Module 6 topic 1. Leadership and Learning

DiscussTopic 1. By focusing on the behavior of the followers, Daniels provides a refreshing look at leadership that is different from the typical “cult of personality theories”. Provide your assessment of the value of Daniels’ approach as similar to, or different from, your understanding of effective leadership, and the implications for organizational learning and performance.

Instructor requirements about responds: Your response to each topic question should be substantive, providing a perspective based on your reading, knowledge, and experience. Make sure to reference the readings as appropriate with specific page numbers and quotes for full credit

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Safety of Two Nurses Insulin Checks Protocol

Insulin is one of the very essential drugs to be discovered in the history of medicine,and it is among the high-alert drugs. The drug’s therapeutic benefits cannot be undervalued, especially in the management of the critically ill patients suffering from diabetes. Although insulin is an important drug, errors associated with the drug are dangerous, both to the patient  and the staffs handling the drug. However, although the insulin errors have continued to be a major problem in many hospitals, they are preventable. Research indicates that, although measures to prevent medication errors with insulin have been in place for more than a decade, the medication errors are still a prevalent issue associated with insulin use (Ramasamy, Bayasari, Lehnborn & Westbrook, 2013). Improving the safety of insulin use is thus, very important in achieving its efficiency in patient care. Some of the errors associated with insulin include administration of the wrong dose, omission of doses, wrong patient, using the wrong type of insulin, failing to adjust insulin therapy appropriately, improper assessment, timing and monitoring, and administering via the wrong route.

In order to maintain and guarantee insulin safety in hospitals, protocols are needed that should guide the procedures for the use of insulin. One major protocol that has been used in some hospitals is the use of two nurses to check for insulin before administering to the patient (Chant, Mustard, Thorpe & Friedrich, 2012). The safety of the two nurse check protocol is controversial, based on many factors such as the availability of nurses, adherence of nurses to the protocol, obvious human errors and nursing workloads. As such, many hospitals are reluctant to implement the two nurse check protocol. Some hospitals have gone ahead and eliminated the already launched two nurse insulin check protocol. In the hospital where  did my clinical placements, the protocol was eliminated because the administration observed that it was causing delays in patient care, as a nurse on duty would wait for a second nurse to assist in checking the insulin. Eliminating the protocol may not promote patient safety, according to the Institute of Medicine’s (IOM) Quality and Safety Education for Nurses (QSEN) competencies (Dolansky & Moore, 2013).

Patient and provider safety is one of the five competencies for practice advocated by the IOM/QSEN. Considering the potential for errors in insulin use and administration, it is very paramount that all providers mind about its safety, especially to the diabetic patient. As seen from the errors associated with insulin administration, a wrong dose, wrong route, wrong type and other errors are very risky to the life of the patient. The two nurse insulin-checkprotocol aims at ensuring, improving, guaranteeing and maintaining patient and provider safety in the use and administration of insulin, in line with the requirements of the IOM/QSEN. In lieu of this, the essay investigates the safety of the two nurse insulin check protocol. The research paper attempts to answer the question: To what extent is two nurse insulin check protocol safe? This is an important concern to the nursing fraternity because it is a measure of promoting patient safety as encouraged by the Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) competencies (Dolansky & Moore, 2013). Ascertaining the degree of safety of the protocol will serve as a guide as to whether the protocol should be encouraged or discouraged. Such knowledge will lead to the institution of measures to enhance the implementation of policies and procedures related to the protocol, or doing away with the protocol all the same. The paper answers the research question through a literature search.

Review of Research Literature:

Olinghouse (2012) outlines some of the factors leading to medication errors the calculation of doses, human errors in the timing of doses, errors in setting the insulin pump, decimal-point errors, the deficitin the insulin therapy knowledge, miscommunication and inability to  interpret the available client information. In line with these factors, it is evident that human nature is liable for errors in the use and administration of medications. Insulin is  a sensitive medication; it needs sensitivity in the use and administration. Most of the factors identified lead to errors that can be eliminated through the use of two nurse insulin check protocol. The use of two nurses to check the calculation of doses, counter-check the rightness of the patient, and combine therapy knowledge during administration, reduces errors, improving the safety of insulin administration for a particular patient. As a pointer to the need to double-check insulin use and administration, Olinghouse (2012) concludes that; the effective implementation of the recommended protocols to double-check insulin use and administration will lead to the reduction of risks associated with the use of insulin. Such can be interpreted as safety being guaranteed by the use of double-checking insulin by two nurses before administration. On the same note, Chant, Mustard, Thorpe and Friedrich (2012)  observe that; the implementation of second-person check protocol is an important milestone in guaranteeing patient safety with the use of insulin. According to Chant, Mustard, Thorpe & Friedrich (2012) the control of glycemic levels by only avoiding errors is only one, among the many milestones needed to guarantee patient safety. Deficiencies in monitoring and administering insulin therapy are among the leading causes of errors in insulin use. As such, achieving glycemic control should be a major goal in insulin therapy. In order to achieve this goal, one major protocol is the use of two nurse insulin check. Such an initiative would lead to effective management of patients, avoiding adverse patient outcomes.

According to Ramasamy, Bayasari, Lehnborn & Westbrook (2013), double-checking of medications by nurses has been seen to reduce patient risks that may lead to medication errors. However, these authors observe that double-checking is effective only when its importance is taken into account, rather than when performed as a routine task. There has been a tendency for nurses to perform the double-checking activity as if it is a routine activity, yet such cannot achieve the intended purpose of promoting patient safety. Ramasamy et al. (2013) argue that; even though many hospitals have drawn the double-checking procedures and policies, the implementation has been very inconsistent, leading to dilution of the intended purpose of promoting patient safety. In addition, the double-checking procedures for some hospitals do not contain explicit definitions, which leads to their being followed inconsistently. Further, Ramasamy et al. observe

The scarcity of research data documenting the effectiveness of double-checking in reducing patient errors is also a major limitation of the protocol (Ramasamy et al., 2013). Currently, the protocol lacks a concrete definition that can be used to develop procedures and policies that will ensure the protocol is implemented consistently. In essence, the currently available definitions do not clarify whether the second nurse should counter-check all the procedures with the first nurse as they are done or just check after the procedures have been done. For example, when calculating insulin doses, some hospitals advocate double checking as the calculations are done, while others only require the second nurse to check the calculations done by the first nurse. The lack of clarity in the procedures is a loophole for the double checking protocol, that can lead to risks, limiting the safety of the patient.  In other words, the policies are not explicit as to what exactly needs to be checked. Ramasamy et al. advises that an effective protocol should be explicit that the second nurses should be able to countercheck all the probable risks in order to promote the safety of the patient. Regarding the effectiveness of double-checking as a method of  ensuring patient safety with medications, Ramasamy et al. reiterated that; it is an effective method. However, these authors confirm that double checking is not all good for all the medications, but it is highly recommended for the high-alert medications like insulin. The authors mention time constraints as a major challenge to implementing the double checking protocol. However, the authors concur that  medication errors have been prevalent even in hospitals where double-checking has been practiced.

When a computerized system of calculating insulin doses was compared with the double-checking protocol (Olinghouse, 2012), a computerized system is reported to be more effective in reducing errors. According to Olinghouse, the double-checking protocol and other labor-intensive protocols are not favorable for the current millennium, which is affected by a huge shortage the nursing staff. While Olinghouse faults the labor-intensive nature of the double-checking system, he does not doubt the effectiveness of the protocol in ensuring the patient’s safety, if implemented effectively. The author, however, faults the tendency by some staffs to consider some orders superior to others. According to the author, protocol orders are medication orders, and they should be followed to the letter. The lack of enough time and the fear of the development of hypoglycemia lead to the violation of protocols that are labor intensive. As such, the two nurse insulin-check protocol is likely to suffer from such blows if the nursing staffs are not enough.

While supporting the need for double-checking and the need to develop and adhere to the protocol, Cobaugh et al. (2007) assert that insulin errors during administration include, but are no limited to using insulin pens incorrectly, confusing names and administration of incorrect doses. The observations posed by Caubaugh et al. (2013) are in agreement with the lamentations of Olinghouse (2012) concerning the medication errors in the administration of insulin and the need for such a protocol like the double-checking protocol. In order to minimize errors and improve the safety of administration of insulin, Cobaugh et al. recommend that; all calculations should be left to the pharmacy department.  However, Caubaugh’s team agrees that hospitals should have policies that will promote the safety of the administration, since errors are not limited to calculations. Through such an observation, the need for a double-checking protocol is realized, as a measure of ensuring nurses combine their knowledge and skills to promote ts led to the conclusion that; a nurse-directed glucose control is as effective as a nomogram directed glucose control. The authors recommend the use of nurse’s experience and judgement in the titration of insulin for the ICU patients. However, these authors fault the system of working in groups because of the need for autonomy, nurses’ satisfaction and the current incidence of nursing workloads.

The two nurse protocol is a nurse-led protocol of insulin administration and use. According to Khalaila et al. (2007) nurse led protocols of insulin administration have been found to be effective in the control of glycemic levels in the critically ill patients. According to these authors, a nurse-led protocol has been found to be associated with few cases of hypoglycemia levels as compared with the standard set procedures for glucose monitoring. Their findings support a nurse led double-checking of insulin before it is administered to the patients to maximize its safety.

Case Study Example:

This research paper is a clinical integration paper thatconnects to the case study in the hospital where I did my clinical placement. When I started working at the hospital, the two nurse insulin-check protocol was in place, and every nurse caring for a diabetic patient or such a case had to adhere to the protocol. However, by the time I left the hospital, the protocol had been eliminated. The protocol was eliminated because the heath care workers and the administrators felt that the protocol was causing delays in care as the nurses were always waiting for the second nurse to verify the insulin before administration. With time, it came to the attention of the administration that the second nurses were not always available to verify the insulin. At other times, the nurses were available but were overloaded with their patients, such that they could not leave the patients whom they were allocated to assist other nurses to countercheck the insulin. It became common in the hospital that all insulin administration delays were associated with the unavailability of second nurses to countercheck the insulin. The hospital administration called for a review board meeting and decided to eliminate the protocol as they observe the situation for some time.

The challenges associated with the two nurse insulin-check protocolhave been documented in the literature.  Ramasamy, Bayasari, Lehnborn & Westbrook (2013) observed that nurse workloads, nurse shortages and disregarding the protocol, are among the major problems associated with the two nurse insulin protocol, threatening its safety. As encouraged by Chant, Mustard, Thorpe & Friedrich (2012), I also felt that the method should not have been eliminated in my hospital, but it should have been reinforced to promote the safety of the patients. The decision to eliminate the protocol does not guarantee safety to the patient. As Olinghouse (2012) advised, a medication protocol should be taken as serious as a medication order. The hospital administration should have looked for alternatives, better ways, or improve the implementation of the two nurse insulin protocol to ensure its effectiveness, thus the safety of the patients.

Conclusion:

The majority of the studies reviewed in this paper agree that the two nurse insulin-check before administration is a protocol that guarantees patient safety (Chant, Mustard, Thorpe & Friedrich, 2012; Olinghouse, 2012; Sharpe, 2012). The research articles also concur that the safest protocol in the use and administration of insulin has not been determined. A computerized system of calculating insulin doses may, in some way, exceed the safety of the two nurse insulin-check protocol (Olinghouse, 2012). However, calculation of doses is only a component of the many sources of errors that need double-checking during the use and administration of insulin. Thus, although two nurse insulin protocol has been faulted for being labor intensive, it is a bit more favorable. Many challenges have been identified as reasons for faulting the double-checking protocol. These include its labor intensive nature, the need for autonomy of nurses, the shortage of nurses and the huge nursing workloads. In order to promote the safety of the protocol, the protocol needs to be implemented with seriousness. The best practice is where the hospital culture promotes the application of the protocol just as a medication order (Olinghouse, 2012). The protocol needs to be integrated into the culture of the organization. While allocating nurses to their various duty stations, the nurse manager needs to consider the labor-intensive nature of the protocol. Such measures will deal with the challenge of unavailability of nurses.

Nurses need to be educated on the need to observe the safety of the patient and provider in line with the QESN guidelines (Dolansky & Moore, 2013). The current nursing guidelines for educating nurses about the care of patients in regard to insulin use and administration focus on safety and effective use (Sharpe, 2012). In essence, the education focuses on the importance of safety in the administration of insulin, being among the high-alert medications (Sharpe, 2012). In addition, nurse education emphasizes that staffs need to be updated  about insulin therapy frequently. In the teachings, it should be emphasized that insulin medication errors are preventable, and the two nurse insulin-check for insulin medication should also be emphasized. In addition, it should be made clear that the two nurse insulin-check protocol is safe, but it should be implemented effectively.

Further research is needed to determine the safest protocol among the insulin administration protocols. In regard to the two nurse insulin-check protocol, further research needs to be directed to determining its safety in an ideal setting, where the challenging factors are held constant. In sum, the two nurse insulin-check protocol is a safe method. However, it is faced with many challenges that compromise its safety.

References

Chant, C., Mustard, M., Thorpe, K. E., & Friedrich, J.E. (2013). Nurse-versus normogram directed glucose control in a cardiovascular intensive care unit. American Journal of Critical Care, 21(4), 270-279.

Cobaugh, J.D., Maynard, G., Cooper, L., Kienle, C.P., Vigersky, R., Childers, D… & Cohen, M. (2013). Enhancing insulin safety in hospitals: Practical recommendations from an ASHP foundation expert consensus panel. American Journal of Health Systems Pharmacy, 70, 18-27.

Dolansky, M.A., & Moore, M.S. (2013). Quality and Safety Education for Nurses (QSEN): The key is systems thinking. The Online Journal of Issues in Nursing, 18(3), Manuscript 1. <http://www.nursingworld.org/Quality-and-Safety-Education-for-Nurses.html>

Khalaila, R., Libersky, E., Catz, D., Pomerantsev, E., Bayya, A., Linton. M.D., & Sigal, S. (2011). Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit. Critical Care Nursing, 31(6), 26-36.

Olinghouse, C. (2012). Development of a computerized inravenous insulin application (AutoCal) at Kaiser Parmanente, Northwest, integrated into Kaiser Permanenete HealthConnect: Imact on safety and Nursing workload. The Permanente Journal, 16(3), 67-70.

Ramasamy, S., Baysary, T.M., Lehnborn, E.C., & Westbrook, J.I. (2013). Evidence briefings on interventions to improve medication safety: Double-checking medication administration. Australian Commission on Safety and Quality on Healthcare, 1(3), 1-4.

Sharpe, L. (2012). Improving safety of insulin administration: A pilot audit of hospital staff knowledge. Journal of Diabetes Nursing, 16(1), 8-16.

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Adenocarcinoma of Lung: Imaging tests and Treatment Options

Computed Tomography Scan (CT scan):

It allows visualization of the size and location of the adenocarcinoma or cancer metastasis. Portrays a three-dimensional picture of the image. The computer produces a cross-sectional, detailed view of the tumors. Through a die called contrast medium, it enables one to measure the tumor size (Weissferdt& Moran, 2012)

Positron Emission Tomography (PET Scan):

It utilizes a radioactive sugar. Cancerous cells take more of the sugar; they are detected through the sugar.

Magnetic Resonance Imaging:

Allows visualization of tumor size, location and metastasis. It uses magnetic fields and a die contrast medium to create clear pictures of the tumor (D’Addarario et al.,2010)

Bone Scan:

The scan uses a radioactive tracer to visualize the inside of a bone. It portrays the cancerous areas of a bone as being dark (Yachnis& Rivera-Zengoteta, 2012).

Treatment Options:

Surgery:

It is the primary treatment for early-stage cancer. One must be in good health in order to undergo surgery. It provides cure by eliminating all the tumor cells. Segmentectomy is the removal of a section of the lung, while lobectomy is the removal of an entire lobe.

Radiation Therapy:

The method uses high-energy x-rays to destroy the rapidly dividing cancer cells. It can be used as a primary therapy, to shrink the tumor before surgery, as a follow up after surgery or to treat metastasis. It is also good for relieving symptoms in terminal stage cancer. It can be combined with chemotherapy to boost results (Belkacemi, Mirimanoff&Ozsahin, 2011).

Chemotherapy:

This method uses drugs that are known to be toxic towards cancer cells. They can be given after a surgery with the aim of sterilizing the microscopic cells. The drugs also relieve symptoms and slows growth in patients who are not healthy enough to have to undergo surgery. It is useful in all the stages of lung cancer and can be used in the elderly. Chemotherapy can be combined with radiation therapy to increase efficacy (Radiology Society of North America, 2013).

Conclusion:

The lung adenocarcinoma decision tree shows the various options of treatment and the various imaging techniques that can be used. The different imaging modalities are appropriate for the different stages. For example, the CT scan is appropriate for stage IV to determine the size, location and spread of the cancer. Accurate staging is necessary to determine the best treatment method, and the best imaging modality (Roth, Cox & Hong, 2011). The different therapies have different outcomes, which also depends with the stage.

References

Belkacemi, Y., Mirimanoff, R., &Ozsahin, M. (2011).Management of rare adult tumors. New York, NY: Springer Science & Business Media.

D’Addarario, G., Fruh, M., Reck, M., Baumann, P., Klepetko, W., &Felip, E. (2010). Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 21(5), 5-9.

Radiology Society of North America.(2013). Lung cancer treatment. Retrieved from http://www.radiologyinfo.org/en/info.cfm?pg=lungcancer

Roth, J.A., Cox, D.J., & Hong, K.W. (2011).Lung cancer. Hoboken, NJ: John Wiley & Sons.

Weissferdt, A., & Moran, A.C. (2012).Diagnostic pathology of pleuropulmonaryneoplasia. New York, NY: Springer Science & Business Media.

Yachnis, T.A., & Rivera-Zengoteta, L.M. (2012).Neuropathology: A volume in the high yield pathology series. Melbourne: Elsevier Health Sciences.

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His 204W Document Analysis

The author of the document under analysis is IbnRushd, who was better-known in the Latin West as Averroes, and lived between 1126 and 1198. According to the introductory note to the excerpt, IbnRushd was a leading (distinguished) Muslim philosopher of the twelfth century. A confirmation of his greatness is that, he was well-known to the “thirteenth century western Europeans,” (220) as they enjoyed reading his philosophical interpretation of the accounts of Aristotle. In addition, IbnRushdof the Maliki tradition” (220). Further, he was a judge in Seville, Spain and his native Cordoba. Most of all, IbnRushd composed the “Distinguished Jurist’s Primer,” one of the well known and best books of Sharia Science. The book contains the views of the other schools of the Hanbari, Zahiri, Shafee and Hanifi

IbnRushdalso records that his role as a jurist of the Maliki tradition gave him the claim to fame within the Muslims. In that case, IbnRushd had proper knowledge of the subject.

IbnRushd wrote this excerpt as a result of the differences between the “four major schools of Rushd

by verses from the Quran can be easily trusted, while those that IbnRushd.

Part II:

According to the document, Jihad had a number of restrictions. The first restriction regards the issue of collectivism. For example, the author notes that: “prophtet never went to battle without leaving some people behind” (221). Additionally, the people who were to go to war were “free men who have the means at their disposal..”(221). The men were also supposed to be healthy. As such, there was a restriction to the blind, the lame, the sick and “those who found nothing to expend” (221). Secondly, the issue of permission brought some restrictions. Scholars could not agree whether a man needed permission from his parents in order to go to war. Additionally, scholars did not agree on the issue of debts as regards going to war. There were also restrictions about who should be killed. For example, the Malik were not allowed to kill the Ethiopians. Further, there were some grievances as some scholars taught that the captives “should never be slain” (222).

The author argues his points professionally by drawing from the traditions, the Quran and the observations by other Muslim scholars. He also reinforces the observations he gets from other sources through opinion. In order to reinforce the credibility of his points, the author compares and contrasts the views of different scholars on a particular issue in a professional manner, in order to reach an agreeable conclusion. For example, on the issues of the damage to be inflicted on the enemies, the author refers from the Quran (47:4) thus: “When you meet the unbelievers, smite their necks…” (222). In order to expound more on the same issue, the author has referred to the works of scholars like DawudIbnZayidIbnWahb as a “famous traditionist” (224). Similarly, the document refers to Khalid Ibn al-Walid as being “Early Islam greatest general” (224). These sources enhance the credibility of the document and reinforce the author’s argument.

The content of this document portrays fighting in Islamic societies as being acceptable, holyalludes to the Quran (8:39), as regards enemies, thus: “Fight them until there is no persecution, and the religion is God’s entirely.” In essence, their religious teachings justified fighting. In general, this document portrays war as an obligation, and that it should be guided by some rules, which should be applied consistently.

Work Cited

Rushd, Ibn, A. “Rules regarding jihad.” In Chapter 8: Faith, Devotion and Salvation (220-224).n.d. Web. 15th September, 2014. <file:///C:/Users/adminpc/Downloads/jihad_doc.pdf>

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Statement of Purpose for MBA

My passion and motivation for business management arose since when I was 16 years as I worked for my father’s company. I used to help him organize business meetings and also in drawing business strategies. The combination of knowledge and skills that I got from the company’s management enabled me to score high in secondary school, enabling me to secure a chance to study Bachelor of Business Management at Trent University, here in Canada. At the university, the study of organizational behavior and theories enabled me to figure out the relationship between good management practices and organizational success.

The first quarter of the year 2013 was the downfall of our family company. The financial problems are related to limited availability of revenues and  cash-on-hand due to bill-overdue. At the height of the downfall, my father called me back home to go help with the management of the company. I had to call off a semester in order to attend to such a noble call of duty. The activities of re-inventing the business were a learning experience for me. I met with people of different professions including lawyers, accountants and other business people. Interactions with them enhanced my communication, management and people-management skills, as I also knew more of the businesses in the area. Throughout the five months of activity, I was able to integrate the theoretical knowledge I had learnt at the university into real business management. I applied the online marketing skills I had acquired in school to establish e-marketing for our business and the results were very positive. It is through such experiences that I came to appreciate the value of practical as opposed to theoretical learning as supported by Adekola and Sergi (2012).

I am glad that, in August 2014, the ministry of higher education in Saudi Arabia accepted my application for a full educational scholarship in masters of business administration. I enable me to rebuild our company and serve my country as a model business practitioner.

My goal in life is to influence the people and the environment around me. As the Quran verse goes: “Allah will not change the condition of a people until they change what is in themselves,” I believe in effecting societal change through touching the life of an individual. The verse is simple, yet it carries a big meaning. I believe that the chance you will give me will be an avenue towards influencing a whole society.

 

Reference

Adekola, A.P., & Sergi, B.P. (2012). Global business management: A cross-cultural perspective. Burlington, VT: Ashgate Publishing Ltd.

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Emerging Topics in Homeland Security

ISIS is an al-Qaeda affiliate in Syria. The group originated from Iraq and is composed of SunniMuslims. At first, the group targeted the Iraq government, US forces in Iraq, Shia Muslims and Christians. Currently, it has spread in Syria. The ISIS demands are that allMuslims in the world should live in one Islamic state ruled by Sharia law. Foreign fighters, including the United States, have joined Syria to fight against the ISIS. The insecurity in Iraq and Syria has provided a way for the ISIS to attempt to build a pro-state in the Sunni majority areas of the two nations. TheISIS continues to use ruthless tactics to declare its authority. Once the group controls an area, it tells women to cover up and kidnaps journalists, Syrian activists and aid workers. Suicide bombings and beheading is a common feature of the ISIS/Syrian conflict.  The magnitude and outcome of this conflict show that it is a threat to Syria and Iraq and the international community where United States is inclusive(Post wires and Earle 1).Weapons of mass destruction possessed by the group are a threat to global peace. ISIS is also a threat to the economy as oil prices has risen up. The conflict further threatens to destabilize the entire Middle East.

Explanation

The major reason for the Islamic state Iraq and Syria (ISIS) conflict is the political enmity between the Sunni and Shia Muslims of Syria and Iraq. The al-Qaeda of Iraq fought against the majority Shia representation in the Iraq government. Though the group was defeated after the US intervention, it was never destroyed. It reemerged as ISIS and incorporated other al-Qaidamembers after freeing them from the Iraq government. The political enmity of the two Muslims groups drives this conflict. Another driver of this conflict is the support from Sunnis from both nations. The support the ISIS ideology and this gives the group the support and strength to keep fighting. Also, the ISIS is driven from the money from extortion and oil. Syria’s northern oil fields are under the control of ISIS. Therefore, they use trucks to transport oil to Turkey. Also, the group has established networks in the society that generate money. Also, it is believed that US allies such as Saudi Arabia especially rich Saudis have been supporting the group. The main reason for the conflict is to create an Islamic state in Sunni areas of Syria and Iraq (Post wires and Earle 1).This ideology drives the group.

The United States, the world power and having the strongest military could deal and end the ISIS conflict if only the best policies were put in place. Two US policies can change the situation in Iraq and Syria. First, military force should be used with the aim of shaping diplomacy. Rather than using military to destroy ISIS and its supporters, a political accommodation can be successful. The US should put measures on how to ensure that Iraq has an inclusive government where Shiite and Sunnis will be equally represented. This would end communal violence. This intervention will lead to the formation of a new Iraq government. This will also prevent the conflict from spreading to Lebanon and other areas. The second policy is related to ISIS assistance.  The US and its allies need to combat the ISIS and other similar groups not only through military support but also through use of various tools such as working withpartners to counter the ISIS ideology, ending the groups finances and logistics and most importantly, winning over the support of Sunnis in the Iraq and Syria areas.

Analysis

As ISIS conflict worsens, police officers offer a close vigilant to the heavily populated areas with Sunnis and Shias in both Iraq and Syria. Since ISIS is Sunni-dominated and also receives support from SunniMuslims, it is evident that the military intervention in ending the ISIS conflict would be futile as this would not solve the differences between the two groups. As the main driver of the conflict, the political difference between the two groups should be central to every action that is focused towards ending the conflict. Though the war is not between the Shias and the Sunnis, the history of the two stirred the emergence of the group from the former al-Qaida. The second driver, the ideology that the ISIS bases its action on should be an issue of concern (Kerry 1).  Any intervention should ensure that Sunni supporters drop that ideology and focus of building an inclusive national government. To conclude, the US military will create more harm through use of weapons to end the ISIS conflict, US policy makers should identify the drivers of the conflict and therefore make interventions to create a firm solution. This is because it is only through political accommodation and unmilitary interventions(pulling down the foundation of the group) that the ISIS will not only be defeated but destroyed completely.

Recommendations

So far, US air strikesagainst the ISIS has been important in containing the group, responding to threats to US citizens in Iraq and preventing possible actions of genocide(Baldor2). However, US military action needs to be just part of the most important multinational security and political strategy. The US should have a strategyaimed at degrading the ISIS. This policy should contain the threat of ISIS to Middle East and international security, reduce humanitarian crisis troubling Iraqis and civilians and finally restoring the territorial integrity of Syria and Iraq. Furthermore, the US should cooperate with its partners(Kerry 1). This would provide a coordinated action towards defeating the ISIS.

Works Cited

Baldor, Lolita. U.S. Launches Airstrikes against ISIS near Baghdad, Marking First Step in Expanded Fight. Huffpost. September 17, 2014

Post wires and Earle, Geoff. Obama administration confirms ISIS conflict is war. New York Post. September 13, 2014

Kerry, John. The Threat of ISIS Demands a Global Coalition. The New York Times. AUG. 29, 2014

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MATERNAL AND CHILD HEALTH

kilometer racial composition was 86% for the white people, 5.5 % Native Americans, 3.1% African- American, 1.4% Asian, 1.8% from other races and 2.2% Pacific Islanders. The number of total births per 300 people in Doyle community is 124 per year while the number of live births for is 112 births. The Doyle maternal mortality stands at 4% for every 100 women, and the infant mortality is 7% for every 100 live births. The Low Birth Weight is 17% infants for every 100 live births and 2% Very Low Birth Weight for every 100 live born. The rate of premature births is 12% according to the statistics (Short, Frank & Conrey, 2012). Majority of women prefer to give birth under the care of a physician, as indicated by the number of women who visit maternity hospitals and birth centers during birth. 82% of the births take place under the care of a physician, 8% under the CNMs, 7% under CMs and 3% under the other types of midwives in homes.  The government pays maternity fees for 75% of the total births while the Medicaid pays the 25% of the maternity fees (Short, Frank &Conrey, 2012). There are many policies on the role of midwives to encourage then to attend to many births, and the state offers a number of maternal services such as immunizations, antenatal and postnatal care.

Maternal Child Health indicators in Doyle

during pregnancy, during birth or immediately after birth due to maternal causes. Maternal mortality rate=Number of maternal deaths/number of 100,000 live births in a year.  That is MMR =total deaths/100000 live births per year (Zoti, Williams & Wako, 2014). The figures on Maternal Mortality Rate are useful to the health departments of the US. they help to plan on the causes of maternal deaths, how to reduce the death rates, and the amount of funding for achieving the low maternal death rates.

Infant Mortality refers to the death of a child less than one year of age due to various causes, such as infant diseases. Infant Mortality Rate is the number of deaths of infants under one year for every 1000 live births. Infant Mortality Rate =number of infants under 1 year /1000  (Zoti, Williams &Wako, 2014) live births in the same year. The statistics on Infant Mortality Rates are very vital to help in the countries work on the ways to curb infant deaths by indentifying the causes and laying down the necessary strategies.

Prematurity is a case of the delivery of neonates that are less than 37 weeks of the gestation period. Premature infants of with a weight, which is less than 1000g die due to congenital malformation, respiratory failure, and infections. Prematurity rate is the number of premature babies for every 10 live births. Prematurity rate = number of premature infants /1000 live births per year (Zoti, Williams & Wako, 2014). The data on the prematurity rates assists the health planners to come up with strategies, which can help to reduce the number of premature infants in the US. The strategies can include education, funding, and counseling.

Low Birth Weight (LBW) is the weight of a live infant, which is less than 2500 g regardless of the age of the gestation. The normal weight for a healthy infant is 2500g to 4200g at delivery. LBW can result from preterm birth or the low prenatal growth rate. Other cases are young age, poor nutrition, multiple pregnancies, heart diseases, and drug abuse. The LBW rate is the number of life infants born with low birth weight for every 1000 live births in a year LBWR =number of low birth weight infants/ 1000 live births in a year (Zoti, Williams & Wako, 2014). The data on LBW helps the health ministry to come up with solutions to the causes of low birth weight infants and teach mothers on the best diets during the pregnancy period.

Very Low Birth Weight (VLBW) is the birth weight of an infant, which is less than 1500g. The causes may be due to drug abuse, preterm birth, multiple pregnancies, and poor nutrition. Very Low Birth Weight Rate is the number of infants with less than 1500g for every 1000 births. That is, VLBWR= number of infants less than 1500g/ 1000 live births in a year. Similar to the case of low birth weight infants, the information on very low birth weight infants assists the health sector to plan on how to reduce the cases and save the VLBW infants (Zoti, Williams & Wako, 2014).

Local outcome Disparities in Doyle community

There are a number of disparities in the outcomes of the indicators in terms of ethnic community, married and unmarried mothers, underage, educated, and overage mothers.  Maternal and infant mortality rates are higher in the African- American origin than in the pure Americans. Low birth weight and very low birth weight is very common in underage, overage mothers and the less educated mothers. The unmarried mothers also contribute to the higher rate in the low birth weight and the premature infants, in the community (Short, Oza, Frank & Conrey, 2012).

Maternal-Child Data for Doyle community Lassen County (US Department of Health and Human Services Office of the Disease Prevention and Health promotion. Health People 2020 Washington, DC. Retrieved from http://www.healthypeople.gov.)

Health Measure Lassen County CA % Doyle % National Data % HP 2020 Baseline % HP 2020 Goals
Maternal mortality 3.7 4 12.5 12.7 /100000 occurred in 2007 Reduce the rate of mortality
Infant Mortality 4.5 7 10.1 6.7/1000 deaths  reported in 2007 Reduce infant mortality
Prematurity 5.4 12 9.5 12.7% premature births in 2007 Reduce the total premature deaths
Low Birth Weight 6.8 10.2 5.6 8.2% low birth weight in 2007 Reduce deaths due to low birth weight
Very Low Birth Weight 4.9 2 4.8 1.5% of  very low birth weight in 2007 Reduce cases of very low birth weight

 

Comparison of Doyle Community to the State and the National Data

In Doyle, Lassen County the percentage of the total maternal mortality rate is 4%, which is higher than the state at 3.7% and lower than the national figure at 12.5. Comparing it with the HP2020, the mortality rate in Doyle is lower than the base line of 12.7% but it is lower than the national figure at 12.5%. The mortality rate in Doyle is quite low when compared to the above statistics, though there is a need to lower it below the state level.

Infant mortality rate in Doyle, Lassen County is at 7%, which is higher than the state or county value at 4.7%, though lower than the national level at a value of 10.1%.  The infant mortality rate is higher than the HP20 baseline by 0.3%, which deviates from the HP2020 goal of reducing the rate of infant mortality in the US. In Doyle, prematurity rate stands at 12%, a value that is higher than both the state and the national figures, which stand at 5.4 and 9.5 respectively.  He figure is quite high in comparison to the national and the county values, but is lower than the HP2020 baseline level at 12.7%. The HP2020 of lowering the rate of premature births is achievable, according to the statistics. Achievement of low premature births will ensure that infants grow healthy and do not suffer from childhood ailments, such as respiratory diseases.

The cases of low birth weight in Doyle are very high in comparison to the county and the national statistics, which stands at 6.8% and 5.6% respectively. The Doyle low birth weight rate is 10.2%, which is higher than the HP2020 base line of 8.2%. This means that the goal of achieving a lower level of prematurity is a bit difficult for the Doyle community. Prematurity can cause health challenges to infants as they grow up since they have low immunity to various kinds of diseases.

In Doyle, the rate of the Very Low Birth Weight is at 2%, which is lower than the state’s value at 4.9% and the national value at 4.8%. The value in Doyle is higher that the HP2020 base line value at 1.2%, which means the goals of lowering the rate of very low birth rate, was not achievable. Very low birth weight increases the infant mortality rate in Doyle and the nation as a whole.

The analysis table shows a trend in which the rates of, infant mortality, low birth weight, and very low birth weight are higher than the HP2020 baselines and the goals. The aim of the HP 2020 goals is to reduce the mentioned rates but their values are higher in Doyle compared to the values on the base line.  However, the rates of maternal mortality and the prematurity are lower than the values set on the HP2020 base line.

The health indicator that needs improvement is the low birth rate. The rationale for the need to improve on measures to reduce low birth rates in Doyle is due to the health risks experienced by the low birth weight infants.  Reduction of low birth weight in infants will help the infant to develop immunity that helps to fight the childhood ailments. The reduction of the low birth weight will reduce the cost in terms of the incubation fees in the hospital and any further cost related to low birth weight complications (Frioux, Wood, Fakeye, Luan, Localio & Rubin, 2014).

There are a number of programs to address the LBW and the other indicators in Doyle and other states in the US. Some of the programs are Maternal and Child Health Program, the Epidemiology Program, Research on the Preterm Birth Program, and improving the National Reporting of the Sunken Infant Syndromes (SIDs) (Thompson, Black, Esernio-Jennsen, Hardt, Das & Roth, 2012).

Conclusion

 

There are very many maternal child indicators in Lassen especially in Doyle community, such as maternal mortality rates.  The rates are higher in many cases compared to the HP2020 baselines and goals, though it is possible to reduce them to manageable levels. There are also some disparities in the maternal child health indicators based on the community or the race of origin. There is the need to improve on the low birth weight indicator to assist the infants live a healthy life.  There are programs to help lower the levels of the indicators, which help to reduce the percentage levels on the indicators in the community and the state.

References

Frioux, S., Wood, J., Fakeye, O., Luan, X., Localio, R., & Rubin, D. (2014). Longitudinal Association of County-Level Economic Indicators and Child Maltreatment Incidents. Matern Child Health J18(9), 2202-2208. doi:10.1007/s10995-014-1469-0

Thompson, E., Thompson, L., Black, E., Esernio-Jenssen, D., Hardt, N., Das, R., & Roth, J. (2012). Identifying Indicators During Pregnancy for Child Maltreatment. Matern Child Health J17(10), 1817-1824.

Short, V., Oza-Frank, R., & Conrey, E. (2012). Preconception Health Indicators: A Comparison Between Non-Appalachian and Appalachian Women. Matern Child Health J16(S2), 238-249. doi:10.1007/s10995-012-1129-1

U.S. Department of Health and Human Services.Office of Disease Prevention and Health Promotion.Healthy People 2020. Washington, DC. Retrieved from http://www.healthypeople.gov

Zotti, M., Williams, A., & Wako, E. (2014). Post-disaster Health Indicators for Pregnant and Postpartum Women and Infants. Matern Child Health J. doi:10.1007/s10995-014-1643-4

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AGREE II Analysis of a Guideline

This paper aims at analyzing a clinical practice guideline regarding triaging at the emergency room. The problem at hand regards the delays that patients experience at the emergency room, coupled with extended wait times, which is likely to lead to increased mortality. The related guideline developed by the National Guideline Clearinghouse will be analyzed using the AGREE II instrument developed by the AGREE Research Trust (Brouwers et al., 2010). The paper will also enumerate the development of a theoretical/conceptual framework regarding the chosen concept. A theoretical creation of the newly developed framework will also be provided.

Part 1:

The problem identified for discussion in the paper is: “Delays in emergency room triage area with extended wait times.” The rationale for the choice of the problem regards the realization that a majority of trauma patients spends quite a lot of time in the emergency room before they are attended. Due to the hitches in the triaging of patients, some well-up patients may be attended before more severe cases are attended. Such a scenario leads to the loss of lives that could have been, otherwise, prevented. The concept, in this case, is to: “Apply the field triage principle to the advanced nurse practitioner role in the triage area of the emergency room.”

The guideline under analysis in this case is: “Guidelines for field triage: recommendations of the expert panel on field triage, 2011”  (Agency for Healthcare research and Quality, 2011)

The AGREE II instrument ratings for the guideline will be discussed under this section. AGREE II Instrument was developed with a view to addressing the aspect of variability in the quality of guidelines. The instrument has six domains, and all the domains will be used in the current appraisal. Under each domain, there are various aspects that the appraiser considers. They are called ‘items.’ The items are rated between 1 to 7, depending on their reliability. The score ratings range from ‘1′ to ‘7′ as shown below:

1

Strongly Disagree

2 3 4 5 6 7

Strongly Agree

 

Explanation of the Formula:

Before going to the tables showing the calculations, it is important to understand how the calculations have been done. In this case, there is one appraiser. The maximum possible score for on item 7. The maximum possible score for 2 items would be 7 x2, which is 14, and so on. The minimum score for one item would be 1 since the appraiser is one. The minimum score for 2 items will be 2, and so on.

The percentages will be calculated  using the formula:

Obtained Score-Minimum possible score, divide by Maximum possible score – minimum possible score, and then multiply by one hundred. If, for example, three items of domain one are rated 4, 5, and 6, respectively, the total score would be 15. The maximum possible score would be 21; minimum possible score would be 21-3=18. The percentage would be 13/18, multiplied by 100, which is 72%.

Below are the ratings, rationale, total scores and percentages for each of the six domains for the chosen guideline

Domain 1: Scope and Purpose

  Item 1 Item 2 Item 3 Total Percentage
Rating 7 5 5 17 77
Rationale Guidelines are well written, specific and with easy content Target population not very specific Does not give the specifics of the target population    

 

Domain 2: Stakeholder Involvement

  Item 4 Item 5 Item 6 Total Percentage
Rating 6 5 7 18 83%
Rationale Some stakeholders do not have all aspects considered A good search for views, but some groups not consulted The users are clearly identified    

 

 

 

Domain 3: Rigour of Development

  Item 7 Item 8 Item 9 Item 10 Item 11 Item 12 Item 13 Item 14 Total score Percentage
Rating 5 7 4 7 6 6 7 7 52 92
Rationale No record of information from clinical evidence Clear docu-

mentation of criteria

No clear explanation of limitations Clearly stated  

Lacks deeper explanations

Explicit link evident Yes. It is even an updated review Was reviewed thoroughly    

 

Domain 4: Clarity of Presentation

  Item 15 Item 16 Item 17 Total score Percentage
Rating 5 4 7 16 72
Rationale Most are specific; a few are ambiguous Has not majored on the different options Meets all requirements    

 

Domain 5: Applicability

  Item 18 Item 19 Item 20 Item 21 Total score Percentage
Rating 6 7 4 7 24 84
Rationale Yes, but not very specific Tools provided, though not in totality No much consideration of resource implications Yes, and has provided the specifics    

Domain 6: Editorial Independence       

  Item 22 Item 23 Total score Percentage
Rating 7 7 17 100
Rationale A clear statement of financial disclosures A clear statement of conflict of interests    

My overall recommendation regarding the use of the guideline, as evidenced by the AGREE II scores, is that the guideline is suitable for application to curb the identified problem. In the application of the guideline, any recommendations for improvement can be done by following the recommended criteria for making improvements into the guideline. The experience of using the AGREE II analysis for this analysis has been good. I have learnt a lot regarding the reliability of a guideline. I will apply the knowledge I have gained from this exercise in the evaluation of other guidelines before using or recommending them for use.

Part II: Theoretical and Conceptual Framework

In relation to the guideline, the chosen related concept is: “The benefits of using a provider (advanced nurse practitioner) in the triage area of an emergency room.” It is assumed that such a policy will lead to reduced wait times. A conceptual framework model is drawn to guide the process at hand. In truth, a conceptual framework model enables the learner/researcher/implementer to know the factors/concepts that one needs to focus on (Ilot, Gerrish, Laker, & Bray, 2013, P.1). In a case like the one under discussion in this paper, a conceptual framework guides the implementation of the concept through clinical evidence. The clinical evidence will be monitored using the factors identified in the conceptual framework model. The Knowledge to Action (K2A) process is one such model that was developed in Canada by Graham et al. (2006). The model focuses on easing the concepts in regard to understanding knowledge, translating it and applying it.

Assumptions:

The conceptual framework derived from the chosen concept leads to the following assumptions:

I). The use of an advanced practice nurse in the triage area will result in reduced wait time.

II). Reduced wait time will result in casualties being attended on time, leading to a reduction in mortality in the casualty department

III). Intermediate outcomes for on-time attendance to casualties will be desirable, enabling time for a comprehensive management.

The model is very applicable in the clinical area since all the necessary factors have been considered. Additionally, the guidelines from which the concept was drawn was analyzed using the AGREED II Instrument, and the results were excellent.

Diagram of the New Framework:                                        (1)

Priority Casualties(2)

Early detection of priority cases

Screening (3)                                                             Association (6)

Intervention (4)

(5)

(8)

(7)

References

Agency for Healthcare research and Quality.(2011). Guidelines for field triage of injured patients.Recommendations for the National Expert Panel on Field Triage, 2011. Rockville, MD: Author. Retrieved from http://www.guideline.gov/content.aspx?id=38452&search=field+triage

Brouwers, M., Kho, M.E., Browman, P.G., Cluzeau, F., Feder, G., Fervers, B., Hanna, S., Makarski, J., on behalf of the AGREE Next Steps Consortium.  (2010). AGREE II: Advancing guideline, development, reporting and evaluation in healthcare. Canadian Medical Association Journal, 182, 839-842.

Graham, D.I., Logan, J., Harrison, B.M., Straus, E.S., Tetroe, J., Caswel, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26, 13-24.

Ilot, I., Gerrish, K., Laker, S., & Bray, K. (2013). Naming and framing the problem: Using theories, models and conceptual frameworks. Bridging the Gap Between Knowledge and Practice, Your Starter, 10(12), 1-4.

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Policy Recommendation on the Middle East to the Congress

Solutions to the Unemployment problem in the Middle East

Zohny 2011).

Developing a relevant education and training System

Middle Eastern countries and more so in Saudi Arabia is mostly theoretical (Al-Atawneh 2009). Many job markets, especially in the industries and the technical companies require people to have technical knowledge and practical experience for effective production. . The education system in the middle should have the basis of the modern technology to enable the graduates cope up with the current trends in digitization.

Encouraging and developing the private sector

(Al-Gelban 2009). The government of Saudi Arabia should encourage and develop the private sector by offering a good environment for the investors to operate. Some of the ways the government can encourage the growth of the private sector is by lowering the taxes imposed on both the local and foreign-owned companies. The authorities should also give incentives to the potential investors and remove any barriers such as high license fee and tough regulations that discourage investors in the country. The government should also set minimum wages paid to employees in the private sector as most of the employers offer very low salaries. Low wages and salaries discourage many people from seeking job opportunities in the private sector, which in turn leads to high unemployment levels.Middle East countries and Saudi Arabia include the banking sector, the manufacturing sector, the transport sector, and the service industry. Many of the private businesses face many challenges from the government regulations, such as high-interest rates, high taxation, and license fees. These challenges discourage investors, contributing to the increased unemployment levels in the Middle Eastern countries.

Population control

(Ali & Abdulrahman 2012). High population leads to strains on the available resources, leading to their depletion. The major contributor to the high population is the uncontrolled birth-rates where families have many children. There are many young people graduating from the learning institutions every year to join the labor market. The labor market cannot absorb all the graduates leading to the high population of jobless people. To control population, the government, through the health sector should implement birth control methods to reduce the high birth rates. The authorities should educate the citizens on the importance of having small families by the adoption of the family planning programs (Ali & Abdulrahman 2012). Religious leaders should teach their followers to have fewer children and educate them, instead of practicing their cultural values of having many children. The other way of reducing the high population is regulating the number of immigrants entering the Middle Eastern countries in search of job opportunities. Controlling immigrants will create vacancies for the locals in different sectors and reduce the number of people struggling to get jobs in the country.

Fighting corruption

Corruption is rampant in many developing countries and more so in the Middle East and Saudi Arabia (Devlin 2010). Corruption is in different forms such as bribery, nepotism, stealing of public funds, tribalism, and sometimes the religious discrimination. In Saudi Arabia, for example, the business owners have to bribe the government officials and trade regulators to operate their businesses. Many people have to pay some amount to secure a job in many government and some private organizations, which locks out many qualified people. Other employers employ people from their tribes, race, and religious denomination. The governments of the Middle East countries and Saudi Arabia can fight corruption through the formation of anticorruption commissions, which can track and investigate any corruption allegations. The other way is encouraging people to report any bribery claims to the authorities instead of paying the bribe to secure jobs.  The government should carry out an audit in all the employment institutions to determine the level of tribalism and nepotism in the organizations. The people caught engaging in any corrupt activities should face the law and serve as an example to the other corrupt individuals. Those people found misusing the public funds; especially the politicians should face the law and pay back the resources stolen from the government.

Reducing the bureaucracies in doing business

In many Middle East, countries and Saudi Arabia there are many bureaucracies required for the private investors in order to set up businesses (Forstenlechner & Rutledge 2010). Those people interested in setting up business have many applications and submit them to various ministries. The requirements are tiring, and time-consuming making many potential investors to give up on starting businesses. Most of the companies also depend on contracts from the government, which discourages competition with similar companies in the region. The government of Saudi Arabia should work on the methods of reducing the requirements for those who want to venture into private businesses. The applications should be fewer to avoid discouraging many potential investors, which help in creating job opportunities. The government should also leave the private companies and business to compete and provide excellent services to the country. Competition will also lead to increased salaries to the employees as the organizations struggle to retain their employees.

Empowering Women and the Youths

number of young people graduating from the institutions of higher learning is more than the number of job opportunities in Arabia. The other unemployed youths do not have any skilled labor since some are school dropouts (Grammy 20130). The authorities should come up with policies that help the youths to get into self-employment and reduce employment levels. Some of the means to help the youths to start their own business is by funding their projects and providing loans al lower interest. The government can also empower the youths by organizing education and training forums in entrepreneurship and business management. The government should set women funds to help women secure enough capital to start up their businesses. The government should also support all the small and medium enterprises through funding and advising the owners.

In the Middle Eastern countries and Arabia, women do not seek employment due to religious, cultural, and social beliefs. The Arab’s culture dictates that women’s role is taking care of their husbands and children (Gerner & Schwedier 2004) women from seeking employment opportunities.  The belief that only men should be the breadwinners is an outdated belief and societies should change their perceptions on the role of women in the society. The religious leaders should encourage women to venture out and participate in the nation building through their summons. Full participation of women in employment and job creation will help in developing the economies of these countries and reduce unemployment.

Development of infrastructure

any economy and where it lacks, the country’s developments stagnate resulting increased levels of unemployment. Infrastructural facilities such as good transport system, good communication, and other social amenities are very important for private investors in an economy. In the Middle Eastern countries and Arabia, infrastructure is a challenge, which makes it very hard for many business people to carry out their operations (Hanati 2011). The government of these countries will need to improve and build good infrastructure to enable the investors operate their ventures effectively. There is a dire need to establish more banking and financial institutions to help in funding projects such as housing and businesses. In many Arabian countries, funding is from the government and the competition for funds is quite stiff.

Encouraging self-employment and small-medium enterprise

In many countries in the developing world, many graduates always struggle to get employment instead of trying to create employment (Hjort 2013)The semi-skilled sector, if well managed can create many jobs to the unemployed and improve their way of life. The government should also provide market for the products from the small and medium enterprises in order encourage the owners to achieve their goals.

Adoption of good policies

Policies are the strategies adopted by various governments with the purpose of improving their countries’ economy (Nabli 2007). Some policies are good while others can lead to a negative impact on the development of the country. Middle East countries and Arabia should adopt only those policies that help to improve the people’s standard of living instead of widening the gap between the rich and the poor. The Arabian governments should work together with the other countries to establish ties that help in investments and trade. The countries in the Middle East should join world organizations to help in trade and development. For example, Saudi Arabia is the member of many world organizations, such as the World Trade Organization WTO and the International Monetary Fund IMF (Nabli 1007).

Encouraging innovation

Innovation is an important aspect of development in any economy and where it lacks, the development of that country lags behind. In many Middle East countries and Arabia, little innovation takes place as the countries rely on exporting petroleum and forgets the other sectors of the economy (Shahin & Dibe 2000). The Saudi Arabian government should encourage and fund innovative projects, which will create jobs for many people in the county. These projects will employ several people and help in industrialization of the economy. The government should encourage the use of the modern technology in all the sectors of the economy.

Opening investment to foreign businesses

Most of the businesses in the Middle Easter countries and Arabia are under the government and very few belong to private investors. The investments from foreigners are very few because of the restrictions set by the laws (Stampini & Verdier 2000). One way of creating job opportunities is by allowing foreign investors to set businesses in the country. Foreign investors can only invest in the Middle Eastern countries and Saudi Arabia if there is a favorable environment for investments.  The governments can sign contracts with foreign companies to enable them operate with minimum challenges.

Effectiveness of the policies

The current policies in the Middle Eastern countries and Arabia are not very effective in addressing the unemployment challenges. Some of the policies are improving the country’s educating system, programs such as the Hafiz program, cooperate with the private employers for more jobs (Shahin & Dibe 2000). Some of the policies can reduce the level of unemployment while others will not. The policies, such as improving the education, the private, arresting the employs who break labor rules, and support for small businesses will help improve employment. However, policies such as deportation of illegal workers might not over a solution to the unemployment problem.

Recommendations to Reduce Unemployment Levels in the Middle Eastern and Saudi Arabia

The Middle Eastern countries and Saudi Arabia should venture in the tourism industry and encourage tourist from the foreign countries to visit in large numbers. The other recommendation is that the countries should change their cultural and religious values of the position of women, to allow them to venture into businesses. The countries should reduce the number of foreign experts and encourage the locals to take the positions. Adoption of family planning methods will be an important action to take to reduce overpopulation, and reduce the number of youths entering the job market. The other recommendation is for the government to privatize some institutions and allow the locals participate in the ownership and management of the institutions.  Technology is very important for the development of any economy through innovations. For these countries to curb the unemployment, challenge innovation and invention must play an important part. Innovation helps in modernization and creation of job opportunities for the young people graduating from universities (Shahin & Dibe 2000)

There are other areas that the governments of the Middle East and Saudi Arabia sidelines when dealing with matters of unemployment. These areas are the cooperation with the other countries on matters of trade and industry. The authorities in these countries should join trade unions and world organizations to help in the export and the import industry. The Middle East countries are the main exporters of crude oil to many countries yet the poverty levels are very high. The reason for increased poverty is exportation of the crude oil instead of the final products, which can fetch better prices (Shahin & Dibe 2000). The government in these countries should invest in value addition to the oil products and export products such as petrol, diesel, paraffin, and the other products from the refined oil. Exporting the finished products will increase the earnings and create jobs in the manufacturing sector.

realize the fruits of their effort.

The role of the US and other countries in the reforms in the Middle East and Saudi Arabia

There are major reforms in the Middle East countries and Saudi Arabia to reduce unemployment, illiteracy, and high population. Most of the reforms touch on the education sector, women and youth empowerment, the health sector, and modern technology (Stampini & Verdier 2000). There are many challenges faced by these countries when trying to implement their reformation policies making it difficult to achieve their target. The Middle East and Saudi Arabia require technical and material support for them to carry out their reforms. The support includes the following.

Funding women and youth projects

(Stampini & Verdier 2000). Many women and the youths are jobless and can only venture into private businesses to earn a living. The government of the US and the other countries can fund several projects to encourage the women and the youths to venture in self-employment. The funds can be in for of loans at lower interest or just free funding. Once the groups have the funds, they can start and run small enterprises, which will grow into big businesses leading to the growth of the economy.

Offering advisory services to the government officials

There are many policies set by the governments in the Middle East and Saudi Arabia, but the problem is their implementation. The US government and the other countries can help these governments to implement the policies by offering advice and the right information. The advice can range from the source of funding, the usage of the funds, and the expertise required to implement the projects. With the correct advice, there is a guarantee of the success of the projects to create more employment to the local citizens.

Helping  the reformation of the education sector

Education is the main contributor to the development of technology through innovation. Education can only be effective if the curriculum allows for practical skills and integration of modern technology (Grammy 2013). The US and the governments of the other countries can help in the reformation of the education sector by contributing ideas to the best skills required in those countries. Since the Middle East, countries and Saudi Arabia are mainly oil producers the best education system should incorporate technology related to industrialization.

Offering scholarships and exchange programs for students

the role of women in employment and economic development.

Offering expertise personnel

In the Middle Eastern countries and Arabia, there is a big challenge with respect to the supply of experts in various fields such as the manufacturing, education, technology, and management (Hanati 2011). Many jobs that require expertise go to the foreigners, as the locals have no skills to perform the jobs.  The US government can assist the countries with the personnel required to shape the economy of the Middle East countries. The skills from the experts will assist in creating more industries and manufacturing plants in the Middle East and Saudi Arabia, which will lead to more job opportunities.

Help to lower the high population

(Hanati 2011). The US can help in the management of the high population by donating family planning drugs and services to reduce the high birth rates. The US can also help in funding the campaigns on family planning and the need to have fewer children. Some people cannot afford family planning drugs and the assistance offered by the other countries will be very important.  The other offers from the US and the other countries will be funding of projects such as infrastructure, health, irrigation, and agriculture.

Conclusion

There are several challenges associated with unemployment and high population in the Middle East and Saudi Arabia, where many people face poverty and lack basic facilities. The research paper provides some solutions to the high level of unemployment to the problem, which include empowering of women and the youths, reducing bureaucracies, development of infrastructure, good policies, innovation and many others. There are a number of recommendations for the solutions to the unemployment problem such as adoption of the appropriate education system, fight against corruption, family planning, and many others as discussed. The US and other countries can help the Middle East countries in various ways as discussed such as offering advice, donating family planning drugs, funding projects, exchange programs in higher education, and funding infrastructure.

eferences

Al-Atawneh, M. (2009) ‘Is Saudi Arabia a Theocracy? Religion and Governance in Contemporary Saudi Arabia’. Middle Eastern Studies, 45 (5), 721-737.

Al Gelban, K. (2009) ‘Prevalence of psychological symptoms in Saudi secondary school girls in Abha, Saudi Arabia’. Ann Saudi Med, 29 (4), 275.

Ali, J., & Abdulrahman A. (2012) ‘Corporate Social Responsibility In Saudi Arabia’. Middle East Policy 19 (4) 40-53.

Bosbait, M., & Wilson, R. (2005). Education, School to Work Transitions and Unemployment in Saudi Arabia. Middle Eastern Studies, 41(4), 533-546. doi:10.1080/00263200500119258

Devlin, J. (2010) Challenges of economic development in the Middle East and North Africa region. Singapore: World Scientific.

Forstenlechner, I., & Rutledge, E. (2010) ‘Unemployment in the Gulf: Time to Update the“Social Contract”’. Middle East Policy, 17(2), 38-51.

Grammy, A. (2013) ‘The Inflation–Unemployment Trade-Off Under Stagflationary Conditions: The Case of Post-Revolution Iran’. Review of Middle East Economics and Finance, 9 (1).

Gerner, D., & Schwedler, J., (2004) Understanding the contemporary Middle East. Boulder, Colo: Lynne Rienner Publishers.

Hanafi, O. (2011) ‘Arab youth unemployment: roots, risks and responses’. Contemporary Arab Affairs, 4 (3), 385-388.

Hjort, M. (2013) The education of the filmmaker in Africa, the Middle East, and the Americas. New York: Palgrave Macmillan.

Menoret, P. (2011). Development, Planning and Urban Unrest in Saudi Arabia. The Muslim World, 101(2), 269-285. doi:10.1111/j.1478-1913.2011.01356.x

Nabli, M. 2007. Breaking the barriers to higher economic growth. Washington, DC: World Bank.

Shahin, W. & Dibeh, G. (2000) Earnings inequality, unemployment, and poverty in the Middle East and North Africa. Westport, Conn.: Greenwood Press.

Stampini, M. and Verdier-Chouchane, A. (2011). Labor Market Dynamics in Tunisia: The Issue of Youth Unemployment’. Review of Middle East Economics and Finance, 7(2), 1-35.

Zohny, H. (2011) ‘Good Prospects For Computer Sciences In Saudi Arabia And The Middle East’. Nature Middle East. n.p.

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The Picture-book and the Child

For a long time in the history of the earth, picture-books have been in use, not only for children, but also for teaching adults. However, the current discussion focuses on picture-books and their use in children’s educational development. The discussion relates to Salisbury and Style’s book. ‘Children’s picturebook: The art of visual storytelling,’ especially chapter three, which comes out as the most significant chapter in the book. The rationale behind the choice of chapter three as the most significant in the book has been backed by the introduction part of Horning’s 2010 book about evaluation and reviewing of children’s books. It is important to recall that the authors of the book under focus are renowned scholars in the field, with Salisbury being a professor of illustration, and Styles being a professor of children’s literature. In this book of seven chapters, the content of chapter three, in relation to the overall purpose of the book, makes this the most significant chapter in the book.

As can be seen from Horning’s (2010) introductory part, the different parts of a book, carry different weights, and some are more significant than others. Cording to Horning, every part of a book should communicate specific information though inclined to achieve the overall purpose of writing the book. Salisbury and Styles’ 2012 book aims as several purposes as can be seen from the different content that each of the seven chapter carries. Comparing the content of each chapter with the overall purpose of the book, chapter three has more emphasis than the others, fitting to be the most significant chapter in the book.

A reader who examines chapter three of Salisbury and Styles book will agree that it is the nerve center of the book. The chapter carries the specific information that relates to picture-books and the child. In essence, the title of the book can be seen as the main theme that has been discussed in chapter three. The chapter has been divided into two parts. The first part mentions picture-books as a tool for children’s learning. The second part shows picture-books as the visual form through which children tell their stories. With such understanding, chapter three of the book has made an exposition of the title. The chapter, which starts with a preamble from Morag Styles, delves into how children interact with picture-books, how the reading gap between words and images challenge children, and the relationship between visual texts and the educational development of children (Salisbury & Styles, 2012). Indeed, the chapter is about how the child learns through picture-books.

. They are also important since the two processes complete the process of coming up with picture-books, which has been a hurdle worldwide for a long time. However, chapter three is more significant because it carries the main idea of writing the book.

In sum, the parts of a book communicate different messages but are in line with the main idea or purpose of the book. In Salisbury and Styles’ book, chapter three (The Picture-book and the Child) is the most significant part. The rationale for this connotation lies with the fact that chapter three carries the main message of the book, contentwise. Other sections are important in supporting the main message.

References

Horning, K.T. (2010). From cover to cover: Evaluating and reviewing children’s books (Rev. ed). New York, NY: Collins

Salisbury, M., & Styles, M. (2012). Children’s picturebooks: The art of visual storytelling. London, UK: Laurence King Publishing.

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