Learning about America in the Dominican Republic :: Personal Narrative Essays

Exactly one week after graduating from high school, with thirteen years of American education behind me, I boarded a plane and headed for a Caribbean island, I had fifteen days to spend on an island surrounded with crystal blue waters, white sandy shores and luxurious ocean resorts. With beaches to play on by day and casinos to play in during the night, I was told that this country was an exciting new tourist destination. My days in the Dominican Republic, however, were not filled with snorkeling lessons and my nights were not spent at the black jack table. Instead of visiting the ritzy East Coast, I traveled inland to a mountain community with no running water and no electricity. The bus ride to this town called Guayabal, was long, hot and uncomfortable. The mountain roads were not paved and the bus had no air conditioning. Surprisingly, the four-hour ride flew by. I had plenty to think about as my mind raced with thoughts of the next two weeks. I wondered if my host family would be welcoming, if the teenagers would be friendly, and if my work would be hard. I mentally prepared myself for life with out the everyday luxuries of a flushing toilet, a hot shower, and a comfortable bed. Because Guayabal was with out such basic commodities, I did not expect to see many reminders of home. I thought I was going to leave behind my American ways and immerse myself into another culture. These thoughts filled my head as the bus climbed the rocky hill towards Guayabal. When I finally got off the bus and stepped into the town-square, I realized that I had thought wrong: there was no escaping the influence of the American culture. In a way, Guayabal was an example of what author Mary Louise Pratt refers to as a contact zone. Pratt defines a contact zone as "a place where cultures meet, clash, and grapple with each other, often in contexts of highly asymmetrical relations of power" (Pratt 76). In Guayabal, American culture and American consumerism were clashing with the Hispanic and Caribbean culture of the Dominican Republic. The clash came from the Dominicans' desire to be American in every sense, and especially to be consumers of American products. This is nearly impossible for Dominicans to achieve due to their extreme poverty. Their poverty provided the "asymmetrical relation of power" found in contact zones, because it impeded not only the Dominican's ability to be consumers, but also their ability to learn, to work, and to live healthily.

Nursing Leadership and management Essay

Continuous quality improvement (CQI) is the responsibility of all nurses and is vital when addressing the challenges of the health care industry. Provide an example of how you would apply CQI in your current or past position. The purpose of QI is to use a systematic, data-guided approach to improve processes or outcomes (Conner, 2014). Principles and strategies involved in QI have evolved from organizational philosophies of total quality management and continuous quality improvement. Connor (2014) emphasizes that while the concept of quality can be subjective, QI in healthcare typically focuses on improving patient outcomes. So the key is to clearly define the outcome that needs to be improved, identify how the outcome will be measured, and develop a plan for implementing an intervention and collecting data before and after the intervention. Connor (2014) points out QI methods as follows: Various QI methods are available. A common format uses the acronym FOCUS-PDSA: Find a process to improve. Organize an effort to work on improvement. Clarify current knowledge of the process. Understand process variation and performance capability. Select changes aimed at performance improvement. Plan the change; analyze current data and predict the results. Do it; execute the plan. Study (analyze) the new data and check the results. Act; take action to sustain the gains. Unlike research and EBP, QI typically doesn’t require extensive literature reviews and rigorous critical appraisal. Therefore, nurses may be much more involved in QI projects than EBP or research. Also, QI projects normally are site specific and results aren’t intended to provide generalizable knowledge or best evidence states Conner (2014). Examples of QI projects include implementing a process to remove urinary catheters within a certain time frame, developing a process to improve wound-care documentation, and improving the process for patient education for a specific chronic disease. The institution I have been at has been working on decreasing central line associated bloodstream infection and peripheral line blood stream infections. Numerous risk factors for CLABSI associated with needleless connectors have been proposed. Some are attributed to poor hand washing before manipulation, inability to properly disinfect the connection site due  to poor design, aseptic d evice management, and frequency of the connector exchange. In addition, several studies looking at intraluminal contamination from the needleless connector have demonstrated that high levels of contamination can be seen colonizing the connector and subsequently moving into the CVC (Ramirez, Lee, & Welch, 2014). Even with varying levels of disinfection, colonization can still occur. Studies of current I.V. practices demonstrated that 56% of Registered Nurses typically do not believe it is necessary to disinfect catheter hubs and >90% of nurses do not cover an intermittent infusion (Ramirez, Lee, & Welch, 2014). The 70% isopropyl alcohol cap known as â€Å"Curos† is used as an attempt to reduce intraluminal contamination. The cap requires ongoing training and encouragement to change practice. Studies indicate that consistent use of the caps does influence CLABSI rates substantially in terms of morbidity and the financial resources that are expended because of CLABSI’s. References Conner, B. T. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today, 9(6), 26-31. Ramirez, C., Lee, A. M., & Welch, K. (2012). Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection. Journal Of The Association For Vascular Access, 17(4), 210-213. doi:10.1016/j.java.2012.10.002

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