Influence of Gender Socialisation Causes of Inequality

Influence of Gender Socialisation Causes of Inequality In our society gender is considered one of the most important things by which a person can identify themselves. When a baby is born the first question one asks is not if the baby is healthy or how the woman who has just given birth is but if its boy or a girl?. The gender we are assigned when we are born sticks with us throughout our life, regardless of if we agree with it or not, seemingly influencing the way we act, dress and live our lives. In the following essay, I will discuss the way in which we can define gender both scientifically and sociologically. I will examine how the socialisation process influences our learning of gender norms and how these norms perpetuate gender differences in our society and the inequality that can occur as a result. There are many ways in which one can define gender. Macionis and Plummer define gender as the social aspects of differences and hierarchies between male and female (Macionis Plummer, 2012). While sex is often defined as the state of being either male or female as determined by biological characteristics. (Marchbank Letherby, 2007). We often see sex as being something natural while gender is a social construct built to more clearly define the differences between the sexes. Gender is evident throughout the social world. We see it in our workplaces, schools and in everyday society. Sociologists believe gender cannot exist on its own, it interacts with social norms, values, and in particular, social differences. For example, while society tells us, men are to have traditional masculine traits, to be strong and forceful, one would not expect the strength of a thirty-year-old man to be the same as an eighty year old. (Punch, et al., 2013). We do not have a say in the gender that is assigned to us, it is given to us based on our biological sex. However , there are arguments that show that sex does not always equal biology. Humans do not always fit into the mould of male and female. A study carried out by the University of Sussex, stated that in countries such as India and the USA; the idea of being transgender and gender fluid is becoming progressively more common and accepted. (Jolly, 2002) This study leaves many questions as to whether we are bound by our biological sex at all. If it is possible to change the sex we were born, then why should our gender identity be so important? Nonetheless the gender that is given can and does have implications on the life we will evidently lead and the way is which we experience socialisation throughout our life. Gender socialisation is the way in which boys and girls learn their gender scripts, the appropriate roles they are expected to follow. Boys and girls experience gender socialisation and are taught there gender identity in different ways. However, this gender identity most often highly tainted by the social world around said person. Marchbank and Letherby researched and wrote about many studies which examine the way in which we encourage masculine and feminine ideals, noting that this encouragement is unescapable in schools, the media, clothing, and toys. This does not allow people to explore their own gender, instead pushing people to conform to one definition either male or female. Something many people feel they do not fit. Many leading sociologists have augured that this does, in fact, lend its hand to the problems many people face in terms of gender discrimination and inequality. (Marchbank Letherby, 2007) While we are moving towards a day of gender fluidity in terms of peoples preferences of their own gender and in our gendered roles, inequality does still exist and is evident in everyday life. These differences and inequality vary greatly from country to country. What is considered acceptable in one country may not be in another. This is all a part of a particular countries gender order, defined by Macionis and Plummer as the way in which societies shape notions of masculinity and femininity into power relationships (Macionis Plummer, 2012) Jill Matthews first developed the idea of the gender order in 1984. Matthews argued that the gender order does not mean inequality but allows a distinction to be made between males and females that relates to the general form of gender relations. (Pilcher Whelehan, 2004, p. 61). This idea however, is outdated. Many critics of this theory agree that the gender order does account for the differences in gender expectations between countries it does not account for inequalities between both male and female and those who may not identify as such. Maharaj (1995) and Pilcher (1999) recognize that Matthews and consequently Connell, who based his studies off of Matthews, have theories that are historical in context and do not allow for differences such as time, place and diversity. Similarly, the theory of gender order does not account for gender norms varying from country to country, while gender inequity does not. (Pilcher Whelehan, 2004) Seen all over the world, perhaps the most universa l form of gender inequality is found in the work place. Woman are much less likely to be promoted to managerially and senior positions in work and are highly unlikely to be doing the same job as her male counter parts. For example, in the United States, less than ten percent of workers said they have a co-worker of a different gender who does the same job. (Ryle, 2015) A huge reason for this form of inequality and many more; is the negative qualities seen as being feminine or possessed by only women. Women are seen as the weaker sex, they are too emotional to take on high power roles and are better suited for care giving ones. These connections are directly related to the way in which gender is seen and taught by society. In the USA, women are more likely than men to have a college degree yet are more likely to live in poverty and have lower earnings than men. (Smilowitz, 2015) After examining the meaning of gender, how we learn gender through the socialisation process and societys gender order it is clear to see that all these factors lend their hand to gender inequality. Gender inequality is seen throughout the world, in ways that are often universal. And, contrary to popular belief does not only affect one gender but both and all genders. The social contrast of gender puts us a box. A box that aims to dictate how we will lead our lives based on our biological sex. Inequality runs rapid through our daily lives References Jolly, S., (2002). Issue 10: Culture, Sussex: In Brief . Macionis, J. Plummer, K., (2012). Gender and Sexualities. Third Edition ed. Harlow: Pearson Prentice Hall. Marchbank, J. Letherby, G., (2007). Introduction to Gender Social Science Perspective. First ed. Harlow: Pearson Education Limited. Pilcher, J. Whelehan, I.,( 2004). 50 Key Concepts in Gender Studies. 1st ed. London: Sage Publications. Punch, S., Marsh, I., Keating, M. Harden, J., (2013). Sociology: Making Sense of Society. Fifth Edition ed. Harlow: Person Education Limited. Ryle, R.,( 2015). Questioning Gender: A Sociological Exploration. 2nd ed. California: Sage Publications. Smilowitz, A., (2015). For U.S. Women, Inequality Takes Many Forms The Huffington Post, 14 April, avaliable: http://www.huffingtonpost.com/ariel-smilowitz/for-us-women-inequality-takes-many-forms_b_7064348.html [accessed 18 Mar 2017]

Emergency department patient satisfaction Essay

Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s response to the case study is also included. Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department a nd level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s repsonse to the case study is also included. You  have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of th e translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC. Headnote visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive mar ket advantage, as well as improve the patients’ perception of quality and outcome. INTRODUCTION Recent changes in healthcare have led to increasing competition and the perceived commercialization of the healthcare provided to patients. At the same time, a need for reaffirmation of the importance of the patient-physician relationship has been expressed in the midst of such powerful forces (Laine and Davidoff 1996; Glass 1996; Pellegrino and Thomasma 1989). One aspect of the patient-physician relationship deserving further study is the role of customer service training in healthcare. While numerous customer service training tools exist in business and industry, no studies have clearly delineated the efficacy of customer service training for patients in a clinical setting. This study examines the effect of a required customer service training program taught by healthcare professionals on patient and family complaints, compliments, and satisfaction in a high-volume high-acuity emergency department. METHODS Patient Base All patients presenting to the Emergency Department at Inova Fairfax Hospital, Falls Church, Virginia, between May 1, 1994 and April 30, 1995 formed the control group, representing the period prior to emergency department customer service training. Patients presenting to the emergency department between May 1, 1995 and April 30, 1996 formed the study group, representing the period following customer service training intervention. The mechanism of patient complaint/compliment analysis and the survey criteria were identical in the control and study periods. Patient acuity was assessed by three measures: the number and percentage of patients admitted to the hospital; the number and percentage of patients with Current Procedural Terminology 1996 (CPT) evaluation and management (E/M) codes 99281-99285, (Kirschner et al. 1996); and a nursing acuity rating scale (EMERGE, Medicus Systems, Evanston, Illinois). Inova Fairfax Hospital is a 656-bed not-for-profit institution that is a teaching h ospital, regional referral center, and level I trauma center. Customer Service Training All emergency department staff involved in patient contact (physicians,  nurses, ED technicians, registration personnel, core secretaries, social workers, ED radiology, and ED respiratory therapy) were required to attend an eight-hour customer service training program. The numbers and types of staff involved in training are listed in Table 1. Because of logistic limitations, emergency medicine residents attended a focused fourhour required training course. The eight-hour program consisted of the following modules: basic customer service principles, recognition of patients and customers (Are they patients or customers?), service industry benchmarking leaders, stress recognition and management, communication skills, negotiation skills, empowerment, customer service proactivity, service transitions, service fail-safes, change management, and specific customer service core competencies. (More detailed information on the content of these modules is listed in Appendix 1.) These core comp etencies follow: making the customer service diagnosis (in addition to the clinical diagnosis) and providing the right treatment; negotiating agreement resolution of patient expectations; and building moments of truth into the clinical encounter. Following the initial required training, new physicians or ED employees were required to attend identical customer service training within four months of their initial employment. Additional mandatory customer service training updates were offered three times per year and included modules of conflict resolution, customer service skill updates, advanced communication skills, and assertiveness training. Patient Satisfaction Data Patient satisfaction data in both the control and study groups consisted of patient complaints, patient compliments, and a telephone patientsatisfaction survey conducted by an independent research firm (Shugoll Associates, Rockville, Maryland) that was blinded to the study hypothesis and course content. Patient complaints and/or compliments were systematically identified from all available means, including verbal, written, telephone, or electronic mail sources. Sources of patient complaints, data analysis, and categorization of complaints were identical in the control and study groups, which was coordinated by hospital quality improvement analysts. ED  staff were instructed to report all potential complaints and concerns, regardless of how minor, to appropriate physician or nurse managers in both the control and study periods. Complaints were logged into a central office and were investigated initially by three authors (TM, RC, DR). In cases where classification of type of complaint differed, additional information and/or clarification was sought from staff, patients, and family. Any discrepancies were resolved by group-consensus techniques. All complaints and the classification thereof were independently reviewed and verified by quality-improvement analysts. Patient complaint and compliment letters were referred for comment or clarification to appropriate ED staff in both the control and study periods. Outpatient satisfaction surveys were conducted by an independent research firm (completely blinded to the study and its hypothesis) utilizing a 50-item questionnaire to identify key factors in customer satisfaction. This survey instrument was validated on a sample of more than 3,000 patients prior to implementation in either the control or study group. The study used a telephone survey on a randomized number table basis to 100 ED outpatients per quarter (Appendix 2). Logistic regression analysis performed on these data identified 14 areas of more important/key attributes in the ED (see Table 2). Patient compliment and complaint data, as well as acuity data, were subjected to a two-tailed ttest and the Fisher Exact test. Patient satisfaction surveys were subjected to a two-tailed t-test with a 95 percent confidence level. Patient Turnaround Times Patient turnaround times (TAT) were calculated from time of initial arrival in the ED to either discharge or transfer to an inpatient unit. Turnaround times were routinely calculated on each patient and on an aggregate basis by day, month, quarter, and year. RESULTS ED Volume/Acuity Neither ED volume nor acuity changed to a statistically significant degree between the control and study periods, based on both admission percentage and nursing acuity (see Table 3). Analysis of CPT 96 Evaluation and Management Codes showed a statistically significant increase in codes 99283 and 99285, with a similar decrease in codes 99281 and 99284. The number of pediatric patients did not change in a statistically significant fashion during the study period. The only payor mix category to rise in a statistically significant fashion was managed care (p < .01), with a nearly identical decrease in commercial insurance. Neither compliments nor complaints correlated with payor category. Patient Turnaround Time Mean patient turnaround time dropped from three hours and 24 minutes (204 minutes) to three hours and seven minutes (187 minutes), but this difference was not statistically significant, nor did the percent of patients at one and two standard deviations from the mean change in a statistically significant fashion. Patient Compliments The total number of patient compliments rose from 69 in the control period to 141 in the study period, an increase of more than 100 percent (p < .00001) (see Table 3). Patient compliment letters consistently mentioned warmth, compassion, and skill of the emergency care provider as the reason for contacting management to praise the ED staff. There was no statistical difference between males and females among patient compliments. Patient Complaints Patient complaints dropped from 153 in the control period (2.5 complaints per 1,000 ED visits) to 36 in the study period (0.6 complaints per 1,000 ED visits), (p < .00001) (see Table 3). Complaints about perceived rudeness, insensitivity, or lack of compassion on the part of ED staff dropped most dramatically. Two-thirds of complaints in the study period were a result of waiting times, billing, or delays in obtaining an inpatient bed, compared to 30 percent in the control period. Nevertheless, complaints regarding waiting times, billing, and wait time for an inpatient bed still decreased 50 percent in the study period (p < .001). There were no significant differences in patient complaints based on age or sex, confirming results of the study by Hall and Press (1996). Patient Satisfaction Survey Data Baseline survey data were subjected to logistical regression analysis that indicated that 14 surveyed areas formed a core group of key satisfaction attributes. All of these 14 attributes showed increases in the study period (p < .001, see Table 2). The largest increases were in the following areas: skill of the emergency physician, skill of the nurse, likelihood of returning, overall quality of medical care, doctor’s ability to explain condition, diagnosis, and treatment options, and triage nurse’s sensitivity to pain. DISCUSSION The patient-physician and patient-nurse relationships are arguably the oldest in the history of medicine. These relationships have recently been described as being under siege because of an increase in the tension between the art and science of medicine, as well as the strains attendant to changes in the economic structure of healthcare (Glass 1996). To this list may be added a third causative factor: the lack of rigorous, formal training for healthcare professionals in the customer service fundamentals of the patient-provider relationship. The fundamentals of such training are closely tied to what has traditionally been described as the art of medicine or the concept of beneficence (Pellegrino and Thomasma 1989). Physicians have for the most part learned appropriate patient interaction skills through observing their mentors and peers during the course of graduate medical education. However, there has only recently been substantial study of this important subject (Buller and Buller 1987; Aharony and Strasser 1993). While customer service has been emphasized in American business and industry in recent years (Zeithamal, Parasuraman, and Berry 1990; Jones and Sasser 1995; Reichheld 1996; Berry and Parasuraman 1991; Berry 1995), few training modules are specifically targeted toward physicians and healthcare professionals. For this reason, the authors created an eight-hour customer  service training course for their ED providers, based on principles of adult education, benchmarks from the customer service industry (Sanders 1995; Spectre and McCarthy 1995; Carlzon 1987; Connelan 1997), experience in the clinical setting, and the existing literature on patient satisfaction (Pelligrino and Thomasma 1989; Thompson and Yarnold 1995; Thompson et al. 1996; Bursh, Beezy, and Shaw 1993; Rhee and Bird 1996; Dansk and Miles 1997; Hall and Press 1996; Eisenberg 1997). This literature emphasizes the importance of communication skills, managing information flow, actual versus perceived waiting times, and the ex pressive quality of physicians and nurses. All of these concepts were built into the training modules, including practical clinical examples of behaviors reflecting these and other concepts. Our philosophy in designing this course was simple. Customer service is a skill for which we hold our staff accountable but in which they had never formally been trained. We believed that this dilemma required, at a minimum, two sentinel events to occur. First, the department needed to have a clearly articulated and easily understood cultural transformation to a solid commitment to customer service. Second, staff members needed education in a practical, pragmatic fashion regarding precisely how such customer service principles could be applied in the clinical setting. Just as advanced cardiac life support, advanced trauma life support, and pediatric advanced life support courses can be used to improve cardiac, trauma, and pediatric resuscitation, respectively, we believed customer service outcomes could be improved by well-designed, mandatory, rigorous application of customer service training. The training was provided by active clinicians involved in day-to-day patient care activities (TAM, RJC). We believe this clinical credibility may have played an important part in the customer service transformation, inasmuch as the staff knew the trainers were well aware of the inherent problems of applying pragmatic customer service skills in a busy emergency department. The data from this study strongly support the hypothesis that clinically based, formal customer service training grounded on these principles can  dramatically decrease patient complaints, increase patient compliments, and improve patient satisfaction, at least in a high-volume, high-acuity ED. Patient complaints dropped by over 70 percent and compliments more than doubled during the study period, such that patient compliments actually exceed complaints in our 62,000 patient visit emergency department and level I trauma center. National data indicate that ED complaints average between three to five per 1,000 emergency department patients, although no data are available regarding rates of patient compliments (Culhane and Harding 1994). Our emergency department was slightly below that national standard level even during the control period. Analysis of the patient satisfaction survey data revealed an extremely important trend. Specifically, patients rated skill of the emergency physician, overall quality of medical care, and skill of the ED nurse as three of the most improved areas during the study period compared to the control period, despite the fact that there were no changes in the ED physician staff during the study and there was very little turnover among ED nurses. This strongly implies that patients rate the quality of care and the skill of the physician and nurse based on elements of the customer service interaction. These data suggest an important causal relationship between the technical component of care and the patient caregiver interaction, which has not been previously demonstrated. It is important to recognize that both customer service and technical skills are competencies to which hospitals and healthcare systems should hold their staff accountable on a daily basis. Hospitals spend substantial dollars to ensure that their staffs are technically competent to deliver quality medical care (Herzlinger 1997). However, to ensure that customer service is effective, clinically based customer service training is essential to give staff the appropriate skills in the clinical setting to deliver service competently. This concept is indirectly supported by data from Mack and colleagues (1995), who found that satisfaction with interactive aspects of emergency medical care produced higher correlations with measures of future intention to use the service than did satisfaction with medical outcomes themselves. Their study, however, did not undertake interventions to improve the interactive,  communicative aspect of healthcare in that setting. Similarly, Smith and colleagues (1995) evaluated the effect of a four-week training program, focusing on patient interviewing, somatization, patient education, and self-awareness, that was taught to first year internal medicine and family practice residents. Their data were not conclusive, but suggested that some but not all aspects of patient satisfaction could be improved by such training. This study tends to confirm the work of Thompson and colleagues (1996) that demonstrated in a much smaller sample size that expressive quality and management of informatio n flow to the patient had an effect on patient satisfaction. However, their study did not assess the impact of strategies and techniques for ED staff to improve patient satisfaction by improving expressive quality. While several studies (Thompson et al. 1996; Thompson and Yarnold 1996; Dansk and Miles 1997; Hall and Press 1996) have emphasized the importance of waiting time and exceeding patient expectations regarding length of waiting time, our study demonstrates a dramatic improvement in patient satisfaction without a statistically significant reduction in patient turnaround time. This supports the work of Bursch and colleagues (1993), who found in a study of 258 patients that the five most important variables for patient satisfaction were the amount of time it took before being cared for in the ED, patient ratings of how caring the nurses were, how organized the ED staff was, how caring the physicians were, and the amount of information provided to the patient and family. However, the study did not assess strategies to improve satisfaction based on this knowledge. All of this information was built into the training modules to assist staff with practical strategies to manage waiting time effe ctively using information flow, queuing theory, and verbal skill training. The implications of the higher ratings of the skill of the emergency physicians and nurses are intriguing and could have a far-reaching impact on healthcare. Perhaps the strongest implication is that perceived skill stands as a marker for quality and/or outcome in the mind of patients and their families. It has been shown repeatedly that patient compliance increases with confidence in the physician (Frances, Korsch, and Morris 1969;  Sharfield et al. 1981; Waggoner, Jackson, and Kern 1981; Schmittdiel et al. 1997). While our study did not directly assess improvements in outcome, quality of care, or appropriateness of care, it certainly appears that patients rated the skill of the healthcare providers as a key quality characteristic in this survey. Furthermore, the fact that ratings of quality of medical care and likelihood of returning also increased dramatically speaks to the importance that effective customer service training may have in offering a competitive market advantage to hospitals and healthcare institutions. This is particularly important as the concept of customer loyalty is closely tied to the likelihood of a patient or their family returning to that healthcare institution. As the focus on outcomes management and evidence-based medicine increases, it is important to take into account the effect that customer service skills have on patients’ perceptions of quality and outcome. This study may be subject to several criticisms. First, while statistical data on patient compliments and complaints obtained substantial statistical significance, the number of patients contacted for the outpatient satisfaction telephone survey may have resulted in sampling bias. While a larger sampling is planned in the future, the patient satisfaction survey data trends were consistent throughout all quarters and appear to be a valid statistical tool, despite the number of patients sampled. Second, it was not possible to blind those responsible for investigating and classifying complaints and compliments. However, we did attempt to reduce or eliminate possible reporting or observer bias by identifying complaints from all sources and ensuring that all complaints and their classification were reviewed and approved by an author who was not involved in ED operations and by quality improvement analysts. Third, information is not available on national or regional trends of patient compl aints and/or satisfaction during the study period. It is possible that the data in this study may reflect local, regional, or national trends toward decreased complaints and increased satisfaction, either globally throughout healthcare or in ED patients specifically. However, this is highly unlikely as no such trends have been previously reported, nor would such trends fully explain the data from this study, even if they were present. The data on patient acuity  indicated an increase in CPT codes 99283 and 99285, suggesting a slight trend toward higher patient acuity. This could mean that patients with higher levels of acuity are more satisfied and less likely to complain. No data are available to either prove or disprove this possibility, but the trend toward higher acuity would not appear to completely explain the dramatic improvement seen in this study. Furthermore, the patient-satisfaction telephone survey excluded inpatients, who comprise a larger percentage of patients in the 99285 service code. Further study is needed to delineate the relationship of ED patient acuity to satisfaction. Despite these potential limitations, this study demonstrates that clinically based customer training for ED staff can decrease patient complaints and increase patient satisfaction in a large volume, high-acuity ED, and that satisfaction is independent of patient turnaround times. Furthermore, the data support the concept that patients rate the skill of the emergency physician, overall quality of medical care, and skill of the ED nurse significantly higher after such training is provided to the ED staff. Additional studies in ED with different volumes, acuities, and geographic locations are needed to demonstrate whether these results can be duplicated. Studies of the impact of customer service training in other healthcare settings would also be of benefit. Nonetheless, clinically focused customer service training has been shown in this study to improve patient satisfaction and ratings of the skill of physicians and nurses. If verified by other studies, customer service training should be considered an important part of graduate and undergraduate medical education to improve both the art and science of the patient-physician relationship. The clinically based customer service training described in this study is now a required part of competency based orientation for all physicians, nurses, residents, and support staff in the emergency department. All professional and non-professional staff interviewed for positions in the emergency department are advised of the institution’s strong commitment to customer service training and the necessity of attending the required training course. As healthcare increasingly emphasizes accountability for customer service in its staff, it is increasingly important that practical and effective customer service training is provided. While not directly addressed in this study, the data on ratings of quality of medical care, skill of the physician and nurses, and likelihood of returning strongly suggest that effectively completing the customer service transition offers a competitive market advantage to hospitals and healthcare systems. References Aharony, L., and S. Strasser. 1993. â€Å"Patient Satisfaction: What We Know About and What We Still Need to Explore.† Medical Care Review 50 (1): 49-79. Berry, L. L. 1995. On Great Service: A Framework for Action. New York: Free Press. Berry, L. L., and A. Parasuraman. 1991. Marketing Services: Competing Through Quality. New York: Free Press. Butler, M. K., and D. B. Buller. 1987. â€Å"Physician’s Communication Style and Patient Satisfaction.† Journal of Health and Social Behavior 28 (4): 375-88. Bursh, B., J. Beezy, and R. Shaw. 1993. â€Å"Emergency Department Satisfaction: What Matters Most?† Annals of Emergency Medicine 22: 586-91. Carlzon, J. 1987. Moments of Truth: New Strategies for Today’s Customer-Driven Economy. New York: Ballinger Publishing. Connelan, T. 1997. Inside the Magic Kingdom. Austin, TX: Bard Press. Culhane, D. E., and P. J. Harding. 1994. â€Å"Quality in Customers: Great Expectations.† Presented to the American College of Emergency Physicians Management Academy, Boston, Massachusetts, May 19, 1994. Dansk, K. H., and J. Miles. 1997. â€Å"Patient Satisfaction with Ambulatory Healthcare Services: Waiting Time and Follow-up Time.† Hospitals and Health Services Administration 42 (2): 165-77. Eisenberg, B. 1997. â€Å"Customer Service in Healthcare.† Hospitals and Healthcare Services Administration 42 ( 1 ): 17-32. Frances, V, B. M. Korsch, and M. J. Morris. 1969. â€Å"Gaps in Doctor-Patient Communication. Patient’s Response to Medical Advice.† New England Journal of Medicine. 280: 535-49. Glass, R. M. 1996. â€Å"The Patient-Physician Relationship: JAMA Focuses on the Center of Medicine.† Journal of the American Medical Association 275: 147-48. Hall, M. F., and I. Press. 1996. â€Å"Keys to Patient Satisfaction in the Emergency Department: Results of a Multiple Facility Study.† Hospitals and Healthcare Administration 41 (4): 515-32. Herzlinger, R. 1997. Market-Driven Health Care. New York: Free Press. Inova Health System. 1997. â€Å"Outpatient Satisfaction Research.† Shugoll Research. Rockville, MD. Jones, T. O., and W. E. Sasser, Jr. 1995. â€Å"Why Satisfied Customers Defect.† Harvard Business Review 73: 88-99. Kirschner, C. G., R. C. Burkett, G. M. Kotowicz, et al. 1996. Physicians’ Current Procedural Terminology-CPT 96, ed 5. Chicago: American Medical Association. Laine, C., and F. Davidoff. 1996. â€Å"PatientCentered Medicine: A Professional Evolution† lournal of the American Medical Association 275: 152-56. Mack, J. L., K. M. File, J. E. Horwitz, and R. A. Prince. 1995. â€Å"The Effect of Urgency on Patient Satisfaction and Future Emergency Department Choice.† Health Care Management Review 20: 7-15. Pellegrino, E. D., and D. C. Thomasma. 1989. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press. Rhee, K., and J. Bird. 1996. â€Å"Perceptions in Satisfaction with Emergency Department Care.† Journal of Emergency Medicine 14: 679-83. Reichheld, E E 1996. â€Å"Learning from Customer Defections.† Harvard Business Review 74: 56-69. Sanders, B. 1995. Fabled Service: Ordinary Acts, Extraordinary Outcomes. San Diego: Pfeiffer and Company. Schmittdiel, J., J. V. Selby, K. Grumbach, and C. P. Quesenberry. 1997. â€Å"Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization.† Journal of the American Medical Association 278 (19): 1596-1612. Sharfield, B., C. Wray, K. Hess, and E. M. Smith. 1981. â€Å"The Influence of Patient-Practitioner Agreement on Outcome of Care.† American Journal of Public Health 71: 127-31. Smith, R. C., J. S. Lyles, J. A. Mettler, et al. 1995. â€Å"A Strategy for Improving Patient Satisfaction by the Intensive Training of Residents in Psychosocial Medicine: A Controlled, Randomized Study† Academic Medicine 70: 729-32. Spectre, R., and P. D. McCarthy. 1995. The Nordstrom Way: The Inside Story of America’s #1 Customer Service Co mpany. New York: John Wiley and Sons. Thompson, D. A., P. R. Yarnold, D. R. Williams, and S. L. Adams. 1996. â€Å"Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient Satisfaction in the Emergency Department† Annals of Emergency Medicine 28: 657-65. Thompson, D. A., and P. R. Yarnold. 1995. â€Å"Relating Patient Satisfaction to Waiting Time Perceptions and Expectations: The Disconfirmation Paradigm.† Academic Emergency Medicine 2: 1057-62. Thompson, D. A., P. R. Yarnold, S. L. Adams, and A. B. Spaccone. 1996. â€Å"How Accurate Are Waiting Time Perceptions of Patients in the Emergency Department?† Annals of Emergency Medicine 28: 652-56. Waggoner, D. M., E. B. Jackson, and D. E. Kern. 1981. â€Å"Physician Influence on Patient Compliance: A Clinical Trial.† Annals of Emergency Medicine 10: 348-52. Zeithamal, V. A., A. Parasuraman, and L. L. Berry. 1990. Delivering Quality Service: Balancing Customer Perceptions and Expectations. New York: Free Press. You have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. 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Bacterial Growth Requirements

Bacteria Growth Requirements Microbiology Life as we now it has ended. What is left you ask? Well it is said the only thing that could survive an incident that could end our known way of life is a roach and a pack or Twinkies. In truth the great survivor would be microorganisms. Microorganisms can survive where most cannot due to their size, nutritional needs, energy requirements, and are very good at adapting to different environments (Black 2008).Microorganisms require two things to live a long healthy life, and these are physical and nutritional factors. Physical factors include pH, temperature, oxygen concentration, moisture, hydrostatic pressure, osmotic pressure, and radiation (Black 2008). Nutritional factors include carbon, nitrogen, sulfur, phosphorus, trace elements, and sometimes vitamins (Black 2008). For the purpose of this exercise I will focus on E. coli. Pathogenic Escherichia coli will be discussed since it is a common, but dangerous bacterium.E. coli in humans is fo und in the intestines. This bacterium is very durable, meaning that it is well-adapted to its habitat. For example, it can grow with glucose being the only food source. This bacterium can also grow with or without O2. If located in anaerobic habitat it can it will use the fermentation process producing mixed acids and gases (Todar 2012). This bacterium has shown that it can also use anaerobic respiration when NO3 or NO2 is available.Chemicals, pH, temperature, are a few signals that determines how E. coli will respond (Todar 2012). When it senses a change in the environment it can swim toward or away from anything useful or harmful. Temperature can also affect E. coli. A change in temperature allows E. coli to change pore diameter of its outer membrane to accommodate certain nutrients, or to exclude something harmful. E. coli also rations its nutrient supply by taking in account how much is available in its environment.This means that it will not take in nutrients unless it has enou gh to feed more bacteria that will be produced (Todar 2012). As you can see, this amazing microbe has the ability to adapt to its environment and in some case overcome. Imagine the microbes that are out there that has not be identified yet. Reference Black, J. (2008). Microbiology principals and explorations. (7th Edition ed. ). Jefferson City: GGS Book Services. Todar, K. (2012). Todars online textbook of bacteriology. Retrieved from http://www. textbookofbacteriology. net/e. coli. html Bacterial Growth Requirements Bacterial Growth Requirements Evelyn Lyle ITT Technical Institute Angela Ask, MPS January 15, 2012 Every organism must find in its environment all of the substances required for energy generation and cellular biosynthesis. The chemicals and elements of this environment that are utilized for bacterial growth are referred to as nutrients. Many bacteria can be identified in the environment by inspection or using genetic techniques. The nutritional requirements of a bacterium such as E Coli are revealed by the cell’s elemental composition.These elements are found in the form of water, inorganic ions, small molecules and macromolecules which serve either a structural or functional role in the cells. Bacteria thrive by four things oxygen, food (nutrients), warmth and time but two others can be moisture and acidity. Nutrients are needed for energy, nitrogen (for DNA and proteins), phosphorus (for energy), and others. Warmth is needed so the bacteria can stay warm. Oxygen is needed so the bacteria can make energy and time is needed for the bacteria to complete binary fission over and over again. Acidity is needed so the bacteria can survive in its environment.Highly base or acidic environments may harm the bacteria and hinder its lifespan. In order to survive and grow, microorganisms require a source of energy and nourishment. Bacteria are the most primitive forms of microorganisms but are composed of a great variety of simple and complex molecules and are able to carry out a wide range of chemical transformations. Depending on their requirements and the source of energy used they are classified into different nutritional groups. Most microorganisms grow well at the normal temperatures favored by man, higher plants and animals.Certain bacteria grow at temperatures (extreme heat or cold) at which few higher organisms can survive. Most bacteria grow best in an environment with a narrow pH range near neutrality between pH 6. 5 and 7. 5. Microbes contain approximate ly 80-90% water and I f placed in a solution with a higher solute concentration will lose water which causes shrinkage of the cell. Some bacteria have adapted so well to high salt concentrations that they actually require them for growth. Nitrogen and phosphorus are particularly critical because they often control the rates of photosynthesis.Carbon is significantly more abundant than either of them and oxygen and sulfur are more abundant that phosphorous. Nitrogen and phosphorous are less available to plants relative to their growth requirements than are other elements. Phosphorus is often in short supply and limits plant and algae growth. Nitrogen is a major constituent of all proteins and of all living organisms. A lack of nitrogen can limit growth of plants, since nearly three quarters of its atmosphere consists of natural gas, N2. REFERENCES A New Way to Look at Microorganisms. (n. d). American Scientist, 93(6), 514.

How to Write a Compelling, Informative News Lede

What is a lede? A lede  is the first paragraph of any news story. Many would say that it’s also the most important part, as it introduces what is to come. A good lede must accomplish three specific things: Give readers the main points of the storyGet readers interested in reading the storyAccomplish both of these in as few words as possible Typically, editors want ledes to be no longer than 35 to 40 words. Why so short? Well, readers want their news delivered quickly, and a short lede does just that. What Goes in a Lede? For news stories, journalists use the inverted pyramid format, which means starting with the five W’s and H:† who, what, where, when, why, and how. Who: Who is the story about?What: What happened in the story?Where: Where did the event you’re writing about occur?When: When did it occur?Why: Why did this happen?How: How did this happen? Lede Examples Now that you understand the basics of a lede, see them in action with these examples. Lede Example 1 Let’s say you’re writing a story about a man who was injured when he fell off a ladder. Here are your five W’s and H: Who: the manWhat: He fell off a ladder while painting.Where: at his houseWhen: yesterdayWhy: The ladder was rickety.How: The rickety ladder broke. So your lede might go something like this: A man was injured yesterday after falling from a rickety ladder which collapsed as he was painting his home. This sums up the main points of the story in just 19 words, which is all you need for a good lede. Lede Example 2 Now you’re writing a story about a house fire in which three people suffered smoke inhalation. Here are your five W’s and H: Who: three peopleWhat: They suffered smoke inhalation in a house fire and were hospitalized.Where: at their houseWhen: yesterdayWhy: A man fell asleep while smoking in bed.How: The cigarette ignited the mans mattress. Heres how this lede might go: Three people were hospitalized for smoke inhalation yesterday from a house fire. Officials say the fire was ignited when a man in the home fell asleep while smoking in bed. This lede clocks in at 30 words. Its a little longer than the last one, but still short and to the point. Lede Example 3 Heres something a bit more complicated—this is a story about a hostage situation. Here are your five W’s and H: Who: six people, one gunmanWhat: The gunman held six people hostage in a restaurant for two hours before surrendering to police.Where: Billy Bobs Barbecue JointWhen: last nightWhy: The gunman tried robbing the restaurant but police arrived before he could escape.How: He ordered the six people into the kitchen. Heres how this lede might go: A failed robbery of Billy Bob’s Barbeque last evening resulted in six being held hostage as police surrounded the building. The suspect surrendered without incident following a two-hour standoff. This lede is 29 words, which is impressive for a story that has a bit more complexity to it. Write Ledes on Your Own Here are some examples to try on your own. Lede Exercise 1 Who: Barrett Bradley, the president of Centerville CollegeWhat: He announced tuition will be raised 5%.Where: at a gathering in the colleges amphitheaterWhen: yesterdayWhy: The college is facing a $3 million deficit.How: He will ask the colleges board of trustees to approve the tuition hike. Lede Exercise 2 Who: Melvin Washington, point guard for the Centerville High School basketball teamWhat: He scored a record 48 points to lead the team to the state championship over the rival team from Roosevelt High School.Where: in the schools gymnasiumWhen: last nightWhy: Washington is a gifted athlete who observers say has an NBA career ahead of him.How: He is a remarkably precise shooter who excels at making three-pointers. Lede Exercise 3 Who: Centerville Mayor Ed JohnsonWhat: He held a press conference announcing he has a drinking problem and is stepping down from his post.Where: in his office at City HallWhen: todayWhy: Johnson says he is entering rehab to deal with his alcoholism.How: He will step down and deputy mayor Helen Peterson will take over.