Sunday, January 26, 2020
Episiotomy Rates Vary Widely Worldwide Labour is a wondrous act of nature and unique to every childbearing women. It is a transformative and special event in a womens life. It is the magic of creation. The very process of giving birth is the most beautiful one on earth and the mother attains unique capacities and true nobility through childbirth. The onset of motherhood present a unique set of physical, emotional and psychological challenges. Episiotomy is a common surgical procedure performed during second stage of labour. The first performance of episiotomy was done in 1742, when perineal incision was made to facilitate difficult deliveries (Grass, Dunn and stys 1986). It is made both to prevent tearing of the perineum and to release pressure on the fetal head with birth (Lawsan and Bienstock, 2007). It is the only procedure in obstetrics is performed without the patients specific consent. The advantage of an episiotomy is that it substitutes a clean cut for a ragged tear, minimize pressure on the fetal head, and may shorten the last portion of the second stage of labour (Incerpi,2007). Episiotomy rates vary widely worldwide, depending on whether the procedure is used restricvely / routinely. The worldwide episiotomy rate was 27%, 54% are nulliparous and 6% are multiparous women (WHO 2003).Rates vary from 8% in the Netherlands,13% in England to 25% in the USA. Among English speaking countries, the US had the highest episiotomy rate, varying greatly from region to region. One in three mothers who delivered vaginally in the U.S from 1995 to 2003 had episiotomies. In India the birth rate is very high 56% of women had an episiotomy compared to the 46% of white women. The difference between these percentage (10%) is measure of the excess frequency of episiotomy in Indian women. According to the American college of Obstetrics and Gyenaecology, approximately one in three women having a vaginal delivery also have an episiotomy. Approximately 70% of women with a vaginal birth experienced some degree of damage to the perineum due to tear (or) episiotomy and needed stitches. Like any other surgical incision, episiotomy results in some discomforts for most of postpartum patients (Hill,2000). Although relatively small in size, episiotomy sutures can cause considerable discomfort, because the perineum is an extremely tender area and the muscles of the perineum are involved in so many activities such as sitting, squatting ,bending ,urinating and defecating. Even without episiotomy women may experience bruising / tearing in the perineum. This is the most common source of infection in the days after giving birth. Various interventions are found to reduce episiotomy wound infection and enhance the healing process which include administration of antibiotics, cleanliness, topical application of ointments, infra red therapy, sitz bath, performance of kegals exercise and perineal care (Helen et.al 2009). In addition complementary therapy is another great aid to perineal healing. In recent years it has been seen that there has been a shift people from allopathy medicine to complementary medicine. The shift may be because people are becoming more conscious of their health and realize the need of holistic health. Quality of life is felt more important. In 2007 National health interview survey of complementary medicine use by Americans, showed that approximately 38% adults use complementary medicine. A survey by NPS medicine wise in 2008 revealed that 65% of Australians had used one (or) more complementary medicine in the previous 12 months. The term complementary medicine is primarily used to describe practices employed in conjunction with (or) to complement conventional medical treatment. Complementary medicine is sometimes called mind body medicine because it is an approach to healing that uses the power of thought and emotions positively influence physical health ( USA Drug, 2005). Complementary therapies can help to boost the immune system, help eliminate toxins, help relieve pain, improve sleep pattern, increase energy levels, induce sleep relaxation, reduce stress and tension, restore balance to body systems. Lavender oil is one of the complementary medicine. It has a light fresh aroma, is clear in color and watery in viscosity. Lavender has been use continuously for thousands of years, either in the form with lavender water of essential oil / dried flowers. In the 1800s the yardly company in England, realizing the healing properties of lavender , began adding it to their soaps and perfumes. Lavender oil promotes rapid healing and helps to prevent scarring. These remarkable healing properties of lavender were accidently discovered by French chemist Dr. Rene Maurice Gattefosse when he burnt his hand in a laboratory experiment. He instantly plunged it into a nearby bowl of lavender oil and discovered that it stopped throbbing pain and allowed the burn to heal quickly. The therapeutic properties of lavender oil are antiseptic, analgesic,anticonvulsant,antidepressant,antirheumatic,antispasmodic,antiinflammatory,antiviral,bactericidal,sedative,carminative,soothing,hypotensive,decongestant and diuretic. The main effects of lavender are calming, soothing, balancing and normalizing. Lavender can be used to a state of mental and physical imbalances to a state balance in which healing can take place. On the skin, lavender oil tones, revitalizes and it is useful for all types of skin problems such as abscesses, acne, oily skin, boils, burns, sunburns, wound, psoriasis, insect bites, injuries and also acts as an insect repellant. Lavender oil can be used in a sitz bath and it would also have the added benefit of decreasing anxiety in the new mother which povidine iodine does not. Research carried out at Huntingtons Hinchinbrooke Hospital has found that the use of lavender oil in the sitz bath led to greater comfort and improved healing of the perineum between the third and fifth days after delivery. Adding lavender oil to a sitz bath aids in the healing of torn vaginal tissue. It also prevents the formation of excessive scar tissue, according to Margaret Fawcett of Aroma therapist and author of Aromatherapy for pregnancy and childbirth. It is one of the safest essential oil and can be used in full strength on the skin also referred to as neat. The use of lavender oil can be effective in reducing perineal discomfort and promote wound healing following episiotomy. It is being used due to its antiseptic and healing properties. Lavender oil is found as a good choice in treating episiotomy wound healing because of its cell regenerating properties. Need for the Study The postnatal period refers to 6 weeks period after childbirth. The period is popularly termed the fourth trimester of pregnancy. It comprises an amazing variety of complex physiologic and psychological adaptations. Protecting a womenÃ ¡Ã ¾Ã ½s health as these changes occur is important for preserving the future childbearing function and for ensuring that she is physically well enough to incorporate her new child into her family. The physical care a women receives during the postnatal period can influence her health for the rest of her life. The nurses role is vital as she assists the mothers through these adjustments and supports them as they make a fresh start as a new family. Postnatal women are more prone for puerperal infection as a result of episiotomy which can be prevented by proper postnatal care. Approximately 33% of women with vaginal delivery had episiotomy in 2000 (American College of Obstetricians Gynaecologist, 2008). However the prevalence of episiotomy is not the same in different countries, Asian race are presumed to have smaller and tighter perineum so, the routine episiotomy may reduce the risk of Perineal tearing during delivery (lam et.al 2008). Studies about the episiotomy rates around the world showed that this surgery ranged from 9.7% (western Europe-Sweden) to 96.2% (South Africa-Ecuador) with lowest episiotomy rates in English speaking countries (North America Canada united states) and it remained high in many countries (centered south -America like brazil-94.2%, south Africa-63.3% and Asia like China-82%). One study revealed that episiotomy was performed in 97.3% of 510 primiparous women who had vaginal delivery in Tehran (Shojariet.al.2009). Barnabas (July 2012) conducted a study to determine the rate and risk factors for episiotomy at Baptist medical centre, Nigeria. Out of 280 subjects who had vaginal delivery, 96 (34.3%) subjects had episiotomy .The rate of episiotomy decreased with parity. The nulliparous had the highest rate (62.2%). The episiotomy rate among assisted vaginal delivery was 80.0% among those who had spontaneous delivery. Law kw, wong Hs, Pan Tc (2006) were reviewed the use of episiotomy during vaginal delivery in Hongkong puplic hospitals. A prospective observational survey was carried out in total 6222. Women who underwent normal vaginal delivery of a singleton fetus with cephalic presentation of the 6167 women in whom the status of the perineum was known. Episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs. 71.4%). Several studies suggest that using episiotomy in normal delivery results in fewer perineal laceration and trauma. The episiotomy discomfort and its consequences can affect maternal quality of life as well as the mothers and baby relationship. Like any other surgical procedure episiotomy carries number of risks: excessive blood loss, hematoma formation and infection ( Roberts and Chalmers 1989) S.T Sule and S.D. Shittu ( July 2003) conducted a prospective cohort study to establish the epidemiological variables associated with episiotomies and their puerperal complications at Ahmadu bedlo university teaching hospital Zaria. The result findings suggest that the episiotomy rate was 35.6% of all vaginal deliveries . Episiotomies were significantly associated with primi gravida. The most common puerperal complications of episiotomies was asymmetry (32.9%), infection (23.7%), partial dehiscence (14.5%), hemorrhage (5.3%) and extension of the incision (1.3%). Nahid Arianpour 2009 (June) conducted a descriptive study to determine the bacterial species in postpartum infections at khanevadeh hospital. Postpartum infections among 6077 patients from 2003 till 2008 was studied in this study. In this study out of there different kinds of postpartum infections (i,e genital, breast and urinary tract ). Only genital infection is considered. Postpartum infections among 6077 patients from 2003 till 2008 was studied in this study. In result findings revealed that 7.59% (461 ) patients had postpartum infection, out of which 1.03%(63) patients were re hospitalized. The commonest infection was infection at the site of episiotomy. Kathelin Karla (2005) stated that the routine use of episiotomy harmful to the pelvic floor that creates greater extent of surgical incision and delayed perineal wound healing, compared with no episiotomy group. Continues improvement in quality of care after episiotomy could helps to control the infection and improves episiotomy wound healing. Nurse midwife plays on important role to promote postnatal care , to prevent complication of episiotomy wound earlier and hence force to bring a healthy mother. A well integrated postnatal care has an important role in assessing the transition to physical and psychological well being of the mother and baby . Episiotomy wound care is important for comfort and cleanliness and to prevent infection. Attention should be afforded to episiotomy wound care since it parallels any other wound. One of the suggested method is a regular antiseptic sitz bath. Nowadays using complementary therapies such as essential oils have been recognized in Obstetrics. Mechanism of action of each essential oils is related to its complex active substances .One of the main action of these oils are easy absorption through the skin. The molecule of essential oils are small enough to permeate through the skin barrier. The molecule will be absorbed easily into the skin within 20-40 minutes depending on the chemical nature of the oil. Lavender oil is one of the frequently prescribed essential oil due to its antibacterial, antifungal, sedative, anti depressant and healing properties. Research has been done to evaluate the effect of lavender oil sitz bath on episiotomy wound healing (Katayan Vakilan 2012). This randomized control trial was conducted on 120 primiparous women with singleton pregnancy who had received mediolateral episiotomy during spontaneous delivery. Redness in lavender oil group was significantly less than control group (p Fatemeh Sheikhan (Feb 2012) conducted a study on use of lavender oil essence in primiparous women in Iran. This clinical trial was involved 60 primiparous women. In result the REEDA score was significantly lower in experimental group (lavender group) 3 days after episiotomy (p=0.000). It is suggested that lavender oil essence may be preferably to the use of betadine for episiotomy wound care. Though there are many studies done in various methods of episiotomy healing, only a very few studies are conducted to assess the effectiveness of lavender oil sitz bath on episiotomy wound healing. So the researcher felt the need to evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among postnatal mothers with episiotomy. Statement of the Problem A study to evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among post natal mothers in government head quarters hospital at kanchipuram. Objectives To assess the level of episiotomy wound healing among postnatal mothers in experimental and control group. To evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among postnatal mothers in experimental group. To determine the association between the level of episiotomy wound healing among postnatal mothers with their selected demographic and obstetric variables in experimental and control group. Hypothesis H1-There will be a significant difference between the mean post test level of episiotomy wound healing between experimental and control group. H2- There will be a significant association between the level of episiotomy wound healing with their selected demographic variables among postnatal mothers in experimental and control group. Operational Definition Effectiveness In this study effectiveness refers to the extend to which the lavender oil has produced desirable effect on episiotomy wound healing. Lavender Oil Sitz Bath It is a clean procedure in which the perineal area is immersed in 4 liter of warm water with a temperature of 100 105Ãâ¹Ã ¡F added with 5 drops of lavender oil for 10-15 minutes thrice a day for 3 days is used. Episiotomy It refers to the surgical incision on the median or right/ left medio lateral aspect of the perineum during second stage of labour to enlarge the vaginal introitus, to facilitate easy and safe delivery. Postnatal Mothers It refers to mothers who have undergone normal vaginal delivery and instrumental delivery with episiotomy. Episiotomy Wound Healing It refers to absence of redness ,edema, ecchymosis , discharge and presence of well approximation of wound as measured by using REEDA scale. Assumption Presence of episiotomy wound may predispose to wound infection. Lavender oil aids in improving the healing of episiotomy wound. Delimitation The study is limited to the postnatal mothers who had normal vaginal and instrumental delivery with episiotomy. The data collection period is limited for six weeks. Projected Outcomes This study will help in assessment of episiotomy wound healing among postnatal mothers. This study will help to evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among postnatal mothers. This study enables nurses to practice lavender oil sitz bath during postnatal period.
Saturday, January 18, 2020
1. What is JetBlue strategy for success in the marketplace? Does the company rely primarily on a customer intimacy, operational excellence, or product leadership customer value proposition? What evidence supports your conclusion? Product leadership and customer value proposition are definitely Jet BlueÃ¢â¬â¢s strategies for success. They pride themselves on low fares and great customer service. They are also focused on bringing low airfares to customers that need low fare options to fly to destinations with high airfares. Jet Blue has been so successful in their strategies that they have the highest percentage of seat capacity utilized. They have certainly created a winning formula. 2. What business risks does JetBlue face that may threaten its ability to satisfy stockholder expectations? What are some examples of control activities that the company could use to reduce these risks? Jet fuel prices and operating costs are two of the business risks that Jet Blue faces. An example of a control activity the company could implement to reduce these risks is putting into place a contract that puts jet fuel at a fixed price for a certain amount of time. In addition, another possible risk is foreign exchange and a contract should be entered to protect their proceeds. JetBlueÃ¢â¬â¢s workforce could seek to unionize. This process could result in work slowdowns or stoppages and it could increase operating expenses. Control activities: Establish a Human Resource Management Department that proactively works with employees to ensure that their morale remains high and that they feel fairly treated. 3. How can the concept of unit level activities be applied to an airline? More specifically, what are 2 examples of unit level activites for JetBlue? What steps has JetBlue taken to manage these unit level activities more efficiently? In a manufacturing context, a unit refers to an individual unit of product. In an airline context, a Ã¢â¬Å"unitÃ¢â¬ refers to a passenger on a particular flight. Two examples of unit-level activities include baggage handling and ticket processing. Both activities are directly influenced by the number of passengers served. JetBlueÃ¢â¬â¢s point-to-point flights simplify the baggage handling process because there is no need to transfer luggage from one flight to numerous other connecting flights. Point-to-point flights also lower the incidence of mishandled bags. JetBlue reports that it mishandled only 2. 99 bags per 1,000 customers. JetBlue uses technology to streamline ticket processing. This is the companyÃ¢â¬â¢s least expensive form of ticket processing. It also mentions that JetBlue further simplified ticket processing by enabling on-line check-ins, allowing customers to change reservations through the website, and installing 76 kiosks in 19 cities. 4. How can the concept of batch-level activities be applied to an airline? What are two examples of batch-level activities for JetBlue? What steps has JetBlue taken to manage these batch-level activities more efficiently? In a manufacturing context, a batch refers to a number of units of product that are processed together. A batch-level cost is the same regardless of how many units of the product are included in the batch. In an airline context, a Ã¢â¬Å"batchÃ¢â¬ refers to a flight departure. Examples of batch-level activities include refueling the airplane, performing pre-flight maintenance, and cleaning the interior of the cabin. The costs to refuel an airplane, maintain it, and clean it are essentially the same regardless of how many passengers are on board. Using only one type of aircraft simplifies the gate turnaround process, which includes all of the batch-level activities mentioned in the prior paragraph. JetBlue operated each airplane an average of 13. 4 hours per day, which the company believes was higher than any other major U. S. airline. Efficient gate turnarounds are one of the keys to JetBlueÃ¢â¬â¢s high rate of aircraft utilization. 5. What is one example of a customer-level activity and an organization-sustaining activity for JetBlue? An example of a customer-level activity for JetBlue is maintaining its customer loyalty program called TrueBlue Flight Gratitude. An example of an organization-sustaining activity is complying with government regulations that are established by the Department of Transportation, the Federal Aviation Administration, and the Transportation Security Administration. JetBlue must comply with these regulations in order for the business to operate. Reference Ã¢â¬Å"Jetblue Airways Corporation,Ã¢â¬ Securities and Exchange Commission, (2004), Retrieved on April 25, 2011 http://www.sec.gov/Archives/edgar/data/1158463/ 000104746905005739/a2153142z10-ka.htm#05NYC1962_1
Friday, January 10, 2020
1. LOI 39/2001 Ã¢â¬Å"SANDIGAN MASTER PLANÃ¢â¬ (Anti-Criminality Master Plan) dated 03 December 2001 This Plan shall serve as the Master Plan in which all plans and programs of the PNP shall conform with and supplement. It shall prescribe the grand strategy to be undertaken by PNP Offices and personnel on crime prevention, control and suppression, in the total fight against all forces of criminality. 2. LOI 40/2001 Ã¢â¬Å"SANDUGO MASTER PLANÃ¢â¬ (The PNP ISO Master Plan) dated 04 December 2001 This serves as the long-range and holistic master plan of the PNP in waging an internal security support operations nationwide. Premised on the estimate of the national situation and other considerations, it prescribes the counter-insurgency support strategy, operational concept, scheme of implementation, service support and coordinating instructions in order to accomplish the PNPÃ¢â¬â¢s internal security support mission. 3. LOI 42/2001 Ã¢â¬Å"SANGYAMAN MASTER PLANÃ¢â¬ dated 06 Decem ber 2001 (PnpÃ¢â¬â¢s Master Plan To Help Protect And Preserve Our Environment, Cultural Properties And Natural Resources) See more: Social process essay This master plan prescribes the guidelines to be followed by tasked PNP Units/Offices in assisting lead government agencies in the enforcement of laws over Philippine territorial waters, lakes, rivers, mountain ranges, forest, to include laws and ordinances that have been set forth to preserve, protect and enhance our environment and natural resources, in close coordination with the Department of the Environment and Natural Resources (DENR) and other tasked government agencies. 4. LOI 43/2001 Ã¢â¬Å"SANG-BANAT MASTER PLANÃ¢â¬ (PnpÃ¢â¬â¢s Master Plan For The Campaign against Illegal Drugs) dated 07 December 2001 This master plan sets forth the concept of operations, operational guidelines and tasks of all PNP units/offices in the total fight against illegal drugs: integrating/orchestrating the activities of all concerned National Government Agencies (NGAs) in the conduct of anti-illegal drug campaign at the national down to barangay levels. LOI 44/2001 Ã¢â¬Å"SANG-INGAT MASTER PLANÃ¢â¬ (Master Plan On Security Preparations) dated 10 December 2001 This Master Plan sets forth the strategic concepts and operational guidelines, as well as contingency plan to ensure the maintenance of peace and order during the year-round observance of holidays, which involves great concern on movement of the citizens, international, national and local meeting/conferences/events, and rallies/mass action in protest to wide rangeÃ of issues. 6. LOI 45/2001 Ã¢â¬Å"SAKLOLO MASTER PLANÃ¢â¬ (MASTER PLAN ON DISASTER PREPAREDNESS) dated 12 December 2001 This Master Plan sets forth the strategic concepts, operational guidelines and coordinating instructions to be undertaken by PROs and tasked units/offices on disaster management. With this Letter of Instructions, the action that will be undertaken by the concerned PNP units/offices will be as responsive and possible with the support of the government agencies and community.
Thursday, January 2, 2020
Counseling and Christian Perspective Studying psychology and philosophy has made me ask many questions. By what principles do people make decisions? What drives us? Where do emotions come from? Are there such things as unconscious motives and thoughts or are those ideas nothing more than the clever and profitable figment of psychologistsÃ¢â¬â¢ imagination? However, the main question I struggled with is who we are and how we operate? Counseling is seen as a very solution focused approach. The temptation to rush quickly to the end of the mystery novel must be resisted. The detectiveÃ¢â¬â¢s clever conclusions cannot be fully appreciated without first understanding the complexities of the tangle he unravels. The same principle applies here: an adequate appreciation of solutions depends on an adequate understanding of people and their problems. The Christian community and secular communities are overrun with ideas about wholeness and growth. The solution of Calvary, for example, is only valued too the degree that the problem of sin is grasped. If we skip the hard and sometimes tedious work of figuring out who we are and why we struggle so much, then our efforts as counselors to help others will be shallow and, in the long run, unhelpful. The relationship between Christianity and Counseling Ã¢â¬Å"Trust and obey, for thereÃ¢â¬â¢s no other way to be happy in Jesus.Ã¢â¬ Could it really be as simple as the hymn suggests? This sort of thinking sounds very hopelessly naive and dangerously superficial. IfShow MoreRelatedThe Counsel Of Heaven On Earth Essay1596 Words Ã |Ã 7 Pageswritten by Ian F. Jones on the topic of Christian counseling. Jones makes sure to let his readers know that this book is not meant to be a guide for Christian counseling; he in no way means to advocate a particular methodology, system, or school of thought. 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