Mehmet Egirgen Essay Example

Mehmet Egirgen Essay PARAGRAPH STRUCTURE THE THREE PARTS OF A PARAGRAPH 1. TOPIC SENTENCE: States the main idea of the paragraph. It limits the topic to one specific area that can be discussed completely in the space of a single paragraph. It has two parts: a) Topic b) Controlling idea. e. g. Driving on freeways requires skills and alertness. Topic controlling idea Registering for college classes can be a frustrating experience for new students. Topic controlling idea Gold, a precious metal, is prized for two important characteristics. Topic controlling idea 2. SUPPORTING SENTENCES: develop the topic sentence. They explain or prove the topic sentence by giving more information about it. e. g. First of all, gold has a lustrous beauty that is resistant to corrosion. For example, a Macedonian coin remains as untarnished today as the day it was made 25 centuries ago. 3. CONCLUDING SENTENCE: signals the end of the paragraph and leaves the reader with important points to remember. e. g. In conclusion, gold is treasured not only for its beauty but also its utility. HOW TO WRITE GOOD TOPIC SENTENCES 1. It must be a complete sentence. 2. It must contain both the topic and the controlling idea. 3. A topic sentence is the most general sentence in the paragraph because it gives only the main idea. It doesn’t give specific details. A reader wants to know generally what to expect in a paragraph, but they don’t want to learn all the details in the first sentence. a) A lunar eclipse is an omen of a coming disaster. ______too specific. _____ b) Superstitions have been around forever. ______ too general_______ c) People hold many superstitious beliefs about the moon. ___ best TS______ d) Is made of green cheese. _____ incomplete_____ Now, it’s your turn: a) The history of astronomy is interesting. ___________ b) Ice age people recorded the appearance of new moons by making scratches ___________ in animal bones. c) For example, Stonehenge in Britain, built 3500 years ago to track the ___________ movements of the sun. d) Ancient people observed and recorded lunar and solar events in different___________ ways. ********************************************************* a) It is hard to know which foods are safe to eat nowadays. __________ b) In some large ocean fish, there are high levels of mercury. ___________ c) Undercooked chickens and hamburger may carry E. coli bacteria. ___________ d) Not to mention mad cow disease. ___________ e) Food safety is an important issue. ___________ Writing topic sentences: Read the paragraphs below. The topic sentence of each paragraph has been omitted. Try to write a suitable topic sentence for each paragraph. ______________________________________. In Beijing, China, people own over 7 million bicycles. In cities in Denmark, between 20 and 30 percent of daily trips are made on bicycles. We will write a custom essay sample on Mehmet Egirgen specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Mehmet Egirgen specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Mehmet Egirgen specifically for you FOR ONLY $16.38 $13.9/page Hire Writer In many Asian cities, bicycle-like vehicles called rickshaws carry between 10 and 20 percent of the goods moved daily. In Africa, the bicycle is the most common means of traveling intermediate distances. In Iran, too, bicycles are the primary means of transportation in such cities as Yazd and Kerman. ____________________________________. The earliest known examples of wheels are from Mesopotamia. It dates from about 3500 to 3000 BC. Wheels were first used in the cart or wagon, pulled by humans or animals. After the invention of the steam engine, wheels were driven by steam. Today, animal-drawn carts re still used in many countries. The horse-drawn chariot appeared in Mesopotamia around 2000 BC. It was later used in Egypt, Persia, Greece, Rome, and other ancient civilizations. _________________________________________. Water is often drawn from rivers, lakes, or the ocean for use in factories and power plants. This water is usually returned to the source warmer than when it was taken. This small temperature change in the body of water can drive away the fish and other animals that were originally present. It attracts other animals in place of them. The result may be fish and other wildlife deaths. ____________________________________. The United Nations (UN) estimates that the world population reached 6 billion in 1999, and is increasing by more than 77 million persons each year. The rate of increase, 1. 3 percent per year, has fallen below the peak rate of 2 percent per year attained by 1970. By the late 2040s, the UN estimates, the growth rate will have fallen to about 0. 64 percent annually. At that time more than 50 countries will experience negative growth. __________________________________________. The worlds heaviest rainfall is about 10,922 mm per year. It occurs in northeastern India. As much as 26,466 mm, or 26 m, of rain have fallen there in one year. Other extreme rainfall records include nearly 1168 mm of rain in one day during a typhoon in Philippines; 304. 8 mm within one hour during a thunderstorm in Missouri; and 62. 7 mm in over a 5-min period in Panama. HOW TO WRITE SUPPORTING SENTENCES The biggest problem in student writing is that student writers often fail to support their ideas adequately. They need to use specific details to be thorough and convincing. There are several kinds of specific supporting details: examples, statistics, and quotations. Sample paragraph: HOW TO WRITE CONCLUDING SENTENCES: A concluding sentence serves two purposes: 1. It signals the end of the paragraph. 2. It leaves the reader with the most important ideas to remember. It can do this in two ways: a) By summarizing the main points of the paragraph. b) By repeating the topic sentence in different ways. You may start your concluding sentence with one of those signals: End-of-paragraph signals followed by a comma| End-of-paragraph signals not followed by a comma| Finally, Lastly, In brief, Therefore, Thus, Indeed, To sum up. In conclusion,In short, | The evidence suggests that†¦. There can be no doubt that †¦These examples show that †¦We can see that †¦. | Now it’s your turn. Write concluding sentences for the follwing paragraps: **************************************************************************** Read the two paragraphs below and answer the questions that follow each paragraph: PARAGRAPH 1 To be able to make good coffee, you should be aware of some delicate points. First, it is very important to make sure that the pot in which you want to make coffee is clean. Dust can make your coffee bad. Second, pour some clean water into the pot, and let it boil. When the water boils, remove the pot from the stove and let it remain still for a few seconds. Next, pour some instant coffee into a cup and fill the cup with water from the pot. The Lavazza brand is the best instant coffee on the market. What is the topic sentence of the paragraph? What are the controlling ideas in the topic sentence? Circle them. Are all the supporting sentences related to the topic sentence? Are any of the sentences indirectly related to the topic sentence? Are there any sentences that do not belong? PARAGRAPH 2 An ideal husband has several characteristics. First, he must be gentle. Second, he must come from a respectable family. Moreover, he must be an honest man who always tells the truth and never cheats his wife. Loyalty is another important point in an ideal husband. Finally, he must be in an acceptable financial situation. All girls like to live in their husbands personal house, go to work in their husbands personal car, and have fun with their husbands money. What is the topic sentence of the second paragraph? What are the controlling ideas in the topic sentence? Circle them. Are all the supporting sentences related to the topic sentence? Are any of the sentences indirectly related to the topic sentence? Are there any sentences that dont belong? Why dont they fit? THE OUTLINE The outline gives you a general plan for your paragraph. It will tell you what points you should include in your paragraph. There are two types of outlines: topic outline, and sentence outline. In topic outlines, you use phrases after each head number. In sentence outlines, however, you use complete sentences after each head number. The outline below—the plays of Shakespeare—is a topic outline. As you can see, only words or phrases have been used in this outline. Notice that in writing courses, topic outlines are often preferred over sentence outlines. Developing the skill of outlining is a good help for any beginner. Outlining can give you a general plan, a platform, an emblem, or a blueprint. You can then use your outline to give organization to your paragraphs. Suppose that you are asked to write about Shakespeare. Shakespeare will be the subject of your writing. Now, it is for you to decide what to write about Shakespeare. You may decide to write about the plays of Shakespeare. This will be the topic of your paragraph. You should then narrow this topic by a number of controlling ideas. Suppose that you decide to write about three types of Shakespeares plays. You have limited your topic in terms of number and type. Now you can make the following outline: The plays of Shakespeare I. Tragedies A. Macbeth B. Othello II. Comedies A. The comedy of errors B. The merchant of Venice III. Histories A. Richard II B. Henry V This outline can then be expanded into the following paragraph: The plays of Shakespeare can be classified into three types. First, there are the tragedies. Two of his most famous tragedies are Macbeth and Othello. Shakespeare has also written a number of comedies. Shakespeares most outstanding comedies are The comedy of errors and The merchant of Venice. Moreover, some of Shakespeares plays focus on history. Richard II and Henry V belong in this category. EXERCISE 1. Read the following paragraph carefully, and: 1. Underline the topic. 2. Circle the controlling ideas. . Write an outline for the paragraph. Forests may be divided into the following six general types. First, there are the forests of the hot areas. The famous subtypes are the forests of the northern hemisphere and the oceanic forests. Second, monsoon forests are characteristic of Bengal, Myanmar, Southeast Asia, and India. Tropical forests, on the other hand, are found in regions such as the Campos of Brazil. The next ca tegory—Northern pine forests—form a worldwide belt around the earth. Next, rain forests are characteristic of central Africa and the Amazon. Finally, evergreen forests are found in North America and the Caribbean islands. 2. Write a unified paragraph on the basis of the information you get from the following outline. Types of trees I. Fruit trees A. Fleshy fruits 1. Orange 2. Apple B. Dry fruits 1. Nuts 2. Almond II. Fruitless tress A. Pine B. Oak STEPS OF WRITING A GOOD PARAGRAPH On the whole, there are eight steps for writing a good paragraph. 1. Think about the subject carefully. Example: Air pollution 2. Narrow the subject to a few topics. Example: Causes of air pollution Effects of air pollution Air pollution and the environment Air pollution versus water pollution The history of air pollution Air pollution and global warming 3. Choose one of the topics. Make sure you know about what you write. Also, make sure the topic will be of interest to the readers. Example: effects of Air pollution 4. List some details about your topic. Example: Effects of air pollution on animal life Effects of air pollution on plant life Effects of air pollution on human health Effects of air pollution on atmosphere 5. Choose the most important detail you want to communicate. It should be interesting or important to the readers too. Example: The effects of air pollution on human health 6. Write a topic sentence based on this detail. Include a few controlling ideas in the topic sentence to limit the size of your paragraph. Example: Air pollution has two major effects on human health. 7. Make an outline for the paragraph. Effects of air pollution on human health I. Physical effects A. Heart attack B. Lung cancer II. Psychological effects A. Depression B. irritation 8. Write your paragraph, using the information you have listed in the outline. EXERCISE 1. Choose one of the following subjects: coin airplane shark sea . Follow the eight steps of paragraph writing and develop a paragraph. Then read your own paragraph and try to answer these questions: 1. Is my paragraph unified? 2. Is it complete? 3. Which sentence is the most general? 4. Which sentences provide specific details to support the topic sentence? 5. Are any sentences unrelated to the topic sentence? 6. Is my paragraph sketchy? 7. What are the controlling ideas of my topic sentence? 8. Is my paragraph interesting? 9. Are my supporting sentences related to my topic sentence? 10. Is there any irrelevant supporting sentence in my paragraph?

Project Essay Example

Project Essay Example Project Essay Project Essay The polymer will lose its high bendable strength as more water is animal units bonded together. Polyvinyl acetate is a rubbery synthetic polymer. This polymer is a component in glue. Mixing borax with polyvinyl acetate will cause it to cross-link and form slime. Cross-linking is a bond that links one polymer chain to another. (see diagram below). Borax, which is also, known as sodium borate is a non- toxic substance and has a wide-variety of uses. We need to use our knowledge of chemistry to explain the physical characteristics and chemical behavior of a particular material. Our objective in this experiment was to create a polymer ball that was both echo-friendly and nontoxic. Methods/Procedures The following items were used: -Polyvinyl alcohol -Sodium borate -Polyvinyl acetate solid -Starch During week one of our experiment we used all of the ingredients that were given to us. A 10:1 ratio between polyvinyl alcohol and sodium borate was used. We used this ratio because while conducting research, there was a similar experiment to the polymer ball and it said a 10:1 ratio was used. Ml of borax and ml of polyvinyl alcohol was poured into a mall beaker. Then the mixture was stirred for about 10 minutes until the mixture became a sticky substance. Ml of polyvinyl acetate was hen poured into the mixture. The mixture was stirred for 2-3 minutes. During week two we were supposed to tweak our mixture and also make our polymer ball resistant to the heat and cold because it was going to be shipped from Florida to New Mexico to Alaska. During this experiment we changed our experiment using less ingredients and less substances. The only ingredients used were the polyvinyl alcohol and the sodium borate. Ml of polyvinyl alcohol and ml of sodium borate were mixed in a mall beaker. The mixture was stirred until it started to thicken which took about 10-15 minutes. The mixture was taken out of the beaker, and rolled into a ball for about 5 minutes then put back in the beaker and let it sit for 20 minutes. After 20 minutes, the mixture became less sticky and was easier to roll into the shape of a ball. Since we were supposed to create a ball that was resistant to different climate temperatures, the polymer ball was split into two. Half of the ball would be in hot water and the other would be in ice. Results/Discussion When the Papa and sodium borate were mixed together, the mixture became very sticky and a lot of air bubbles were formed and the mixture also foamed. The mixture kook the shape of the beaker, but when it was taken out of the beaker and was left to sit on the table, the polymer would flatten out. This is called shape memory, materials that can remember their shape after a distortion occurs and can reconfigure its shape upon a stimulus. In the second week of this experiment we planned to not use starch, or polyvinyl polyvinyl acetate solid did nothing to our product. To test the polymer ball as to whether or not the ball could withstand different temperature climates. Two tests were performed. An ice bath test, and a boiling water test. One half of the ball was tinting in a beaker of ice. As soon as the polymer was placed in the beaker it started to steam and immediately it started to freeze. The p olymer also started to flatten out. When it was taken out of the ice it was very slippery and hard to grip. It was also difficult to roll into a ball. But, after it sat in room temperature it was easier to mold into a ball and still carried the bounce that a bouncy ball should have. In boiling water experiment, water was boiled in a beaker with the use of a Bunsen burner. After the water was boiling we placed the polymer ball into the water and it melted UT didnt fully dissolve in the water. There was a layer of the polymer ball floating in the water. We collected the layer and put the substance into a beaker. When the substance cooled down and was back to room temperature, the substance became very stretchy. The polymer could also be rolled back into a ball. Conclusion In conclusion, we were not able to create a polymer ball that would be able to withstand different climate changes, but were able to create the bouncy ball. The polymers we created did bounce although they were a little floppy and werent perfect spheres. The polymer stuck to all surfaces but was easy to pull off. It was moldable and easy to form. It couldnt be pulled apart or stretched, Just squished and squeezed. When the polyvinyl acetate solid was added to our first mixture it had glue like color and no changes were made to the substance. When you add borax solution to polymers like PA, it cross-links the two polymers together like a net. Depending on how much of each ingredient is mixed you can either make a mixture that is slimy or stretchy. By adding cornstarch the mixture will be able to bend and stretch the mix. Most plastics are polymers. For example PVC pipes is the continuous linking of the same molecule.

A Relationship between Followers and Leaders Thesis

A Relationship between Followers and Leaders - Thesis Example Leadership is one of the most discussed topics in the contexts of scholarly domain, the work and organizational environment. Most authors have delved into research that is aimed at shedding light on the various leadership styles, basing their arguments on leadership theories that were earlier developed by scholars such as Conger and Kanungo, Weber, Bass and Lewin among others. Leadership in itself gives a sense of positive direction to the involvement of human resources and brings out the best from the employees thus meeting the organizational goals. Charismatic leadership, transformational leadership, autocratic leadership, and bureaucratic leadership are just but a few examples of leaderships that are applicable cross several organizations. Some leadership styles are rigid whereas some flexible to change of any sort that is inevitable in any organization.Demographic change makes leadership an aspect of critical necessity because the war of talents is getting harder than ever before . Most people are getting educated on leadership, making it necessary for the leaders to change their styles of leadership to those that are effective in meeting the organizational objectives. The best leadership style will not only be able to make a company or organizations realize its objectives but also change the face of the organization. Additionally there are also changes that are bound to take place in the organization

Abortion Essay Example | Topics and Well Written Essays - 1000 words - 7

Abortion - Essay Example topic of abortion first from a standpoint of statistical data which reinforces the fact that teen pregnancy, though declining in number, is leading to an abortion epidemic in the U.S., â€Å"In the U.S., teen abortion accounts for 19% of all procedures of this nature†(Huttenlocker, 2008). Establishing quantitative data by obtaining statistics from a reliable source is an effective approach to structuring a sound and convincing argument on any topic, especially one of this nature. Huttenlocker proceeds to establish that though teen pregnancy has actually declined in number within the last ten years, the abortion rate has not. This validates the fact that abortion is being treated as a means of birth control as opposed to being a last resort decision in extreme circumstances. By going on to include health information pertinent to teens having abortions, Huttenlocker is able to clearly establish the notion that abortion may not be the best alternative for teens, especially as a m eans of birth control, â€Å"Teens are at higher risk for post-abortion infections such as pelvic inflammatory disease (PID) and endometritis (inflammation of the uterus), which may be caused either by the spread of an undiagnosed sexually transmitted disease into the uterus during the abortion, or by micro-organisms on the surgical instruments which are inserted into the uterus†(Huttenlocker, 2008). Huttenlocker does not exhibit specific rhetoric which serves to convince his reader as much as he presents claims supported by quantitative data thus reinforcing his credibility. This method utilized by Huttenlocker leaves little room for fallacy or the suspicion of it. This article does not leave its reader in the dust as does the following article but instead, actively informs the reader without prejudice or preaching and thus should be rated as 1 out of 4, 1 being the highest rating due to skilled rhetoric, without a great deal of unsubstantiated claims or fallacies. The next article was

Bank Failures over Last 25 Years Essay Example for Free

Bank Failures over Last 25 Years Essay The banks began to fail because of misappropriation of funds and loose lending practices to the majority of the US citizens living above their means. The government estimated 2,657 closures from bank failures from 1987 to 2012 (http://bankvibe. com). Currently, there is a total 7,074 FDIC insured banks (http://www. mybankertracker. com/banks). This caused was from credit stipulations were lowered to allow the subpar credit working Americans to obtain personal loans, car, homes or other amenities. Most banks were very stable but were not prepared for the financial bubble to burst in the distance near future. Moreover, in my experience with working for a few financial institutions, I observed the credit parameters amended to fit a customer’s financial state. These loans stipulations were as follows: no documentation, no income, no assets, or no verification job; underwriting went only off credit score in some cases. The small, mid-size, and corporate banks are all competing for the public’s business which caused disarray of bad banking decisions. Hence, the banks that failed from 1987 until present time in researching last 25 years; we don’t read much about these failures in our daily newspapers, simply just; there is an over abundant of banks failures every day and this has become very common (www. davemanuel. com/history-of-bank-failures-in-the-united-states. php) Nevertheless, these banking behaviors caused a massive failure of mortgage banks and commercial banks. This caused the government to become very involved when Freddie Mac and Fannie Mae were affected by these lending behaviors (Johnson, 2010, p. 4-28). My research will display the trend of failing banks over the last 25 years and data will give insight on the numbers of banks. The Federal Reserve had centralized banking responsibility to save the banks, they deemed too big to fail. The depositors decide to simultaneously withdraw their funds from banks, which resulted in a bank panic. If several banks experience these actions at same time, this throws the banks into a bank panic. The Feds loan the banks money at a discounted rate to sustain these indiscretions (Hubbard O’brien, 2010, p. 37). Consequently, the US Congress started holding hearings, and questioning these huge corporate banks whose bonuses, incentives, and other loose business practices. These banks closed, sold, or merged with other banks to survive inevitable reality of failing (NAOAKI, 2011, p29). The investment banks were also involved in the buying and selling of bundled mortgages, investments, or other banking products to raise their capital. Lehman Brothers, Bear Stearns, and Countrywide were guilty of such practices as seen all over the TV national news. These companies have been either sold or closed down after the hearings on Capitol Hill. Currently, In order to resolve this crisis, banks have drastically changed their lending practice and the closure of failing banks has slowed down. Corporate banks were also beginning to receive stimulus funds to save them from failing. The government found themselves in a position of using the Feds to prevent catastrophic melt down of financial industry. The 12 districts are replenished to keep the general public getting loans; thus, keeping money in circulation (Hubbard O’brien, 2010, p. 438). All banks did not take the stimulus funds, but devised a plan to prevent failure. Therefore, banks had to pay back the loans in the billions, but were not charged interest if they paid the funds back early. The small to mid-size banks were left to fail, because they were not too big to fail. A double standard was shown to small businesses the backbone of America (http://economics. bout. com/). A bank of ineffective practices has shown small mom and pop banks they should not try to compete with Corporate Banking in America. They are not going to be bailed out, and allowed to fail. These small or mid-size banks are microeconomics not in macroeconomics equation of America big businesses. In conclusion, the bank failures are significant to our economy tremendously regardless the size, from the housing market, investments, or checking/savings accounts. The Feds saved the banks worth saving to boost the economy and slow down inflation. Perhaps, further research conducted to answer the following questions, and ask the questions: Do you think if people were given the stimulus funds instead of the banking institutions? What kind of economic boost would banks have, if the citizens were given stimulus funds? How does the government determine who receives funds to survive a financial set back? Why are parts of corporate America deemed too big to fail?

Nothings Changed :: Afrika Culture Cultural Poems Poetry Essays

Nothings Changed In ‘nothings changed’ Afrika describes the cultural difference between coloured people and whites. He represents this by using many different poetic techniques, he does this by emphasising that there is a cultural difference between them, he shows this by using a small village in Africa called District six. The Title of the poem suggests that when the whites destroyed District six and built a new village, for coloured and whites to mix, it did not work. He shows this with the feeling of being unwelcome, in the village that used to be his home when he was a child. In this poem the cultures are divided because of wealth and power. In stanza 1, Afrika clearly builds up a sense of his anger at the continuing injustice. As he walks through District six, once so familiar to him, he feels an outsider. He begins his poem with short monosyllabic words, ‘small round stones’, which adds a feeling of sharpness to the tone which suggests his anger. In addition, the onomatopoeia word ‘click’ emphasises his anger because of his sharp aggressive ‘ck’ sound. Secondly he begins to use harsh and aggressive words, for example the word ‘thrust’ is a very harsh and unwelcome word, and it sounds very violent and aggressive. In this poem Afrika uses the symbol of â€Å"weeds† as the weeds are unwelcome, the weeds and Afrika are similar because they are unwelcome as they are both outsiders. Afrika’s hatred for what he believes it continually discriminated, this it shown as a symbol with the ‘whites only inn’, Afrika uses a word ‘brash’ which shows his vulgar, garnish and ostentations into appearance. Also alliteration is used in ‘guards at the gatepost’ with its aggressive ‘g’ sound, to reveal how intimidating it feels. Secondly there is a sense of unwelcome ness this is symbolised with the imported trees, menus and luxury foods; additionally there is repetition of the word ‘glass’ this symbolises a barrier physical and psychological as he is not allowed in. In the poem ‘nothings changed’, Afrika compares the working-mans cafe to the up-market restaurant. He compares the imported trees, menu, to the cheap and basic cafe, this is shown by when he says ‘we know where we belong’, and this says that he knows that he can’t go into the up-market restaurant because of laws and feels that he doesn’t fit in there. Also in this stanza there is also a symbol ‘it’s in the bone’, this symbolises that his culture is inside like it is imbedded inside him, he also shows this by saying ‘wipe your fingers on your jeans’ it

Raft2 Sentinel Event

Sentinel Event: Child Abduction Description of Event A three-year-old patient presented to the hospital for outpatient surgery of bilateral myringotomies with mother. After the patient was registered, consent for surgery signed by mother, and prepped for surgery, the mother gave the pre-op nurse her phone number and left to run an errand with instructions to be called if her daughter was finished with surgery sooner than expected. The mother was expecting the patient would be ready to go home in about 2 hours.The pre-op nurse stated that she wrote down the mother’s phone number in her own notepad to call her. The patient completed surgery and was taken to recovery. At this time the recovery nurse paged out to the waiting room for the mother as parents are encouraged to come back to the recovery area as the children come out of anesthesia. With no answer from the page and the patient awake and stable, the patient was then given to the post op nurse for discharge. The post op nu rse stated that the recovery nurse had tried to page the mother, but made no mention of trying herself.The patient was becoming upset because she had not yet seen her mother. The security personnel called informing the nurse that the patient’s father had arrived and the patient happily met the â€Å"father,† so the discharge nurse waited another thirty minutes before releasing the patient to the father as there was no sign of the mother. When the mother of the patient arrived thirty minutes after the patient had been discharged looking for the patient, security was called, an internal code pink was initiated and law enforcement notified.Security stated that the mother informed them she had full custody of the patient and that the parents were divorced. The patient was found within thirty minutes in the care of the patient’s father at home. No charges were filed against the father. Roles of Personnel Registrar: A hospital registrar â€Å"performs scheduling, reg istration, verification and reception for all outpatient surgical patients (Northeast Health, 2012). † A hospital registrar is very important to hospitals, as they are the people who obtain insurance and billing information so that the hospital can get paid for the services it provides.The registrar at Nightingale Hospital stated that she entered the patient’s demographics and insurance information, obtained consent to treat the patient, and copied the patients insurance card. She did identify that, as it is not standard process, she did not ask for any other form of identification from the patient’s mother or ask about custody. At most hospitals that deal with pediatric patients, a standard part of the registration process is to have the parent’s present identification and a social security card of the patient. This is one way to help identify the parents as the parents of the patient.While custody information does not have to be given, as part of the con sent for treatment there is a clause stating that the parents who bring the child in are the only people to whom the child will be released upon discharge. Usually an identifier is placed on the parents by registration, such as a matching wristband that has the patient information and says parent, which helps staff know who to release the patient too. As there is no such process in place at Nightingale Hospital to verify parent identification, the registrar completed her job and moved on to the next patient.Pre-Op Nurse: The pre-op nurse is responsible for getting the patient ready for surgery. From â€Å"assess patient’s status, to reviewing the chart, identifying the patient, verifying the surgical site and marks site per institutional policy, establishing IV line, giving medications, and providing emotional support (Nurselabs, 2012). † The pre-op nurse stated in her interview that she was very busy the day of the patient’s surgery and did her usual assessment s and patient preparation, however she did have to run around to track down a gown.The nurse also stated that she wrote the mother’s phone number down on a notepad that she carries with her at all times. The mother requested to be called when the surgery was complete. The nurse made no mention of passing the phone number off to any of the other nurses or making a note on the chart for the other nurses to see regarding the mothers wish to be called and the number she could be reached at. The nurse also stated that she did not ask for custody information and felt that the doctor’s office should be responsible to get and give that information to the hospital.Overall the nurse did her basic work to prepare the patient for surgery. OR Nurse: The next nurse to receive the patient and have contact with her was the OR nurse. This nurse â€Å"maintains aseptic technique, controls the environment of the OR suite, transfers patient to operating room bed or table and positions th e patient: function alignment, exposure of surgical site, applies grounding device to patient, ensures that the sponge, needle, and instrument counts are correct and completes intraoperative documentation (Nurselabs, 2012). The OR nurse expressed concern in her interview that there was a possibility of this type of incident happening in other areas or departments in the facility as the OR is not the only area that separates children and parents to do procedures or tests. Overall the nurse did not identify much of her role and interactions with the patient or other staff in her interview. It is therefore assumed she did her role as described above but nothing further. Recovery Nurse: After the OR the patient was then sent to the recovery nurse.His role is to â€Å"determine the patient’s immediate response to surgical intervention, monitor patient’s physiologic status, assess and reassess patient’s pain level and administers appropriate pain relief measures, mai ntains patient’s safety (airway, circulation, prevention of injury), and assess readiness to be discharged or admitted (Nurselabs, 2012). † The recovery nurse stated that he received report from the OR nurse and took care of the patient as described above. As the patient woke up he â€Å"paged† to the waiting area to have the mom brought back.She did not answer and as the patient was stable and awake he took her to the post op nurse. There was no mention of the recovery nurse calling the mother as she had expressed to the pre-op nurse. The recovery nurse did not appear to know of these wishes, have her phone number, or be aware that the mother was not going to be in waiting room. The lack of communication from one staff member to another becomes apparent at this point in the patient’s care. The recovery nurse did not have any ideas on how to improve the system, but did express concern over lengthy and formal hand off report among nurses.The recovery nurse did not think outside of the normal standard when it came to trying to contact the patient’s mother, however he did his job according to hospital standards. Post-Op Nurse: The last phase of the patient’s care was to be transferred to the Post-Op nurse for â€Å"continued monitoring of patient’s physical and psychological response to surgical intervention, provides teaching to patient and family for discharge (Nurselabs, 2012). † The nurse stated that she was informed that the recovery nurse could not reach the mother via page.There is no mention of her trying to obtain a phone number to reach the mother. The nurse expressed that the patient was very distraught over not having her mother there. When security notified her that a person who stated he was the father was there, the nurse agreed to let him in and the patient was very happy to see him. The nurse stated in her interview that she waited for the mother, but when she did not show agreed to discharge the patient to the father’s care. The nurse did not check any identification from the father that acknowledged he was in fact the patient’s father.While the nurse did not have a specific hospital policy to follow regarding discharge of a patient, there was no extra effort on the part of the nurse to contact the mother per her report. Had there been notification on the patient chart regarding custody or a phone number the nurse could have easily verified information and not let the patient leave or gotten the mother’s approval for discharge. The nurse adequately took care of the patient during her time in the nurse’s care, however her choice to discharge the patient home without the mother was a lapse in judgment causing an error that could have potentially harmed the patient.Security: A security officer at a hospital has many responsibilities and depending on the needs of the hospital those duties may vary. Overall the officer is supposed to â€Å"write daily reports regarding the activities and disturbances (if any) that occur during his serving period, checks lights, alarm system, windows, doors, and gates, gives access to family members to see their patients, responds to any fire alarms, violent patients, and assists with helicopter landings (Sandhyarani, Ningthoujam, 2011). The security officer at Nightingale Hospital was responsible for bringing the â€Å"father† of the patient to the post-op care area to meet the patient, as well as responding to the â€Å"code pink† and notifying law enforcement of the abduction. The officer expressed concern over the delay in time of reporting the abduction when in fact, the nurse was unaware that the mother did not know the child had been discharged. The officer had an idea for using the same alarm coded bands used in the OB department with any pediatric patient and placing sensors around the hospital.It is great that he is thinking of new ways to help improve the system fro m a security standpoint. The officer responded to the situation quickly and efficiently using the information and resources he had available at the time. In the end the child was found and he therefore performed his duty quickly and efficiently. Surgeon: The surgeon’s responsibilities include ensuring that the patient is a good candidate for surgery, preparing the parents and patients for surgery, performing the surgery, overseeing the patients care post surgery. The urgeon who worked on the patient at Nightingale Hospital stated that he is the #1 ENT physician at the hospital. That implies he is very good at what he does. He stated that his office had records that state the mother is the primary custody holder of the patient and that the hospital did not get those records. While the hospital could have obtained the records, simply adding the question to the registration process would rectify the situation. The surgeon is very angry that this incident occurred and he does hav e a right as this is his patient and if these things continue to happen he will not have patients.The surgeon role is the overseer of the patient’s care before, during and after surgery. The surgeon completed the surgery and care of the patient as part of his job. Chief Nursing Officer: This person is responsible for just about anything that happens in the hospital from a nursing standpoint. This means that anything that is going right or wrong they deal with. The officer usually sits on many different committees to help with improving and maintaining staff education, competence, patient safety, and hospital management.The officer was not involved in the sentinel event, however it will be her responsibility to form committee, to complete the documentation, and to develop a way to ensure the event does not happen again. Barriers There are many different barriers that can impede effective interactions among people. These include physical, emotional, communication, language and cultural barriers (Ivanov, Tatyana, n. d). Physical barriers include demand of the nurse’s jobs including being short staffed, time constraints, technology, and unable to do face to face hand off reports. Emotional barriers include stereotyping, fear, anger, frustration, and mistrust.Communication barriers can encompass all the types of barriers. This barrier inhibits people’s ability to speak so that others understand, not all the information is given, and an inability to fully listen to what is said. Language and Cultural barriers include not being able to understand someone due to an accent, different meanings of words when translated from one language to another, and not understanding or respecting cultural views or practices. In this situation all of the staff experienced some form of barrier during the course of the patients visit. The biggest barriers appear to be communication and emotional barriers.A lack of proper hand-off report from one staff member to the next and nurses who appeared to feel overwhelmed and unsure of themselves or what to do next contributed to the patient being discharged to the wrong parent. Ways to decrease the presence of barriers and improve the staff interactions include a standardized hand off report, decreasing use of jargon or slang, giving timely feedback, decreasing physical barriers and talking in person, and learning about other cultures (Neusom, Ruby, n. d. ). Knowledge is power and the more the staff knows the better equipped they will be to identify and handle barriers as they arise.Getting a team of nurses together from multiple departments to help develop a standardized hand off report for staff will ensure that important information is passed on and not missed. In this report, staff must relay vital information for that patient as well as give report in person so that technology and language are not barriers. This will allow the staff to work together to improve their areas and it allows them to ta ke ownership of the project, meaning they will be more likely to utilize the hand off process in the future.Another way to improve interactions is to include barriers as a topic of education in the annual risk management education that staff completes each year. By helping staff to see and identify potential barriers they can hopefully prevent them from impeding patient care in the future. Quality improvement Method The quality improvement is a concept that not only hospitals but companies all over the world have been using for a very long time. Quality improvement is the process of looking forward and backward at company, process, policy, and/or safety. It is simply the process of making things better or improving them.It can be done to correct something that went wrong or used to prevent something bad from happening in the future. The method the Nightingale hospital needs to utilize is the FADE method. Focus, analyze, develop, and execute/evaluate (Wiseman, Beau and Kaprielian, Vi ctoria S, 2005). While there are many different models available in the business world today, they all have the common theme of analysis, implementation and reviewing. Different businesses tend to have different needs and therefore no model is better than another. The FADE model is useful to the hospital’s root cause analysis as it gives guidance and direction.The reason this model was chosen was because of the ease of use, the detailed direction and instruction, and the completeness of the model. This model allows the staff or committees to look at all angles of the situation and work to improve it. It is a complex model not a basic simple one, which gives better instruction. The first step of FADE is to focus. This means the hospital needs to identify a problem within the hospital and write a problem statement to help narrow down what is being looked at. The current issue is how to prevent child abductions within the hospital.While the OR is where the current event happened , it can easily become an issue for other areas of the hospital who care for children. The next step is to analyze the data and determine influential factors. This means the hospital will need to compile lists of what information is important to this case and what information is not. Collect any data about patterns and things that influence the outcomes or contribute to the problem or solution. This is the time for the hospital to evaluate what went wrong that lead to the child being discharged to a person that potentially could have not been the child’s relative.The more data that is gathered and analyzed the better understanding and better outcome the hospital can hope for in fixing the problem. The third step is to develop a plan of action. After gathering and reviewing all the information provided regarding the issue at hand. The hospital must develop a plan that helps to solve the problem. This is the time when getting people from multiple departments and areas of the ho spital will be important as each area will have a different view point that may help develop a plan that works for the majority of the people.During this stage not only does a plan need to be made but also planning to implement the plan. New policies and procedures cannot be implemented over night and expect all staff to agree and utilize it. All staff must complete proper training regarding the new plan before it can be put into use. For the hospital a plan needs to be developed that includes the input of security, OR staff, ER staff, OB staff, radiology, and administration. As multiple areas of the hospital will be affected by the new plan for pediatric patients, all those working with them should be included in the planning process.Once a plan is developed to prevent child abduction from happening again, education of all staff will be required. The last step in the quality improvement method is execute and evaluation. After staff has been trained it is time to put the plan into a ction. This is the time when committees will need to be organized to continue to evaluate and monitor the progress of the plan, keep records of the impact the plan has, and most important execute the plan. As time passes the committees will need to continue to evaluate the plan for success.If it is successful then continued monitoring is all that is needed. If the plan is not successful then the quality improvement methods starts again. It is during this phase that the hospital will need to ensure that every aspect of the plan is in place in a timely manner so that it can be properly evaluated. In this stage maintenance of the equipment and technologies will need to be completed as well as any minor adjustments to the plan that need to be made to better serve the entire staff and ensure the safety of the pediatric patients.Overall quality improvement is vital to patient safety and necessary for the continued advancement and improvement of patient care. By utilizing this method the h ospital will be able to complete a thorough root cause analysis that focuses, analyzes, develops, executes and evaluates the success and failure of the hospital. The Joint Commission requires that all sentinel events be reported and that the hospital develop a reason and solution to the problem. This method allows the hospital to follow Joint Commission Standards ensuring they keep their Joint Commission Accreditation.Corrective Action Plan: The development of risk management officers and committees started when lawsuits and insurance premiums began to rise. The goal of these people was to establish guidelines in which to help reduce and prevent errors, increase safety, and decrease financial loss. While the committees work daily to accomplish these things by utilizing a process of identifying, analyzing, treating and controlling, and evaluating (Chubb Healthcare, n. d. ), it is important to note that all staff must take an active role in risk management to ensure the hospital maint ains its high standards of care.It is the responsibility of all staff to identify areas of concern and report to the risk management committee so that changes can be made. Annual education of all staff is required on this subject to ensure that everyone is doing all they can to decrease risk. A thorough risk management program includes policies and procedures on the running of a risk management committee as well as maintenance and changes to the company’s policies and procedures to ensure compliance and proper utilization. It also has formal incident reporting, tracking and trends, and staff education.These are the basics of a very complex program that helps to decrease risk in the hospital setting. The areas that need to be changed and addressed in regards to the Nightingale Hospital is the area of policies and procedures that are related to patient safety. In ensuring patient safety the hospital can decrease the occurrence of lawsuits, decrease insurance costs, and increase staff awareness. While the risk management committee will be doing much of the initial review of the incident and changes to the policies, other committees and staff must be included in the change process.These resources include quality assurance, administration, safety and security, legal, and nurses, physicians, and other ancillary staff. The risk management committee should be reviewing the hospitals policies and procedures on a routine basis, at least annually, to look for areas of improvement, compliance with Joint Commission standards, and changes in healthcare advancements that therefore make the policies outdated. This area of the risk management program is clearly not being followed if there is no policy or procedure in place to prevent child abductions from happening in areas outside of the OB department.The risk management committee needs to address this lapse in protocol by taking five simple steps. First a review of the incident that happened, second gathering resource s to help gain insight into the different areas of the hospital, third developing a new hospital policy, fourth implementing the policy and educating staff, and lastly reviewing the policy on a annual basis to ensure compliance and monitor the need for improvement (Chubb Healthcare, n. d. ). In doing these steps the risk management committee can decrease the potential for child abductions in the hospital.First the committee must review the formal incident report, looking at the who, what, where, when, why, and how of the situation. Review any prior claims, patient complaints, staff complaints, and quality assurance reports (Chubb Healthcare, n. d. ). These allow the risk team to identify the problem and start to pinpoint the areas that need changing. The risk committee will need to work closely with the quality assurance committee, who likely have already gathered much of this information.They also will be a resource with regards to the requirements of the Joint Commission standards and be able to help identify any missteps that are resulting in non-compliance. This step needs to be completed in a timely manner, the longer it takes to get the information the longer it will take to get a new policy in place. The risk committee should set a deadline of no more than one month to complete this step. It is more likely that the committee could complete this step in two weeks but as many members may be working on other projects at the time, the committee will be allowed one month to complete this step.Next the risk management committee must meet with the different resources available to discuss the changes that need to be made to patient ensure safety. During this time the committee will hear from the legal department, safety and security department, staff from all areas of the hospital, and administrative staff. The point of this step is to gather as many ideas for change and improvement as possible from as many different aspects. As child abduction prevention is no t just security’s responsibility it will be important to understand what all staff can do (CNA, 2006).The legal department will be able to give feedback on what the hospital can and cannot do to ensure that the hospital does not develop a potential lawsuit from the new policy or lack of any previous policies. The safety and security department will be a huge resource for the risk committee as their job is to ensure that everyone stays safe. The new policy will greatly impact the security department as they will be required to potentially perform â€Å"code pink† drills, research and obtain new monitoring and sensor equipment or even increase staff levels to accommodate the increased security measures.Ensuring that the safety and security department is working closely with the risk committee will be key to ensuring a policy that is beneficial to everyone. The administrative staff involvement will be important as they will be looking at the information from a corporate s tandpoint. Their input on the policy will be centered on what is best for the hospital and how it ties into the values and standards of the corporation as a whole. They also will know budgets available for changes that need to be made to staff or security systems.The administrative resource is important because they look at the whole picture. The last resource that the risk committee will be utilizing is the staff, both clinical and non-clinical staff. This includes input from physicians, nurses, maintenance, environmental, technical support, and volunteers. These are the front line defenders when an abduction happens. These are the staff members that are present when it happens. Their input is key to being able to ensure that a new policy will help prevent any future abduction.As these staff live the day-to-day responsibilities of caring for patients, their suggestions and points of view are important. Also by having staff involved in the planning process they will be more likely t o adopt the new policy and follow it, because it will make sense to them and fit into their needs for the hospital. By utilizing all these different resources a proper policy can then be developed. This step should only take two weeks to complete. Taking longer may cause delay in development of the policy that is needed.The thirds step is to develop the new hospital policy utilizing all the information gathered from the sentinel event, quality assurance committee, and the hospital resources. The new policy must meet Joint Commission requirements for standards of care and safety of patients, as well as the hospitals needs (Chubb Healthcare, n. d. ). During this time, research for any new technology or materials to implement the new policy must be completed and quotes for pricing submitted to administration for approval. When the risk committee writes the new policy it must be written in a way that everyone can understand.This step should take no more than one month to complete. The c ommittee should spend a week reviewing all the notes and information gathered from the first two steps, then one week gathering the pricing information needed to implement the plan and then two weeks to have a completed policy. Everyone on the committee and in administration must be aware of these deadlines so that the policy can be implemented in a timely manner and all approvals completed in the appropriate deadlines. Next, the risk committee must ensure the staff is educated on the new policy and implement the policy.Live classes and computer-based learning will be important to educate all staff in the hospital on the new policy, technologies, and equipment (CNA, 2006). It is during this time that any new technology, forms, or other materials must be installed, printed, and dispersed so that when training is completed it will be ready for staff to use. This includes but is not limited to new forms for registration, new matching armbands for the children and parents, sensors aroun d the hospital that connect with the sensors in the armbands of the children, increased security staffing, etc.This step may take up to two months to complete depending on the ability of the committees to get the materials needed for training as well as materials installed and dispersed. Lastly the risk committee must continue to monitor the policy and compliance for any issues that may arise and make changes accordingly. It is recommended that with any new policy the risk committee monitor progress, compliance, and whether it is working or not by compiling risk reports on â€Å"code pinks† or other child safety reports as indicated in the policy monthly for the first year.As the hospital becomes more comfortable with the policy and it is changed to fit the needs of the hospital, and the policy has not been changed for six months; the policy can go into the yearly review area. The quality assurance committee can then continue to monitor the policy for compliance, impact, and maintenance. This last step can take up to a year, if not longer to complete depending on the needs of the hospital. Conclusion In the end a child being abducted whether by a parent who does not have custody or by a stranger is an emotionally trying experience for any parent as well as the child.All measures must be taken to ensure that the sentinel event does not occur again. By working with the quality assurance committee to utilize FADE (focus, analyze, develop, execute/evaluate), the risk management committee to create a new hospital policy, and the entire hospital staff, this will hopefully never happen again. While there are always legal and financial issues involved when something happens to a patient to compromise their safety, care, or well being, it is important that the hospital learns from these mistakes and takes action to correct them for the future.