosmos and that although the lovers appear to exist only in their own dream world, they still find themselves stuck in reality. The couple quickly determines that the fish does not serve as a symbol of humor, but as an emblem of their love. â€Å"But took it for an emblem of / Their sudden, new and guilty love† (33-34). Through the use of short words, the speaker infuses energy into the lovers’ new interpretation of the goose fish to convey passion and lust behind the lovers’ relationship. Finally, the couple decides to look to the fish as their patriarch and friend. When conveying this final conclusion, the speaker expresses the naivete of the lovers and their desperate attempts to extract blessings from the goose fish. However, the lovers overlook the fact that the fish has died. This use of irony shows how the appearance of the fish symbolizes a personal connection to the lovers while in reality, the dead fish cannot fulfill this role. The visual division of this poem into five stanzas serves to create a play that consists of five acts. The lovers represent the actors of a drama. The fish becomes the unwelcome audience as the lovers share their intimacy with one another. When the lovers realize that something has watched their actions, they shiver with embarrassment, or stage-fright. While pondering over the goose fish, they stand hand in hand as if waiting for the curtain call. The goose fish appears to act as the comedian whose play may end in success or failure of the lovers’ relationship. In this way, the poet reinforces the conflict between the appearance of the numerous roles of the goose fish and the reality that the goose fish no longer lives.

Female Participation in the Labour Force

Female Participation in the Labour Force INTRODUCTION Female participation in the labor force has been a compelling issue throughout the history. It is also a very dynamic topic in all countries independent of that development level. It’s because, the place of women in work life can be considered as brand-new subject compared to that of men in all societies. Therefore, from 1980’s the states which are more classified as welfare states like Sweden, Norway and The Netherlands have been trying to implement some social policies in order to increase women participation in the labor force. In this paper, I would like to propose a study to find out the relation between female participation in the labor force and social policies implemented by states. My plan is more to focus on women’s point of views and their perception of family policies. More specifically, I am interested in mothers and what sort of influences that family policies have on mothers in terms of their participation in work life. The reason makes me sceptic about this issue is that family policies can have negative results on mothers which is considered as ‘’mommy track’’ in the literature. (Ejnà ¦s, 2011, p.242) [1] As I mentioned before both women studies and welfare state studies are new phenomena and there is barely a research especially on mothers and the consequences of the policies rather than type of policies. For this reason, I believe there is a lack in the literature that allows me to make a research on this crucial issue. If there is a significant relationship between female participation in the workforce and family policies done by state? Even though my starting point is thinking that these policies have negative results on women’s participation in labor force. In literature there is quite disagreement in interpreting policies’ results as good or bad. However, even current literature is rich about consequences of family policies, there is still lack of study which looks at the issue from mothers’ point of views. Hence, through this study I would like to contribute to literature while showing mother’s perception of family policies. The proposal begins with literature review. Second, it describes offered methodology and then finally I will elaborate what kind of further studies can be done depending this research. LITERATURE REVIEW Although traditional family structure, which encourages male participation in the labor force for breadwinning, is chancing recently, parenthood still has a huge negative effects on female. That is because women are still recognized as most important caregivers. Most of the time, the place of women has been fixed within the private sphere, in other words within their home life. Thus, literature of family policies’ effects on the labor force mostly focuses on women and especially mothers. As I mentioned above, despite the fact that researchers use the same subject for their research, there is a disagreement about how do they describe the effects of family policies. Now, I will summarize some important works which try to understand issue of family policies and its effects on the female participation in the labor market. OECD (2005) focuses on the consequences of policy reforms and policies that regulate female participation in the labor market. The author accepts the flexibility of working-time arrangements, family taxation, to support to maintenance and care of children as indicators of policies that affect female participation in the labor market. OECD claims that more flexible working-time causes more opportunity to access to part-time works for women increase female participation. Moreover, if second earners of home and single earners are taxed in the same way, it would be an increase in female labor force. In addition to that according to OECD findings childcare subsidies and parental leave promote female participation but there is a trick in parental leave if it is more than 20 weeks, it begins to create negative consequences on participation rate. On the other hand child benefit reduces women participation in the labor market after the birth. Basically, they claim that longer prental leave du ration and high child benefits lead to ‘sit back and earn’ idea in families. The author uses OECD’s database and analyze 17 OECD countries for panel data regression. (OECD, 2005) Mandel and Semyonov (2006) try to understand women participation in labor market and their occupational achievement among welfare state. They assumed that the state has two dimension; as a legislator and as an employer. For both two perspectives, they claimed that family policies in welfare states increase women participation in the workforce. However, this situation does not solve the problem of gender inequality and gender wage gap. Either women get paid with lower salaries because of their ‘excuse time’ or maternal leave is given one-sided which creates an unequal division of labor between father and mother to take care their babies. They analyze 22 countries and their findings depend on Welfare State Intervention Index and Luxemburg Ä °ncome Study. (Mandel Semyonov, 2006) Warnecke (2008) conduct a research about that although Spanish government try to regulate family policies such as maternal leave, child benefits and child provision, why there is a still lower female participation in the workforce. She claims that all social policies’ consequences differ in different countries and on different group of women in one country. In the Spain case; the maternal leave has a negative impact on mother’s decision about returning work force. That is because there is a social support for a traditional division of labor in Spain. Woman who uses maternal leave start to see her child as a main occupation and do not want to reenter her position in the worklife. The author uses one case study as a method for her study.(Warnecke, 2008) Another one case study analyzes Sweden. Evertsson and Duvander (2011) analyze Sweden because that there is flexibility about length of maternal leave. They claimed that if the length of the maternal leave, which is one of the most important family policy as they claim, is more than 3 years, women would become less willing to go back to their job. In addition to this, employers become skeptic about women’s productivity and work effort. Accordingly, even though some women want to go back to their job, they have hard times to find one and because of the less opportunity of finding a job, their salaries are considered as favour by employers and they are generally lower compared to male workers who are count as more constant and reliable for companies. (Evertson Duvander, 2011) Ejnà ¦s (2011) aims to show relationship between family policies and mothers’ choices between work and childcare and perceived occupational consequences of that choices. He analyzes maternal leave and child care in 5 different countries depending on Round 2 of the European Social Survey. He uses â€Å"multivariate logistic regression model† for his research. (Ejnà ¦s, 2011, p. 246) His findings show that long maternal leave policies discourage women to go back to their work but on the other side of the coin, short maternal leave and lack of child care force women to choose early return or unemployment. In the case of mother’s perception, long maternal leave and childcare provision reduce mothers’ negative feeling about their career. METHODOLOGY First of all, family policies and mothers’ perception of career are the main concepts in this research. Family policies aim to increase women participation to labor force and they are regulated by state. These policies try to regulate market itself by taxation or women’s participation to work force. In this research, I will use length of maternal leave as an indicator for family policies. That is because only maternal leave has direct effects on mothers’ daily life. In addition to that, generally, most of the researchers consider that maternal leave is the most important measure. (Henning, Gatermann, Hà ¤gglund, 2012) I will use OECD (2005) database for operating family policies. Another concept is mothers’ perception about their future and present career. I mean that I will research mothers’ feelings and opinion about their present and future career after the maternal leave. What are the effects of state policies on mothers’ subsequent lif e outcomes? I will use mothers’ feeling and opinions about that they whatever they will come back to labor market or not as an indicator. I will use my survey’s result for operating mothers’ perception. Secondly, my research question is the following: is there a relationship between the length of maternal leave and the perception of mothers’ about their career? Accordingly, my hypothesis is that there is a relationship between the length of maternal leave and the negative perception of mothers’ about their career. In this hypothesis, the length of the maternal leave is the dependent variable and mothers’ perception is the independent variable. I measure mothers’ perception in the nominal and ordinal level by doing survey. I use ratio level of measurement for length of maternal leave. I will use qualitative methods to conduct this research. That is because mothers’ perception about their career is an empirical variable. I mean that it is a human behavior and linked to how mothers feel and act. In addition to this, I want to show that deeper causes of mothers’ non-reenter in labor market and I will not use numerical and statistical variables for my research. This kind of variable is measured by qualitative methods. Although qualitative method is the most appropriate method for my research, there are some possible disadvantages. First of all, qualitative methods are more expensive from quantitative methods and it takes more time than other methods. Secondly, in qualitative methods, researches’ bias effect is inevitable but I try to reduce this effect by my research design which I you will show next paragraph. Finally, qualitative methods are not generalizable easily because it is not statistical. I will plan to conduct a survey. This survey should be a personal interview. My target of survey must be mothers who have at least one year work experience before having baby. That is because I want to eliminate mothers who have already no willingness about their future and present career. In addition to that, I will choose mothers that are in the decision making process about their career. This process corresponds to one month ago before that maternal leave is finished. Moreover, interviewers of my research should be women. That is because mothers are more comfortable about their feelings in front of their fellows. As I mentioned above, I have a target group for my research, so my sample must be non-probabilistic and it should be purposiveness. I want to choose sample groups through Austria, France, Denmark, and United State of America, Australia and United Kingdom. I choose first three of them because that they have the longest maternal leave process. I choose United State of Ameri ca, Australia and United Kingdom because that they have the shortest length of maternal leave. (OECD, 2005) After that for each country, I will try to access mothers who have at least one year work experience by using data from public employment offices or ministries of labor. Possible questions that the survey includes will try to figure out women’s perception with as little bias as possible. For instance, participants will be asked how much time they have spent at home just because to take care of their children. This question aims to understand that to what degree women have dependency to their homes and children. Subsequently, the participants will be asked some questions about family policies of their countries. Potential questions for this section would be: (1) How maternal leave affects your feeling and opinions about your business life? (2)Why do you work before having baby? (3) Does your children have any health problem? (4) Do you have any relatives who can help you about childcare? (5) What do you think about the length of maternal leave? (6) Do you think maternal leave changes your perception about your career? (7) Are you divorced/single parent? Question 3 and 4 aim to understand if mothers are not returning their work because of economic difficulties or not and the rest of the questions intend to focus on mothers’ perception and their psychological condition about maternal leave and working after birth. Finally, I want to discuss my measurements’ reliability and validity. It should be known that each respondent has different characteristics. This diversity might reduce our survey reliability. For making my survey is more reliable I will use split half method- designing the same question in different words to eliminate different characteristics of respondents. I assume that these qualitative questions combined with field work will give me consistent results about women’s perception of maternal leave and their participation in the labor force. CONCLUSION AND FURTHER RESEARCH TOPICS In this section, I will discuss further research question that would be asked based on my potential results. First of all, I am aware that even though women perception will give us a different angle while critising family policies of the states, the culture and family structures that women are part of are very influential on women decisions. For this reason, more anthropological researchs can be done to figure out the divergence of reentering decisions of women. Each country can be elaborated with their different cultural rituals and it can be seen that to what extend that particular culture fosters gender stratification. Secondly, I will conduct my research in country-level. But, it is possible that even within a country, the regions can affect policies, perceptions and opportunities of women to return the work life. Thus, regional-level survey may help us to see regional differences if there is any. Finally, I believe the most important aspect of my research is to be based on my main target group, mothers. Thus, in any case the attempt to understand mothers’ perception on maternal leave will be valuable for further researchs both culturally and politically. REFERENCES Ejnà ¦s, A. (2011). The Ä °mpact Of Family Policy And Career Ä °nterruptions Of The Negative Occupational Consequences of Full-Time Home Care. European Societies, 239-256. Evertson, M., Duvander, A.-Z. (2011). Parental Leave- Possibility or Trap? Does Family Leave Lenght Effect Swedish Womens Labour Market Opportunities? European Sociological Review, 435-450. Henning, M., Gatermann, D., Hà ¤gglund, A. E. (2012). Pros and Cons of Family Policies for Mothers Labour Market Participation . Ä °nternational Journal of Sociology and Social Policy, 502-512. Mandel, H., Semyonov, M. (2006, may). A Welfare State Paradox: State Ä °nterventations and Womens Employment Opportunities in 22 Countries. American Journal Sociology, 1910-1949. OECD. (2005). Female Labour Force Participation: Past Trends and Main Determinants in OECD Countries. OECD ià §inde, Economic Policy Reforms 2005: Going for Growth (s. 161-174). OECD Publishing. Warnecke, T. L. (2008). Women as Wives, Mothers or Workers: How Welfare Eligibility Requirements Ä °nfluence Womens Labor Force Participation -A Case Study of Spain- . Journal of Economic Ä °ssues, 981-1004. [1] Ejnà ¦s citied this concept from Fraser,N., 1994,’After the family wage; Gender eqiuty adn the welfare state’, Political theory 22(4): 591-618