Reflection on Refusal of Treatment

The purpose of this essay is to select an incident which occurred during clinical placement and to discuss and reflect on it in order to improve future practice. To do this, the framework of the Marks-Moran and Rose Model of Reflection (1997) will be used. Utilizing the four stages of this model, I will describe the incident, give a reflective observation, discuss related theory and conclude with thoughts for any future actions. Any patient discussed will be given a pseudonym to ensure patient confidentiality as described by the Nursing and Midwifery Council (NC) (2010).During a recent placement in an Endoscope day unit, I met Mrs. Smith who was attending to undergo a Gastropod. She had a history of acid reflux and had been referred for the procedure as an outpatient but had not attended her Pre-Admission Clinic appointment. Upon her arrival, myself and a staff nurse took baseline observations and spoke with the patient to ensure that she had fasted from midnight which was necessary for the procedure. On advising her on anesthesia, I informed her that she had two options. The first was a throat spray to numb the local area and she could leave almost immediately afterwards.The second was sedation and analgesia in the form of Fontanel and Modally which would be given through intravenous accumulation; however, she would have to remain with us for several hours post procedure. Mrs. Smith began to panic and became quite irate. She stated that she had been under the impression that she would be given a general anesthetic and would be asleep the entire time. I explained that the doctor required her to be awake for this procedure and that general anesthetic was not an option. Mrs. Smith then stated that she was withdrawing her consent and wished to leave.The staff nurse who had been observing me swiftly took over the conversation and tempted to calm down the patient. She advised me to escort Mrs. Smith to the private seating area that was reserved for consultations but not to offer her anything to drink; Just in case she changed her mind about the Gastropod going ahead. Once we were all in privacy, the nurse then sat down and asked Mrs. Smith why she was so scared. Mrs. Smith stated that she had heard of complications involved with Stereoscopes and she would rather not take the risk.The nurse explained that the risk of a serious incident was extremely rare and at worst, she may suffer from a sore throat and gastric bloating afterwards. Mrs. Smith was supplied with an information booklet and we allowed her some time to digest all of the information that she had been given and assured her that any questions she wanted to pose would be answered. Afterwards, she stated that she still did not want to undergo the procedure and that she wanted to go home. At this point, the nurse advised that she should return to her doctor and inform him that she had not undergone the test.Mrs. Smith was also advised that she could return at a later date if she so wish ed and then she left the clinic. During my explanation of the procedure, I felt capable enough to fully explain what it entailed. However, when Mrs. Smith began to panic, I lost some of my confidence as this was something that I had not faced before. Therefore, I felt unable to calm Mrs. Smith down as I was lacking experience in this scenario. I was pleased that the nurse accompanying me took over in an instant. I felt to notice this.As I listened to the nurse, I noted the optimism displayed by the nurse when she instructed me not to provide refreshments for the patient. When I later questioned her on this matter, she told me that she had been in the same position any times before. Mrs. Smith was competent enough to exercise her right to refuse treatment. This is the moral and ethical right of every patient so long as they are deemed to have the mental capacity to make such a choice (Griffith and Teenage 2012). A medical professional cannot force a patient to undergo a procedure aga inst their will.However, the practitioner must discuss all treatment options, relay the correct information and allow the patient time to come to an independent and informed decision (Ellen et al 2012). The term â€Å"Autonomy' underpins the patient's ethical and moral right to choose which path of treatment, if any, that they will follow. Glibber and Kingston (2012) state that the patients' autonomy is in the clinician's hands under duress of professionalism and nursing ethics, our advice and information is responsible for any decision reached.In this instance, Mrs. Smith was taken to a private seating area where a nurse calmly talked her through the procedure at length, answering any questions and also informed her of the statistical risks of a Gastropod which were her biggest concern. By doing this, the nurse wowed that she was empathic to the worries of the patient and also did her utmost to preserve patient confidentiality, as well as, providing a wealth of information precedi ng the refusal of treatment (Torrance et al 2012). It was obvious from the reaction of Mrs. Smith that she had anticipated treatment under a general anesthetic at her appointment.When reading through her notes previous to admission, I realized that she had not attended the pre-admission clinic. Had she attended this previous appointment, she would have been given all the information required for her proposed treatment. She would have been briefed fully on sedation, the basics of the procedure and many other factors consistent with treatment. Claritin et al (2009) describes pre-admission clinics as a necessity to provide the correct information and give patients the time to think and digest before presenting at hospital for a procedure.Evidence shows that pre-admission clinics have reduced the instances of failure to attend appointments and that patients are more involved in their care, which encourages a higher rate of recovery and reduces stress levels pre-operatively (Mitchell 200 8). Knox et al (2009) also suggested that the implementation if these clinics have substantially reduced the instances of refusal of treatment due to more accurate information being given in a comfortable setting at a more relaxed time. If Mrs. Smith had attended the pre-admission appointment, she would have been given all the information and been able to ask any questions that she wished.Thus she would have been aware that she would not be offered a general anesthetic and a deeper understanding of the procedure. Thus this may have resulted in assisting Mrs. Smith with regards to informed consent. The nurses working within the clinic were all very well versed in the procedures and welcomed any questions. As soon as Mrs. Smith began to worry, there was sufficient evidence on hand in the form of a patient information guide as well as a knowledgeable nurse. In a study conducted by Amtrak (201 1), patients were found to be more comfortable when in the presence of a knowledgeable nurse.P atients overall concluded that this group to benefit from this. Postural et al (2010) suggests that the experiences gained by nurses in specialized areas are beneficial to the learning curve of student urges and their knowledge is a valuable tool in the production of a more advanced health care system. In the case of Mrs. Smith, the nurse highly educated in this area and was able to sufficiently assist the patient in making a fully informed choice without being devoid of any facts. Moser et al (2007) describes this approach as â€Å"a highly effective way of achieving patient autonomy'.In this scenario, the nurse was catering to Mrs. Smith's first and foremost care requirements. During my reflective observations of this experience in my training, I have realized that there is nothing rater than knowledge and experience to assist patients with many aspects of their care. In the case of Mrs. Smith, the manner in which her questions were answered was tactful and informative. However, the patients' right to choose was evidently the main priority. Mrs. Smith was never coerced, all information required was on hand and supplied without delay.The nurse ensured that she was competent to refuse the treatment and advised on how to proceed following the refusal. An obvious effort to calm the patient was made and the privacy afforded by the private seating area dad a huge difference in allowing her to digest all information that she had been given. The nurse made a tactful decision by advising me not to offer refreshments in case of a decision to proceed, however, this did not occur. In hindsight, I have realized that I have a long and hard road to travel before I am capable of the level of care that I would like to give my patients.I can draw from this experience and I can see that having the correct information is a must while at the same time being aware of the patients' feelings and offering them an informed and involved choice in their care. I have also come to under stand the relevance and requirement for clinics such as pre-admission. These clinics are indispensable in reducing patient anxiety, ensuring that patients have all the correct information and fully understand their proposed procedure prior to presenting for treatment.

North Korea at the Winter Olympics

North Koreas ruler repeatedly exhibits repulsive violations of human rights. Just thinking that we participated in the 2018 winter Olympics with this country gives me the hebegeebes. Kim Jong Un, the ruler of this ruthless, repulsive, regime, shows little to know recognition of human rights. I believe we have sullied the name of the United States by allowing North Koreas Participation. The Olympics are the international celebration of human excellence, Kim's North Korea falls far from the definition of excellence. Excellence is the quality of being outstanding or extremely good. Kim is power hungry and will stop at nothing to make sure he stays in power, or example he felt that his 67-year-old uncle was a threat to his power, so he had him stripped down to his bear skin and thrown in a cage of 120 dogs that had been starved for five days. Kim is mentally INSANE!!!North Korea is a dictatorship, Kim decides everything, and nobody can go against his wishes without punishment. North Korea is known to many as todays worst persecutor of Christians. For example, anyone caught with any contact with a missionary can be killed or tortured. In north Korea Kim has established political prison camps where men women and children can be found, it does not matter whether the person is young or old. To ensure his regimes success Kim has made sure that no one can leave. He underpays workers and raises the price of airline tickets for a time it would cost one person $8,000 to leave North Korea. Kim, his father, and his grandfather were all self-proclaimed gods. North Koreas calendar starts at the birth of Kim's grandfather instead of the birth of Christ. In North Korea in any way you turn it is not hard to find a statue of a previous ruler of a picture plastered across a wall. There is even a special place where you can visit the corpses of Kim's father and grandfather, because the mentally deranged Kim has them embalmed is glass cases. if this is not mentally ill then I don't know what is. We participated in the winter Olympics with these crazy people! Kim has also threatened to nuke us on multiple occasions. I conclude that if it were my decision I would not have let them participate in the winter Olympics.

Desert Biome

De iomee ert B s n g rick Bor By: E Period:2 Where is the desert biome located Usually located in U. S. A, South America, Africa,Europe,Austalia,and Asia. located in hot, dry locations around the Earth. Deserts cover about one fifth of the Earth's land surface. What's the climate like? All deserts are dry, arid places, but some may be cold depending on the location. Desert regions usually only receive 10 inches of rain per year. A very low latitude climate. Usually have average temperature over 64Â ° F(18Â ° C). The climate is formed by high-pressure zones in which cold air descends.Who lives in the Desert? The animals that live in the desert such as camels, snakes, lizards, scorpions, coyotes, armadillos, hawks, and kangaroos, have special adaptations that allow them to survive the extreme temperatures and conditions that present in a desert. There's also things like plants such as cactus, ocotillo a leafy green plant that produces flowers) and shrubs. Plants in the desert are for ced to make many adaption's in order to survive in this dry, hot land. Some adaption's are when rain falls they sprout at that moment. SpecialityReceives a extremely low amount of perspiration. More water is lost by evapotranspiration. Deserts can be Cold or hot. Cold deserts are usually covered in snow or ice. classified by their geographical location and dominant weather pattern. Sand covers about only 20% of earths deserts. Antarctica is actually the biggest desert. level of biodiversity I believe the level of biodiversity is hot and dry. Not to many living things live in the desert, because of heat. Deserts don't really have plants because it rarely rains. Animals that can live in the heat can sustained the deserts biodiversity.

Fossil Fuels versus Renewable Energy Essay Example | Topics and Well Written Essays - 250 words

Fossil Fuels versus Renewable Energy - Essay Example There are also alternatives to fossil fuels. One of the alternatives is wind energy. Wind energy is cheap, proficient, and pollution free (Natural Resources Defense Council, 2013). Wind energy is made from big windmills that are placed on hills to supply power to the households. The downside of windmills is that they kill millions of birds in a year (Fear, 2011). The other alternative is solar energy. Solar energy is used to power houses, cars, satellites, and buildings. The suns energy is captured and harnessed to provide heat for electricity. Solar power is free to harness. However, it is costly to buy and install panels (Llorens, 2011). Another source of energy is biomass and cellulosic ethanol. This energy is from crops remain, and fast growing trees. The uses of the products influence the environment. However, biomass that uses trees harms the environment. The other source of energy is hydropower. This uses water to spin turbines to make electricity. Although is cheap to make electricity, it is harmful to plants, fish, and other wildlife in and near rivers (Natural Resources Defense Council,

Inclusion of SEN Students in Schools Essay Example | Topics and Well Written Essays - 5000 words

Inclusion of SEN Students in Schools - Essay Example Just as much as in schools, societal attitudes can represent a great obstacle to the inclusion of disabled people in the community (Forest, 1991)3. The societal attitude of the 'normal' people towards disabled people has been characterised by confusion, ambiguity and a modicum of good will. It therefore comes as no surprise that, mainstream pupils exhibit an ambiguity, not dissimilar to their elders, in regard to their few disabled colleagues in school (Lewis, 1995)4. Researchers and educators have developed legal, educational, ethical and psychological arguments to support the inclusion of children with disabilities into mainstream schooling. However, for the successful integration of these students into the mainstream, there needs to be a total reappraisal of the existing educational system. This would include changes in organisational structures, curriculum and teaching methodology (Meijer, 1994)5. For this system to become a success would need the wholehearted support and integration of all teachers (Michael Shevlin, 2000). Having understood the basic idea of what is necessary to the inclusion of special educational needs in schools for introducing students with learning difficulties, the next logical step would be to understand what this term 'Special educational needs' mean in the context of this paper. Disability, difficulty in learning, learning difficulty and special educational needs, may seem a lot similar, but they are quite different in their literal sense. Special Educational Needs under the Education Act of 1996 states that 'a child is in need of special educational needs if he/she has a learning difficulty which calls for special educational provision to be made for that student (Section 312). Learning Difficulty is attributed to students with: Greater difficulty in learning than other children of his/her age Has a disability which prevents him/her from making use of facilities that is provided to children of their age in school (Section 312 (2)) of the Education Act. (Michael Farrell, Ch.1, p.11-12, 2003) 2.0 Executive Summary Disabilities are a curse on society. Disabilities can be physical, mental, or social. The perspectives and social relationships of young children, including gender bias, the relationship between racism and education, and racism and identity in school and curriculum are social barriers that must be addressed in inclusive policies. These social cancers must be removed from schools to make inclusive education a success. Such discrimination of disabled and under-privileged children can lead to depression. Mental disorders can play havoc with children at a young age. Language is also a barrier for children to mix and learn with other children. Physically challenged children also face the embarrassment of being recognised as

The Distribution of Primary Goods by Nozick and Rawls Essay

The Distribution of Primary Goods by Nozick and Rawls - Essay Example He contends that if individuals have acquired their share in the distribution in a fair manner, without violating the rights of other people, then the distribution is just. Since such acquisitions are made using the natural talents that individuals possess, he argues that injustice cannot contend in the allocation and use of natural talents. The system whereby such distributions have resulted are the result of gifts or acquisitions made on the basis of individual initiative, which is just, as a result, the distribution resulting out of it is also just. Rawls, however, offers a different view on the distribution of primary assets, viewing it on the basis of its end outcome. He contends that since the outcome is an unjust distribution of primary assets in society, it is morally repugnant and must be redressed through the input from social and legal establishments by providing equality in opportunity for access to those resources to all individuals. Nozick’s theory of justice is based upon the â€Å"entitlement theory of holdings†, wherein the question of justice in acquisition is determined by the manner in which the property is acquired rather than the final outcome itself. Property may be transferred either through gift giving or by free exchange selling. Both these methods are undertaken voluntarily and there is no coercion at all that is involved in one person passing on a property to another. (Nozick, 151). He argues that when land does not belong to anyone at first, then a just acquisition process would allow someone to own it legitimately and claim it as theirs, so long as they do not make anyone else worse off in the process. Nozick’s theory of justice is, therefore, a system of pure procedural justice, where the important aspect to be considered is the process and system by which distributions are made, rather than the final outcome of that distribution.

Depletion of Social Security For The Retired Essay

Depletion of Social Security For The Retired - Essay Example It is observed that the policies like Medicare and Medicaid fail to deliver sustained assistance in regards to the inflationary drives in healthcare. The government of the state looks after these medical financing policies for the elderly and the poor people. In a similar manner, the pension for the elderly people is in utter doldrums. The nature of the pension crisis is observed to be much more complex in regards to the Medical benefits. Companies go on retrenching old people giving them to retire and save labor cost. The pension schemes of the corporate sector have become very misleading making the retirees and old people suffer for the same. (Eyal & Sherman, 3) The paper researches on the nature and magnitude of the stated problems and endeavors to find a probable solution to such. The conglomerate terminology given to a host of programs targeting incidents like retirement, disability, dependency and survival needs in a person’s life is regarded as Social Security programs. The scope of the social security programs center on providing the households of working families needed financial assistance at times when they become unable to earn further owing to the above reasons. In the initial stage, the social security programs were designed to cater to the needs of the elderly population of America. In regards to the depletion in the job availability of the elderly population and the division of the family owing to the job, transfers the social security schemes targeted providing financial assistance to the elderly population. However, the current scenario, which is a combination of inflationary living standards and stagnation of benefits coupled with rise in penalty to the elder working force ears up the benefits accruing from such programs. The wealth and income gap in America plays havoc with one percent of the rich population controlling 40 percent of America’s wealth

A Story of Forgiveness Essay Example | Topics and Well Written Essays - 500 words

A Story of Forgiveness - Essay Example From this paper it is clear that in the solution-centered approach provided by Charles Alan Kollar in his book, he focuses on counseling to take off the attention from the problems thereby helping the counselee to focus on the solution leading to emotional and psychological well-being. This type of counseling will allow Bruce to come out of the hard situation he is going through to realize further needs to educate drag drivers and other young individuals about safety. In such a way, he can recover from the problem he is going through and at the same time, it will provide inspiration for other individuals who have gone through a similar situation. In addition, this will help promote safety among young individuals who might risk their safety of themselves or others while acting rashly.This discussion outlines that  Bruce shows characteristics of a D type in the DISC relational style and hence he likes to lead and take charge. This quality can prove to be positive during his treatment according to the approach mentioned in Johnson and Johnson's book as he is suffering from an anxiety disorder after the loss of his daughter and his wife.  A very important challenge to deal with will be Bruce's involvement and his progress during the treatment. A result-oriented or solution-oriented approach is appropriate for Bruce's current behavioral position.

Science Essay Example | Topics and Well Written Essays - 1000 words

Science - Essay Example It is one of the alkali metals having a chemical symbol â€Å"Na† with atomic number 11. Sodium is soft and silvery white metal in color. Aside from one of the most abundant elements in the planet, sodium in nature belongs to halite group which means it is highly reactive. Aside from its silvery-white color, sodium is also waxy in appearance, can easily be cut by a knife because it is soft, it reacts with oxygen once exposed to air and forms sodium oxide film (Chemistry Explained, par. 1-60). This is the reason why a bright and shiny surface of sodium once cut lacks luster because the sodium oxide film covers the metal. According to Resusch (par. 5), the atom of sodium has only one electron in its valence shell that at times when it losses it, it will result to lower shell valence octet which further results to obtaining a positively charged atom. Sodiums’ atomic mass is 22.98 (Chemistry Explained, par. 1-60). Sodium’s melting point is 97.82 °C, boiling point of 881.4 °C, density of 0.968 grams per cubic centimeter and since it is a metal, it excellently conducts electricity (Chemistry Explained, par. 1-60). At 298 0K, sodium is at its solid state (Winter, par. 1-8). 3. Sodium also reacts with other elements and compounds. Once sodium reacts with acid, it produces hydrogen gas. It can also be dissolved in other metallic elements such as mercury to create an alloy such as amalgam. In the periodic table of elements, it can be observed that the number of protons is what actually tries to determine a certain element among any other. However, the number of neutrons in an atom varies and this variation is considered an isotope (Chemistry Explained, par. 1-60). Therefore if an element is having forms of more than one, then its other forms are considered isotopes. In the case of sodium, it has one naturally occurring isotopes which is sodium-23 and it has six radioactive isotopes, which break apart and

Automotive Essay Example | Topics and Well Written Essays - 1000 words

Automotive - Essay Example The first person to cross the line is not automatically the winner because the race involves the concept of time taken to leave the station, and the route that an individual follows. The race emphasizes the time factor because the Christmas tree system coordinates the individual vehicles. It checks the time that a car takes from the beginning to the end. The competition allows participation of vehicles that are tested by qualified mechanics. It also considers the type of cars that take part in the race. In the standard racing, the losing car and driver exit the contest, while the winner goes on to race with other winners, until only one is left, based on a traditional bracket system. In standard formats, the pairings consider the lowest elapsed times. In bracket racing without a breakout, pairings depend on time compared to their index. In bracket racing with a breakout, the closest to the index is favorable (Boyce, 2012). There are different categories of drag races; each class has the requirement of one restriction. For instance, there is category in terms of weight, engine size and modification (Boyce, 2012). The category that I took part in is the dragster race that involves the young stars. This type of racing involves young people who have the experience in track racing. They take part in an eight-mile race that takes place for each pair. The race involves the young people in there activities. It is usually fun to attend such events because of the enthusiasm that they show when they participate in the races. The event is also thrilling to the spectators because of the showcase of talents by the drivers. Such events are legal, and an established institution organizes them. I participated in the event for the same reason. However, some events are usually illegal because they contravene the traffic rules. The state prohibits them by arresting the people that are involved in the practice (Boyce 2012). The

Proposal on the Disposal of Old Computers by Recycling Essay Example for Free

Proposal on the Disposal of Old Computers by Recycling Essay Imagining if we have 500 computers to dispose of, including its monitors attached to it, we are leaving approximately 3,000 lbs. of lead in the ground contaminating our environment if we do not recycle them properly. First step is the creation of a Disposal Team consisting of at least three IT personnel of our company and be responsible in the proper disposal of all the old machines by forwarding it to a third-party recycling organization. The team shall first take inventory not only the computers but also the monitors attached, non-working printers, fax machines, and copiers. Everything should be accounted for and make sure nothing will be just sitting around or just piling up somewhere in the workplace and suggest that this assessment must be done regularly. The team will also be responsible in reformatting and removing the hard drives using applicable security software in cleaning all the information of the hard drives to prevent from other people from recovering any vital or sensitive information it may hold. It is also important to remove all company control tags to avoid identification to which company it came from. In the selection of the right recycling company, the disposal team shall make a thorough research and make recommendations for me as to the name of the company and why they had chosen such company. My primary requirement is that the company should not only be reputable but also certified, and a participant of the EPAs Sustainable Materials Management (SMM) Electronics Challenge program. The Challenge has three main goals, namely: 1. Ensure responsible recycling through the use of third-party certified recyclers, 2. Increase transparency and accountability through public posting of electronics collection and recycling data, and 3. Encourage outstanding performance through awards and recognition (EPA. gov, 2012, Electronics Challenge, p. 2). Participants under this program responsibly manage used electronics collected by maximizing recycling and possible reuse, minimize damage to humans and the environment and proper destruction of sensitive information on all recycled machines. Reputable recycling companies must provide written documentation of the disposal procedures, they should tell us where did the hard drive sent or how did they destroy it. We do not want the old machines to be sent to third-world countries dumping ground where it will harm their own people due to its hazardous waste. The company should state it clear how they handle data destruction. If they cannot provide such documentation then it is not a reputable one. Finally, the recycling company must submit to our company a report or written documentation on the procedure on how it handled its machine disposal with record of serial numbers, type of machine, description, and date of disposal. Recommendation In addition to the new recycling program being adopted in our company, I am also suggesting leasing of computers instead of buying them. Leasing in the financial aspect may save the company money by not spending too much on computers upfront. Usually, lease runs for about three years almost the same time as new technology has just set in. The companys computer then will always have the latest technology and even the latest operating system. The company will also be entitled for purchase credits from the vendor upon return of older units when lease is up and upgrade for newer ones. In that way our company will not assume ownership of the machines and the vendor itself will be the one responsible in recycling it, less burden, and lesser tasks from our IT department. References What are the benefits of the SMM Electronics Challenge? (2012, September). Electronics Challenge, page 1. Retrieved  from  http://www. pa. gov/smm/electronics/ec_q;amp;a. htm Meyer, M. J. , El Ella, W. A. , ;amp; Young, R. M. (2004, 2004). Disposal of Old Computer Equipment. The CPA Journal, page 1. Retrieved  from  http://www. nysscpa. org/cpajournal/2004/704/essentials/p70. htm

Cell Phone Technology Essay Example for Free

Cell Phone Technology Essay The cell phone technology that is ever changing by the day was scientifically invented and born back in the early 1980’s. Science was the main key to the birth of the cell phone which was put together by the Motorola Company who today is still making cell phones. Before the cell phone came out the car phone was the first mobile phone which were very large and had to be hooked up to a briefcase which supplied the power for the mobile phone. Science was the utilized to create the cell phone and today the use of cell phones has brought literature to the palm of our hands. With science as the foundation to the birth of the cell phone technology age has not only brought the birth but has also brought new births of other new technologies. The cell phone is basically a radio and the invention of the cell phone traces back all the way to the radio. As we all know Alexander Bell back in 1876 invented the telephone and shortly after that the radio was invented around 1880 by Nikolia Telsa. Now with science and technology these two were combined to create what we call the cell phone or cellular phone. How stuff works) With science came the cell phone and with continued scientifically research the years bring more technology to the cell phone that would change the world. Professors, cell phone companies, and others use the art and knowledge of past use science to keep building on top of the birth of the cell phone. Scientist and researchers around the world see a successful future in the cell phone industry and jumps on the opportunity that will be one of the fastest growing industries of today. Just after the invention of the cell phone researches begin to work on a smaller and more efficient cell phone as the first one is very inefficient as it requires a large power supply to run the phone. It was impossible to carry around as it only could be used in automobiles due to the large power supply. Not only the power supply was large the actual radio waves used where also not suited to availability for everyone to use as there were at most around 25 available channels per tower, per town. (How stuff works) Researchers begin to use science to begin to make the cell phone industry more efficient and available for everyone. The next step to making the cell phone more available was to start with having more channels to handle all the cell phone conversations. Duplex channels are needed to be used in order for two people to talk to each other at the same time. The next step was figuring out how to increase the amount of available frequencies and how to make them available without confliction. Cell towers were built across cities and each cell tower were available to have up to 56 conversations going at one time. That was still not enough as they forecasted to have more than that as people started to purchase cell phones. The problem with this is that if anyone more that those 56 would not be able to talk with anyone until someone out of the 56 ended. The next scientifically challenge was to make the availability of conversation at a greater number with the use of higher frequencies. (How stuff works) One problem with cell towers is that in the beginning there were not enough cell towers to keep a conversation going when the person on the cell phone was on the move. As a person on a cell phone is on the move through a city it connects itself to the closest cell tower in range and when out of range it connects to the next nearest cell tower. The problem with this is that there were not enough cell towers which created â€Å"dead spots† which we all know as drop calls. Along with insufficient number of towers the cell phone was analog which was known as 1G (1st Generation) cell phones. As cell towers grew more frequencies were needed to grow as well. This brought the first digital cell phone which was considered the 2G (2nd Generation) cell phone. (How stuff works) With the creation of the digital cell phone also brought the availability of more frequencies. With more frequencies more people were able to have conversations at one time for each tower. Each tower carried the same number of frequencies and as the digital phone came in more cell towers were being built. Eventually there would be hundreds of cell towers in each city that would be able to handle the number of people with cell phones. Currently we are now in the 4G (4th Generation) age and with that technology we are able to do things on cell phones that we never thought we could do 30 years ago. Over the year the technology and science of cell phone has grown faster than any other product. The technology has driven the cell phone technology to connections around the world. It has also connected people like no other communication device. People from around the world are now communicating and connecting more to family, friends, and others across the country. Not only are they talking to each other but they are also communicating now with other technology aspects that has grown onto the cell phone age. People are now connecting through the internet using their cell phones and people are now connecting in ways that are changing the world. The biggest technological change in cell phones is text messaging. The cell phone eventually became more than just a radio telephone communication device. We then started to use the cell phone to send text messages like a email message. Businesses around the globe had a big impact on the technology that was built in cell phones technology. Business people around the globe needed to have email communication at all times so then that was integrated into the cell phone. Then came text messaging which was short text messages sent from phone to phone. Text messaging became a big hit as more and more people started to sway towards the text messaging than talking over the phone. When text messaging started T9 was introduced which is predictive texting or others may know it as Text on 9 Keys. (http://www. ask. com/wiki/T9_(predictive_text) This is a program running in the background that automatically predicts the words you are trying to type in a text message. This made it easier and faster to spell out words as it would spell out the word you are trying to type without having to type out the whole word. The creation of texting has not only brought a new way of communicating with others but has also created another problems in results of the creation of texting. A 2008 study by the mobile industrys trade association CTIA found that among teens ages 13 to 19, 57 percent view their cellphones as key to their social life, and most view texting as a vital feature. † (#34) According to this information it has brought attention that teen drivers are being distracted while driving with cell phone usage and texting. This is creating an upwards in automobile accidents and deaths in this country. â€Å"The California Highway Patrol released a report Wednesday showing that talking on a cellphone while behind the wheel is the leading factor contributing to crashes blamed on inattentive drivers. Furthermore, the US Department of Transportation reports that distracted driving played a role in nearly 6,000 deaths and 500,000 injuries in 2009. † (#34) As you can see in the California Highway Patrol report it shows a growing number of accidents due to text messaging or using cell phone while driving a automobile. The government today is having a hard time reducing the statistics of automobile accidents due to cell phone usage and is looking for a solution to eliminate it. No matter what is done you cannot stop public drivers from using their cell phones in a automobile. A probable solution has come up that may help in reducing the statistics by installing cell phone jammers. When a automobile is in the drive mode a cell phone jammer will activate and prevent anyone in the car from using a cell phone. A person would have to pull to the side of the road and put the automobile into park mode in order to deactivate the cell phone jammer. Then they will be allowed to use their cell phones for any use. This is only a probable solution and it doesn’t sound like a great one but it is something to start off with and hopefully eventually one day it can be sculpted into a real solution.

Analysis of Orthopeadic Theatre Time Utilization

Analysis of Orthopeadic Theatre Time Utilization ANALYSIS OF ORTHOPEADIC THEATRE TIME UTILIZATION AT KENYATTA NATIONAL HOSPITAL Trauma is the leading causes of admission in Kenyatta National Hospital and often these patients require surgery. The trauma burden unpredictability usually mismatches demand and supply of the hospital thus posing challenge for systems improvement and streamlining. Utilization is defined as the ratio of time that an asset is used, against its capacity. For uniformity among the OR team, it is extremely important to developing a precise definition of turnaround time. For the purpose of this paper, turnaround time is defined as the time between incision close of patient n and incision open of patient n+1. This definition captures the surgeon’s, anaesthetist and nurse perspective of turnaround time and allows us to see the delay between the most expensive value-added times in the theatre. Previous study from KNH reported high rate of cancellation of elective list on the day of surgeries (20.6%)1. One of the causes attributed to these delays was inefficient utilization of OR time, mainly due to delay in starting time and long turnaround time within the OR. It was noted that 70.9% of non clinical cancellation was due to list overrun/lack of time. It was also the leading cause of cancellation in KNH at (43.8%). Three specialty were identified to have recorded the highest cancellation rate were Cardiothoracic surgeries 38%, Neurosurgeries 37.8% and Orthopedic surgeries 32.6%1. Cancellation generally increases waiting list and the risk of further cancellation, which may cause patient dissatisfaction and compromise patient’s safety2. Poor scheduling of operations can result in cancellation of operation which is costly to both the patient and the hospital3. With the escalating cost of healthcare, quality of care fails to meet expectation of our patients and therefore, the health care organization should look on strategies to improve quality while reducing cost of running hospitals. The efficiency of operating room can be measured in variety of ways4. Efficiency is defined in term of ability to translate available time into earning5–8. Computer simulation and mathematical models, both of which essentially idealizations that the practical capacity for OR to be between 80-90%9. Justification Theatre complex is a high cost department with the hospital and therefore considerable resources are wasted if operating room if not used effectively. Improving the performance of operating room is key to achieving shorter waiting time for surgery, reducing cancellation for operations and more so achieving the implementation of booking of elective surgery in our hospital. Increased utilization of operating room improves patients flow and reduces the waiting list time. Improving theatre utilization would lead to a reduction in cost recovery from each patients10. 4 in their study in South African concluded that private operation theatre utilization rates were higher than public operation theatres due to commercial nature of private healthcare and absent consequent cost drivers in public health sector10. Utilization rate in South Africa was found to be 48% which was significantly lower than the globally bench mark of between 70-80%4. 11 concluded that the delay in starting list, under s chedule, interruption due to emergency surgeries, administrative reasons, induction of anesthesia and recovery police are the main factor that account for inefficient use of operating room facilities in India hospitals Operating room utilization rate is usually an indicator used in measuring efficiency in use of hospital resources. It is argued that high utilization is cost effective and improves quality of care10,12–15. Brief Description of KNH Main Theatre KNH Main theatre is located in the first floor of the tower block adjacent to Critical Care Unit (CCU), Renal and Burns Unit. It has twelve operating rooms out of which two are allocated to Prime Care Center; one is dedicated for emergency surgeries 24 hours a day. The remaining nine are allocated to different specialty in a week. The specialties are General surgery, Urology surgery, Maxillofacial surgery, ENT surgery, Pediatrics surgery, Plastic surgery, Ophthalmology surgery, Orthopedic surgery, Cardiothoracic surgery, Neurosurgical and Obstetrics and Gynecology surgery. Within the OR the following equipments are found, Operating table in the center of the room, Operating lights directly over the table to provide bright light during surgery, Anaesthesia machine is at the head of the operating table equipped with Electronic monitor machine which records the heart rate and respiratory rate by adhesive patches called chest leads placed on patient’s chest, it has also the Pulse oximeter which is attached to the patient’s finger with an elastic band aid. Pulse oximeter measures the amount of oxygen contained in the blood, an automated blood pressure measuring machine that automatically inflates the blood pressure cuff on patient’s arm continuously recording blood pressure, there is the diathermy machine which uses high frequency electrical signals to cauterize blood vessels and cut through tissue with a minimal amount of bleeding. Other specialized machines may be brought in depending on the nature of surgery. In a week there are 45 theatre space slot allocated to different specialty, out of which orthopedic surgeries have 12 slots and the remaining 33 slot are allocated among the remaining 10 specialty. The orthopedic department is located on the sixth floor of the tower block and has four wards namely 6A, 6B, 6C and 6D. Ward 6B serves as a joint admission for all pediatric cases from 6A, 6C and 6D. Each ward has four days in a week to do the elective surgeries. Theatre procedure Each ward is expected to submit its operation list to main theatre reception before 15:00 hours on the day before its as ­signed operation day. In the evening before the surgery, anaesthetists visit the wards to do a pre-anesthetic assessment on patients who had been scheduled for surgery. They are expected to re-assure these patients, assess their fitness for surgery, and also confirm the necessary investigation are done which they document in the pre-anesthetic check list. On the day of surgery porters are sent to the ward to bring the patients who are then received by a designated theatre nurse at the receiving area, the Receiving Area nurse check to confirm the identity of the patient, see that consent for the surgery had been given and all necessary investigation have been done. Thereafter, the patient is wheeled to waiting bay where he/she is kept on-hold until the theatre room is ready. All other procedures like intravenous access and induction of anaesthesia are done in theatre. After surgery, the patient is taken to Post Anesthesia Care Unit (PACU) while the oper ­ating room is cleaned in preparation for the next patient. Economic considerations also suggest that it is desirable to keep operat ­ing rooms fully used. Thus, it is imperative that areas of time wastage in the theatre time flow be recognized and their causes identified. This will assist theatre managers take necessary steps to correct the problem14. Objective To identify areas of, and causes of operating room time delay, and suggest solution based on the identified deficiencies. Operating theatre represents an area of considerable expenditure in a hospital budget. Consequently, hospital administrators are so concerned with maximizing utilization of OR. This can only be made possible by knowing how much time is spent on which activity and there by identify the factors resulting in under utilization of OR16. Staffing KNH theatre complex is being managed by Assistant Chief Nurse (ACN) with the help of Administrative Officer. The two are answerable to the Head of Department (HOD) Theatre, TSSU and CSSD. The staff within each OR includes Surgeons, Anesthetist, 1- circulating nurse , 1- scrub nurse and 1- theatre sterile assistant (TSA). The general theatre activities are overseen by a Theatre Users Committee (TUC), with HOD as the chairperson. Other members are from Nursing, Surgery, Anaesthesia, Administration and Technical departments. Data Collection I will survey the timing of events in the Orthopedic OR using their elective operating lists available from Monday to Friday at theatre front office desk for a period of one month. I will use a designed proforma based on established oper ­ating theatre process steps to record the following; Patient sent-for (PS): Time when porter leave R/A to the ward for the patient Patient available (PA): Time the patient arrives at theatre R/A Patient in room (PIR): time when patient enters OR Anesthesia/Induction start time (AIT): time induction of anesthesia starts Surgery start time (ST): time cleaning of surgical area Surgery finish (SF): time dressing is put on the incision site Patient out OR (POR): Time at which patient leaves the OR From the above times, I will derive the following: Ward to theatre transfer interval: the interval between PS and PA (b-a). This interval is prolonged when it is greater than 20 minutes. R/A waiting time: It is the interval be ­tween patient available (PA) and when patient is transferred to OR (c-b). It is prolonged if it is greater than 10 minutes. Pre-anesthetic waiting time: the difference between patient’s in room (PIR) and anesthesia/induction start time (AIT) (d-c). It is prolonged when it is greater than 20 minutes. Anaesthesia admission time (AAT): the interval between AIT and ST (e-d) and it is prolonged when it is greater than 20 minutes. Surgery duration: the interval between ST and SF (f-e). Anesthesia reversal time (ART): the interval between SF and POR (g-f) Turnaround time (TAT): the interval between incision close of patient n and incision open of patient n+1. There will be a one week pilot study to set the cut-off point for the intervals between normal and delayed time. This will be based on the mean time observed in the pilot study and for convenience it will be rounded-up to the nearest number divisible by five. In case of delay outside theatre the officer involved will be interviewed to determine the cause of the delay. However, delays that occures in the theatre will be observed directly by the research assistant filling the proforma. The data was entered into SPSS 11.5 which was used to calculate the time intervals and for statistical analysis Efficiency means the management of theatre time, costs resources and staff to undertake as many procedures as possible within given levels of resources, or doing the same number of procedures using a lesser amount of resources .

An Artist in her Way: Representations of the Woman Artist in Margaret Oliphants Kirsteen :: Margaret Oliphant Kirsteen Essays

Representations of the Woman Artist in Margaret Oliphant's Kirsteen Margaret Oliphant (1828-97) was a prolific writer. She published almost 100 novels as well as biographies, art criticism, travel writing, historical sketches, and over two hundred articlesfor periodicals like Blackwood's Edinburgh Magazine andThe Cornhill Magazine, yet her ambivalence about representing herself as a serious artist in her Autobiography provides Oliphant aficionados with grist for speculation and conjecture: did Oliphant even think of herself as an artist? While I will answer this question with are sounding yes, still there is enough equivocation in the Autobiography to give scholars room to play. And although Oliphant herself once wrote that "scholarship is a sort of poison tree, and kills everything" (279), the recent scholarship on Oliphant's Autobiography has enlivened rather than killed debate by calling attention to Oliphant's struggle with self-representation. When it came to writing about her particular experience as both mother and writer, Oliphant found the contemporary discourse, with its rigidly discrete ideologies of motherhood and authorhood, stifling. Thus the Autobiography can be read as Oliphant's poignant effort to extend the meaning of the term `artist' to one flexible enough to include a woman who wrote not only because it came as naturally to her as "talking or breathing" (4), but also because her children needed to eat. In this paper I will argue that Oliphant's preoccupation with what it means to be or call herself an artist can be mapped in her novel, Kirsteen, which was written in 1890--roughly the same period as the Autobiography--and chronicles the life of a Scottish woman in the early part of the 19th century. Although Kirsteen Douglas is a dressmaker rather than a writer, Oliphant takes care early in the novel to encourage the idea (through theScottish dressmaker Miss Macnab) "that a dressmaker `is an artist in her way' and that ... dressmaking is `just like a' the airts'"(Jay 260). I will thus read dressmaking as a trope for writing, Kirsteen as an artist figure, and the novel as Oliphant's portrait of the artist as a young dressmaker. Reading dressmaking as a metaphor for writing, I hope to demonstrate that this late novel presents a self-consciousness and humor about artistic production the analysis of which will clarify what Oliphant means by the term`artist.' First to contextualize Oliphant's portrayal of Kirsteen. Here I will argue that not merely personal but also larger cultural associations with needlework made dressmaking Oliphant's inevitable choice of metaphor for writing.

Governance in the CNMI Essay -- Unicameral, Bicameral, legislature, Uni

Is the Commonwealth of the Northern Mariana Islands (CNMI) better yet with a Unicameral Legislature or with the current Bicameral Legislature? According to Wikipedia, the Northern Mariana Islands Commonwealth Legislature is defined as the territorial legislature of the United States of America (Wikipedia). The legislative branch of the Marianas is bicameral. It consist of twenty members in the lower House of Representatives, and an upper house Senate with nine members. The Representatives serve two-year terms, and the Senators serve four-year terms, both without term limits. Both houses of the legislature convene and conduct their meetings on the Island of Saipan, the capital island of the Northern Mariana Islands. The House seats are elected in seven districts. Two districts have one seat each, one for Tinian & Aguiguan, and one for Rota. The remaining five districts elect multiple members, two with three members and two with six members which are all located in Saipan. According to the Mariana Islands Constitution, the requirements for House of Representative are a minimum age of 21, must be a residence of the Commonwealth for at least three consecutive years, and a registered voter in the district you represented. Reapportionment occurs every ten years following the census. Together with the Senate, the Constitution permits the Legislature to enact a higher residence requirement (CNMI Government laws). The Senate seats are divided into three districts containing three seats each from Saipan, Tinian, and Rota. The Senate seats are divided into two classes that are similar to the classes of the United States Senate. One class consisting of a single Senator from each district, and the second class consisting of two Senators from... ... Mariana Islands, 1998- 2013. Web. Retrieved from http://www.nationsonline.org/oneworld/northern_mariana_islands.htm Commonwealth of the Northern Mariana Islands Country Brief. Home page. Bilateral, Sept. 2013. Web. Retrieved from http://www.dfat.gov.au/geo/cnmi/ Farrell, Don. â€Å"Tinian: A Brief History.† Tinian. (Original work published 2012) Northern Marianas Commonwealth. Home page. Legislature, 2006. Web. Retrieved from http://www.cnmiago.gov.mp/government.html Covenant of the Commonwealth of the Northern Mariana Islands. Home page. Web. Retrieved from http://en.wikipedia.org/wiki/Northern_Mariana_Islands Covenant. Law revision commission, 2013. Home Page. Web. Retrieved from http://cnmilaw.org/cnmicovenant.html Farrell, Don. Personal Interview. 26 Nov. 2013 Cruz, Peter. Personal Interview. 29 Nov. 2013

Why Did The Polls Get It Wrong In 1992? :: essays research papers fc

Why Did the Polls Get it Wrong in 1992? Opinion polls play a major role in politics, they can be used by the Government to decide when to call and election, and, among other things, how their pre- election campaigns are run. Throughout the history of opinion polling, from the time when polling began to be widely used before an election, in 1945, until 1987, the last general election before 1992, the polls have on average been correct to within 1.3% of the vote share between the three leading parties, and the 'other' category (Crewe, 1992, p. 478). This puts all the previous opinion polls well within the +/-3% margin of error. Because of the past accuracy of opinion polling, the system has had great credibility and has always been trusted, both by the public, and political parties. The way polling forecasts can affect the way people vote is very dramatic, this is because they can be a 'self fulfilling prophecy', in that some voters like to back the 'winning team', and others only vote for a party they feel has a real chance. This was demonstrated in 1983, when the Alliance, frustrated with the media concentrating only on their position in the polls, leaked their own private polls to the press, resulting in a late surge of support (Crewe, 1992, p.478). Britain generally has a much greater number of opinion polls carried out than in other countries, this is due to the large number of national newspapers, and the amount of current affairs programming on television. The period prior to the 1992 general election saw a much greater intensity of opinion polling than ever before. During the 29 days between the date of the announcement of the actual election date, 11th March, and the election date itself, 9th April, there were a total of no less than 57 national opinion polls. The 1992 election will always be remembered as the one the pollsters got wrong, during the lead up to the election, they almost all showed Labour ahead of the Tories. Of the four polls carried out in the two days prior to the actual election date, all of them pointed to a hung parliament; one put the Conservatives 0.5% ahead, one put Labour and the Tories neck and neck, the other two showed Labour ahead by a narrow margin (Crewe, 1992, p. 8). On the actual day of the election, exit polls carried out by the BBC and ITN both showed there would be a hung parliament, although both of them had the Conservatives slightly ahead. They were both not far from the actual Conservative 43%, and Labour 35%, Why Did The Polls Get It Wrong In 1992? :: essays research papers fc Why Did the Polls Get it Wrong in 1992? Opinion polls play a major role in politics, they can be used by the Government to decide when to call and election, and, among other things, how their pre- election campaigns are run. Throughout the history of opinion polling, from the time when polling began to be widely used before an election, in 1945, until 1987, the last general election before 1992, the polls have on average been correct to within 1.3% of the vote share between the three leading parties, and the 'other' category (Crewe, 1992, p. 478). This puts all the previous opinion polls well within the +/-3% margin of error. Because of the past accuracy of opinion polling, the system has had great credibility and has always been trusted, both by the public, and political parties. The way polling forecasts can affect the way people vote is very dramatic, this is because they can be a 'self fulfilling prophecy', in that some voters like to back the 'winning team', and others only vote for a party they feel has a real chance. This was demonstrated in 1983, when the Alliance, frustrated with the media concentrating only on their position in the polls, leaked their own private polls to the press, resulting in a late surge of support (Crewe, 1992, p.478). Britain generally has a much greater number of opinion polls carried out than in other countries, this is due to the large number of national newspapers, and the amount of current affairs programming on television. The period prior to the 1992 general election saw a much greater intensity of opinion polling than ever before. During the 29 days between the date of the announcement of the actual election date, 11th March, and the election date itself, 9th April, there were a total of no less than 57 national opinion polls. The 1992 election will always be remembered as the one the pollsters got wrong, during the lead up to the election, they almost all showed Labour ahead of the Tories. Of the four polls carried out in the two days prior to the actual election date, all of them pointed to a hung parliament; one put the Conservatives 0.5% ahead, one put Labour and the Tories neck and neck, the other two showed Labour ahead by a narrow margin (Crewe, 1992, p. 8). On the actual day of the election, exit polls carried out by the BBC and ITN both showed there would be a hung parliament, although both of them had the Conservatives slightly ahead. They were both not far from the actual Conservative 43%, and Labour 35%,

African American Cultural Assessment Essay

Abstract In order to provide culturally appropriate care, an examination of one’s personal views, beliefs, and prejudices must be examined. The first portion of this paper will examine my personal values, beliefs, biases, and prejudices. The remaining paper will analyze the African American culture relating to the Ginger and Davidhizar’s Transcultural Assessment Model cited in Hood (2010). This model uses six key cultural elements that include communication, space, social organization, time, environment, and biological variations. This model provides a systematic approach for assessing culturally diverse clients. I will also discuss an aspect of care that I would advocate a change in my clinical practice for the African American population. Cultural Self-Assessment Culture is one of the most basic elements that makes up the identity and personality of each individual. Every individual has their own culture rooted from the community they lived in and the family they grew up making up the personal identity people have in the general society Personal views, aspects of reasoning and judgment and the general logical thinking of an individual are affected significantly by the culture he or she has. In this aspect, the entire well-being of a person depends greatly on his or her culture. Becoming aware of how your actions and cultural beliefs affect the patients that you deal with is important. Thus, a person must regularly assess himself because an action or a mere word done or spoken by a nurse can be misunderstood by these patients coming from different cultures Being an American born and lived all my life in New Bedford, Massachusetts, culture has really affected me as a person. My mother and grandparents were born in Portugal and this gave me a variety of culture since we all know that New Bedford is a melting pot of cultures. Portugal possesses rich cultural inheritance from European, African, and North American cultures. Aside from that, mainly Portuguese and Hispanic people populate the community where I live in. These further made me grow as an individual that is rich in cultural inheritance. I am a person who has a Portuguese lineage, since my grandparents were natives of Portugal and a person who grew up in a community wherein Portuguese people mainly inhabits the land. Having an ethnic identity as a Portuguese American who acquiring the Portuguese cultures and practices surrounding me molded me as to who I am now. This ethnic affiliation will always be a part of me, my friends, and my family. Each cultural belief that I introjected within has already affected how my mentality works, and how my feelings reacts. Family and friends have always served as my fortress in time of trials and difficulty. They remain as my comfort zone whenever I feel so down. They are the main support people in my life from which I extract my energy from. Adopting this belief from my parents and from the community I live in is one of the proofs that the culture of the people around me had affected me well. Living with people who provide high regards to friends and families will make you have the similar perspective too. My culture does not affect much my preferences with medical treatments. In line with this, being an independent person, the decisions for my health mainly comes from me since I am the owner of this body. My family and friends will surely voice out their concerns, but it does not mean that I have to follow them, I might consider it but what would really matter will be my decision for my own health. As of what I have observed in my family, especially among my grandparents, the family is mainly a patriarch form of family. Decisions mainly depend on my grandfather since he is the father and the man in the family. Especially among Portuguese, it was noted that people in Portugal gives higher regards to male than to female. They still have this belief that a woman shall always be better than woman. However, in my case, growing as an American with a Portuguese lineage, things were far more different. I grew up having giving importance to democracy and equality. Voices of the female are now more heard, and I think male and female are both equal. This is because I think they have equal abilities, as well as, equal rights. Living in a community filled with Portuguese people made me learn English and Portuguese. Aside from that, my grandparents required me to learn those languages too, especially Portuguese which is their main language in their main land. However, the primary language that I utilize in everyday conversation is English and the secondary language that I know is Portuguese. However, most of the time, I am comfortable with non-verbal forms of communication, especially doing hand gestures. I am more expressive with this form of communication because I think it can bring many messages to the people that I interact with. With a mere wave of a hand, it can show joy, respect, accommodation, or even comfort to those people you interact with. Being a Roman Catholic is very importance to my daily life because this gives me support, comfort, and security whenever difficult situations occur. This belief helps me to cope with the trials I face by knowing that there is a supreme being up there that is in control of everything. That the God whom I know as my Father, my King, and my Savior loves me so much and will never forsake me whatever happens. Daily life gives us opportunities to grow with our spiritual relationship with God by walking each day with him, and applying his will and commandments in everything that we do. Foods are one of the things that I truly enjoy. I do not have any prohibitions whenever it comes to food. I know how to eat a variety of foods. I do not have any food allergies that might prohibit me from eating other foods. As long as it is clean and digestible, I can definitely give it a shot. Currently, I am in a relationship with my boyfriend of eight years who is interracial himself. My work provides me career growth and financial security that I definitely need to support myself. I have no issues with the job that I have right now, since it suffices the finances that I have. Nevertheless, of course, like anyone else, an opportunity for greener pastures will be much appreciated and entertained when it comes. Being a nurse, I am aware of all the possible medical treatments that can be done to each person experiencing illness. Even though I know how much these practices could help me survive various predicaments in health, I still prefer not to undergo through some of it in case I will encounter them in my life one day. I do not have problems taking medications and intravenous lines; however, I really do not want to be intubated at end of life decisions. I know how awful it seems, and how difficult is it having a tube being attached to me. I also do not want to live on life support because I think that such modalities only prolongs the agony that you feel. It has been my personal belief ever since that when the time comes that God wants to take the life He has given me, nothing can prevent that. As a Catholic, I believe that birth is a gift of life from God. Thus, I definitely go against with abortion, which kills an innocent child’s life. With regards to death, I believe that after death, the soul goes to purgatory, and God will judge you whether you will go to heaven or to hell. However, with regards to miracles and afterlife, I do not think that these are rational. As a person, I give high regard to a person’s hope. I believe that hope is essential for a person to live the life we have, and to fight the everyday battles that we face. Without hope in our lives, we lose the chance of living and enjoying the life we received from God. Instead, we become a living corpse, a person who is literally living physically yet the inside of the heart is as cold as a corpse, because he has no hope and no joy for anything. Cultural Assessment and Analysis Paper on African American Population The population that interested me to do additional research is African American population. The total population including all races and ethnicities in the United States is 308 million. After researching on the U. S. Census Bureau, I found 39 million African Americans live in the United States. One of the most glaring disparities is apparent in the African. American community, where 48% of adults suffer from a chronic disease compared to 39% of the general population (Health Reform, 2009). The CDC states that in 2004, African Americans had the highest age-adjusted all-causes death rate of all races/ethnicities (CDC, 2008). African Americans have become susceptible to many diseases and health problems throughout the last number of years. The male and female citizens of the African American population have been struggling with high rates of cardiovascular disease, hypertension, cancer rates, stroke, diabetes, asthma and HIV/AIDS just to name a few. African Americans have numerous health risks as well such as; higher incidence of homicide, lower physical activity levels, obesity, cigarette smoking, alcohol abuse, incarceration, unintended pregnancy, and untreated dental carries (Hood, 2010). Despite remarkable improvements in the overall health of our nation during the past couple of decades, compelling evidence suggests that our nation’s racial and ethical minority African Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans (Copeland, 2005). The predominant barriers to accessible health care services for African Americans include inability to pay for services, lack of transportation and childcare, decrease understanding of treatment plans and inability to incorporate prescribed health plans into daily living patterns (Russell & Jewell, 1992). Furthermore, the African American population’s cultural beliefs and health practices have a significant impact upon their well-being regardless of their educational levels and income. Therefore, these health beliefs and practices affect utilization of contemporary health-care service delivery systems even when other barriers have been eliminated. Differences in health beliefs and practices can be observed among African Americans in varying age groups, socioeconomic levels, and geographic locales. The commonalities include religious orientation, social support networks, and inform health care systems (Russell & Jewell, 1992). Religion is a focal point within the lives of African Americans. Many African Americans characterize health as a continuum evolving around mind, body, and spirit. African Americans also have large support systems including nuclear and extended families. They would rather rely on someone who may not be related by blood or marriage than to receive help from community agencies. Informal health care systems within the African Americans community often are consulted. A study showed that African Americans used an informal social network rather than receiving professional health care. Instead of consulting appropriate personnel, they are consulting family members and friends in regards to their personal health problems. This could be a factor in why the health disparities in this particular population are greater than any other race or ethnicity. The Ginger and Davidhizar’s Transcultural Assessment Model focuses on cultural elements. The model includes six cultural phenomena: communication, time, space, social organization, environmental control, and biological variations. These provide a framework for patient assessment and from which culturally sensitive care can be designed. In the following paragraphs, I will begin to talk about each key element and how it corresponds to the African American population. Communication is meaningful because of the culture that frames it, and culture must be expressed to exist. Communication is seen as a problematic part of cultural affiliation and not as caused or predicted by affiliation. Miscommunication is a frequent problem in hospitals. The most obvious is when the patient and hospital staff does not speak the same language. Although the dominant language spoken among African Americans is English, there is a way of speaking among some African Americans that sociolinguists refer to as African American English (AAE) (Campinha-Bacote, 2009). These terms include Black English, Ebonics, Black Vernacular English (BEV), and African American Vernacular English (AAVE) (Campinha-Bacote, 2009). They also prefer the use of nonverbal communication. Therefore, as nurses we should be able to provide care to African Americans without there being a language barrier present. In addition, a head nod does not necessarily mean agreement and when asked personal questions on initial contact with a person it may be viewed in their eyes as intrusive. Space refers to the distance between individuals when they interact. All communication occurs in the context of space. There are four distinct zones of interpersonal space: intimate, personal, social and consultative, and public. Research on use of space among African Americans is mixed. Some studies indicate that, in race-matched pairs, black children will stand closer to each other during conversation than white children do. Other research has shown that African American adults employ a greater public distance from each other than compared when interacting with family and friends. They also prefer close personal space and touching another’s hair is considered improper. African Americans tend to be late for appointments because relationships and events may be deemed more important than being on time. Social organization refers to the manner in which a cultural group organizes itself around the family group. Family structure and organization, religious values and beliefs, and role assignments may all relate to ethnicity and culture. African American’s have many female single-parent families. They are also known for large extended families, in which elders are respected. There preferred religion is Protestant (Baptist), majority of African Americans have a strong church and social affiliations. In 2005, the National Institutes of Health urged African Americans to use family reunions as venues for discussions about diabetes and kidney disease—diseases that disproportionately affect this group (McCoy, 2011). Time is an important aspect of interpersonal communication. Time orientation varies according to age, socioeconomics, and subgroups and may include past, present, or future orientation. Preventive health care requires some future time orientation because preventive actions are motivated by a future reward. African Americans time orientation is present over future. Environmental control refers to the ability of the person to control nature and to plan and direct factors in the environment that affect them. African Americans have traditional health and illness beliefs. They also are known to use folk medicine; the folk healers are root workers. Some African Americans, particularly of Haitian background, may believe in sympathetic magic. Sympathetic magic assumes everything is interconnected and includes the practice of imitative and contagious magic. Contagious magic entails the belief that once an entity is physically connected to another, it can never be separated. This type of belief is seen in the practice of voodoo, when an individual will take a piece of the victim’s hair or fingernail and place a hex, which they believe will cause the person to become ill (Campinha-Bacote, 2009). To African Americans God is thought to be the spiritual healer. Biological differences, especially genetic variations, exist between individuals in different racial groups. Although there is as much diversity within cultural and racial groups as there is across and among cultural and racial groups, knowledge of general baseline data relative to the specific cultural group is an excellent starting point to provide culturally appropriate care. Nutritional preferences for African Americans include fried foods, and among pregnant women pica ingestion. African Americans are susceptible to many health conditions such as; keloid formation, lactose intolerance, sickle cell anemia, glucose-6-phosphate dehydrogenase deficiency, thalassemia, sarcoidosis, hypertension, coccidioidomycosis, esophagus and stomach cancers. African Americans are at greater risk for many diseases, especially those associated with low income, stressful life conditions, lack of access to primary health care, and negating health behaviors (Campinha-Bacote, 2009). The greatest risk factor for cardiovascular disease and heart attacks amongst African Americans is hypertension. Compared with hypertension in other ethnic groups, hypertension among African Americans is more severe, more resistant to treatment, and begins at a younger age, and the consequence is significantly worse, including organ damage (Brewster, Van Montfrans, & Kleijnen, 2004). African Americans also have an overall higher cancer incidence and mortality rate than any other race African Americans suffer from certain genetic conditions. Sickle cell disease is the most common genetic disorder among the African-American population, affecting one in every 500 African Americans. In addition to sickle cell disease, glucose-6-phosphate dehydrogenase deficiency, which interferes with glucose metabolism, is another genetic disease found among African Americans (Caminha-Bacote, 2009). African Americans also metabolized certain drugs differently such as immunosuppressants, antihypertensive, cardiovascular, antiretroviral, psychotropic drugs. After reading through several articles and journals regarding African Americans there are many areas that I would advocate for change but if I had to choose just one, I would pick HIV/AIDS. Many African-Americans are at high risk for HIV infection, not because of their race or ethnicity, but because of the behaviors, they may engage in. As with other ethnic/racial groups, HIV risk depends not on who you are, but on whether you engage in risk-taking behaviors with an HIV positive partner, and whether you have access to care, education and prevention services. The greater number of people living with HIV in African American communities and the fact that African Americans tend to have sex with partners of the same race/ethnicity means that they face greater risk of HIV infection with each new sexual encounter (CDC, 2011). Lack of awareness of HIV status can affect HIV rates in communities. Late diagnosis of HIV infection is common, which creates missed opportunities to obtain early medical care and prevention of transmission to others (CDC, 2011). This disease/illness can be prevented if maximizing the effectiveness of current HIV prevention methods. Implementing programs that teach individuals how to get tested for HIV and prevent the spread of the infection to others. The CDC has set up numerous activities within the communities to address prevention and spread of HIV. For example, The Act against AIDS campaign encourages African American women to get tested for HIV. In 2010, the CDC also began an Expanded Testing Initiative (ETI) for individuals to be tested for HIV. Even though there are multiple resources available to the African American population, I believe stigma, fear, and discrimination are a risk factor in which why they are afraid to be tested. Working in a hospital facility for almost over a year already, I have only been across two individuals who were tested for HIV/AIDS. After learning so much about African Americans and their numerous health disparities this particular infection, can be prevented. It amazes me that in 2009, black men accounted for 70% of the estimated new HIV infections among all blacks. By the end of 2008, an estimated 240,627 blacks with an AIDS diagnosis had died in the U. S. (CDC, 2011). After researching African Americans this particular race/ethnicity bares the most health disparities of all. A major aspect is the quality of the relationship with a health care provider, which is linked to patient satisfaction, adherence, and health outcomes. If African Americans feel that their provider has been, disrespectful they may not return for treatment, may try another provider, or may change their health care plans. This may be an enormous reason why the health disparities are the way they are in African Americans. Success in eliminating disparities in health care access and utilization requires all professionals to critically examine their own biases and to adopt the values and behaviors needed for social change. References Brewster, L. , Van Montfrans, G. , & Kleijnen, J. (2004). Systematic review: Antihypertensive drug therapy in Black patients. Annals of Internal Medicine, 14(18), 614-627. Campinha-Bacote, J. (2009). Culture and Diversity Issues: A Culturally Competent Model of Care for African Americans. Urologic Nursing, 29(1), 49-54. Center for Disease Control and Prevention. (2008). Highlights in Minority Health & Health Disparities. Retrieved from http://www. cdc. gov/omhd/Highlights/2008/HFeb08. htm Center for Disease Control and Prevention. (2011). HIV among African Americans. Retrieved from http://www. cdc. gov/hiv/topics/aa/PDF/aa. pdf Copeland, V. C. (2005). African Americans: Disparities in Health Care Access and Utilization. National Association of Social Workers, 30(3), 265-270. Health Reform. (2009). Health Disparities: A Case for Closing the Gap. Retrieved from http://www. healthreform. gov/reports/healthdisparities/ Hood, L. , Leddy, S. (2010) Conceptual Bases of Professional Nursing (7ed. ) Philadelphia: Lippincott William & Wilkins. McCoy, R. (2011). African American Elders, Cultural Traditions, and the Family Reunion. Generations-Journal of the American Society on Aging, 35(3), 16-21. Russel, K. , Jewell, N. (1992). Cultural Impact of Health-Care Access: Challenges for Improving the Health of African Americans. Journal of Community Health Nursing, 9(3), 161-169. U. S. Census Bureau. (2010). County Business Patterns and Demographics. Retrieved from http://www. census. gov/cbdmap/.

Environmental & Health Impacts of Mining on Surrounding Communities

Background of the Study INTRODUCTION To achieve rapid economic development, many countries resort to various activities to use and take advantage of natural resources. One of such activities is mining. Thus, mining became an important activity which has potential for the contribution of development of areas enriched with resources. Having visited Surigao Del Norte once a month starting February until August of this year, I was deeply frustrated by the negative impact of mining in the province. I saw how communities affected by mining.I heard how indigenous people had been shifted off their lands to make way for mining and how their consultation rights had been ignored. I saw polluted rivers, destroyed mangrove forests, damaged coral and ruined agriculture. I concluded that Surigao del Norte is in danger of losing much of its rich biodiversity and damaging the lives of unique indigenous cultures. Surigao Del Norte is a province of the Philippines located in Caraga Region in Mindanao. It has a population of almost 450,000 lines between the different groups which cannot be accurately distinguished.It has an area of 2,740 square kilometers. It embraces within its domain 27 municipalities and a component city. Mangrove is the major theme in the coastal areas of the province. It has also many caves and tunnels in its islands. The ironwood forests of the province are one of the watersheds most productive resources. By its nature, it is growing and adapted to a mineralized soil. So it should be carefully managed for sustained productivity. Its biggest islands are usually mountainous and rich in minerals. Its islands have one of the world's largest deposit of nickel and chromite.The smaller ones either rest on sand and gravel or have a limestone base bonded by boulders ( large rounded mass of rock lying on the surface of the ground or embedded in the soil ), reefs, and sandbars. There are also springs, lagoons, caves, waterfalls, mangroves, marshes and whirlpools which made the province more appealing to all nature lovers. Surigao is home to the â€Å"Mamanwa† ethnic tribe. The Department of Labor and Employment – Caraga Region released an official list of mining companies in Caraga for 2012 Inspection.There are 35 mining companies declared in the list that continuously operate in the whole region. And there are other non registered mining companies that are not included in the list that are pursuing mining operations. Mining activities have lots of environmental and health impacts. This has derived from the methods of operation by the mining companies, of course it has effects on the natural environment as well as the people in the surrounding communities. STATEMENT OF THE PROBLEMSurigao del Norte has a variety of mineral resources and corrispondingly there's large-scale mining companies invested more and expanded their operations in the province. Nickel production in the province is dominated by these large mining companies that ar e operating in different communities in Surigao del Norte. The three giant and controversial mining companies located in the province are Tag-anito High Pressure Acid Leaching (THPAL-Sumitomo), Tag-anito Mining Corporation (TMC), and the Platinum Gold Metal Corporation (PGMC).The giant Tag-anito Mining Corporation (TMC) is one of three mining companies of the Nickel Asia Corporation in Surigao del Norte owned by Manny Zamora, located at Brgy. Taganito,Claver. The TMC has ravaged the area for many years and has immensely destroyed the environment of the province. It has ruined both fresh water and marine sources, devastated mountains, violated the rights of the indigenous people and workers. The Platinum Gold Metal Corporation (PGMC) is mining nickel ore for foreign buyers with a permit to operate under the name of Mr. Atayde, but is currently operated by one Mrs.Tata Dasmarinas Marahomsar. Millions of tons of nickel ore have already been plundered and shipped to imperialist countrie s, which has resulted in the total effacement of forest and mountains within its concession, as well as the destruction of rivers and seas. Almost all workers in this company are under contract-basis. This gigantic Tag-anito High Pressure Acid Leaching Plant (THPAL), which processes nickel, is principally owned by the Japanese imperialist Sumitomo Mining Corporation, which is in partnership or connaivance with the Nickel Asia Corporation owned by Manny Zamora.Its operation uses massive quantities of sulfuric acid that is highly toxic to both humans and environment. It is also a coal-fired plant that exhausts out tons upon tons of highly toxic fumes into the atmosphere. The said plant also only processes millions of tons of low-grade nickel ore coming from different mines from the four provinces of Caraga, as they prefer to export high grade nickel ore to foreign countries. At the rate they are currently mining both low and high grade nickel ore, in the net few decades, the environme nt in the province will be completely destroyed.The method of extraction that is mostly used by these mining companies is open-pit. It is a kind of surface mining that the mining companies choose to get rocks and minerals out of the ground because it is easiest and cheapest way. The top of the layers of the land are removed. After that, layer after layer is taken away until the rock or mineral is visible. This is taken out and processed. Taking away layer after layer of land creates a gigantic, open hole or pit that keeps getting deeper and deeper until there is nothing left to bring out.Heavy machines are used for this purpose. The use of heavy machines and chemicals underground do not only cause instability within the earth crust but also underground water which serves as source of water to various waterbodies in the area are affected by infiltration of toxic materials. Also, explosives like dynamites are used to blast the large rocks out of the earth. The loud noise and the vibra tions from the blasts have affected people within the surrounding communities. There is also spillage of poisonous chemicals used in the process in drainage to nearby streams.This causes aquatic life loss, as these chemicals are highly toxic. It also seeps down into the soil causing plant roots to die. The combination of inadequate protection measures and natural hazards can be and has been calamitous. The province's record of mining incidents is evident of this. Last January 2011, Surigao del Norte was under state of calamity as several towns were hit by floodwaters . Numerous houses were totally and partially damaged, and the floods killed number of people. Families from barangays provincewide were affected.Last October 2011 more than 200 heavily armed New People's Army rebels attacked three mining companies in Surigao del Norte, burning heay equipment, disarming guards and briefly holding several people in their attack. This conflict between the rebels and the mining companies ha d made the local people alarmed and troubled. These incidents are proof how mining brought distruction on the livelihoods, health and even the human rights of indigenous people and other local communities of Surigao del Norte.These environmental, health, and social effects of mining activities have been attracting attention, thus, need to be addressed. Although, the mining company is believed to have made steps to improve health conditions of residents within the surrounding communities, however, the extent to which these efforts are reducing the negative environmental and health impacts is yet to be established. For instance, the three mentioned large mining companies in the province said that their top priority is local employment in the communities they operate.Also they claim that they are engaged in environmentally responsible practices in their mining operations, complied with local and national guidelines and programs on the preservation and restoration of the environment. Bu t it is clear in the incidents happened in the province that their missions/vissions to care for the environment and community are not met. OBJECTIVES OF THE STUDY In line with the problems outlined above, the aim of this research is to answer the following concerns: a. What are the effects of the method(s) used in mining on the environment? b. What are the health effects of mining on the people living in Surigao del Norte? . What measures have been put by the government and other organizations to reduce the negative effects (environmental & health) of mining activities on the people of Surigao del Norte? Accordingly, the main objective of the study was to ascertain the environmental and health impacts of Surigao del Norte on the surrounding communities. The specific objectives were to: 1. 3. 1 Determine the methods of mining operations and their effects on the environment and health of the people. 1. 3. 2 Determine and examine the measures of the mentioned mining companies (TMC, PD MC,THPAL) in ensuring the safety of residents in the surrounding communities. . 3. 3 Assess the role of the Chamber of Mines Caraga Region, inc. , Department of Environmental and Natural Resources (DENR), Local Government Units (LGU), and Non government organizations (NGO's). 1. 4 HYPOTHESES 1. 4. 1 Appreciation of mining effects on the environment by residents is related to their number of years of stay in the communities. 1. 4. 2 Knowledge of mining effects on health is positively related to years of schooling (education). 1. 4. 3 The infections/diseases among residents are related to mining activities. 1. 6 RESEARCH METHODOLOGYThe data collected included background data on respondents, awareness, perception and effects of mining within the surrounding communities. Also data on the methods of the mentioned mining companies were collected, as well as data on the effects of their operations. Also data interventional measures of the organizations involved were collected. 1. 7 Sources of Data and Methods of Data Collection Data for this study were from primary and secondary sources. Primary data included administering of questionnaires in the field to residents of surrounding communities of the mining companies and some mine workers.There were also interviews with staff and officials of the mentioned mining companies (TMC,PDMC,THPAL) as well as officials of government agencies such as LGU and DENR for relevant information. Moreover, there were field observations to the mine sites and other areas to determine the effects of mining operations on the environment. Secondary data were gathered from books, relevant articles from journals and reports of researches conducted on the effects of mining operations on the surrounding communities. There were data also obtained from library of Far Eastern University – Makati, internet and other sources. SAMPLING DESIGN 5 people were randomly selected for the execution of a detailed questionnaire. The justification of th e sample size lies in the fact that the time and resources available were not enough to cover the entire area with its whole population. CONCEPTUAL FRAMEWORK Provision of Health Facilities Land Degradation The conceptual framework shows the impact of mining on the environment and the health of people. Mining method used by mining companies in surigao is open-pit ( surface mining). The method used have environmental and health impacts.Opininon of Respondents on Effects of Mining on the Environment Years of Staying in town Do Methods affect the environment? Yes No Total 1-4 years 3 3 5-8 years 2 2 9-12 years 13-16 years 2 2 17-20 years 3 3 21-24 years 2 2 25-28 years 5 5 29-32 years 1 1 33-36 years 1 1 37-40 years 6 6 41+ years Total 25 25 It is evident from the table that those who have stayed longer period within the mining area gave a large percent attestation that mining methods affect the environment. The analysis confirms that the years of staying in town affect respondent's kno wledge on mining effects on the environment.Therefore , the first hypothesis is validated. Table 2. Respondents' responses to environmental effects of mining on the locality Effects of Mining Frequency Percentage Land Degradation 17 32. 08 Air Pollution 12 22. 64 Water Pollution 15 28. 3 Noise Pollution 9 16. 98 Total 53 100 NB: The total frequency is exceeding 25 because there were lot of respondents noted more than one form of effect. The highest percentage of the respondents noted that contributes environmental problem is land degradation followed by water pollution , air pollution , then noise pollution.The pollution are associated with mining activities in their respective communities. Table 3. Respondents' views on relationship between mining and health by education Years of education Are diseases related to mining? Yes No Total None (illiterate) 3 3 6 7-9 yrs ( basic) 4 4 10-15yrs ( secondary) 4 3 7 16-18 yrs ( tertiary) 8 8 Total 19 6 25 Approximately 76% of the respondents asserted that the diseases endemic in their communities were as a result of the mining activities , while 24% disproving this claim.The analysis also shows that the years of schooling of respondents (education) affected the views of respondents on relationship of diseases endemic in the area of mining activities. For those with higher years of schooling (10-18 yrs. ) asserted that mining activities had caused diseases endemic in the area. The second hypothesis that knowledge of mining effects on health is positively related to education levels of respondents is therefore validated. Table 4. Diseases frequently contracted by respondents Diseases Frequency Percentage Malaria 2 8 Diarrhea 11 44 Skin Diseases 4 16 Fever 5 20 Cough and colds 3 12 Total 5 100 Most of the respondents complained of incidence of diarrhea from mining activities. Then some noted infections of fever, skin diseases, cough and colds ,then malaria. Health effects associated with the mining activities are noteworth y. The research revealed that there is high prevalent rate of diseases such as diarrhea and other infections among residents which were direct and indirect effects of mining activities. Summary of Research and Findings The research examined the mining methods of the three mining companies (TMC,PGMC, THPAL) and their environmental and health effects on the surrounding communities.Moreover, measures being put in place by the mining companies to moderate the environmental, health and other socio-economic effects of their activities on the people of Surigao del Norte. Also the roles of some public sector mining industry support organizations were also examined. The three big mining companies that are currently operating in the province of Surigao del Norte, on their part, have realized the effects of their activities on the people living in the communities and have sought to institute measures to reduce and moderate the environmental, health, and other effects on the people.Measures tha t have been undertaken which include reforestation, resettlement and compensation to affected communities, and providing alternative sources of drinking water to communities whose water resources have been contaminated with toxic chemicals. On health, the mining companies have built clinics and health posts within the communities for the benefit of both workers and people within the communities.With the view to ensuring better conditions for residents within the mining area, some public sector mining industry support organizations such as Chamber of Mines of Caraga Region, also government agencies like Department of Environmental and Natural Resources (DENR) and Local Government Units contributed their contributed efforts of restoration. The Department of Environmental and Natural Resources whose primary duty is to ensure that mining companies undertake their operations in conformity with the laws, is responsible for the monitoring of mining activities from time to time.The Local Go vernment Units, as a government agency responsible for taxing and imposing charges for mining companies that are operating in communities of the province , ensures that the just amounts were collected from these mining companies. Also LGU implemented and supervised social support programmes in mining areas. The Chamber of Mines in Caraga Region (CNC), the peak mineral industry association not only in Surigao del Norte but in the whole Caraga Region, represents the collective interest of companies involved in mineral exploration, production, and processing in the province.The chamber has not only functioned to promote and protect the interest and image of the mining industry but has also committed itself to addressing mining related environmental and socio-economic problems. This is evident in the Chamber's commitment in initiating alternative livelihood programmes and executing its corporate social responsibility in host communities of mining activities. CNC initiated inland rehabil itation and reforestation in the Surigao del Norte province. It initiated and committed about 5 hectares of mined-portion for rehabilitation and reforestation.The activity involved re-contouring of the area, backfilling of the topsoil, preparation of site, and planting of endemic and exotic tree species. Despite of the efforts by these organizations in ensuring that mining activities are carried out on sustainable basis without serious problems to the environment and the host communities, the public is yet to feel the impact of their activities. A critical assessment of their activities therefore shows that there is more to be achieved than what has been accomplished so far as far as environmental and health problems in the mining industry are concerned.Conclusion In as much as we acknowledge the economic benefits of mining activities in Surigao del Norte, there is the need also to recognize the environmental and health hazards that come with it in order to find ways of dealing with them. It must be recommended that further researches are conducted into the assessment of intervention measures adopted andimplemented by mining companies and stakeholder organizations in reducing and moderating the economic, social,environmental and health impacts of mining activities on the people in the surrounding communities.There should be funding from the government and other institutions for researches conducted, with a move to educate the general public on the need to provide information needed for researches since they will ultimately lead to the development of the country. There is the need for an effective collaboration and coordination among governmental agencies and others so that they can perform their roles effectively in dealing with the environmental and health problems associated with mining activities within the affected communities.