Monthly Archives: July 2018

Synthesis is the act of creating something new from multiple existing entities.

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Synthesis is the act of creating something new from multiple existing entities. Synthesis of research, then, is creating a new idea from existing ideas. It is a process developed through time and practice. In this assignment, you will apply the synthesis process to the journal readings from the first four modules of this course. As you synthesize, remember that Freud and the Psychodynamic and Psychoanalytic theory suggest that early stages of human development have a significant impact on our relationships and our Ego throughout the life span. This leads to the notion that manifested behavior is based on latent problems of the past.
Use the following information to ensure successful completion of the assignment:
• Refer to the annotated bibliography and outline you created in the Module 2 assignment along with the assignment feedback from your instructor.
• Review the journal readings from the first four modules of this course. You may wish to create annotations for the readings from Modules 3 and 4 for use in the synthesis process.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center.
Directions:
Locate the annotated bibliography and outline you created in the Module 2 assignment. Using the outline you developed, the information from the annotated bibliography, and the feedback provided by your instructor, write a paper (2,000-2,250 words) that synthesizes all of the articles assigned in the first four modules of this course. Do that by including the following:
1. A statement of common themes addressed in each of the articles.
2. A statement of the conclusions that can be drawn when the articles are taken together as a single entity. What is the overall message of the group of articles? Focus specifically on the key developmental terms, processes and challenges that individuals may face up through adulthood. Why are the unconscious mind, dreams, and ego defense mechanisms important to understand from the Psychoanalytic perspective? Be sure to address the notion that Freud and the Psychodynamic and Psychoanalytic theory suggest that early stages of human development have a significant impact on our relationships and our Ego throughout the life span.
Pages does not include Reference Page
I will email all of the articles
Instruction are attracted as well



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Research a manufacturing company for the final project.

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Research a manufacturing company for the final project. Your research should be significant.

The manufacturing company that you will research is Pepsi CO.

 



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Which of the 2 options in Growing Trees case study would you choose and why?

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Watch TED TALK.

https://www.ted.com/talks/audrey_choi_how_to_make_a_profit_while_making_a_difference?language=en&utm_source=tedcomshare&utm_medium=email&utm_campaign=tedspread
READ THE CASE STUDY

http://www.nytimes.com/2013/09/12/business/smallbusiness/a-fast-growing-tree-service-considers-selling-franchises.html?ref=topics
Which of the 2 options in Growing Trees case study would you choose and why?

Reply to two students.
Do you agree or disagree.



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Once I have two students I will email you back for the replies to be completed.

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Download Reference 1 and read the instructions

Once I have two students I will email you back for the replies to be completed. As of right now, go ahead and do the intial post first. Below are the links you need for this assignment.

https://www.amazonrobotics.com/#/
http://www.nielsen.com/content/dam/nielsenglobal/vn/docs/Reports/2015/Nielsen%20Global%20E-Commerce%20and%20The%20New%20Retail%20Report%20APRIL%202015%20(Digital).pdf



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How should employers deal with situations in which performance problems might be related to employees’ disabilities?

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1.How should employers deal with situations in which performance problems might be related to employees’ disabilities? Search the Internet for and review the Gambini v. Total Renal Care case. In that case, did the employer violate the ADA by terminating the disabled employee? What did the court decide? Do you agree with the court’s decision? Why, or why not?

Your response should be at least 150 words in length. You must use at least your textbook to complete this assignment. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. All references and citations used must be in APA style.

2. Review the McDonald’s strip search incident. Imagine a scenario that is not quite as egregious as the one referenced. Instead, imagine that a female assistant manager performed the same cavity search of the 18-year-old female employee because she thought the employee had stolen some money from the register. The assistant manager was alerted by a co-worker that the female employee in question had just walked from the front of the store (where the registers are located) immediately to the employee bathroom with some paper-like object balled up in her hands. The female employee was humiliated by the search and felt sexually assaulted by the assault and helpless because she was held there for three hours despite her objections. In this changed scenario, do you believe McDonald’s would have faced a similar judgment from the courts ($6 million award and guilty of negligence, sexual harassment, and false imprisonment)? Why, or why not? What defense(s) would the employer likely raise in order to try and justify the actions taken? Do you think these defenses would be persuasive? Why, or why not?

Your response should be at least 150 words in length. You must use at least your textbook to complete this assignment. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. All references and citations used must be in APA style.

3.

What is the hazard communication standard? Explain how this standard applies to the workplace. What should employers do in order to be compliant with this standard? What are the possible implications to an employer for failure to adhere to this standard?

Your response should be at least 150 words in length.

4.A research analyst for the Indiana Department of Corrections was told that she would have to submit to a psychological examination in order to keep her job. She took the exam, which lasted two hours and contained many questions related to details of her personal life. She sued, claiming that the test violated her constitutional rights. What should the court decide (your opinion)? Why? After writing your initial thoughts, use the Internet to look up the case. What was the actual decision, and why? (Greenawalt v. Indiana Department of Corrections, 397 F.3d 587 [7th Cir. 2005])

Your response should be at least 150 words in length.



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A Fortune 500 employer wishes to lay off 25% of its workforce due to rapidly declining sales.

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1. A Fortune 500 employer wishes to lay off 25% of its workforce due to rapidly declining sales. The employees vary in age and length of service, with half of the employees being above the age of 40 and half being below the age of 40. Also, half of the employees have been with the employer in excess of 10 years. What legal consideration(s) must the employer assess before engaging in this reduction-in-force?

Your response should be at least 150 words in length.

2. An employer fires an employee in an employment-at-will state. The employee knows that the termination was not discriminatory but is concerned that the termination might have had to do with his outspoken nature about what he deemed to be unethical marketing practices of the employer. What possible legal theory(ies) might the employee be able to advance against the employer?

Your response should be at least 150 words in length.



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Critically analyze the standards/ guidelines: Early Learning Standards NAEYC

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Critically analyze the standards/ guidelines:
Early Learning Standards NAEYC and Scott-Little_Lesko_Martella_Milburn_2007_Early Learning Standards Results from a Naitonal Survey-1
What are the strengths ,
what are the weaknesses?



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Joint Position Statement of the National Association for the Education of Young Children (NAEYC)

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         Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved.            A Joint Position Statement of the National Association for the Education of Young Children (NAEYC) and the National Association of Early Childhood Specialists in State Departments of Education (NAECS/SDE)        Early childhood education has become part of a standards-based environment. More than 25 states have standards* describing desired results, outcomes, or learning expectations for children below kindergarten age; Head Start has developed the Head Start Child Outcomes Framework; and national organizations have developed content standards in areas such as early literacy and mathematics. This movement presents both opportunities and challenges for early childhood education. Rather than write a new set of standards, in this statement the National Association for the Education of Young Children (NAEYC) and the National Association of Early Childhood Specialists in State Departments of Education (NAECS/SDE) address the significant educational, ethical, developmental, programmatic, assessment, and policy issues related to early learning standards. The position statement outlines four features that are essential if early learning standards are to be developmentally effective. The recommendations in this position statement are most relevant to young children of preschool or prekindergarten age, with and without disabilities, in group settings including state prekindergarten programs, community child care, family child care, and Head Start. However, the recommendations can guide the development and implementation of standards for younger and older children as well.                                                              *The National Center for Culturally Responsive Educational Systems (NCCRESt) defines standards as “the broadest of a family of terms referring to expectations for student learning.” This position statement uses the term early learning standards to describe expectations for the learning and development of young children. Narrower terms included in standards and early learning standards are content standards (“summary descriptions of what it is that students should know and/or be able to do within a particular discipline” [Mid-continent Regional Educational Laboratory (McREL)]); benchmarks (“specific description of knowledge or skill that students should acquire by a particular point in their schooling” [McREL]—usually tied to a grade or age level); and performance standards (“describes levels of student performance in respect to the knowledge or skill described in a single benchmark or a set of closely related benchmarks” [McREL]). Important, related standards that are not included in this position statement’s definition of early learning standards are program standards: expectations for the characteristics or quality of schools, child care centers, and other educational settings. It should be noted that Head Start uses the term performance standards in a way that is closer to the definition of program standards—describing expectations for the functioning of a Head Start program and not the accomplishments of children in the program. A working group of representatives from NAEYC, the Council of Chief State School Officers (CCSSO), the Educational Resources Information Center (ERIC), and other groups is developing a more complete glossary of terms related to standards, assessment, and accountability. naeyc         Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved.   The first years of life are critical for later outcomes. Young children have an innate desire to learn. That desire can be supported or undermined by early experiences. High-quality early childhood education can promote intellectual, language, physical, social, and emotional development, creating school readiness and building a foundation for later academic and social competence. By defining the desired content and outcomes of young children’s education, early learning standards can lead to greater opportunities for positive development and learning in these early years. NAEYC and NAECS/SDE take the position that early learning standards can be a valuable part of a comprehensive, high-quality system of services for young children, contributing to young children’s educational experiences and to their future success. But these results can be achieved only if early learning standards (1) emphasize significant, developmentally appropriate content and outcomes; (2) are developed and reviewed through informed, inclusive processes; (3) use implementation and assessment strategies that are ethical and appropriate for young children; and (4) are accompanied by strong supports for early childhood programs, professionals, and families. Because of the educational and developmental risks for vulnerable young children if standards are not well developed and implemented, the recommendations in this position statement are embedded in and refer to the principles set forth in NAEYC’s code of ethical conduct.1 According to this code, early childhood professionals and others affecting young children’s education must promote those practices that benefit young children, and they must refuse to participate in educational practices that harm young children. Thus, a test of the value of any standards effort is whether it promotes positive educational and developmental outcomes and whether it avoids penalizing or excluding children from needed services and supports.            NAEYC and NAECS/SDE have developed this position statement, and invited other associations to support and endorse its recommendations, in order to • Take informed positions on significant, controversial issues affecting young children’s education and development • Promote broad-based dialogue • Create a shared language and evidence-based frame of reference so that practitioners, decision makers, and families may talk together about early learning standards and their essential supports • Influence public policies—those related to early childhood systems development as well as to the development, implementation, and revision of standards—that reflect the position statement’s recommendations • Stimulate investments needed to create accessible, affordable, high-quality learning environments and professional development to support the implementation of effective early learning standards • Strengthen connections between the early childhood and K–12 education communities • Build more satisfying experiences and better educational and developmental outcomes for all young children         One of NAEYC’s first publications, written in 1929, was called Minimum Essentials for Nursery Education. 2 Since then, NAEYC has developed criteria for accrediting early childhood education programs,3 teacher education standards,4 guidelines for developmentally appropriate practice,5 and, in partnership with NAECS/SDE, curriculum and assessment guidelines.6 NAEYC publications7 have also described the role of professional organizations’ content standards in early childhood education. Yet the U.S. standards movement in elementary and secondary education, begun in the 1980s, did not have an immediate impact on education before kindergarten. In recent years, however, increased public awareness of the importance of early education, the expanded involvement of public schools in education for 3- and 4- year-olds, and reports from the National Research Council, including the influential report Eager to Learn, 8 have stimulated a rapid expansion of the standards movement into early education. Preliminary results from a recent national survey show more than 25 states with specific child-based outcome standards for children younger than kindergarten age.9 The Head Start Bureau has established the Head Start Child Outcomes Framework10 describing learning expectations in each of eight domains. Professional associations have developed content standards in areas including early mathematics and literacy.11 National reports and public policies have called for the creation of standards—variously         Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. including program standards, content standards, performance standards, and child outcomes—as part of a broader effort to build school readiness by improving teaching and learning in the early years.      Early childhood is a distinct period of life that has value in itself as well as creating foundations for later years. States and others must consider the characteristics of early childhood as the standards movement extends into the years before kindergarten: • The younger children are, the harder it is to create generalized expectations for their development and learning, because young children’s development varies greatly and is so heavily dependent upon experience.12 • This variability also creates greater challenges in assessing young children’s progress in meeting standards or achieving desired results.13 • To a greater extent than when children are older, young children’s development is connected across developmental domains, with progress in one area being strongly influenced by others. This again has implications for how standards are written and implemented. • Young children’s development and learning are highly dependent upon their family relationships and environments. The development and implementation of early learning standards must therefore engage and support families as partners.14 • Our youngest children are our most culturally diverse.15 Early learning standards must take this diversity into account. In addition, many children transition from culturally familiar child care programs and family environments into settings that do not reflect their culture or language. These discontinuities make it difficult to implement early learning standards in effective ways. • Early childhood programs include an increasing number of children with disabilities and developmental delays.16 These children must be given especially thoughtful consideration when states or others develop, implement, and assess progress in relation to early learning standards. • Finally, settings for early education before kindergarten vary greatly in their sponsorship, resources, and organization—far more than the K–12 system—and the vast majority of those programs are not regulated by public schools. In such a fragmented system, standards cannot have a positive effect without intensive attention to communication, coordination, consensus building, and financing.             Reflecting on this expanded interest; on more than a decade of experience with systems of K–12 standards, curriculum, assessment, and accountability; and on the experience of a number of states and professional organizations, NAEYC and NAECS/SDE see risks as well as significant potential benefits in the movement toward early learning standards. Both need to be taken into account as early learning standards are developed and implemented.    The major risk of any standards movement is that the responsibility for meeting the standards will be placed on children’s shoulders rather than on the shoulders of those who should provide opportunities and supports for learning. This risk carries especially great weight in the early years of schooling, which can open or close the door to future opportunities. Negative consequences potentially face children who fail to meet standards, because the data may be used to label children as educational failures, retain them in grade, or deny them educational services.17 Culturally and linguistically diverse children, and children with disabilities, may be at heightened risk. Other issues also require thoughtful attention. The development of high-quality curriculum and teaching practices—essential tools in achieving desired results— can be forgotten in a rush from developing standards to assessing whether children meet the standards. Standards can also run the risk of being rigid, superficial, or culturally and educationally narrow. In the K–12 arena, at times standards have driven curriculum toward a more narrowly fact- and skill-driven approach with a resulting loss of depth, coherence, and focus. In the early childhood field, this trend could undermine the use of appropriate, effective curriculum and teaching strategies. Finally, the K–12 experience has shown that even the best-designed standards have minimal benefit when there is minimal investment in professional development, high-quality assessment tools, program or school resources, and a well-financed education system.18  Despite these cautions, past experience also suggests that under the right conditions early learning standards can create significant benefits for children’s learning and development.19 Eager to Learn,20 From Neurons to Neighborhoods, 21 and other reports underscore young          Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. children’s great capacity to benefit from experiences that are challenging and achievable. Clear, researchbased expectations for the content and desired results of early learning experiences can help focus curriculum and instruction, aiding teachers and families in providing appropriate, educationally beneficial opportunities for all children. These opportunities can, in turn, build children’s school readiness and increase the likelihood of later positive outcomes. Besides their potential benefits for young children, early learning standards may carry other advantages. The process of discussing what should be included in a standards document, or what is needed to implement standards, can build consensus about important educational outcomes and opportunities. Strong reciprocal relationships with families and with a wide professional community can be established through these discussions. Families can expand their understanding about their own children’s development and about the skill development that takes place in early education settings, including learning through play and exploration. Teachers, too, can expand their understanding of families’ and others’ perspectives on how children learn. Carefully developed early learning standards, linked to K–12 expectations, can also contribute to a more coherent, unified approach to children’s education. Educators, families, and other community members see the connections between early learning opportunities and positive long-term outcomes. For example, they can see that standards emphasizing the value of conversations with toddlers are based on evidence that such conversations promote acquisition and expansion of vocabulary in preschool, which in turn predicts success in meeting reading standards in the early elementary grades.22 Finally, a developmental continuum of standards, curriculum, and assessments, extending from the early years into later schooling, can support better transitions from infant/toddler care through preschool programs to kindergarten and into the primary grades, as teachers work within a consistent framework across educational settings.                 In order for early learning standards to have these benefits for young children and families, NAEYC and NAECS/ SDE believe that four essential features must be in place: • significant, developmentally appropriate content and outcomes • informed, inclusive processes to develop and review the standards • implementation and assessment strategies that are ethical and appropriate for young children • strong supports for early childhood programs, professionals, and families Recommendations in each of these areas follow, with a brief rationale for each. NAEYC and NAECS/SDE have grounded these recommendations in a knowledge base that includes educational, developmental, and policy research; positions and other statements by our own and other organizations and agencies; and promising practices in a number of states.              ! To be effective, early learning standards must explicitly incorporate (1) all domains of young children’s development; (2) content and desired outcomes that have been shown to be significant for young children’s development and learning; (3) knowledge of the characteristics, processes, and sequences of early learning and skill development; (4) appropriate, specific expectations related to children’s ages or developmental levels; and (5) cultural, community, linguistic, and individual perspectives. • Effective early learning standards give emphasis to all domains of development and learning. Young children’s development is strongly interconnected, with positive outcomes in one area relying on development in other domains. Therefore, early learning standards must address a wide range of domains— including cognitive, social, emotional, physical, and language development; motivation and approaches to learning; as well as discipline-specific domains including the arts, literacy, mathematics, science, and social studies. Three recent early childhood reports from the National Research Council (Preventing Reading Difficulties,23 Eager to Learn,24 and From Neurons to Neighborhoods25) explicitly underscore this point. K–12 standards have often focused on academic subject matter rather than including other domains. When standards give undue weight to only a few content areas while ignoring or lessening the importance of other areas, young children’s well-being is jeopardized. Because research has emphasized how powerfully early social and emotional competence predicts school readiness and later success, and because good early environments help build this competence, this domain should          Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. be given explicit attention in early learning standards.26 At the same time, early learning standards must create and support expectations that promote children’s learning in areas such as language, literacy, and mathematics,27 which have at times been underemphasized or inappropriately taught. • The content and desired outcomes of early learning standards are meaningful and important to children’s current well-being and later learning. In creating early learning standards, states and professional organizations must answer the “so what” question: What difference will this particular expectation make in children’s lives? Standards developed for elementary and secondary education have varied in how well they address the issue of meaningfulness. Those standards that focus on the “big ideas” within domains or academic disciplines appear better able to support strong curriculum, high-quality assessments, and positive results for children.28 Longitudinal research may provide guidance in selecting significant content for early learning standards—if a specific piece of learning appears to make little difference for children’s current well-being or later outcomes, then it may not be worth attending to in a standards document. • Rather than relying on simplifications of standards for older children, the content and desired outcomes of effective early learning standards are based on research about the processes, sequences, and long-term consequences of early learning and development. Pressures to align standards with those in the K–12 system can influence standards for younger children in undesirable ways. For instance, working backward from standards for older children, some may reason that if the kindergarten standards say that 5-year-olds are expected to count to 20, then 4-year-olds should be expected to count to 10 and 3-year-olds to count to 5. This simplified approach to alignment contradicts developmental research consistently showing that earlier forms of a behavior may look very different from later forms.29 One example is the finding that nonacademic strengths such as emotional competence30 or positive “approaches to learning”31 when children enter kindergarten are strong predictors of academic skills in later grades. For these reasons, early learning standards should be built forward, from their earliest beginnings, rather than being simplified versions of standards for older children. The result will be more powerful content and more valid expectations for early learning and skill development. With this process, early learning standards do align with what comes later, but the connections are meaningful rather than mechanical and superficial. • Effective early learning standards create appropriate expectations by linking content and desired outcomes to specific ages or developmental periods. An especially challenging task is to determine how the expectations in early learning standards may best be linked to specific ages or developmental levels. When a standard is written to cover a wide age spectrum—for example, ages 3 through 6—adults may assume that the youngest children should be accomplishing the same things as the oldest children, leading to frustration both for the youngest children and for their teachers. Conversely, with such broad age ranges for standards, adults may also underestimate the capacities of older children, restricting the challenges offered to them. Alternatives are available. Reports on standards development work from the U.S. Department of Education’s Mid-Continent Regional Educational Laboratory (McREL)32 recommend broadly written content standards but with specific grade-level benchmarks being used to describe year-by-year knowledge and skills related to a particular standard. Yet yearly age- or grade-level expectations may also ignore the wide developmental variability of young children who are the same age or in the same year in school, including children with disabilities. For early learning standards, then, a good approach may be to provide flexible descriptions of research-based learning trajectories or developmental continua, referring to but not tightly linked to age-related yearly accomplishments (as in NAEYC and the International Reading Association’s joint position statement “Learning to Read and Write: Developmentally Appropriate Practices for Young Children”33). • The content of effective early learning standards, and expectations for children’s mastery of the standards, must accommodate the variations—community, cultural, linguistic, and individual—that best support positive outcomes. To do so, early learning standards must encompass the widest possible range of children’s life situations and experiences, including disabilities. Young children’s learning is intimately connected to and dependent upon their cultures, languages, and communities. Research shows that there are wide cultural variations in the experiences and developmental pathways taken by young children, as well as in children’s individual needs, including those of children with disabilities.34 Early learning standards should be flexible enough to encourage teachers and other professionals to embed culturally and individually relevant experiences in the curriculum, creating adaptations that promote success for all children.          Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved.          ”  #   ! The processes by which early learning standards are developed and reviewed contribute to their credibility and effectiveness. These processes should rely on appropriate expertise, stakeholder involvement, and regular evaluation and revision. • The process of developing and reviewing early learning standards relies on relevant, valid sources of expertise. Effective early learning standards are developed through a process that uses scientifically valid, relevant evidence to create and review expectations about content and desired outcomes for young children. A sound knowledge base of developmental and educational research exists, including syntheses recently published by the National Research Council,35 as well as publications from national professional associations.36 Over time, standards also require rigorous validation through studies demonstrating that the expectations in the standards do indeed predict positive developmental and learning outcomes. • The process of developing and reviewing early learning standards involves multiple stakeholders. Stakeholders may include community members, families, early childhood educators and special educators, and other professional groups. In all cases, those with specific expertise in early development and learning must be involved. The wide range of cultures, communities, settings, and life experiences within which young children are educated, the critical importance of families in early learning, and the educational significance of transitions into infant-toddler care, preschool, kindergarten, and beyond,37 make it essential to engage many participants in developing and refining early learning standards. States and other groups must find effective ways to bring a wide range of stakeholders to the table, creating opportunities for dialogue between the public school community and others responsible for children’s early learning.38 • Once early learning standards have been developed, standards developers and relevant professional associations ensure that standards are shared with all stakeholders, creating multiple opportunities for discussion and exchange. Standards documents that just sit on shelves cannot be part of an effective early childhood system. Multiple sectors of the early childhood community (e.g., community child care, early intervention, family child care), as well as the K–3 community, families, and others committed to positive outcomes for young children, can develop an understanding of how standards may be used effectively in early childhood education. This requires that standards be communicated in clear language. It also requires commitment from standards developers and from early childhood professional associations to create ongoing dialogue about early learning standards and their implications. • Early learning standards remain relevant and research based by using a systematic, interactive process for regular review and revision. The advancing knowledge base in education and child development, as well as changing community, state, and national priorities, require that standards be regularly reexamined using processes like those used in the standards’ initial development. In addition, as K–12 standards are revised and revisited, standards for children below kindergarten age should be part of the process, so that expectations align meaningfully across the age and grade spectrums.              $   #  ”! Perhaps the greatest difficulty in creating early learning standards is to establish valid, effective, ethically grounded systems of implementation, assessment, and accountability. In their joint position statement on curriculum and assessment,39 NAEYC and NAECS/SDE offer detailed guidelines for the positive uses of child assessment, screening, and accountability systems. NAEYC’s code of ethical conduct40 provides further professional guidance. The recommendations that follow build on these position statements with specific focus on assessments that are linked to early learning standards. • Effective early learning standards require equally effective curriculum, classroom practices, and teaching strategies that connect with young children’s interests and abilities, and that promote positive development and learning. Early learning standards describe the “what”—the content of learning and the outcomes to be expected— but they seldom describe the “how.” While research does not support one best approach to teaching young children,41 it consistently emphasizes the need for curriculum, educational practices, and teaching strategies that respond to children’s needs and characteristics. Language-rich interactions and relationships with adults and peers; challenging, well-planned curriculum offering depth, focus, choice, engagement, investigation, and representation; teachers’ active promotion of concept and skill development in meaningful contexts;          Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. adaptations for children with disabilities and other special needs; an integrated approach to teaching and learning—these are just some of the components of the rich curriculum and repertoire of teaching strategies42 that are essential to young children’s learning. • Tools for assessing young children’s progress must be clearly connected to important learning represented in the standards; must be technically, developmentally, and culturally valid; and must yield comprehensive, useful information. Assessment is an essential component of effective early childhood education,43 and the development of appropriate assessments has long been a priority in the field. Appropriate assessment begins with a comprehensive understanding of what is to be assessed—in this case, the content and desired outcomes expressed in early learning standards. Broad, significant content cannot be assessed with narrow instruments. Beyond the important requirements of technical adequacy (reliability and validity), assessments must also be developmentally valid, including observations by knowledgeable adults in real-life early childhood contexts, with multiple, varied opportunities for assessment over time. Of special importance when developing standards-related assessments are the needs of culturally diverse children and children with disabilities. In addition, the information yielded by these assessments must be useful to practitioners and families. A number of states have intentionally addressed these critical assessment issues when developing their early learning standards. Assessments that are developed or adopted to use with early learning standards should follow the same principles that have been articulated in the joint position statement of NAEYC and NAECS/SDE on curriculum and assessment44 and by other professional groups such as the Commission on Instructionally Supportive Assessment convened by the American Association of School Administrators (AASA), the National Association of Elementary School Principals (NAESP), the National Association of Secondary School Principals (NASSP), the National Education Association (NEA), and the National Middle School Association (NMSA),45 the National Education Goals Panel (NEGP),46 the American Educational Research Association (AERA), the American Psychological Association (APA), the National Council on Measurement in Education (NCME),47 and the National Association of School Psychologists (NASP).48 Using instruments that were designed for older children to assess younger children’s learning is unacceptable. Pulling poorly conceived assessments off the shelf to meet an immediate need, when these assessments do not align meaningfully with the standards or with young children’s characteristics, contradicts these expert recommendations. Such assessments yield developmentally, educationally, and culturally meaningless information. Assessments that are appropriate for young children, including classroom-based assessments, are available in all domains of development and learning and for a variety of specific assessment purposes. Professionals need not and cannot compromise assessment quality. • Information gained from assessments of young children’s progress with respect to standards must be used to benefit children. Assessment and accountability systems should be used to improve practices and services and should not be used to rank, sort, or penalize young children. Professional associations are unanimous in stating that, whenever learning is assessed and whenever assessment results are reported, children must benefit from that assessment. These benefits can and should include improvements in curriculum and teaching practices, better developmental outcomes, greater engagement in learning, and access to special interventions and supports for those children who are having difficulty. The misuse of assessment and accountability systems has the potential to do significant educational and developmental harm to vulnerable young children. Children’s failure to meet standards cannot be used to deny them services, to exclude them from beneficial learning opportunities, or to categorize them on the basis of a single test score.49 For example, families should not be advised to keep a child out of kindergarten because a single test shows that their child has not met certain standards. Such misuses of standards-related assessments violate professional codes of ethical conduct.50 %!      &         # # ! Even the best standards for young children’s learning will be ineffective unless early childhood programs themselves meet high standards, and unless programs, professionals, and families are strongly supported. • Research-based standards for early childhood programs, and adequate resources to support high-quality programs, build environments where early learning standards can be implemented effectively. Research has identified the kinds of early environments and relationships that promote positive outcomes for children.51 Using this knowledge, national accreditation systems such as that of NAEYC52 define         Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. and assess early childhood program quality. In creating a system of standards for early education, a few states have begun by developing program standards before turning to content or performance standards for young children, believing that clear expectations and supports for program quality are an essential first step. • Significant expansion of professional development is essential if all early childhood teachers and administrators are to gain the knowledge, skills, and dispositions needed to implement early learning standards. Well-educated, knowledgeable, and caring teachers are the key to positive outcomes for children.53 Efforts to create early learning standards must be accompanied by in-depth professional development, coaching, and mentoring for teachers, administrators, and teacher educators—not just about the standards themselves, but also about the appropriate curriculum, teaching strategies, relationships, and assessment tools that together make up a systematic approach to improving outcomes for all children. • Early learning standards will have the most positive effects if families—key partners in young children’s learning— are provided with respectful communication and support. Families’ hopes and expectations play a critically important role in early development.54 Families and other community members also provide many of the experiences and relationships needed for young children’s success. Any effort to develop and implement shared expectations or standards for early learning will be more successful if families are well supported as part of the process.    This position statement is subtitled “Creating the Conditions for Success.” In describing the four conditions under which effective early learning standards can be developed and implemented, NAEYC and NAECS/SDE set forth significant challenges to states, professional groups, and the early childhood field. Important, developmentally appropriate content and outcomes; informed, inclusive processes for standards development and review; standards implementation and assessment practices that promote positive development; strong supports for early childhood programs, professionals, and families—each of these requires substantial commitment of effort and resources. Shortcuts are tempting. Yet when these conditions are met, early learning standards will contribute to a more focused, responsive, and effective system of education for all young children.   In July 2000, NAEYC’s Governing Board voted to give focused attention to early learning standards, as a high priority issue for the organization. Following Board discussions and dialogue at several conference sessions, NAEYC’s Governing Board decided to develop a position statement articulating principles or criteria for developing, adopting, and using early learning standards. NAEYC’s long history of collaboration with the National Association of Early Childhood Specialists in State Departments of Education quickly led to a decision by both organizations to create a joint position statement.            !”#  !”$%$       ‘   The processes used to develop the position statement have been collaborative, beginning with the establishment of a joint working group and an invitation to multiple stakeholder organizations and experts to help identify the key issues that the position statement should address. Conference sessions and e-mail distribution to the organizations’ members, other groups, and individuals with special expertise were used to seek feedback on drafts of the position statement. After further input and revisions, NAEYC’s Governing Board and the membership of NAECS/SDE voted to approve the position statement on November 19, 2002. “&&!’         Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. 1 NAEYC. 1998. Code of ethical conduct and statement of commitment. Rev. ed. Washington, DC: Author. 2 National Association for Nursery Education. 1929. Minimum essentials for nursery school education. Chicago, IL: Author. 3 NAEYC. 1998. Accreditation criteria and procedures of the National Association for the Education of Young Children. Washington, DC: Author. 4 NAEYC. 2001. NAEYC standards for early childhood professional preparation. Washington, DC: Author 5 Bredekamp, S., & C. Copple, eds. 1997. Developmentally appropriate practice in early childhood programs. Rev. ed. Washington, DC: NAEYC. 6 NAEYC & NAECS/SDE (National Association of Early Childhood Specialists in State Departments of Education). 1991. Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children 46 (3): 21–38. Rev. 2003. Early childhood curriculum, assessment, and program evaluation: Building an effective, accountable system in programs for children birth through age 8. Online: www.naeyc.org/resources/position_statements/pscape.asp. 7 Bredekamp, S., & T. Rosegrant, eds. 1995. Reaching potentials: Transforming early childhood curriculum and assessment. Vol. 2. Washington, DC: NAEYC. 8 National Research Council. 2001. Eager to learn: Educating our preschoolers. Eds. B.T. Bowman, S. Donovan, & M.S. Burns. Washington, DC: National Academy Press. 10 Head Start Bureau. 2001. Head Start Child Outcomes Framework. Head Start Bulletin 70. Washington, DC: Department of Health and Human Services, Administration for Children and Families. Online: www.headstartinfo.org/pdf/im00_18a.pdf. 11 NCTM (National Council of Teachers of Mathematics) & NAEYC. 2002. Position Statement. Early childhood mathematics: Promoting good beginnings. Washington, DC: NAEYC. 12 National Research Council. 2000. From neurons to neighborhoods: The science of early childhood development. Eds. J.P. Shonkoff & D.A. Phillips. Washington, DC: National Academy Press. 13 Meisels, S., & S. Atkins-Burnett. 2002. The elements of early childhood assessment. In Handbook of early childhood intervention, eds. J.P. Shonkoff & S.J. Meisels, 231–57. New York: Cambridge University Press. 14 Christenson, S. 1999. Families and schools: Rights, responsibilities, resources, and relationships. In The transition to kindergarten, eds. R.C. Pianta & M.J. Cox, 143–77. Baltimore: Brookes. 15 Washington, V., & J.D. Andrews, eds. 1998. Children of 2010. Washington, DC: NAEYC. 16 Odom, S.L., & K.E. Diamond. 1998. Inclusion of young children with special needs in early childhood education: The research base. Early Childhood Research Quarterly 13: 3–26; Shonkoff, J., & S. Meisels, eds. 2000. Handbook of early childhood intervention. 2nd ed. New York: Cambridge University Press. 17 Hatch, J.A. 2002. Accountability shovedown: Resisting the standards movement in early childhood education. Phi Delta Kappan 83: 457–62. 18 Elmore, R. 2002. Bridging the gap between standards and achievement: Report on the imperative for professional development in education. Washington, DC: Albert Shanker Institute. 19 Schmoker, M., & R.J. Marzano. 1999. Realizing the promise of standards-based education. Educational Leadership 56 (6): 17–21; Bredekamp, S. In press. Standards for preschool and kindergarten mathematics education. In Engaging young children in mathematics: Findings of the 2000 National Conference on Standards for Preschool and Kindergarten Mathematics Education, eds. D.H. Clements, J. Sarama, & A.M. DiBiase. Mahwah, NJ: Erlbaum; Kagan, S.L., S. Rosenkoetter, & N.E. Cohen. 1997. Considering childbased results for young children: Definitions, desirability, feasibility, and next steps. New Haven, CT: Yale Bush Center in Child Development and Social Policy. 20 National Research Council. 2001. Eager to learn: Educating our preschoolers. Eds. B.T. Bowman, S. Donovan, & M.S. Burns. Washington, DC: National Academy Press. 21 National Research Council. 2000. From neurons to neighborhoods: The science of early childhood development. Eds. J.P. Shonkoff & D.A. Phillips. Washington, DC: National Academy Press. 22 Hart, B., & T. Risley. 1995. Meaningful differences in the everyday experiences of young American children. Baltimore: Brookes. 23 National Research Council. 1998. Preventing reading difficulties in young children. Eds. C.E. Snow, M.S. Burns, & P. Griffin. Washington, DC: National Academy Press. 24 National Research Council. 2001. Eager to learn: Educating our preschoolers. Eds. B.T. Bowman, S. Donovan, & M.S. Burns. Washington, DC: National Academy Press. 25 National Research Council. 2000. From neurons to neighborhoods: The science of early childhood development. Eds. J.P. Shonkoff & D.A. Phillips. Washington, DC: National Academy Press. 26 Peth-Pierce, R. 2001. A good beginning: Sending America’s children to school with the social and emotional competence they need to succeed. Monograph on two papers commissioned by the Child Mental Health Foundations and Agencies Network (FAN). Chapel Hill, NC: University of North Carolina Press; Raver, C. 2002. Emotions matter: Making the case for the role of young children’s emotional development for early school readiness. SRCD Social Policy Report 16 (3). 27 Neuman, S.B., C. Copple, & S. Bredekamp. 2000. Learning to read and write: Developmentally appropriate practices for young children. Washington, DC: NAEYC; NCTM (National Council of Teachers of Mathematics) & NAEYC. 2002. Position Statement. Early childhood mathematics: Promoting good beginnings. Washington, DC: NAEYC. 28 Elmore, R. 2002. Bridging the gap between standards and achievement: Report on the imperative for professional development in education. Washington, DC: Albert Shanker Institute. 29 National Research Council. 2000. From neurons to neighborhoods: The science of early childhood development. Eds. J.P. Shonkoff & D.A. Phillips. Washington, DC: National Academy Press. 30 Raver, C. 2002. Emotions matter: Making the case for the role of young children’s emotional development for early school readiness. SRCD Social Policy Report 16 (3). 31 West, J., & K. Denton. 2002. Early Childhood Longitudinal Study—K. Children’s reading and mathematics achievement in kindergarten and first grade. Washington, DC: National Center for Education Statistics. 32 Kendall, J.S. 2001. A technical guide for revising or developing standards and benchmarks. Aurora, CO: Mid-continent Regional Educational Laboratory (McREL). 33 Neuman, S.B., C. Copple, & S. Bredekamp. 2000. Learning to read and write: Developmentally appropriate practices for young children, 3–26. Washington, DC: NAEYC. 34 Garcia-Coll, C., & K. Magnuson. 2000. Cultural differences as sources of developmental vulnerabilities and resources. In Handbook of early intervention, eds. J.P. Shonkoff & S.J. Meisels, 94– 114. New York: Cambridge University Press; Sandall, S., M. McLean, & B. Smith, eds. 2000. DEC recommended practices in early intervention/early childhood special education. Longmont, CA: Sopris West; Odom, S.L., & K.E. Diamond, eds. 1998. Inclusion of young children !!( $          Copyright © 2002 by the National Association for the Education of Young Children. All rights reserved. with special needs in early education: The research base. Special issue. Early Childhood Research Quarterly 13 (1). 35 National Research Council. 2001. Eager to learn: Educating our preschoolers. Eds. B.T. Bowman, S. Donovan, & M.S. Burns. Washington, DC: National Academy Press; National Research Council. 1998. Preventing reading difficulties in young children. Eds. C.E. Snow, M.S. Burns, & P. Griffin. Washington, DC: National Academy Press; National Research Council. 1998b. Educating language-minority children. Committee on Developing a Research Agenda on the Education of Limited English Proficient and Bilingual Students. Eds. D. August & K. Hakuta, Board on Children, Youth, and Families. Commission on Behavioral and Social Sciences Education. Washington, DC: National Academy Press; 36 NAEYC & NAECS/SDE (National Association of Early Childhood Specialists in State Departments of Education). 1991. Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children 46 (3): 21–38 [rev. 2003. Early childhood curriculum, assessment, and program evaluation: Building an effective, accountable system in programs for children birth through age 8. Online: www.naeyc.org/resources/position_statements/pscape.asp.]; NAECS/SDE. 2000. Still unacceptable trends in kindergarten entry and placement. Springfield, IL: Author; NAESP (National Association of Elementary School Principals). 1990. Early childhood education: Standards for quality programs for young children. Alexandria, VA: Author; NASBE (National Association of State Boards of Education). 1988. Right from the start. Report of the National Task Force on School Readiness. Alexandria, VA: Author. 37 Pianta, R.C., & M.J. Cox, 1999. The transition to kindergarten. Baltimore: Brookes. 38 NAESP (National Association for Elementary School Principals). 2001. Leading learning communities: What principals should know and be able to do. Alexandria, VA: Author. 39 NAEYC & NAECS/SDE (National Association of Early Childhood Specialists in State Departments of Education). 1991. Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children 46 (3): 21–38. Rev. 2003. Early childhood curriculum, assessment, and program evaluation: Building an effective, accountable system in programs for children birth through age 8. Online: www.naeyc.org/resources/position_statements/pscape.asp. 40 NAEYC. 1998. Code of ethical conduct and statement of commitment. Rev. ed. Washington, DC: Author. 41 National Research Council. 2001. Eager to learn: Educating our preschoolers. Eds. B.T. Bowman, S. Donovan, & M.S. Burns. Washington, DC: National Academy Press. 42 Bredekamp, S., & C. Copple, eds. 1997. Developmentally appropriate practice in early childhood programs. Rev. ed. Washington, DC: NAEYC; NAEYC & NAECS/SDE (National Association of Early Childhood Specialists in State Departments of Education). 1991. Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children 46 (3): 21–38; Bredekamp, S., & T. Rosegrant, eds. 1995. Reaching potentials: Transforming early childhood curriculum and assessment. Vol. 2. Washington, DC: NAEYC. 43 Meisels, S., & S. Atkins-Burnett. 2002. The elements of early childhood assessment. In Handbook of early childhood intervention, eds. J.P. Shonkoff & S.J. Meisels, 231–57. New York: Cambridge University Press. 44 NAEYC & NAECS/SDE (National Association of Early Childhood Specialists in State Departments of Education). 1991. Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children 46 (3): 21–38. Rev. 2003. Early childhood curriculum, assessment, and program evaluation: Building an effective, accountable system in programs for children birth through age 8. Online: www.naeyc.org/resources/position_statements/pscape.asp. 45 Commission on Instructionally Supportive Assessment (Convened by AASA, NAESP, NASSP, NES, & NSMA). 2001. Building tests to support instruction and accountability: A guide for policy makers. Online: http://www.aasa.org/issues_and_insights/ assessment/Building_Tests.pdf. 46 Shepard, L., S.L. Kagan, & E. Wurtz. 1998. Principles and recommendations for early childhood assessments. Washington, DC: National Education Goals Panel. 47 AERA (American Educational Research Association), APA (American Psychological Association), & NCME (National Council for Measurement in Education). 1999. Standards for educational and psychological testing. Washington, DC: AERA. 48 NASP (National Association of School Psychologists). 1999. Position statement on early childhood assessment. Bethesda, MD: Author. 49 Shepard, L., S.L. Kagan, & E. Wurtz. 1998. Principles and recommendations for early childhood assessments. Washington, DC: National Education Goals Panel. 50 NAEYC. 1998. Code of ethical conduct and statement of commitment. Rev. ed. Washington, DC: Author. 51 National Research Council. 2001. Eager to learn: Educating our preschoolers. Eds. B.T. Bowman, S. Donovan, & M.S. Burns. Washington, DC: National Academy Press; Campbell, F.A., C.T. Ramey, E.P. Pungello, J. Sparling, & S. Miller-Johnson. In press. Early childhood education: Young adult outcomes from the Abecedarian Project. Applied Developmental Science; PeisnerFeinberg, E.S., M.R. Burchinal, R.M. Clifford, M.L. Culkin, C. Howes, S.L. Kagan, N. Yazejian, P. Byler, J. Rustici, & J. Zelazo. 1999. The children of the Cost, Quality, and Outcomes Study go to school: Executive summary. Chapel Hill: Frank Porter Graham Child Development Center, University of North Carolina at Chapel Hill. 52 NAEYC. 1998. Accreditation criteria and procedures of the National Association for the Education of Young Children. Washington, DC: Author. 53 Darling-Hammond, L. 1996. What matters most: A competent teacher for every child. Phi Delta Kappa 78 (3): 193–200. 54 Christenson, S. 1999. Families and schools: Rights, responsibilities, resources, and relationships. In The transition to kindergarten, eds. R.C. Pianta & M.J. Cox, 143–77. Baltimore: Brookes.



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Choose five U.S. government policies that affect trade with foreign nations. Identify three factors of production, and describe how their mobility is good or bad for U.S. trade

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Unit III Essay
For this assignment, write an essay that addresses each of the following points:
1. Choose five U.S. government policies that affect trade with foreign nations. Identify three factors of production, and describe how their mobility is good or bad for U.S. trade
2. Distinguish between absolute advantage and comparative advantage trade theories and give examples
3. Choose either the TPP or the T-TIP free trade agreement and describe which other countries have signed on and why the U.S. Senate should ratify or not ratify the agreement. Also, explain how regional trading groups influence organizations.
Your essay submission should be a minimum of three pages in length in APA style; however, a title page, a running head, and an abstract are not required. You are required to use at least two scholarly sources for this essay. Your responses to the three prompts must be in paragraph form. Be sure to cite and reference all quoted or paraphrased material appropriately in APA style.



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Case Study Mercy Hospital Assignment Help

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Case Study Mercy Hospital

Case Study Mercy Hospital

 

Mercy Hospital, started in 1895, is a 143-bed hospital in a small community of 37,000 people. Mercy Hospital is located on a small hill in the center of the town surrounded by upper and upper-middle class homes on the hill and low-income neighborhoods at the base of the hill and surrounding a main street of shops, restaurants, and services.  The main buildings consist of dark red brick with two floors in the center and wings out to each side.  Several additions had been added to the rear of the building in the 1960’s.

The dingy green halls are lined with long windows overlooking the lawns.  Few changes have occurred to renovate the hospital in the last twenty years.  Most of the patient rooms hold four patients each, except the section of private rooms set aside for those who can afford them.  The operating suite occupies on wing of the top floor.  There is a small pediatric unit and small maternity unit, both appear to be stuck in the 1950’s.  There are no security devices on the doors to these units.

As one walks through the halls, it is not unusual to see patients lying alone on stretchers, patient care technicians and nurses gather in nursing stations while patient call lights go unanswered, and soiled linens dropped on the floor.  Physicians give directions to nurses who refuse to follow their orders.  Families can be seen caring for family members because there is no one else who seems to care.  While a simple electronic medical record system was installed, it is not used by physicians or nurses who state it is too difficult to use and they do not have time to learn.

A stop at the Pharmacy indicates that many medications are misplaced on the shelves, there is a backlog of prescriptions to fill, and there is no system for managing unit dosing for patient safety.  The electronic system for managing patient prescriptions has been installed but is not used reportedly because “there is just not enough time and it is too difficult.”  Several pharmacy technicians work in the pharmacy to help in filling prescriptions and transporting them to the units.  However, there is no evidence that these technicians have been trained in a formal program or have passed the national pharmacy technician exam.

Further along, the Central Service Department provides sterile supplies to the units.  Unfortunately, it is obvious there is no system for cataloging or rotating the supplies. This leads to outdated sterile equipment and often inadequate supplies when requested by the units.  Cleaning products used for equipment meets the requirements for type; however, it is being mixed improperly so as to be too weak for adequate disinfection.  Because this is handled in the Central Service Department, it becomes an issue throughout the hospital.

The dietary department provides adequate meals for patients but is known to confuse patient diets.  Families complain that their family members who only eat kosher food have been routinely given products that are not approved.  Cultural insensitivities are common from lack of translators, to biased comments, to outright cultural slights.  Patients and staff also complain of the poor quality of the food prepared, that it is often over cooked, under cooked, or simply bland.  The kitchen have passed the Department of Health inspections for cleanliness but lack updated equipment to streamline service and delivery.

The laboratory lacks adequate qualified staff to manage the required laboratory tests.  Inspection of the blood bank shows that normal blood banking procedures are lacking, refrigeration is inadequate, and labeling is inadequate.  Equipment is outdated.  Spilled blood and other bodily fluids are observed on lab tables.  Samples are lying about the lab, some labeled and some without.  Refrigeration temperatures for blood are adequate.

Sentinel events occur often including:  Surgical and nonsurgical invasive procedures on the wrong patient, wrong site, or wrong body part, unintended retention of a foreign object in a patient after surgery, blood transfusion reaction involving administration of blood or blood products having major blood group incompatibilities (ABO, Rh, other blood groups.)  In addition, patient fall rate and medication errors occur much too often.  These were all noted by the latest visit of the Joint Commission.  The Nursing Director states that this was all just an over zealous visit team.  However, the visit was stimulated as a result of regular reports that are required on sentinel events.

The Human Resource department occupies a small room, little more than a closet on the first floor.  The HR manager has been with the hospital for 25 years, during which time he has maintained a low profile and accomplished little to enhance the conditions or benefits of the staff.  His main objective is to make it through a few more years until retirement.  Staff morale, which is at an all time low, does not seem to be a concern to the department.  Staff benefits have not changed in the last 15 years, with few, if any, raises, no increases in healthcare benefits, and limited contributions to retirement accounts.

The Nursing Director has also been with the hospital for over 25 years and demonstrates little leadership skills, and has made no attempt to improve nursing conditions or professional development for almost as long. She has an authoritarian management style and tends to manage from a position of fear.  On questioning, she is not well informed about current regulations or policies.  Having grown up in the community, attended nursing school at a local diploma nursing program, and beginning her first job at Mercy Hospital, the Nursing Director appears a fixture at Mercy and rules with an iron fist.  This leaves no room for nursing staff involvement in governance or any incentive to engage in evidence based practice. Therefore, standardized practices such as wound care, tracheotomy care, etc, have not been updated for many years.  The management of the nursing department has resulted in many of the staff feeling bullied.  This has led to a high turn over rate especially among the new graduate employees.  The nurses who have stayed have become complacent and “just put in their time.”  When the nurses do not agree with doctors’ orders, they do not question them but rather simply refuse to carry the orders out.   Staffing on most units is very minimal. Usually one RN manages the unit with one or two patient care technicians.  Because the RN is the only one who can give medications, assess patients, provide most treatments, and interact with other departments, medications and treatments are often late and mistakes are made.  The patient care technicians appear to resent the position of the RN and do little to work as a team.

The finance department sits next to admissions.  It is as dysfunctional as other parts of the hospital, with losses in revenue due, not only to a reduction in patients, especially those with insurance, but due to poor systems of insurance billing and coding. In addition, hospital acquired infections and fall rates have affected the income from Medicare.  An electronic health care system to manage billing does not exist.  Payments to vendors consistently run 60 -90 days late, and some as much as 180 days.  Salaries have not been raised in years and while staff is often required to work overtime, no additional pay beyond the usual salary is provided.

The Office of the Chief of Medicine is a bit further down the hall and appears to be the only cheery place in the hospital. The Chief of Medicine is a portly gentleman in his fifties who has been with the hospital for several years, having moved to the community from a nearby urban center. He had grown up in the community and moved away for some time after medical school to specialize in surgery.  He was wooed back to the community to help Mercy Hospital turn itself around after multiple issues with their Joint Commission review.  A sense of loyalty to his home town and a deep sense of caring for the community led him to take on this monumental task.  Since coming to Mercy, the Chief of Medicine has been met with continual barriers from staff, the board of directors, and even patients.  Services are limited and outdated, patient safety and quality is poor, staff is ineffective, and morale is at an all time low.  He is faced with patient care technicians playing cards while patients go uncared for, supplies that are often in short supply because of theft, and systems that do not exist in any part of the hospital.

Current bed occupancy is at 60%.  No new service lines have been added in recent years.  Technology based services such as CTs, specialized sonography, and technology based diagnostics and surgery are not available at the hospital, requiring patients to travel over 30 miles for the service.  The emergency department is often full, being used by the community for routine medical care.  Without outpatient clinics, vulnerable populations flock to the emergency department for a variety of illnesses and routine care. The emergency department becomes as much of a place for social gathering as for care.

A new for-profit hospital, owned by a major medical corporation, has opened approximately thirty miles from Mercy. While inconvenient for most of the community, it offers a much fuller range of services including high tech diagnostics and surgery.  Being new, the hospital has bright walls and shiny floors. Most rooms are singles and a few doubles. The hospital accepts most insurance policies and medicare but otherwise, payment for services is due at the time of service. While families in the community of Mercy are still loyal to their hospital, the improved services available are a definite draw.  This is having a negative impact on the revenue stream for Mercy Hospital.



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