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Jackie Robinson’s impact on culture and race
Jackie Robinson was the first African-American to
play baseball as a professional sport
Jackie Robinson (1919-1972) was
the first African American to become a professional baseball player to join the
Major Leagues. Today it may not be a surprising thing to see a Latino or
African-American player when you watch a TV channel showing Major League
Baseball. For some their favorite player could be someone of color. However baseball
game in America has not always been all that welcoming to diversity as it the
case now. This essay will discuss the accomplishments and life of Jackie
Robinson and the impact of his role as a baseball player towards the Civil
Rights movement. The essay clearly shows how Robison fought back against racial
segregation and discrimination throughout his life.
Jackie
Roosevelt Robinson became famous in 1947 for he became the first African
American to join the team in Major League Baseball. Through taking this road,
it became a crucial but difficult one. The athlete was born on Jan. 31, 1919,
in Georgia, as the youngest of five children. His father and mother separated
when he was only one year old, and his mother took him and the other siblings
to Pasadena California. Robinson grew up in poverty despite her mother’s effort
to provide the family by doing odd jobs. When Robison joined high school, he
was encouraged by his siblings to get involved in a sports team in school. He
excelled in basketball, football, baseball, and track and broke various school
records. Even in junior college, he continued to play these sports. He
considered baseball to be his weak point in all sports. He joined UCLA to
undertake his degree and was the first athlete to succeed in all the four
sports. At that time UCLA had college sports teams that were highly racially
integrated, but Robison was among the small minority non-white athletes to join
these teams.
Fighting
against racism and cultural impact
From an
early age, Robinson was aware of the racism that existed in the society. While
at a junior college in 1938 he was arrested disputing the detention of one of
his African- American friends by the police. He also managed to escape jail
sentences lasting several years, but this including many other run-ins with the
police enabled him to earn a reputation of being highly combative against the
oppression faced by the blacks. Robinson joined the U.S Army a time when the
U.S joined the World War II. His military career was filled with lots of racial
problems. For instance, he boarded a noun -segregated bus in Texas but was
given instructions to sit in the back seat, but he refused. He faced custody
for failure to a subordinate. Fortunately, he was acquitted a month later by
the all-white jury, and this event foreshadowed many other prejudices that he
had to face in his life.
With
the goal of joining the Major League teams, Robinson established relationships
with the Brooklyn Dodgers' general manager called Branch Rickey. Rickey saw
that Robison had great potential. He was also sure that Robinson would face
racial injustice and discrimination by joining the Major Leagues. Robison
became the first black man to break the racial and color barrier as a baseman
in 1880 at the age of 28. Many African Americans became his fans and started
flooding the Dodgers games. Robinson became famous since the press, and general
public gave him a positive view. He faced racial discrimination from his team
members some saying they will not play if Robinson is in the game but the
management took his side. Players were forced to play or quit by the
managements. It was the racism that the Dodgers faced the other teams that made
the later start uniting and more accepting of him.
More
African-Americans were allowed to join the Major Leagues after seeing the
success of Robinson by helping the Dodgers won the National League pennant in
1949. His use of nonviolence approach in handling racial discrimination and
insults as well as his unquestionable talent were the main points in
challenging the traditional basis of segregation which marked the various
aspects of American life. Robinson influenced the culture of American racially
segregated life and also contributed significantly to the movement of civil
rights. After being recognized for his talent through the Baseball Hall of Fame
of 1962, he encouraged voters to only look at his qualifications in the field
and not his cultural impact on the sports.
He became
the first black player to get inducted to the Cooperstown museum. Robinson
through his effort made it easier for other blacks to ignite fires towards full
equity. After the Truman’s decree of 1948, the quest for equal rights did
gather momentum. The doctrine of separate but equal that had governed the relations
of race in the US since the start of the 1900s gave way to the Board of
Education of Topeka vs. Supreme Court decision in Brown in 1954, which struck
down the legal barriers that the blacks had to face. Other changes also
followed, and the pace of the civil rights movement quickened with black
celebrities like Willie May, Larry Dobby, Monte Irvin, and Don Newcomb
continued to prove that they could play and compete alongside the white
ballplayers.
Conclusion
Thus the way Robinson managed to break down the
cultural and racial barriers in baseball it had a direct impact on other areas
specifically the social, political and economic life. Robinson’s efforts had
implications in all these areas in advancing the civil rights as well as other
general human rights in the United States and beyond.
Education
What did you learn from this
assignment?
The
most important lesson concerns the need for communication between teachers and
parents. Teachers should involve parents in their children’s schooling. There are various ways through which teachers
can involve parents in their children’s academics. This provides a great opportunity to track
how their children perform academically and socially relative to their peers. Another
lesson learned is the significance of using gifts as a reinforcement strategy
in the classroom. It is unlikely that
all students in a classroom will require a change in behavior. Depending on the behavior of concern, the
teacher can start working on changing the behavior through rewarding
consistency.
What skills you take from this
assignment to become a better teacher?
The
skill taken from this assignment is that of positive teacher-parent
communications. The manner in which teachers and parents interact affects the
level and value of parents' home involvement with children's learning. The teacher should communicate student
performance more often in order to encourage parent involvement by making
parents feel that they can effectively help their children. On the other hand,
parents get ideas from teachers on how to help and support their children when
they learn more about the class program and how it functions. Perhaps more
important, parents become more confident about the value of their involvement
in children’s education and develop a greater appreciation for the essential
role they play.
How to take this assignment and
apply it?
The
assignment acts as a good start point for initiating parent-teacher
interactions. As soon as I know which
student will be in the classroom, I will initiate contact by means of a letter
to the home or an introductory phone call to introduce myself to the parents
and establish expectations. The communication will be consistent and frequent
to ensure ongoing feedback.
Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in Write My Essay Today services. If you need a similar paper you can place your order from pay for research paper services.
"Soldier's Home" Language and personal experience
The "Soldier's Home" is a short story written by Ernest
Hemingway which has attracted much attention especially among the baby boomers
of the Vietnam era. Like most of his literary works, it is a story that is
highly complex than its surface appearance. Hemingway is well known for his
intelligent use of language especially in the use of a descriptive language
which is a subject of criticism in the story “Soldier’s Home” as being too
simple. On close examination, the story turns out not to be just a simple tale
of a young man coming home after the war, but it is a story about the struggles
in a commonplace as portrayed through the eyes of young Krebs. This style of
implied meaning and simplicity is Hemingway’s trademark, which sets him apart
from other authors.
The
Soldier’s home which is a story of Krebs is one that has its basis in the life
experience of Hemingway. Hemingway was a veteran of the WWI and had to face the
same problems as those of Krebs after returning home from war. He returned home
to the welcome of soldiers had long past, and he lost faith in institutions of
tradition, family values, and religion. As a result of the author's unique link
to Krebs, the story has an easy flow, and it comes to life as the readers read
it. Hemingway’s liberal utilization of vague passages is one of his unique
traits that are part of his stories that is noted in his writings. Such
passages are incorporated to show the mindset of Krebs. For example, the author
spends plenty of paragraphs to show the thoughts that Krebs has about girls.
Most specifically his believe that even though he admires them, he does not
want to bother them. It is found in the twelfth paragraph whereby Krebs informs
the reader that he does not want to face the consequences of having a girl then
goes on to discuss men and what ladies mean to them. It is an example of a
vague passage which has no any impact in contributing to the plot of the story.
However, it helps the reader to get to understand the main
character. We also get to find the author’s point of view through his alter ego
Krebs in that they are both emotionally traumatized after the war and are
finding it difficult to adjust back to their normal lives. They are both
haunted by the sounds of gunshots, bomb alarms and the sight of torn arms and
limbs. They also could not believe that what they saw during the war is
seething than any ordinary man could believe or understand especially in their
reluctances in telling the stories of the war. However, they found sympathy
from their fellow soldiers whenever they had to escape for a short moment.
Michael Reynolds who is the author of the biographical series of Hemingway
indicates that Hemingway was not able to inform his parents concerning his
thoughts about his bloody knee. He could not tell them how scared he was in
another in another country where the surgeon could not speak English on whether
his leg was healing or coming off. It is a reflection that is portrayed in
Krebs ability to narrate about the war with ease among soldiers of the war but
not with his parents.
Also, both men as a result
of the emotional trauma considered women to be accessories. Krebs throughout
the story repeatedly indicates that women are inferior to him even though they
are an object of his desire; they are not worth the effort and time of wooing
them to establish a relationship. Also, he did not see the need of having a
girl. That is a lesson he learned from the Army (p 346, para2). For the case of
Ernest, he was engaged to a nurse Agnus during his service in the military, but
she devastated him badly by leaving him for another soldier. To my opinion, it
is an emotion that came about as a result of his numerous failed marriages
whereby he was the one opting out of marriage to defend another heartbreak he
suffered at Agnus hands. Thus since Hemingway was not able to communicate his
thoughts and feelings verbally, he ended up embodying his experiences in Kreb’s
story.
Narrating this story of his
experience through Krebs is an aspect that influences Hemingway's
characteristic stylistic features that utilize a narrative voice in talking
about his experiences. The Soldier’s Home” shows this feature in an interesting
way despite the fact that the vocabulary and sentence structure is consistent
all through the novel. We, however, note a change in voice from the start to
the end. It starts with a voice that can appear to be omniscient, objective
third person point of view to one which is highly subjective almost becoming
the first person internal narrative. Hemingway’s narrative style is
particularly interesting and is a subject of criticism. For example, Thomas
Strychacz, who wrote the Cambridge Companion to Hemingway indicates that the
“Soldier’s home “ has a narrative voice that shows remarkable achievement of
artists. He states that “to understand the behavior of Kreb it depends partly
on how one reads the striking stylistic performance of Hemingway’s.
Particularly, how the homecoming of Kreb is delivered with obsessive
repetitiveness in a neutral flat prose which closely sounds scientifically
detached”. At the beginning of the story, the narration seems to be nearly
voiceless, and there is a wide range of declarative statements that describe in
flat detail the various photographs of Krebs. However, later in the narration,
there is a shift in voice in that the author begins to describe the thoughts
happening in Kreb’s mind.
Also because the prose is almost elliptical, the narrative ends up
leaving, out too much for its almost close to the stream of consciousness and
interior monologs as shown in the writings of modernist authors like James
Joyce and Virginia Woolf. Hemmingway’s voice is one that is sympathetic towards
Krebs and at the same time relies on dialogue to carry the story’s weight.
Conclusion
"Soldier's Home" is a short story
that is autobiographical for it reflects the experiences of Hemingway that he
choose to focus on the soldier returning home from war as his main theme.
Work cited
Hemingway, Ernest. "Soldier's Home," Scribner, 2003, pp.
67-78
Strychacz, Thomas. "In Our Time, Out of Season," in The
Cambridge Companion to Ernest Hemingway, edited by Scott Donaldson, Cambridge
University Press, 1991, p. 74-75.
Pleasure
Ethical egoism
The classical
utilitarian (consequentialist) theorists are considered to be John Stuart Mill
and Jeremy Bentham. Mill and Bentham associated the happiness of an action with
pleasure, and according to Bentham, humankind gets governed by pleasure and
pain. Bentham believed that some things give us pleasure, whereas other things
lead to pain. This basic fact explains why human beings determine some things
to be good and others evil. Bentham followed the reasoning that morality aims
at trying to bring about as much pleasure as possible and for as many people as
possible in the society, while at the same time attempting to reduce the amount
of pain in the world. When the idea that happiness equates with pleasure is
applied, the principle is said to state that an action is morally right if it
leads to the greatest amount of pleasure for the most significant number of
individuals who are affected; however, it is morally wrong of it does not
accomplish this purpose.
There are two
types of egoism namely psychological egoism and ethical egoism. A psychological
egoism would argue that humanity always inevitably acts in own self-interest.
Ethical egoism claims that an individual should make ethical decisions based on
own self-interest. According to ethical egoism, selfishness is viewed as a
virtue, and those who act in an altruistic way get regarded to be foolhardy and
unethical (Banks, 2012). Ethical egoism is an example of the Consequentialist
theory. Egoists claim that the most appropriate way to act ethically is always
to act out of self-interest. Ethical egoism is a Consequentialist theory
because to determine our self-interest, it is essential to consider the
possible outcomes and to select the one that best serves individual interests.
Human beings are described as a society of egoists, based on the shared belief
that all persons must live their lives self-interestedly, as they see fit,
without necessarily considering others. Self-interest is central to market
capitalism that exhorts us daily to nurture and take care of ourselves, to
indulge and pamper ourselves. According to ethical egoism, they are no reasons
why individuals and professionals should abide by moral standards or rules
unless they suit them.
There are three
kinds of ethical egoism namely personal ethical egoism, universal ethical
egoism, and individual ethical egoism. Personal ethical egoism argues that a
person only should act in their self-interest and all other people can do all
that they want. Individual Ethical egoism claims that all people should act in
my self-interest. Universal ethical egoism argues that all individuals should
act in their self-interest.
Ethical egoism
proposes that in the criminal justice system what should be done is whatever
brings about the most pleasure for the person. Bentham aimed at creating a more
responsive criminal justice to the needs of criminals as opposed to giving a
simple brutality as a way of deterring the individual offender and also
discouraging the masses from engaging in criminal behavior in the future (Roberson
& Mire, 2009).
Ethical egoism
is however criticized by some criminologists and scholars as they argue that
the focus on the self-interest of the ethical egoism lacks a principled
foundation and sometimes get compared to racism in its emphasis on the
interests of an individual group. In the criminal justice system, ethical
egoism would appear to supply justification to corrupt or inhumane actions by
professionals in this discipline (Maguire & Okada, 2014).
References
Banks, C.
(2012). Criminal justice ethics: Theory and practice. Sage Publications.
Maguire,
M., & Okada, D. (Eds.). (2014). Critical issues in crime and justice:
Thought, policy, and practice. SAGE Publications.
Roberson,
C., & Mire, S. (2009). Ethics for Criminal Justice Professionals.
CRC Press.
Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in Write My Essay Today services. If you need a similar paper you can place your order from pay for research paper services.
Considering the Consequences
Ethics provides
professionals in different fields with a way to make moral choices when they
encounter situations involving ethical dilemmas. In the criminal justice
system, questioning and analyzing assumptions is encouraged and should include
raising issues concerning fairness in the workplace through the creation of a
safe working environment, the limits of punishment, the role of law
enforcement, etc. Moral reasoning assists professionals in different fields
including criminal justice system to justify their actions and behavior.
Criminal justice professionals must be guided by ethical standards in the
execution of their roles, and also ethics in decision making involving force,
discretion and due process assist them to avoid abuse of powers (Hayes, 2015).
One of the
ethical standards that guide professionals in the criminal justice system is
questioning themselves whether they should always act in a way that leads to
the best possible consequences. Consequentialism is a significant and widely
discussed theory of ethical action. Consequentialism refers to a class of
normative ethical theories that contend that an action is morally right of
wrong depending on its consequences and nothing more (Banks, 2012).
Consequentialism normative theories that emphasize on the effects of one’s
actions include altruism, egoism, and utilitarianism (MacKinnon & Fiala,
2014). Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873) get regarded
as the classical utilitarian (Consequentialist) theorists. The principle of utility
laid down by the utilitarian argues that an action is right insofar as it has a
tendency to generate the greatest happiness for all the individuals affected by
the action. Act consequentialists equate good with pleasure and have the belief
that the rightness of a person’s acts should be determined depending on whether
the act results into more pleasure than pain (Sanders, Young & Burton,
2010). The act is considered morally right if it results to pleasure and is
morally wrong if it generates more pain than pleasure. Considering the morality
of the conduct of police officers; act utilitarianism would claim that their
actions are morally right and can be defended of they result in a greater
balance of happiness over unhappiness.
In the criminal
justice system, professionals must be responsible stewards over the citizens
whom they have the responsibility to protect. Professionals in the criminal
justice must ensure that all their actions produce good to the society
enhancing safety. The police officers must undertake their duties in a manner
that enhances safety and deters criminal behaviors among offenders in the
society. The correctional and prison officers must ensure that they conduct
their role in a manner that ensures that the detainees in the prisons reform.
The judges and court staff must perform their duties in a way that they promote
justice in the court proceedings. If judges convict the innocent in the
society, they would not have promoted well in the society thus their action
would be regarded as morally wrong. Rule consequentialism principles state that
an action is morally right if and only it does not violate the rules of the
state and whose general acceptance in the society would result in the best
consequences.
The theory of
consequentialism is regarded as significant in the society and plays critical
roles in promoting a safe environment for the society. All the professionals in
the criminal justice system should act in a manner that their actions produce
positive consequences. However, the criminal justice system professionals
should not solely rely on the consequentialism theory in ensuring that they act
morally right.
References
Banks, C. (2012). Criminal justice ethics: Theory and practice. Sage Publications.
Hayes, S. (2015). Criminal Justice Ethics: Cultivating the Moral Imagination.
Routledge.
MacKinnon, B., & Fiala, A. (2014). Ethics: Theory and Contemporary Issues.
Nelson Education.
Sanders, A., Young, R., &
Burton, M. (2010). Criminal justice. Oxford University Press.
Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in Write My Essay Today services. If you need a similar paper you can place your order from pay for research paper services.
Thursday, February 21, 2019
Proposal and Annotated Bibliography
The ability to access news as well as information through
online platform has made many people develop a notion that newspaper person is
doomed. Based on the historical online newspaper as well as magazine
readership, print media is still a necessity.
This is based on the fact that print newspapers are always found at
personal convenience, it is easy to refer to them, does not need digital savvy
to read and that they also have economic value after one has read them. It must also be pointed out that print
newspapers contributor a lot of jobs to the public. As such, making them
unnecessary will mean that unemployment gap will be increased. Personally, I
propose that print newspaper should remain necessary because of many
reasons. This paper will be based on
existing literature on the necessity of print newspapers.
First, print newspapers are convenient to many audiences
as compare to online newspapers. It cannot
be disputed that moist of the people who like reading newspapers are old
people. In many cases, these people are
not technologically savvy for them to use online platforms to read newspapers.
Because of this, print newspapers must remain necessary to meet the readership
demand of this section of customers.
Just as Scupola puts it, online
newspapers have challenges to some sections of readers.
Despite the fact that many people see print newspapers as
being environmentally unfriendly, sustainability of scholarly information must
be given priority. Print newspapers are
still necessary because they are sure ways of sustaining scholarly information
in full and undistorted form. Online
newspapers can be vulnerable to distortion as time goes by. Secondly, print newspapers do not require any
further logistics like accessing the internet or having a gadget that accesses
the internet. What one needs is simply to buy the newspaper. Also, the
newspaper can be read by many people in turn to save their costs. Unlike online newspapers, one will log out
his computer or will not give out his mobile phone to the other person to read
the newspaper. Based on this, print
newspapers are still necessary for more traditional readership. Nielsen asserts
that online newspapers have infiltrated and changed new media. He disputes the fact that print newspapers
are unnecessary. From my personal view, the infiltration does not warrant the
view that the print newspapers are not necessary. With the current unemployment rates, it can
become even worse if the print newspapers are abolished. Print newspapers constitute a large segment
of employment opportunities in the country.
While there can be some opposition that print newspapers pollute the
environment, it must also be known that most print newspapers are recycled and
used in other forms that are beneficial. Currently, there are many newspapers
collection management. Through standard
best practices, print newspapers are as environmentally friendly as online
ones. Based on the fact that the internet also has disadvantages such as
reliance on the power supply, print newspapers must remain necessary in the
society. Scupola qualifies the claim that online newspapers have their
challenges to the readership. While
Chowdhury accepts the fact that digital newspapers have continued to gain
ground in the current generation, he points the need to sustain scholarly
information as a necessity for print newspapers. Through the International
newspaper conference and Walravens, it is clear that print newspapers cannot be
eliminated on the grounds of conserving
the environment.
Many
of the authors who claim that print newspapers are unnecessary always argue
from the pint of impressing technology among the Millennials. They easily forget
that there is a large segment of traditional newspaper readers who are not much
into the digital error. This means that
newspapers still hold a large segment of readers and its print form must
remain. While they also point to the cost of print newspapers, they forget that
print newspapers create jobs and the newspapers can be used for another
purpose. Different people can also read
one newspaper without inconveniencing the owner. This cannot happen in online
newspapers when one sees his privacy being infringed if he allows other to read
the newspaper from his computer or tablet. Also, online newspapers add another
cost such as having a gadget that accesses the newspapers. This is different in print newspapers where
any person can buy a copy at his convenience.
In sum, print newspapers are necessary.
ANNOTATED BIBLIOGRAPHY
Chowdhury, G G. Sustainability of
Scholarly Information. , 2014. Print.
Chowdhury presents landmark text as the first attempt to
discuss the sustainable development of online newspaper information in three
aspects: economic, social and environmental sustainability. He takes the premise that online newspaper
information systems, as well as services, form the backbone of society
knowledge and digital economy. His book focuses on challenges of ensuring
sustainability of newspaper information in the digital world. Indirectly, his
work supports the view that print newspapers are necessary despite the fact
that they are not environmentally friendly.
CHUN, W. H. K., FISHER, A. W.,
& KEENAN, T. (2016). New media, old media: a history and theory reader.
The authors of this book present a comparison of Google
vs. old media which is print. In their view, online newspapers have infiltrated
and changed new media. They give an example of Google as one platform that has
directly completed with print media. On
the other hand, they assert that online newspapers are not convenient to many
people in the world based on the fact that they need internet savvy. Their book
is relevant to the topic because it supports the claim that print newspapers
are more convenient to people as they do not depend on the internet to be read.
Dillmann, Rüdiger. Ki 2010:
Advances in Artificial Intelligence: 33rd Annual German Conference on Ai, Ki
2010, Karlsruhe, Germany, September 21-24, 2010: Proceedings. Berlin [etc.:
Springer, 2010. Internet resource.
Dillmann through the 33rd Annual German Conference on
Artificial Intelligence points that newspapers news provider present
information in a personalized way. He points out that newspapers present more
value to the readership. He points that the printed newspaper are important
because they will be found at any convenience store every day and will not
suffer from internet outage. This book
is important because it presents a claim that lack of internet can make online
newspaper unreliable to the readers.
INTERNATIONAL NEWSPAPER CONFERENCE,
& WALRAVENS, H. (2008). Newspapers collection management, printed and
digital challenges: proceedings of the International Newspaper Conference,
Santiago de Chile, April 3-5, 2007 = La gestión de collections de periódicos,
desafíos an impress y digital. München, Saur.
This conference reports points out that there are many
newspapers collection management, printed as well as digital challenges. The report covers the standards, best
practices as well as digital developments in historical as well as contemporary
newspapers. These reports point out that print newspaper might be costly when
compared to an online newspaper. On the
other hand, it refutes its importance on the basis that old newspapers can find
other economic value in the society which the print ones cannot do. This conference report is well knit on the
topic because it challenges the assumption that print newspapers are expensive.
Nielsen, Rasmus K. Local
Journalism: The Decline of Newspapers and the Rise of Digital Media. , 2015.
Print.
Nielsen and Reuters Institute for the Study of Journalism
analyses the trend of newspapers. He
asserts that their circulation, as well as advertising, has continued to fall
with their readers aging. They also
assert that debt service, as well as production costs, are high in the print
newspaper. They also view stoke prizes as dropping making print media
inconvenience. Despite the fact that print newspapers are struggling to get the
new business model, the author of this book has only looked at the print
newspaper from the maker’s point of view. This book is relevant to the topic
because it tries to point out the disadvantages of print newspapers from
printer’s perspective. Because of this, it can help to build a rebuttal using
readers’ point of view.
Scupola, Adwa. Online Journalistic
Services: Online Journalistic Services. Place of publication not identified:
Idea Group Inc, 2009. Internet resource
In
his journal, Scupola asserts that print newspapers have continued to develop
their digital versions through online communications as well as the new medium.
He asserts that this process includes many shifts at the organizational level
where specific language and multimedia environment. In his journal, he sees the
change to online newspapers as posing new challenges to come. His works support the necessity of print
newspaper to online newspapers by presenting a claim that there are challenges
in making online newspapers a priority.
Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in Write My Essay Today services. If you need a similar paper you can place your order from pay for research paper services.
WORKFLOW FOR EMERGENCY DEPARTMENT
Introduction
Having healthcare workflow charts in an
organization is helpful in showing the organized processes it does and also
provides a summary for the tasks to be performed in ensuring a smooth delivery
of the healthcare services to patients. Workflows represent the simplified
methods that have been laid out in showing how certain tasks flow, the job
stages, the people doing the task and guidelines for executing the tasks. After
creating a workflow chart, it can be analyzed and streamlined to ensure that
the patient’s needs are catered for as well as ensuring that it is a safe and
efficient system for delivering healthcare services to patients. This paper
analyzes the workflow of patients being admitted to the emergency department of
a hospital after experiencing symptoms of stroke.
Explanation of the process
Workflow systems are crucial for examining and
determining the efficiency of healthcare delivery process in the healthcare
sector. Currently, there is the need for healthcare organizations to adapt the
ever-changing scientific and technological interventions, and the need to
digitalize all processes and statements in the healthcare settings (Sheehan
& Bakken, 2012). Thus it's crucial to put into consideration the nature of
tasks required by patients and the efficiency of the workflow systems that has
a way of promoting the efficacy and efficient in health care provision in the
hospital setting.
Cain and Haque (2008) indicate that the
workflow system can arise or evolve organically or it can be designed. They
also point out that a workflow system that has evolved or designed has to be monitored
by the organization’s management to ensure that it has a smooth flow and it’s
capable of promoting the efficiency of service delivery. Current organizations
have shown preferences in designing workflows that align with their operations
as well as the millennia requirements (Sheehan & Bakken, 2012). Thus the
development of the Microsoft Visio 2013 software has given many young people of
today with an excellent platform for designing their workflows using the BPMN
template.
The above diagram shows a workflow system
representing how patients with stroke symptoms have to be attended to after
arriving in the hospital. The system is a digitalized process in a way that
ensures that when patients arrive, they have to be attended to in a
patient-centered approach, given the necessary provisions in emergencies and
special cases under the directions of a triage nurse. The registration of
patient is followed immediately by electronic recording and scheduling for an
appointment while ensuring that these steps do not delay the necessary services
for a patient with stroke symptoms. Documenting the patient information
electronically helps to increase the quality of care that the patient receives.
Also, the scheduling appointment at the initial stage is crucial for ensuring
that the patients who need urgent medical attention can proceed to the
emergency department in the shortest possible time. Also, it ensures that the
limited and available resources at the hospital setting are kept in the best
possible use and ensures the handling of many patients possible. Patients
receive appointments can have the option of choosing to visit the patient
portal in which they can leave the hospital after clearing the bills.
For those in need of
emergency services, they will also have to fill in the soap notes with the help
of their family and other care teams. There is also the recording of
observations which also help to promote patient outcomes since the physician is
well knowledgeable about the system. Using the electronic recordings of the
information about the patient collected in the initial stages helps the doctor
know about the patient even before arriving at the doctor’s office. After
receiving the recorded information of the patient, the doctor sends this
information to other departments such as the emergency department, or the
physiotherapy department or the laboratory.
Patients having symptoms of stroke that are
suggestive of acute stroke are admitted to the hospital whereby they are first
examined neurologically in the emergency room. The neurologists, who are guided
by the requirements of National Institutes of Health Stroke Scale (NIHSS), will
take blood samples and place a peripheral venous catheter on the patient. Also,
a neuroradiologist will be called to do the imaging. The mostly used imaging
modality is the CT in cases of acute stroke, but it can be necessary for some
patients to use MRI. The decision to use either MRI or CT modality is under the
neuroradiologist discretion. The patient is then transferred to a respective
imaging facility which is mostly the no enhanced CT as well as CT perfusion
(CTP), and CT angiography (CTA) is carried out. The examination of MRI included
the T2-weighted sequences, diffusion weighted imaging, Time-of-Flight
MR-angiography, and perfusion. After imaging as well as exclusion of any
intracranial bleeding done by the neuroradiologist, the patient will be
administered with a recombinant tissue plasminogen activator (rtPA) if the
neurologist finds the patient to be eligible. After this, the patient is
transferred back to the emergency room for rtPA administration. The physician,
interventional neuroradiologist and the treating neurologist will evaluate the
images and discuss whether it is necessary to perform EVT. If that is the case
patient will be transferred to the angiography, and the anesthesiologist will
receive the information on the patients’ findings. The anesthesiologist places
an arterial catheter for measuring, intra-arterial blood pressure and a urinary
catheter before anesthetizing the patient. The interventional neuroradiologist
then prepares the patient for starting the treatment and for EVT.
The designing of the flow
chart shows that it gives room for an in-house lab, the prescription area, the
in-house pharmacy, and the insurance quarters. This system aims to be
patient-centered, and it allows the provision of care even before the patient
pays. Thus the system is guided by the laws of proving patent rights and dignity.
Billing is the last activity expected of the client meaning that the patient
will receive all the necessary care before finally paying for the care. Thus
the system values the client and when it's fully implemented it will boost the
outcomes as well as the efficiency of the health provider, the patient, and the
overall healthcare setting.
Metrics for measuring the
soundness of the workflow and its effectiveness
The quality of care at the ED is mainly
dependent on a clinical workflow that is efficient. The Centers for Medicare
and Medicaid Services (CMS) requires that EDs have to report all metrics on the
following aspects publicly
1. Median arrival time to the departures for
all admitted patients.
2. The median arrival
time to departure for discharged patients.
3. The median time from
the admitting discusses to departures for admitted patients.
These metrics have an impact on reimbursement.
And for the case of stroke, an efficient workflow as well as adhering to the
metrics is vital for a patient’s clinical outcome. An example of the measure is
as follows:
|
NQF #
|
Measure Title
|
Measure Description
|
Numerator Statement
|
Denominator Statement
|
|
0437
|
Ischemic stroke 4. Thrombolytic
therapy
|
Patients with acute ischemic stroke arriving
at the hospital within 2 hours of time last that is well known and those who IV t-PA was initiated within 3 hours after a well known
time
|
Patients with Acute ischemic stroke whom were initiated with IV thrombolytic
therapy within 3 hrs of last well known
time
|
Patients with Acute ischemic stroke whose arrival time is within 3 hours of time
last known well.
|
Metrics are crucial since they affect the
scores of patient satisfaction which are publically reported and also impacts on
the volume of patients being treated at the ED is a specific period of time.
Areas for improvements
The workflow is somehow
complicated, and it shows the inefficient use of all practitioners’ time that
is providing care and treatment to patients with stroke symptoms. A lot of time
is taken at the point of care desk whereby the assisting nurse is asking lots
of preliminary questions, taking her vitals, physical examinations, and Soap
notes and adding the information on the computer. This excessive delay is a
risk to the life and health of patients. Also sitting in the waiting room as
the patient waits for diagnostic tests and for the triage nurse to complete
with previous patients is an area that requires improvements. The nurse is also
interrupted severally with calls about patients and visits from other nurses as
the patients are answering questions for their SOAP notes.
In the end, the patient
can spend more than thirty minutes instead of the required 15 to 20 minutes.
Also, tests are delayed in that collection of sample urine takes place two
hours after patient’s arrival. Thus the flow chart of the ED can be improved
trough the use of throughput analytics and via Value-stream mapping. The value
stream mapping helps to pinpoint the potential areas of improvement of the
process. The throughput analytics are the benchmarks for tracking improvements
such as ED waiting times both during the day or night, average arrival to a
room, volumes over time, ED comparisons; ED visits by the clinical program.
Summary
Knowing the effectiveness of a workflow of a
process or activity is crucial for improving patient satisfaction scores. With
the current technology, patients can rate the performance of hospitals online,
and the outcomes are publicly reported. These ratings also get tied to CMS
reimbursements. If a patient has to wait for long durations before receiving
treatment, there is a high chance of other patients leaving the hospital
without being seen. Thus it reduces the possible admission and volume of
patients and also potentially dangerous to those patients who are undergoing
serious health issues. Thus using metrics enables health organizations to
improve the efficiency of their workflows which impact on improving patient’s
volume that the ED can treat in the shortest possible time. Also having an
extra soft capacity in workflow enables the EDs to get patients into beds in
the shortest time possible and reduces the time for testing as well as speeding
discharges.
Reference
Cain, C.,
& Haque, S. (2008). Organizational Workflow and Its Impact on Work
Quality - Patient Safety and Quality - NCBI Bookshelf.
Sheehan, B.,
& Bakken, S. (2012). Approaches to Workflow Analysis in Healthcare
Settings.
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