Ingredients:
1 pound ground meat (hamburger or chicken)
1 onion diced
2 pieces celery cut up small
handful of mushrooms sliced
2 carrots cleaned and cut up small
broccoli cut up small
1 tbs vegetable oil
2 cloves crushed garlic
2 small zucchini cut up in coins
2 cans tomatoes
salt to taste
pepper to taste
1/2 tsp chili pepper spice
1 tbsp chili powder
2 tbsp brown sugar
Cook ground meat in oil add all but the mushrooms and zucchini. Cook for a few mins then add rest of ingredients. Simmer for at least half hour. This makes a large pot of sauce. Feel free to put some in the freezer for another day. I also like to use leftover sauce to make lasagna.
If you prefer chili simply add a can of red kidney beans and enjoy.
Thursday, November 16, 2006
Wednesday, November 15, 2006
Making Pizza
Yes that's right homemade pizza. Believe it or not pizza is not difficult to make. Here is how I make my whole wheat pizza...
Crust Ingredients: yeast, dissolved in 1 & 1/4 cups warm water, add 2 tbs oil, 1 & 1/2 cups whole wheat flour, 2 tbs sugar, 1/2 tsp salt and 2 cups of all purpose flour. Mix and knead the dough for roughly 6 min until the dough is smooth and elastic. Put dough in a covered bowl leave in a warm place for 20-30 mins.
While the dough sits is the perfect time to prepare your toppings. I like to cut up tomatoes, zucchini, broccoli and or other vegetables it is your choice. I also like to add some meat to my pizzas. I saute finely chopped bacon and chicken pieces together and sometimes some ground beef. Every pizza can be different.
To make it easier I mix all of the chopped vegetables together in a bowl and add 2 tbs of olive oil with some spices. Italian spice works well but you can add whatever flavours you like.
I use tomato sauce with some brown sugar mixed in as the first layer on the pizza. I then add the seasoned vegetables followed by the sauteed meat and finally some grated cheese.
For the cheese I like to use various types of cheeses blended together.
20 mins in a 420 degree oven and the pizza is ready to be devoured.
Crust Ingredients: yeast, dissolved in 1 & 1/4 cups warm water, add 2 tbs oil, 1 & 1/2 cups whole wheat flour, 2 tbs sugar, 1/2 tsp salt and 2 cups of all purpose flour. Mix and knead the dough for roughly 6 min until the dough is smooth and elastic. Put dough in a covered bowl leave in a warm place for 20-30 mins.
While the dough sits is the perfect time to prepare your toppings. I like to cut up tomatoes, zucchini, broccoli and or other vegetables it is your choice. I also like to add some meat to my pizzas. I saute finely chopped bacon and chicken pieces together and sometimes some ground beef. Every pizza can be different.
To make it easier I mix all of the chopped vegetables together in a bowl and add 2 tbs of olive oil with some spices. Italian spice works well but you can add whatever flavours you like.
I use tomato sauce with some brown sugar mixed in as the first layer on the pizza. I then add the seasoned vegetables followed by the sauteed meat and finally some grated cheese.
For the cheese I like to use various types of cheeses blended together.
20 mins in a 420 degree oven and the pizza is ready to be devoured.
Tuesday, November 14, 2006
Begining a nursing career
The process of becoming a register nurse seems straight forward. If there is a way to make something difficult I seem to find it.
I decided to enter into the degree program offered by the University of Ottawa. I was working in Pembroke an hour and a half drive from Ottawa and decided to not quit my job as school is expensive. I also decided to live in Pembroke instead of moving to the city. Choosing not to move I drove approximately 130 km to school each day and then back again. I did this and still worked every weekend, holiday and day off to pay for tuition.
I am happy to say that I made it through the entire four years driving back and forth and I still don't mind to drive. I used the same car throughout however I did trade it in for a new Toyota after my last year.
Now a degree in nursing does not make a person a nurse. The definition of nurse legally is a registered nurse (RN) or registered practical nurse (RPN). In order to be registered a nurse requires certain qualifications outlined by the governing body. In Ontario the College of Nurses of Ontario (CNO) is the governing body for both RN's and RPN's. www.cno.org
I am currently waiting for my results from writing the CRNE which is the exam. Once I pass this exam and pay membership fees I will qualify to be called a nurse.
Unfortunately it takes months for this eight hour exam to be marked therefore I will be waiting for a while.
I would like to get a job in health care in the meantime to help out financially however I have not found one so far. I thought with my degree in nursing I would be able to work as an unregulated health care aide or personal support worker however I have sent many resumes out and the two places I have heard from have both said that they cannot hire graduate nurses. A bit of a road block for me but I am sure I will eventually find something that I will be hired for.
I decided to enter into the degree program offered by the University of Ottawa. I was working in Pembroke an hour and a half drive from Ottawa and decided to not quit my job as school is expensive. I also decided to live in Pembroke instead of moving to the city. Choosing not to move I drove approximately 130 km to school each day and then back again. I did this and still worked every weekend, holiday and day off to pay for tuition.
I am happy to say that I made it through the entire four years driving back and forth and I still don't mind to drive. I used the same car throughout however I did trade it in for a new Toyota after my last year.
Now a degree in nursing does not make a person a nurse. The definition of nurse legally is a registered nurse (RN) or registered practical nurse (RPN). In order to be registered a nurse requires certain qualifications outlined by the governing body. In Ontario the College of Nurses of Ontario (CNO) is the governing body for both RN's and RPN's. www.cno.org
I am currently waiting for my results from writing the CRNE which is the exam. Once I pass this exam and pay membership fees I will qualify to be called a nurse.
Unfortunately it takes months for this eight hour exam to be marked therefore I will be waiting for a while.
I would like to get a job in health care in the meantime to help out financially however I have not found one so far. I thought with my degree in nursing I would be able to work as an unregulated health care aide or personal support worker however I have sent many resumes out and the two places I have heard from have both said that they cannot hire graduate nurses. A bit of a road block for me but I am sure I will eventually find something that I will be hired for.
AI and Robotics Today vs. in Lem’s The Hunt
Assignment One
AI and Robotics Today vs. in Lem’s The Hunt
Computers and Human Experience
February 4, 2006
AI and Robotics Today vs. in Lem’s The Hunt
The robots in the story of The Hunt are described to be huge machines with humanistic characteristics. Lem describes the ‘Setaur’ as though it is conscious suggesting it has emotions. The current level of understanding of artificial intelligence (AI) and robotics is far from reaching the point of mechanical beings having and or recognizing emotions if ever. There are many elements of The Hunt that strain the sense of credulity. Definitions of consciousness, intelligence, and human nature all contribute to discredit the realism. The description of the Setaurs capabilities is far from believable at this time if ever. Realities outlined in physics and current accomplishments discredit the description of such feats. In science fiction works there are often robots in various roles that in some way mimic human life and or have conflict with humans. All of these robots are created with computer animation technology these robots are not real. We are not that advanced with artificial intelligence, computers or robotics. We may emerge with further understanding of consciousness within the next century but we are far from AI mimicking life.
AI is defined by TechWEB as “devices and applications that exhibit human intelligence and behaviour including robots, expert systems, voice recognition, natural and foreign language processing. It also implies the ability to learn or adapt through experience”. Robotics is defined by Tyco Electronics as; the theory and application of robots, a completely self-contained electronic, electric, or mechanical device, to such activities as manufacturing. Therefore combining the two AI and robotics would result with a machine with equal intelligence to that of a human. The test for AI was defined in the 1940 by Alan Turing. Known as the Turing test this indicator of artificial intelligence requires that when a machine is conversing with an intelligent human there are no discernible differences. A machine passing the Turing test would assume that the machine is conscious and has equal intelligence. This definition of AI concerns imitating human intelligence.
Consciousness is defined as being the properties of the mind. Being able to perceive, sense, dream, create etc. A loss of consciousness is resulted with the inability to respond to stimuli. Communication is linked to consciousness. Intelligence is defined as a “mental qualities consisting of the ability to learn from experience, solve problems, and use knowledge to adapt to new situations” (Myers, 2001, p 394). There are three aspects of intelligence, analytical, creative, and practical. Analytical intelligence is the academic problem solving attributes. Creative intelligence is reacting to novel situations and creating. Practical intelligence is required for everyday tasks. Picard states that “the hallmark of an intelligent computer will be its ability to recognize emotions” (Picard, 1997, p 50). Emotions are displays of subjective perceptions. Experiencing a perceived horrific event would cause a human to become emotionally upset. Emotions and intelligence are individual meaning each human being thinks differently and reacts differently. The workings of the human brain remain a mystery. There are many more questions in psychology than answers. As such since we do not fully understand how our control center, the brain, works how can we develop an artificial one? At this time a machine passing the Turing test is not realistic. We are far from developing such technology being limited by our current knowledge. Lem’s philosophy seems to be about the limitations of humanity not the limitations of technology and science.
Fictional stories of robots mimicking life are common; stories involving humans, robots and mortality. The father of such writings is Dr. Isaac Asimov who is the first writer to use the term robotics and creator of the Three Laws. The Three Laws of robotics were defined by Dr. Isaac Asimov in his science fiction stories. The Three Laws are as follows. A robot may not harm a human being, or, through inaction, allow a human being to come to harm. A robot must obey the orders given to it by human beings, except where such orders would conflict with the First Law. A robot must protect its own existence, as long as such protection does not conflict with the First or Second Law. There are many fictional films and writings in which the Three Laws of robotics are used in some way. Technologists in the field of AI have speculated upon the role the Three Laws play in research involving real machines. Asimov’s fictional writings have made a huge impact on the view of robots real and imaginary.
Movies such as I, Robot, Bicentennial Man, and Star Wars are some recent examples of the human imagination; tales of machines, human behaviour and mortality. In the movie I, Robot the world thrives on the assistance of humanlike slave robots. The Three Laws are manipulated with the plot however they exist and the result is the ultimate destruction of the computer controlling all of the robots as it had evolved to an extent that it was destroying human life. The conclusion was that robots physically superior to any human would eventually think its creators (humans) to be inferior. In Bicentennial Man the robot is ound to possess creativity and falls in love with a human. He begins to trade in his parts for organic parts and eventually allows his positronic brain to decay wilfully becoming mortal. The thought of eternal life has been introduced in films with controversial opinions. The basic part of being human means that we all live and we all die. Being immortal would change everything. The robot in this story above all wanted to be human. He wanted to live love and die with the love of his life. In Star Wars the robots are portrayed in a comical role. The robots are portrayed with human like personalities but limited to their programming at times. In Star Wars the roles of humans and machines are almost reversed. Humans or at least the Jedi are portrayed with powers and enormous strength; whereas the robots are inferior and act as support. Traditionally the roles played by robots tend to be superior with the enormous strength and abilities. The Setaur is described to be superior in strength but questionably intelligent. Lem alludes to the fact that the machine has thought but does not outright declare superior or even equal intelligence. This leads to the philosophical view of AI, and humans. Interpretations would vary from reading The Hunt. One view is that the Setaur is intelligent and did save Pirx creating sympathy and remorse for killing the Setaur. Another view is that Pirx was lucky that the Setaur was destroyed as he could have easily been killed being so close to it. This theme of robots against humans has been played out in many fictional stories. The unknown of such AI creates ethical dilemmas suggesting that care be taken when creating ‘life’. Would a robot that mimics human being be alive?
Mimicking life is an ethically controversial proposal. Certainly cloning human beings has been condoned within our society. Laws have been implemented since the successful cloning of mammals in recent years. Even with laws in place the ethical view of cloning is much more persuasive in deterring the cloning of humans. Cloning is not an exact science; there are potential side effects as with all scientific experimentation. The possibility of making deformed human clones is likely and therefore ethically wrong. Human cloning is not ethically plausible. McGee asks; if humans “make” babies rather that “have” babies, are they playing God? This ethical dilemma was raised in context to genetic cloning. However, if humans are built by humans rather than born also applies to using AI and robotics. When it comes to building machines to ‘clone’ humans the ethical dilemmas are similar. If this technology is possible is it reasonable? Lem built the theme of Pirx questioning whether the Setaur actually possessed human qualities. He suggested that the Setaur saved Prix’s life in the end. This suggests that this mechanical machine which was built to mine on the moon had evolved or learned very much like a human. Lem creates sympathy for the Setaur by describing him as human. The reader automatically then would think it inhumane to execute a human and thus inhumane to kill the Setaur. Lem skilfully weaves an intricate ethical dilemma; the underlying theme that technology will not better the human condition. This definition of AI is unrealistic yet well known within society.
With both cloning and creating human-like robots we are making individuals. The question here would be do we need to build humans? Our world population is growing in both numbers and age. With the increase in knowledge and technology life expectancy in the western world has increased over fifty percent in the last century. The use of cloning technology could theoretically be used for other purposes such as growing replacement organs rather than making more lives. What purpose does a human like robot serve? An example is researchers are working on developing humanoid robots at Perdue University. These researchers are working to develop robots that could function as aids for people with disabilities. Similar to the use of Seeing Eye dogs these robots would function to help people not replace people. ASIMO is an example of the first such robot. Built by Honda ASIMO currently is used as a tour guide. The development of ASIMO started in 1986. ASIMO has evolved into a humanoid robot capable of walking on various surfaces, opening doors and comprehending and responding to simple voice commands. ASIMO’s top speed is six kilometres and hour on Earth. The goal of ASIMO in the future is to be another set of hands, ears, eyes or legs for people in need. The uses of robots for dangerous and monotamous tasks are realistic however do they need to function autonomously and capable of evolving? Current technology uses robots controlled by humans to perform dangerous and or monotamous tasks.
Perhaps a more realistic definition of AI consist of developing machines to make what people do easier and better. In other words tools for people to simplify tasks instead of mimicking humans. Society thrives on such technology; by this definition AI is a big part of every day life. Current technology has seen a huge increase in the use of computers for everyday tasks. For example computers are used to control the various systems built into vehicles. All vehicles built today have various sensors with computers which sense and indicate problems to the driver; door open lights or tire pressure low indicators. The communications industry is currently thriving on handheld devices that are multifunctional. It is now possible to buy a cell phone that also functions as a text massager, a camera, a television and a day planner. The Setaur was built as a tool that mined the moon. Obviously such a job would be very dangerous for any human to perform therefore logical to build a machine for the task. This definition of AI also applies to The Hunt as the Setaur was built to make mining easier as no humans were required.
Another obstacle facing the development of a humanoid robot and AI is financial restraints. Research and the development of robots are expensive. Millions of dollars has been spent and millions probably billions more will be spent in the future. Research is focused mainly on economically sound foundations. There is no need for artificial human beings economically at this time. The research focus is on smart machinery that is able to perform tasks more efficiently than humans. Robots are used by military to perform dangerous tasks such as clearing of mines and disarming bombs. These robots are controlled by remote and therefore do not possess true AI. The robot in The Hunt is realistic in a way that it was built to work in a mine on the moon which is a task not realistic at all for humans. Using technology to promote health and safety is also true today. Dangerous tasks by health and safety regulations coincide with higher wages for workers. As for building a robot that mimics human life; this is limited to a few funded universities and larger corporations that have a lot of money.
The Setaur described by Lem would be classified as a super human if it were to mimic human life. The Setaur fits under both of the definitions of AI described above. The Setaur is described a mining tool as well as being capable of evolving or learning suggesting human characteristics. Lem describes the Setaur as being not well known being a new design. Alluding to the intelligence of the Setaur being unknown therefore not knowing the reaction it would have when approached. An American model equipped with a limit less 45000 KW per hour laser; capable of fifty kilometres an hour speeds; with no lubricating points and magnetic suspension. The first realism issue is the use of lasers for the actual mining. We do not use lasers for mining today other than for alignment purposes. Laser levels are common. Fifty kilometres an hour is very fast for anything on two legs. ASIMO our current humanoid robot is only capable of six kilometres an hour. With the moon having less gravity and no atmosphere motions appear to be in slow motion. Is a fity kilometre an hour machine possible on the moon? Such capabilities would require enormous amounts of energy. A robot built by Disney in 2003 for a parade was pulling a cart of what appeared to be flowers but was actually the power source for the robot. The Setaur was described to use a power sources called cold chain reaction that is limitless. This technology is fictional and not realistic. The Setaur was unable to communicate. The purpose of the Setaur is to mine on the moon and therefore assumed that it was not meant to be human like at all yet it is described as though it has human characteristics. It has is described to have head trauma resulting in damage that has caused it to destroy objects. Similarly humans with brain damage do not function properly and could suffer from seizures. The Setaur is described to be humanoid with extraordinary capabilities. Such a feat is not currently possible perhaps a machine similar to the Setaur could be developed sometime in the future or not.
Human behaviour is such that the fear of change and unnatural thoughts are strong. The possibility of a computer capable of passing the Turing test is for some unnatural. In the movie X-MEN assume that mutants are equivalent to that of a humanoid robot that passes the Turing test. Society sought out the mutants who largely wished to live out their lives as normal people. Mutants were unknown and thought to be unnatural, not normal potentially dangerous and therefore ostracized. Would society accept humanoid robots? Conflict evolving between humans and robots is evident.
There are many more questions than answers in the world of AI and Robotics. Lem philosophy is the limitations of humanity not the limitations of technology and science. Humans are flawed not perfect. The introduction of robotics and the Three Laws built the foundations for fictitious stories and the dream of what could become reality. The human imagination has created many versions of robots in movies. None of which have actually been built, all of the robots have been computer generated animation. The concept of a robot mining the moon autonomously is farfetched at this time but possible in the future with advances in knowledge and technology.
Ethically the development of humanoid robots is questionable. A humanoid robot built, similarly to a human clone; to simply exist with no other purpose is not ideal. Society would not necessarily accept humanoid robots living amongst people. A realistic reason for the development of robots is to help those requiring need. This is a current topic of interest for researchers such as the American Honda Motor Co and their prototype robot ASIMO. The technology is far from becoming a commonality.
Creation of a robot capable of thought, intelligence, and emotions is not yet thought to be possible. The unknown of how the brain works is a limitation to the creation of an affective AI. Current knowledge of the human brain is in its infant stage for understanding. The Hunt is a wonderful fictitious story but is not realistic related to current technology.
Bibliography
American Honda Motor Co. (2005). ASIMO; Worlds most advanced humanoid robot. Retrieved February 2, 2006 from http://asimo.honda.com/asimos_origin.asp?bhcp=1.
CNN.com. (2000). Dr. James Hendler: A chat about the future of artificial intelligence. Retrieved February 2, 2006 from http://www.cnn.com/chat/transcripts/1999/12/hendler/index.html.
Hooper, R. (nd). Learn About Robotis: Robotic Glassary. Retrieved February 2, 2006 from http://www.learnaboutrobots.com/glossary.htm.
McGee, G. (2006). Primer on Ethics and Human Cloning. Retrieved Febrary 2, 2006 from http://www.actionbioscience.org/biotech/mcgee.html.
Myers, D. (2001). Psychology (6th ed.) New York: Worth Publishers.
Picard, R. (1997). Affective Computing. Cambridge, Massachusetts: Massachusetts Institute of Technology.
ScienceDaily. (2004). Purdue, Japanese researchers to create human like robots. Retrieved February 2, 2006 from http://www.sciencedaily.com/releases/2004/11/041109235501.htm.
TechWeb. (2006). Tech Encyclopaedia. Retrieved February 1, 2006 from http://www.techweb.com/encyclopedia/defineterm.jhtml?term=AI.
Tyco Electronics. (2006). Glossary. Retrieved February 1, 2006 from http://connectors.tycoelectronics.com/glossary/glossary-r.stm.
Wikipedia. (2006). Life expectancy. Retrieved February 2, 2006 from http://en.wikipedia.org/wiki/Life_expectancy.
Wikipedia. (2006). The Bicentennial Man. Retrieved February 2, 2006 from http://en.wikipedia.org/wiki/Bicentennial_Man.
Wikipedia. (2006). Three Laws of Robotics. Retrieved February 2, 2006 from http://en.wikipedia.org/wiki/Three_Laws_of_Robotics#Resolving_conflicts_among_the_laws.
AI and Robotics Today vs. in Lem’s The Hunt
Computers and Human Experience
February 4, 2006
AI and Robotics Today vs. in Lem’s The Hunt
The robots in the story of The Hunt are described to be huge machines with humanistic characteristics. Lem describes the ‘Setaur’ as though it is conscious suggesting it has emotions. The current level of understanding of artificial intelligence (AI) and robotics is far from reaching the point of mechanical beings having and or recognizing emotions if ever. There are many elements of The Hunt that strain the sense of credulity. Definitions of consciousness, intelligence, and human nature all contribute to discredit the realism. The description of the Setaurs capabilities is far from believable at this time if ever. Realities outlined in physics and current accomplishments discredit the description of such feats. In science fiction works there are often robots in various roles that in some way mimic human life and or have conflict with humans. All of these robots are created with computer animation technology these robots are not real. We are not that advanced with artificial intelligence, computers or robotics. We may emerge with further understanding of consciousness within the next century but we are far from AI mimicking life.
AI is defined by TechWEB as “devices and applications that exhibit human intelligence and behaviour including robots, expert systems, voice recognition, natural and foreign language processing. It also implies the ability to learn or adapt through experience”. Robotics is defined by Tyco Electronics as; the theory and application of robots, a completely self-contained electronic, electric, or mechanical device, to such activities as manufacturing. Therefore combining the two AI and robotics would result with a machine with equal intelligence to that of a human. The test for AI was defined in the 1940 by Alan Turing. Known as the Turing test this indicator of artificial intelligence requires that when a machine is conversing with an intelligent human there are no discernible differences. A machine passing the Turing test would assume that the machine is conscious and has equal intelligence. This definition of AI concerns imitating human intelligence.
Consciousness is defined as being the properties of the mind. Being able to perceive, sense, dream, create etc. A loss of consciousness is resulted with the inability to respond to stimuli. Communication is linked to consciousness. Intelligence is defined as a “mental qualities consisting of the ability to learn from experience, solve problems, and use knowledge to adapt to new situations” (Myers, 2001, p 394). There are three aspects of intelligence, analytical, creative, and practical. Analytical intelligence is the academic problem solving attributes. Creative intelligence is reacting to novel situations and creating. Practical intelligence is required for everyday tasks. Picard states that “the hallmark of an intelligent computer will be its ability to recognize emotions” (Picard, 1997, p 50). Emotions are displays of subjective perceptions. Experiencing a perceived horrific event would cause a human to become emotionally upset. Emotions and intelligence are individual meaning each human being thinks differently and reacts differently. The workings of the human brain remain a mystery. There are many more questions in psychology than answers. As such since we do not fully understand how our control center, the brain, works how can we develop an artificial one? At this time a machine passing the Turing test is not realistic. We are far from developing such technology being limited by our current knowledge. Lem’s philosophy seems to be about the limitations of humanity not the limitations of technology and science.
Fictional stories of robots mimicking life are common; stories involving humans, robots and mortality. The father of such writings is Dr. Isaac Asimov who is the first writer to use the term robotics and creator of the Three Laws. The Three Laws of robotics were defined by Dr. Isaac Asimov in his science fiction stories. The Three Laws are as follows. A robot may not harm a human being, or, through inaction, allow a human being to come to harm. A robot must obey the orders given to it by human beings, except where such orders would conflict with the First Law. A robot must protect its own existence, as long as such protection does not conflict with the First or Second Law. There are many fictional films and writings in which the Three Laws of robotics are used in some way. Technologists in the field of AI have speculated upon the role the Three Laws play in research involving real machines. Asimov’s fictional writings have made a huge impact on the view of robots real and imaginary.
Movies such as I, Robot, Bicentennial Man, and Star Wars are some recent examples of the human imagination; tales of machines, human behaviour and mortality. In the movie I, Robot the world thrives on the assistance of humanlike slave robots. The Three Laws are manipulated with the plot however they exist and the result is the ultimate destruction of the computer controlling all of the robots as it had evolved to an extent that it was destroying human life. The conclusion was that robots physically superior to any human would eventually think its creators (humans) to be inferior. In Bicentennial Man the robot is ound to possess creativity and falls in love with a human. He begins to trade in his parts for organic parts and eventually allows his positronic brain to decay wilfully becoming mortal. The thought of eternal life has been introduced in films with controversial opinions. The basic part of being human means that we all live and we all die. Being immortal would change everything. The robot in this story above all wanted to be human. He wanted to live love and die with the love of his life. In Star Wars the robots are portrayed in a comical role. The robots are portrayed with human like personalities but limited to their programming at times. In Star Wars the roles of humans and machines are almost reversed. Humans or at least the Jedi are portrayed with powers and enormous strength; whereas the robots are inferior and act as support. Traditionally the roles played by robots tend to be superior with the enormous strength and abilities. The Setaur is described to be superior in strength but questionably intelligent. Lem alludes to the fact that the machine has thought but does not outright declare superior or even equal intelligence. This leads to the philosophical view of AI, and humans. Interpretations would vary from reading The Hunt. One view is that the Setaur is intelligent and did save Pirx creating sympathy and remorse for killing the Setaur. Another view is that Pirx was lucky that the Setaur was destroyed as he could have easily been killed being so close to it. This theme of robots against humans has been played out in many fictional stories. The unknown of such AI creates ethical dilemmas suggesting that care be taken when creating ‘life’. Would a robot that mimics human being be alive?
Mimicking life is an ethically controversial proposal. Certainly cloning human beings has been condoned within our society. Laws have been implemented since the successful cloning of mammals in recent years. Even with laws in place the ethical view of cloning is much more persuasive in deterring the cloning of humans. Cloning is not an exact science; there are potential side effects as with all scientific experimentation. The possibility of making deformed human clones is likely and therefore ethically wrong. Human cloning is not ethically plausible. McGee asks; if humans “make” babies rather that “have” babies, are they playing God? This ethical dilemma was raised in context to genetic cloning. However, if humans are built by humans rather than born also applies to using AI and robotics. When it comes to building machines to ‘clone’ humans the ethical dilemmas are similar. If this technology is possible is it reasonable? Lem built the theme of Pirx questioning whether the Setaur actually possessed human qualities. He suggested that the Setaur saved Prix’s life in the end. This suggests that this mechanical machine which was built to mine on the moon had evolved or learned very much like a human. Lem creates sympathy for the Setaur by describing him as human. The reader automatically then would think it inhumane to execute a human and thus inhumane to kill the Setaur. Lem skilfully weaves an intricate ethical dilemma; the underlying theme that technology will not better the human condition. This definition of AI is unrealistic yet well known within society.
With both cloning and creating human-like robots we are making individuals. The question here would be do we need to build humans? Our world population is growing in both numbers and age. With the increase in knowledge and technology life expectancy in the western world has increased over fifty percent in the last century. The use of cloning technology could theoretically be used for other purposes such as growing replacement organs rather than making more lives. What purpose does a human like robot serve? An example is researchers are working on developing humanoid robots at Perdue University. These researchers are working to develop robots that could function as aids for people with disabilities. Similar to the use of Seeing Eye dogs these robots would function to help people not replace people. ASIMO is an example of the first such robot. Built by Honda ASIMO currently is used as a tour guide. The development of ASIMO started in 1986. ASIMO has evolved into a humanoid robot capable of walking on various surfaces, opening doors and comprehending and responding to simple voice commands. ASIMO’s top speed is six kilometres and hour on Earth. The goal of ASIMO in the future is to be another set of hands, ears, eyes or legs for people in need. The uses of robots for dangerous and monotamous tasks are realistic however do they need to function autonomously and capable of evolving? Current technology uses robots controlled by humans to perform dangerous and or monotamous tasks.
Perhaps a more realistic definition of AI consist of developing machines to make what people do easier and better. In other words tools for people to simplify tasks instead of mimicking humans. Society thrives on such technology; by this definition AI is a big part of every day life. Current technology has seen a huge increase in the use of computers for everyday tasks. For example computers are used to control the various systems built into vehicles. All vehicles built today have various sensors with computers which sense and indicate problems to the driver; door open lights or tire pressure low indicators. The communications industry is currently thriving on handheld devices that are multifunctional. It is now possible to buy a cell phone that also functions as a text massager, a camera, a television and a day planner. The Setaur was built as a tool that mined the moon. Obviously such a job would be very dangerous for any human to perform therefore logical to build a machine for the task. This definition of AI also applies to The Hunt as the Setaur was built to make mining easier as no humans were required.
Another obstacle facing the development of a humanoid robot and AI is financial restraints. Research and the development of robots are expensive. Millions of dollars has been spent and millions probably billions more will be spent in the future. Research is focused mainly on economically sound foundations. There is no need for artificial human beings economically at this time. The research focus is on smart machinery that is able to perform tasks more efficiently than humans. Robots are used by military to perform dangerous tasks such as clearing of mines and disarming bombs. These robots are controlled by remote and therefore do not possess true AI. The robot in The Hunt is realistic in a way that it was built to work in a mine on the moon which is a task not realistic at all for humans. Using technology to promote health and safety is also true today. Dangerous tasks by health and safety regulations coincide with higher wages for workers. As for building a robot that mimics human life; this is limited to a few funded universities and larger corporations that have a lot of money.
The Setaur described by Lem would be classified as a super human if it were to mimic human life. The Setaur fits under both of the definitions of AI described above. The Setaur is described a mining tool as well as being capable of evolving or learning suggesting human characteristics. Lem describes the Setaur as being not well known being a new design. Alluding to the intelligence of the Setaur being unknown therefore not knowing the reaction it would have when approached. An American model equipped with a limit less 45000 KW per hour laser; capable of fifty kilometres an hour speeds; with no lubricating points and magnetic suspension. The first realism issue is the use of lasers for the actual mining. We do not use lasers for mining today other than for alignment purposes. Laser levels are common. Fifty kilometres an hour is very fast for anything on two legs. ASIMO our current humanoid robot is only capable of six kilometres an hour. With the moon having less gravity and no atmosphere motions appear to be in slow motion. Is a fity kilometre an hour machine possible on the moon? Such capabilities would require enormous amounts of energy. A robot built by Disney in 2003 for a parade was pulling a cart of what appeared to be flowers but was actually the power source for the robot. The Setaur was described to use a power sources called cold chain reaction that is limitless. This technology is fictional and not realistic. The Setaur was unable to communicate. The purpose of the Setaur is to mine on the moon and therefore assumed that it was not meant to be human like at all yet it is described as though it has human characteristics. It has is described to have head trauma resulting in damage that has caused it to destroy objects. Similarly humans with brain damage do not function properly and could suffer from seizures. The Setaur is described to be humanoid with extraordinary capabilities. Such a feat is not currently possible perhaps a machine similar to the Setaur could be developed sometime in the future or not.
Human behaviour is such that the fear of change and unnatural thoughts are strong. The possibility of a computer capable of passing the Turing test is for some unnatural. In the movie X-MEN assume that mutants are equivalent to that of a humanoid robot that passes the Turing test. Society sought out the mutants who largely wished to live out their lives as normal people. Mutants were unknown and thought to be unnatural, not normal potentially dangerous and therefore ostracized. Would society accept humanoid robots? Conflict evolving between humans and robots is evident.
There are many more questions than answers in the world of AI and Robotics. Lem philosophy is the limitations of humanity not the limitations of technology and science. Humans are flawed not perfect. The introduction of robotics and the Three Laws built the foundations for fictitious stories and the dream of what could become reality. The human imagination has created many versions of robots in movies. None of which have actually been built, all of the robots have been computer generated animation. The concept of a robot mining the moon autonomously is farfetched at this time but possible in the future with advances in knowledge and technology.
Ethically the development of humanoid robots is questionable. A humanoid robot built, similarly to a human clone; to simply exist with no other purpose is not ideal. Society would not necessarily accept humanoid robots living amongst people. A realistic reason for the development of robots is to help those requiring need. This is a current topic of interest for researchers such as the American Honda Motor Co and their prototype robot ASIMO. The technology is far from becoming a commonality.
Creation of a robot capable of thought, intelligence, and emotions is not yet thought to be possible. The unknown of how the brain works is a limitation to the creation of an affective AI. Current knowledge of the human brain is in its infant stage for understanding. The Hunt is a wonderful fictitious story but is not realistic related to current technology.
Bibliography
American Honda Motor Co. (2005). ASIMO; Worlds most advanced humanoid robot. Retrieved February 2, 2006 from http://asimo.honda.com/asimos_origin.asp?bhcp=1.
CNN.com. (2000). Dr. James Hendler: A chat about the future of artificial intelligence. Retrieved February 2, 2006 from http://www.cnn.com/chat/transcripts/1999/12/hendler/index.html.
Hooper, R. (nd). Learn About Robotis: Robotic Glassary. Retrieved February 2, 2006 from http://www.learnaboutrobots.com/glossary.htm.
McGee, G. (2006). Primer on Ethics and Human Cloning. Retrieved Febrary 2, 2006 from http://www.actionbioscience.org/biotech/mcgee.html.
Myers, D. (2001). Psychology (6th ed.) New York: Worth Publishers.
Picard, R. (1997). Affective Computing. Cambridge, Massachusetts: Massachusetts Institute of Technology.
ScienceDaily. (2004). Purdue, Japanese researchers to create human like robots. Retrieved February 2, 2006 from http://www.sciencedaily.com/releases/2004/11/041109235501.htm.
TechWeb. (2006). Tech Encyclopaedia. Retrieved February 1, 2006 from http://www.techweb.com/encyclopedia/defineterm.jhtml?term=AI.
Tyco Electronics. (2006). Glossary. Retrieved February 1, 2006 from http://connectors.tycoelectronics.com/glossary/glossary-r.stm.
Wikipedia. (2006). Life expectancy. Retrieved February 2, 2006 from http://en.wikipedia.org/wiki/Life_expectancy.
Wikipedia. (2006). The Bicentennial Man. Retrieved February 2, 2006 from http://en.wikipedia.org/wiki/Bicentennial_Man.
Wikipedia. (2006). Three Laws of Robotics. Retrieved February 2, 2006 from http://en.wikipedia.org/wiki/Three_Laws_of_Robotics#Resolving_conflicts_among_the_laws.
Censorship on the Internet
Assignment Two
Censorship on the Internet
Computers and Human Experience
February 27, 2006
Censorship on the Internet
The Internet is a decentralized worldwide networking infrastructure. In the beginning the internet was relatively simple to control but has since grown to such an extent that policing or controlling the content is impossible. The internet provides easy access to material or information of all types from educational to harmful. As such there is a need for protection. In addition to the offensive material, and illegal content such as child pornography, criminally obscene and criminally racist there is also spy ware, viruses, worms etc which are problematic for internet users. All of the above are common reasons for seeking internet filters and protection. As such there are initiatives to censor material on the internet. There are initiatives to restrict access to various websites within libraries and schools. As a huge community open to all who have a connection, the internet is virtually impossible to censor or control. The question is who controls knowledge, why and to what effect?
Censorship is the control of the circulation of information and ideas. The act of restricting material deemed unsuitable for public consumption. The term “censorship” is a Latin term censere meaning to give as one’s opinion, to assess. Restriction and control of content is censorship on the internet. Censorship is society’s way to build security, freedom from fear, order, civility, racial and religious tolerance, as well as the well-being of our children. Often censorship coincides with restriction of materials of negative connotation by society’s opinion. There are government initiatives for filtering the content on the internet as well as informing parents and children about the internet. There are two arguments concerning censorship of the internet. Those for censorship are interested in protected children from things such as pornography and obscene materials and those against censorship are concerned with freedom of expression and personal rights.
According to Michael Landier “any law advocating censorship of the Internet is too broad and unenforceable on this global information medium” (Landier, 1997). He poses a strong opposition to censorship of the internet for this reason as well as being against freedom of speech. This point of view is well supported comparing restrictions of print media to the internet. Some of the common debates over censorship on the internet are perfectly legal to print media. The opinion is that the internet should be treated similarly to print media.
The most common example when speaking of the internet and censorship revolves around parental control. The media is full of stories in a negative light regarding children using chat rooms, accessing rated websites, etc. From this point of view censorship is important. Children are impressionable and innocent and need protection. Often parents are unaware of exactly what their children are accessing on the internet. Parents tend to think that the computer and internet is being used for educational purposes only. Being able to censor the materials accessed by children is important for their protection. This example could be compared to the well known “never talk to strangers” lesson taught to children. Parents need to know how to protect their children on the internet.
Unfortunately at this point in time the younger generations know a lot more about computers and the internet than their parents. This has been brought about since the internet and computer technology is newly developed. The original internet ARPAnet was first introduced in 1969. The ARPAnet was complex and only used by computer experts, scientists, engineers and librarians. The internet has only been used by non technical people in the eighties and nineties with the creation of email, ftp and telnet. The internet was a government initiative and was not used by independent organizations until 1995. It was developed for communication and sharing of files. Computers and the internet have only been around for 37 years and easily accessible for the general population for much less time. The technology has been developed at a rapid pace and been present within the school systems for about the past ten years or so. As such the younger generations have had the luxury of developing with the technology and learning how computers and the internet work whereas their parents tend to have a knowledge deficit. With the development of the internet there have also been interest groups formed regarding new technologies and public interest. In Canada there is The Canadian Internet Policy and Public Interest Clinic (CIPPIC) which is involved with policy and law making regarding new technologies.
Traditionally censorship has been the regulation of moral and political life. Throughout history censorship has led to destruction and death or burning and banning. Perhaps the most famous and earliest recorded was Socrates who in 399 BC was sentenced to death by poison for corrupting youth and not acknowledging the gods. Censorship has also lead to the destruction of libraries throughout history. One example being the University of Oxford library destroyed in 1663 by orders from the king. Today there continues to be censorship of literary works. Examples of well known works that have been banned or almost banned include To Kill A Mockingbird, Of Mice and Men, Anne Frank’s Diary, Huck Finn, The Grapes of Wrath, An Ideal Husband, The Canterbury Tales, Catcher in the Rye, and the Harry Potter series.
Freedom of speech has throughout history been the counter to censorship. Defined as being a civil liberty, freedom of speech is one of the basic rights in a democracy. Free speech facilitates majority rule. It is through talking that we encourage consensus, that we form a collective speech is a means of participation. Freedom of speech is self-expression. In the United States of America the First Amendment declares freedom of speech as a civil right. As Justice Thurgood Marshall stated "The First Amendment serves not only the needs of the polity but also those of the human spirit — a spirit that demands self-expression." The theory of free speech, the freedom of expression is not a perfect probability. Free expression in certain circumstances leads to consequences. A recent example of resulting with devastating negative affects concerns the publishing of the cartoons of the prophet Mohammed. Demonstrations and riots resulted with the destruction of businesses, cars, and the Danish Consulate.
Blogs are websites that are written diary like. A means of expressing thoughts published on the internet. Blogs have been known as a means of media in restricted countries where the mainstream media is censored. There is a global issue of blog censorship and freedom of speech. In some countries bloggers have recently been jailed. In China blogs are to be registered and have begun to be censored by Microsoft in conjunction with the laws and norms of the country. Freedom of speech is non existent on blogs for many reasons. Typically there are words, phrases, names etc that are censored out automatically by the blog software in most countries. Politics and religion are two topics that are controversial and therefore censored. People do tend to censor themselves especially knowing that there have been consequences for some using blogs for publishing their thoughts freely. An example of a group of professionals working towards freedom from censorship and free speech on the internet is Electronic Frontier Foundation. This non profit organization works for blogger’s rights and freedom of expression in general on the internet.
Obscene material, child pornography and racism are illegal. Unfortunately such things do exist on the internet and are difficult to control. In attempts to censor material available to children filtering programs have been developed. However these filters have been proven to be faulty, allowing inappropriate material to be viewed and inadvertently blocking appropriate general interest material. Using a filtering program is not a solution for parents as it is not a hundred percent effective. One obvious difficulty with inappropriate material is the file names and tags used for these sites. Such problems increase the difficulty of censorship and restriction.
Spy ware is a problem within society related to privacy. A basic description of spy ware is that it is software that covertly gathers information using the internet similar to a Trojan horse. Within Canada there is no specific legislation stating that the use of spy ware is illegal. The use of laws protecting personal privacy and fraud are used to counteract spy ware. The best solution for spy ware is to be cautious and avoid suspicious downloads. However it is sometimes unavoidable to come in contact with spy ware programs attempting to get onto you computer and that are when being able to detect and delete such programs is important. There are anti spy ware programs that will detect and delete spy ware programs.
Pornography on the internet is restricted in public computers such as libraries and schools. There have been laws written specifically to block access to rated websites in libraries and schools. This is a form of censorship in itself. However this sort of censorship has been accepted as it serves to protect a fragile population, our children. The unfortunate problem with this censorship is that the software used is not perfect there are problems sifting through the content of the internet and therefore sometimes rated websites are accessed still. Another issue is the fact that some well written websites are inadvertently blocked by the programs thus limiting the research capabilities for children in schools and libraries.
There seems to be a need to restrict material on the internet for various reasons however it seems like an impossible feat at this point in time. The most apparent reason for censorship is to protect vulnerable populations such as children under the age of eighteen from things such as pornography and profanity. The shear amount of information on the internet today is overwhelming and still growing.
Restriction is censorship and is in place for libraries and schools connected to the internet. Freedom of speech by the true definition does not exist within many societies for example China where there are strict laws and regulations prohibiting certain topics. There has always been and always will be a sort of censorship of unsuitable material for the population. There are various initiatives for freedom of speech on the internet. As much as we advocate for freedom of speech there is no such thing. True freedom would include freedom from prosecution. There have been cases in the world where people have gone to jail for the content of their website. Governments have taken initiatives to censor material on the internet with laws and policies. Blogs are censored. Overall website content is censored to some extent in which illegal information and pictures are enforced as well as political and religious discussions. Censorship continues to counter freedom of expression and freedom of speech. Is freedom of speech possible with the laws and policies in our societies? The debate between censorship and freedom of speech has been and will be around for many more years to come. The only change is now there is a new medium for expression, the internet.
Bibliography
Canadian Internet and Public Policy Interest Clinic. (2006). Spy ware FAQ. Retrieved February 18, 2006 from http://www.cippic.ca/en/faqs-resources/spyware/.
Canadian Internet and Public Policy Interest Clinic. (2005). Internet Censorship in Public Libraries. Retrieved February 17, 2006 from http://www.cippic.ca/en/faqs-resources/internet-censorship-public-libraries/.
BBC News. (2005). Blog Censorship Handbook Released. Retrieved February 23, 2006 from http://news.bbc.co.uk/2/hi/technology/4271062.stm.
Bellis, M. (2006). The History of Computers. Retrieved February 18, 2006 from http://inventors.about.com/library/blcoindex.htm.
Cutugno, F. (1999). Censorship of the Internet: The Job of Parents, Not Government. Retrieved February 18, 2006 from http://www.iusb.edu/~journal/2000/cutugno.html.
Electronic Frontier Foundation. (2006). About EFF. Retrieved February 23, 2006 from http://www.eff.org/about/.
Electronic Privacy Information Center. (1997). Faulty Filters: How Content Filters Block Access to Kid-Friendly Information on the Internet. Retrieved February 23, 2006 from http://www2.epic.org/reports/filter-report.html.
Free Expression Network. (2002). Internet. Retrieved February 18, 2006 from http://www.freeexpression.org/internet/internet-index.htm.
Government of Canada. (2003). Illegal and Offensive Content on the Internet. Retrieved February 18, 2006 from http://cyberwise.gc.ca/english/home.html.
Internet Free Expression Alliance. (2001). Childrens Internet Protection Act. Retrieved February 23, 2006 from http://www.ifea.net/cipa.html.
Internet Watch Foundation. (2005). The Hotline and the Law. Retrieved February 18, 2006 from http://www.iwf.org.uk/public/page.31.htm.
Landier, M. (1997). Internet Censorship is Absurd and Unconstitutional. Retrieved February 24, 2006 from http://www.landier.com/michael/essays/censorship/fulltext.htm.
Newth, M. (2001). The long history of censorship. Retrieved February 18, 2006 from http://www.beaconforfreedom.org/about_project/history.html.
Public Broadcasting Service. (2005). Definitions of Censorship. Retrieved February 18, 2006 from http://www.pbs.org/wgbh/cultureshock/whodecides/definitions.html.
Smolla, R. (2006). Speech. Retrieved February 18, 2006 from http://www.firstamendmentcenter.org/Speech/overview.aspx.
Censorship on the Internet
Computers and Human Experience
February 27, 2006
Censorship on the Internet
The Internet is a decentralized worldwide networking infrastructure. In the beginning the internet was relatively simple to control but has since grown to such an extent that policing or controlling the content is impossible. The internet provides easy access to material or information of all types from educational to harmful. As such there is a need for protection. In addition to the offensive material, and illegal content such as child pornography, criminally obscene and criminally racist there is also spy ware, viruses, worms etc which are problematic for internet users. All of the above are common reasons for seeking internet filters and protection. As such there are initiatives to censor material on the internet. There are initiatives to restrict access to various websites within libraries and schools. As a huge community open to all who have a connection, the internet is virtually impossible to censor or control. The question is who controls knowledge, why and to what effect?
Censorship is the control of the circulation of information and ideas. The act of restricting material deemed unsuitable for public consumption. The term “censorship” is a Latin term censere meaning to give as one’s opinion, to assess. Restriction and control of content is censorship on the internet. Censorship is society’s way to build security, freedom from fear, order, civility, racial and religious tolerance, as well as the well-being of our children. Often censorship coincides with restriction of materials of negative connotation by society’s opinion. There are government initiatives for filtering the content on the internet as well as informing parents and children about the internet. There are two arguments concerning censorship of the internet. Those for censorship are interested in protected children from things such as pornography and obscene materials and those against censorship are concerned with freedom of expression and personal rights.
According to Michael Landier “any law advocating censorship of the Internet is too broad and unenforceable on this global information medium” (Landier, 1997). He poses a strong opposition to censorship of the internet for this reason as well as being against freedom of speech. This point of view is well supported comparing restrictions of print media to the internet. Some of the common debates over censorship on the internet are perfectly legal to print media. The opinion is that the internet should be treated similarly to print media.
The most common example when speaking of the internet and censorship revolves around parental control. The media is full of stories in a negative light regarding children using chat rooms, accessing rated websites, etc. From this point of view censorship is important. Children are impressionable and innocent and need protection. Often parents are unaware of exactly what their children are accessing on the internet. Parents tend to think that the computer and internet is being used for educational purposes only. Being able to censor the materials accessed by children is important for their protection. This example could be compared to the well known “never talk to strangers” lesson taught to children. Parents need to know how to protect their children on the internet.
Unfortunately at this point in time the younger generations know a lot more about computers and the internet than their parents. This has been brought about since the internet and computer technology is newly developed. The original internet ARPAnet was first introduced in 1969. The ARPAnet was complex and only used by computer experts, scientists, engineers and librarians. The internet has only been used by non technical people in the eighties and nineties with the creation of email, ftp and telnet. The internet was a government initiative and was not used by independent organizations until 1995. It was developed for communication and sharing of files. Computers and the internet have only been around for 37 years and easily accessible for the general population for much less time. The technology has been developed at a rapid pace and been present within the school systems for about the past ten years or so. As such the younger generations have had the luxury of developing with the technology and learning how computers and the internet work whereas their parents tend to have a knowledge deficit. With the development of the internet there have also been interest groups formed regarding new technologies and public interest. In Canada there is The Canadian Internet Policy and Public Interest Clinic (CIPPIC) which is involved with policy and law making regarding new technologies.
Traditionally censorship has been the regulation of moral and political life. Throughout history censorship has led to destruction and death or burning and banning. Perhaps the most famous and earliest recorded was Socrates who in 399 BC was sentenced to death by poison for corrupting youth and not acknowledging the gods. Censorship has also lead to the destruction of libraries throughout history. One example being the University of Oxford library destroyed in 1663 by orders from the king. Today there continues to be censorship of literary works. Examples of well known works that have been banned or almost banned include To Kill A Mockingbird, Of Mice and Men, Anne Frank’s Diary, Huck Finn, The Grapes of Wrath, An Ideal Husband, The Canterbury Tales, Catcher in the Rye, and the Harry Potter series.
Freedom of speech has throughout history been the counter to censorship. Defined as being a civil liberty, freedom of speech is one of the basic rights in a democracy. Free speech facilitates majority rule. It is through talking that we encourage consensus, that we form a collective speech is a means of participation. Freedom of speech is self-expression. In the United States of America the First Amendment declares freedom of speech as a civil right. As Justice Thurgood Marshall stated "The First Amendment serves not only the needs of the polity but also those of the human spirit — a spirit that demands self-expression." The theory of free speech, the freedom of expression is not a perfect probability. Free expression in certain circumstances leads to consequences. A recent example of resulting with devastating negative affects concerns the publishing of the cartoons of the prophet Mohammed. Demonstrations and riots resulted with the destruction of businesses, cars, and the Danish Consulate.
Blogs are websites that are written diary like. A means of expressing thoughts published on the internet. Blogs have been known as a means of media in restricted countries where the mainstream media is censored. There is a global issue of blog censorship and freedom of speech. In some countries bloggers have recently been jailed. In China blogs are to be registered and have begun to be censored by Microsoft in conjunction with the laws and norms of the country. Freedom of speech is non existent on blogs for many reasons. Typically there are words, phrases, names etc that are censored out automatically by the blog software in most countries. Politics and religion are two topics that are controversial and therefore censored. People do tend to censor themselves especially knowing that there have been consequences for some using blogs for publishing their thoughts freely. An example of a group of professionals working towards freedom from censorship and free speech on the internet is Electronic Frontier Foundation. This non profit organization works for blogger’s rights and freedom of expression in general on the internet.
Obscene material, child pornography and racism are illegal. Unfortunately such things do exist on the internet and are difficult to control. In attempts to censor material available to children filtering programs have been developed. However these filters have been proven to be faulty, allowing inappropriate material to be viewed and inadvertently blocking appropriate general interest material. Using a filtering program is not a solution for parents as it is not a hundred percent effective. One obvious difficulty with inappropriate material is the file names and tags used for these sites. Such problems increase the difficulty of censorship and restriction.
Spy ware is a problem within society related to privacy. A basic description of spy ware is that it is software that covertly gathers information using the internet similar to a Trojan horse. Within Canada there is no specific legislation stating that the use of spy ware is illegal. The use of laws protecting personal privacy and fraud are used to counteract spy ware. The best solution for spy ware is to be cautious and avoid suspicious downloads. However it is sometimes unavoidable to come in contact with spy ware programs attempting to get onto you computer and that are when being able to detect and delete such programs is important. There are anti spy ware programs that will detect and delete spy ware programs.
Pornography on the internet is restricted in public computers such as libraries and schools. There have been laws written specifically to block access to rated websites in libraries and schools. This is a form of censorship in itself. However this sort of censorship has been accepted as it serves to protect a fragile population, our children. The unfortunate problem with this censorship is that the software used is not perfect there are problems sifting through the content of the internet and therefore sometimes rated websites are accessed still. Another issue is the fact that some well written websites are inadvertently blocked by the programs thus limiting the research capabilities for children in schools and libraries.
There seems to be a need to restrict material on the internet for various reasons however it seems like an impossible feat at this point in time. The most apparent reason for censorship is to protect vulnerable populations such as children under the age of eighteen from things such as pornography and profanity. The shear amount of information on the internet today is overwhelming and still growing.
Restriction is censorship and is in place for libraries and schools connected to the internet. Freedom of speech by the true definition does not exist within many societies for example China where there are strict laws and regulations prohibiting certain topics. There has always been and always will be a sort of censorship of unsuitable material for the population. There are various initiatives for freedom of speech on the internet. As much as we advocate for freedom of speech there is no such thing. True freedom would include freedom from prosecution. There have been cases in the world where people have gone to jail for the content of their website. Governments have taken initiatives to censor material on the internet with laws and policies. Blogs are censored. Overall website content is censored to some extent in which illegal information and pictures are enforced as well as political and religious discussions. Censorship continues to counter freedom of expression and freedom of speech. Is freedom of speech possible with the laws and policies in our societies? The debate between censorship and freedom of speech has been and will be around for many more years to come. The only change is now there is a new medium for expression, the internet.
Bibliography
Canadian Internet and Public Policy Interest Clinic. (2006). Spy ware FAQ. Retrieved February 18, 2006 from http://www.cippic.ca/en/faqs-resources/spyware/.
Canadian Internet and Public Policy Interest Clinic. (2005). Internet Censorship in Public Libraries. Retrieved February 17, 2006 from http://www.cippic.ca/en/faqs-resources/internet-censorship-public-libraries/.
BBC News. (2005). Blog Censorship Handbook Released. Retrieved February 23, 2006 from http://news.bbc.co.uk/2/hi/technology/4271062.stm.
Bellis, M. (2006). The History of Computers. Retrieved February 18, 2006 from http://inventors.about.com/library/blcoindex.htm.
Cutugno, F. (1999). Censorship of the Internet: The Job of Parents, Not Government. Retrieved February 18, 2006 from http://www.iusb.edu/~journal/2000/cutugno.html.
Electronic Frontier Foundation. (2006). About EFF. Retrieved February 23, 2006 from http://www.eff.org/about/.
Electronic Privacy Information Center. (1997). Faulty Filters: How Content Filters Block Access to Kid-Friendly Information on the Internet. Retrieved February 23, 2006 from http://www2.epic.org/reports/filter-report.html.
Free Expression Network. (2002). Internet. Retrieved February 18, 2006 from http://www.freeexpression.org/internet/internet-index.htm.
Government of Canada. (2003). Illegal and Offensive Content on the Internet. Retrieved February 18, 2006 from http://cyberwise.gc.ca/english/home.html.
Internet Free Expression Alliance. (2001). Childrens Internet Protection Act. Retrieved February 23, 2006 from http://www.ifea.net/cipa.html.
Internet Watch Foundation. (2005). The Hotline and the Law. Retrieved February 18, 2006 from http://www.iwf.org.uk/public/page.31.htm.
Landier, M. (1997). Internet Censorship is Absurd and Unconstitutional. Retrieved February 24, 2006 from http://www.landier.com/michael/essays/censorship/fulltext.htm.
Newth, M. (2001). The long history of censorship. Retrieved February 18, 2006 from http://www.beaconforfreedom.org/about_project/history.html.
Public Broadcasting Service. (2005). Definitions of Censorship. Retrieved February 18, 2006 from http://www.pbs.org/wgbh/cultureshock/whodecides/definitions.html.
Smolla, R. (2006). Speech. Retrieved February 18, 2006 from http://www.firstamendmentcenter.org/Speech/overview.aspx.
Optimal Workplace Safety
Assignment Three
Industrial Relations (308)
Occupational Health and Safety
Sept 21, 2005
Optimal Workplace Safety
Occupational safety and health has evolved from contracted employer liability in the mid-nineteenth century to the development of legislature in the last decades of the nineteenth century. Schneiderman and Viscusi share conflicting views with regards to how occupational health and safety should be regulated. The following discussion explores both of these approaches to the procedures used for the setting of occupational health and safety standards.
Viscusi supports a cost benefit approach with no government involvement. “We cannot provide jobs of equal safety for all any more easily than we can ensure that all individuals will be productive on a particular job irrespective of their strength, diligence or intelligence. Indeed, attempts to promote such equalization undermine a beneficial feature of all market allocations” (Viscusi, 1982). Viscusi believes that the onus of safety is on the individual worker with little government involvement. The cost benefit process is based primarily on value of safety. The question of whether it is beneficial or profitable to increase safety in the workplace versus paying for the healthcare of those affected by the hazards.
Conversely, Schneiderman supports government influence for the setting of standards focusing on workplace safety. “I suggest that we attempt to set as our standard for all male workers the level of survival reached by school teachers. After all, if teachers can achieve that perhaps we ought to do as well for all occupations” (Schneiderman, 1982). With the use of a third party, the government, a less biased view and analysis of occupational health and safety legislation is possible. Schneiderman’s goal is to equalize the health and safety risks among all occupations for all individuals. The government in Canada is elected by the people and therefore representative of the working / voting population. The government is challenged with creating legislation that pleases both the employers and the employees.
Schneiderman is not alone; there are others that are apposed to the cost benefit analysis method. Heinzerling & Frank refer to the cost-benefit analysis as being “…a deeply flawed method that repeatedly leads to biased and misleading results”. Tucker describes the use of a cost-benefit basis for “…occupational health and safety standards in Ontario would be a serious mistake which could leave thousands of workers legally exposed to hazardous conditions” Tucker, 1984, p 263). The main issue with the cost benefit method is that of assigning value to the benefits versus cost. If it is financially beneficial to pay for the healthcare of affected workers rather than fixing a workplace hazard the cost benefit process would allow employers to leave the risk and the potential for workplace mishaps or illnesses.
The cost benefit method requires that all elements have monetary values in order to be analysed. This in itself is very biased and produces ethical dilemmas such as deciding on the value of life and health. The ”…cost-benefit analysis cannot produce more efficient decisions because the process of reducing life, health, and the natural world to monetary values is inherently flawed” (Heinzerling & Frank, 2002, p 3). When monetary values are in use there are many possible problems. The value of life cannot be ethically defined monetarily. As well as the cost estimates the benefits are estimated with the cost benefit method. With the cost benefit analysis “…we are required to quantify the value of lives saved and health improved” (Tucker, 1984, p 298). Tucker further describes how this allows for biased results, as misrepresentation is common with the process of measuring the value of benefits. All of these elements given values are subjective. To one person an injury will heal to another an injury is very damaging both physically and mentally.
Risk itself is subjective. “Risk perception is the subjective assessment of the probability of a specified type of accident happening and how concerned we are with the consequences. To perceive risk includes evaluations of the probability as well as the consequences of a negative outcome.” (Sjöberg & Moen & Rundmo, 2004, p.8). Virtually every element of occupational health and safety is subjective. How do we ethically assign monetary values for subjective perceptions? Risks in the workplace are not only subjective but also unknown. The long-term risks of many chemicals and other workplace elements are still unknown. There is “incomplete information on the impact of work-related contaminants on human health” (Law Reform Commission of Canada, 2002, p 12). Workplace pollution is impossible to eliminate and the impact is unknown therefore what value would workplace pollution have with the cost benefit process. Would workplace pollution be written off because of the high prices associated with improving the environment?
Schneiderman’s goal is to equalize the health and safety risks among all occupations by setting a standard for all men and women. This standard setting process with the goal of universal equality would be ideal. Unfortunately reality dictates that such a high universal safety standard is unattainable because of the variable unknowns and variations in workplaces. Perfect safety is unattainable. The multiple variables contributing to worker risk is vastly different from workplace to workplace. There is no similarity of the atmosphere in which a teacher or politician works to that of a factory worker or miner. There is also workplace pollution of which the ill effects are not yet known. Even the office worker is affected by air and noise pollution.
The standard setting process is as Tucker describes a political one, but “it operates under the influence of a legally sanctioned, but largely uncontrolled, exercise of economic power” (Tucker, 1984, p 310). There is no perfect process in determining occupational health and safety standards. Tucker states that “trade offs between productivity and safety will still be necessary” (Tucker, 1984, p 311) even with the implementation of a socialist approach to risk with those directly affected given the democratic ability to decide on what levels of risk they are willing to incur. The main difference is in who makes the decisions between increased productivity and occupational risks. With the standard setting process the individuals directly affected have the ability to sway the decisions whereas with the cost benefit process they do not. The people elect the government officials. With the cost benefit process the decision lies with the values associated with lives and the value of improved health.
The ultimate goal of universal safety is not realistic; the goal may never be achieved however working towards such a goal would gradually improve safety and decrease the risk of injury or death in the workplace. Tossing the ideal because the goal is out of reach should not be an option; the overall improvements of occupational conditions are possible. The standard setting process is also dependant on politics and that in itself is flawed, however the political world is ultimately controlled by the voting population and therefore in my opinion has a more ethical voice compared to that of the cost benefit approach.
Given the choice between these two views the most persuasive in my opinion is that of Schneiderman. Neither view is flawless, however from an ethical point of view the standard setting process is favoured over the cost benefit process. The cost-benefit view does not fit into my set of morals and ethically I could never choose a view that requires quantifying life or risk or workplace pollution. The standard setting method is preferred since it has a positive outlook. It requires positive changes to occupational health and safety. There is no ethical flaw in striving to make health and safety equal for all.
Bibliography
Heinzerling, L., Frank, A. (2002) Pricing the priceless: Cost-benefit Analysis of Environmental Protection. Retrieved September 05 2005 from http://www.law.georgetown.edu/gelpi/papers/pricefnl.pdf
Law Reform Commision of Canada. (2002). Excerpt 1 of Workplace Pollution. Working Paper 53-Protection of Life, 6-15. Ottawa: Law Reform Commission of Canada.
Schneiderman, M. (1982). Cost-Benefit, Social Values and the Setting of Occupational Health Standards, Legal and Ethical Dilemmas in Occupational Health, 191-206
Sjöberg, L., Moen, B., Rundmo, T. (2004). Explaining risk perception. An evaluation of the sychometric paradigm in risk perception research. Retreived August 15, 2005 from http://www.svt.ntnu.no/psy/Torbjorn.Rundmo/
Psychometric_paradigm.pdf
Tucker, E. (1990). Administering Danger in the Workplace: The Law and Politics of Occupational Health and Safety Regulation in Ontario, 1859-1914, 13-32, 237-246. Toronto: University of Toronto Press.
Tucker, E. (1984). The Determination of Occupational Health and Safety Standards in Ontario, 1860-1982: From the Market to Politics to…? McGill Law Journal 29: 260-311.
Viscusi, W. (1982). Setting Efficient Standards for Occupational Hazards, Journal of Occupational Medicine 24: 967-976.
Industrial Relations (308)
Occupational Health and Safety
Sept 21, 2005
Optimal Workplace Safety
Occupational safety and health has evolved from contracted employer liability in the mid-nineteenth century to the development of legislature in the last decades of the nineteenth century. Schneiderman and Viscusi share conflicting views with regards to how occupational health and safety should be regulated. The following discussion explores both of these approaches to the procedures used for the setting of occupational health and safety standards.
Viscusi supports a cost benefit approach with no government involvement. “We cannot provide jobs of equal safety for all any more easily than we can ensure that all individuals will be productive on a particular job irrespective of their strength, diligence or intelligence. Indeed, attempts to promote such equalization undermine a beneficial feature of all market allocations” (Viscusi, 1982). Viscusi believes that the onus of safety is on the individual worker with little government involvement. The cost benefit process is based primarily on value of safety. The question of whether it is beneficial or profitable to increase safety in the workplace versus paying for the healthcare of those affected by the hazards.
Conversely, Schneiderman supports government influence for the setting of standards focusing on workplace safety. “I suggest that we attempt to set as our standard for all male workers the level of survival reached by school teachers. After all, if teachers can achieve that perhaps we ought to do as well for all occupations” (Schneiderman, 1982). With the use of a third party, the government, a less biased view and analysis of occupational health and safety legislation is possible. Schneiderman’s goal is to equalize the health and safety risks among all occupations for all individuals. The government in Canada is elected by the people and therefore representative of the working / voting population. The government is challenged with creating legislation that pleases both the employers and the employees.
Schneiderman is not alone; there are others that are apposed to the cost benefit analysis method. Heinzerling & Frank refer to the cost-benefit analysis as being “…a deeply flawed method that repeatedly leads to biased and misleading results”. Tucker describes the use of a cost-benefit basis for “…occupational health and safety standards in Ontario would be a serious mistake which could leave thousands of workers legally exposed to hazardous conditions” Tucker, 1984, p 263). The main issue with the cost benefit method is that of assigning value to the benefits versus cost. If it is financially beneficial to pay for the healthcare of affected workers rather than fixing a workplace hazard the cost benefit process would allow employers to leave the risk and the potential for workplace mishaps or illnesses.
The cost benefit method requires that all elements have monetary values in order to be analysed. This in itself is very biased and produces ethical dilemmas such as deciding on the value of life and health. The ”…cost-benefit analysis cannot produce more efficient decisions because the process of reducing life, health, and the natural world to monetary values is inherently flawed” (Heinzerling & Frank, 2002, p 3). When monetary values are in use there are many possible problems. The value of life cannot be ethically defined monetarily. As well as the cost estimates the benefits are estimated with the cost benefit method. With the cost benefit analysis “…we are required to quantify the value of lives saved and health improved” (Tucker, 1984, p 298). Tucker further describes how this allows for biased results, as misrepresentation is common with the process of measuring the value of benefits. All of these elements given values are subjective. To one person an injury will heal to another an injury is very damaging both physically and mentally.
Risk itself is subjective. “Risk perception is the subjective assessment of the probability of a specified type of accident happening and how concerned we are with the consequences. To perceive risk includes evaluations of the probability as well as the consequences of a negative outcome.” (Sjöberg & Moen & Rundmo, 2004, p.8). Virtually every element of occupational health and safety is subjective. How do we ethically assign monetary values for subjective perceptions? Risks in the workplace are not only subjective but also unknown. The long-term risks of many chemicals and other workplace elements are still unknown. There is “incomplete information on the impact of work-related contaminants on human health” (Law Reform Commission of Canada, 2002, p 12). Workplace pollution is impossible to eliminate and the impact is unknown therefore what value would workplace pollution have with the cost benefit process. Would workplace pollution be written off because of the high prices associated with improving the environment?
Schneiderman’s goal is to equalize the health and safety risks among all occupations by setting a standard for all men and women. This standard setting process with the goal of universal equality would be ideal. Unfortunately reality dictates that such a high universal safety standard is unattainable because of the variable unknowns and variations in workplaces. Perfect safety is unattainable. The multiple variables contributing to worker risk is vastly different from workplace to workplace. There is no similarity of the atmosphere in which a teacher or politician works to that of a factory worker or miner. There is also workplace pollution of which the ill effects are not yet known. Even the office worker is affected by air and noise pollution.
The standard setting process is as Tucker describes a political one, but “it operates under the influence of a legally sanctioned, but largely uncontrolled, exercise of economic power” (Tucker, 1984, p 310). There is no perfect process in determining occupational health and safety standards. Tucker states that “trade offs between productivity and safety will still be necessary” (Tucker, 1984, p 311) even with the implementation of a socialist approach to risk with those directly affected given the democratic ability to decide on what levels of risk they are willing to incur. The main difference is in who makes the decisions between increased productivity and occupational risks. With the standard setting process the individuals directly affected have the ability to sway the decisions whereas with the cost benefit process they do not. The people elect the government officials. With the cost benefit process the decision lies with the values associated with lives and the value of improved health.
The ultimate goal of universal safety is not realistic; the goal may never be achieved however working towards such a goal would gradually improve safety and decrease the risk of injury or death in the workplace. Tossing the ideal because the goal is out of reach should not be an option; the overall improvements of occupational conditions are possible. The standard setting process is also dependant on politics and that in itself is flawed, however the political world is ultimately controlled by the voting population and therefore in my opinion has a more ethical voice compared to that of the cost benefit approach.
Given the choice between these two views the most persuasive in my opinion is that of Schneiderman. Neither view is flawless, however from an ethical point of view the standard setting process is favoured over the cost benefit process. The cost-benefit view does not fit into my set of morals and ethically I could never choose a view that requires quantifying life or risk or workplace pollution. The standard setting method is preferred since it has a positive outlook. It requires positive changes to occupational health and safety. There is no ethical flaw in striving to make health and safety equal for all.
Bibliography
Heinzerling, L., Frank, A. (2002) Pricing the priceless: Cost-benefit Analysis of Environmental Protection. Retrieved September 05 2005 from http://www.law.georgetown.edu/gelpi/papers/pricefnl.pdf
Law Reform Commision of Canada. (2002). Excerpt 1 of Workplace Pollution. Working Paper 53-Protection of Life, 6-15. Ottawa: Law Reform Commission of Canada.
Schneiderman, M. (1982). Cost-Benefit, Social Values and the Setting of Occupational Health Standards, Legal and Ethical Dilemmas in Occupational Health, 191-206
Sjöberg, L., Moen, B., Rundmo, T. (2004). Explaining risk perception. An evaluation of the sychometric paradigm in risk perception research. Retreived August 15, 2005 from http://www.svt.ntnu.no/psy/Torbjorn.Rundmo/
Psychometric_paradigm.pdf
Tucker, E. (1990). Administering Danger in the Workplace: The Law and Politics of Occupational Health and Safety Regulation in Ontario, 1859-1914, 13-32, 237-246. Toronto: University of Toronto Press.
Tucker, E. (1984). The Determination of Occupational Health and Safety Standards in Ontario, 1860-1982: From the Market to Politics to…? McGill Law Journal 29: 260-311.
Viscusi, W. (1982). Setting Efficient Standards for Occupational Hazards, Journal of Occupational Medicine 24: 967-976.
CHEO Placement Care Plan
NSG 3135; Practicum Acute Care
CHEO Placement Care Plan
November 24, 2004
Care Plan
About the Patient
Patient is a nine year old African American girl previously diagnoses with sickle cell anemia. Patient admitted for a laparoscopic spleenectomy at CHEO. Patient deals with pain and procedures best with distraction and adequate medication. Patient requires lots of encouragement to move in bed and for use of the incentive spiro meter. When receiving this patient post operative, she had a nasogastric tube and a peripheral intravenous in each hand; one for replacing NG losses and the other for fluid maintenance. She also had 5 small dressings on her abdomen. She was on bedrest and NPO. Parents were both present and supportive at the bedside post operation.
Medical Diagnosis
Hyperspleenism (spleen destroys, in excessive numbers, blood cells) secondary to sickle cell anemia. She was at CHEO for a laparoscopic spleenectomy.
Nursing Diagnosis (A)
Acute pain related to surgical procedure.
Nursing Interventions
Rationales
(i) Assess pain level using a self-report measurement tool (scale from 1-10).
(i) Use of tool promotes communication and evaluation of pain control.
(ii) Administer pain medication as ordered, and assess effectiveness. (acetaminophen)
(ii) Use of opioids which bind to opiate receptors to decrease sensations of pain.
(iii) Instruct patient about the importance of pain control prior to pain becoming severe (re use of PCA Morphine).
(iii) A preventative approach to pain control reduces anxiety and promotes a consistent level of relief and overall comfort.
(iv) Use nonpharmacologic pain reduction measures.
(iv) Distraction (movies, etc), proper positioning can increase the effects of pain medication therefore increasing comfort level.
Outcomes
The patient will be more comfortable, as evidence by verbalizing that discomfort is reduced, and moving in bed with less pain.
Nursing Diagnosis (B)
Risk for infection related to surgical wounds, increased environmental exposure to pathogens in hospital, immobility and inadequate secondary defenses.
Nursing Interventions
Rationales
(i) Administer antibiotics as ordered and monitor effectiveness. Monitor vital signs especially temperature and surgical wound sites.
(i) Use of antibiotics decreases likelihood of developing infection. Early detection of infection allows for early interventions to decrease severity.
(ii) Turn patient in bed as ordered and monitor skin integrity paying special attention to pressure points.
(ii) Skin breakdown may occur if patient lies immobile. With skin breakdown risk of infection increases.
(iii) Keep patient clean with regular bed baths and change soiled linen. Monitor dressings to eliminate possible contamination of surgical sites.
(iii) All patients are at risk for nosocomial infections in hospitals. Regular washing eliminates bacteria and decreases risk for infection.
(vi) Ensure immunizations are up to date.
(vi) With the removal of the spleen special attention to immunizations is important.
Outcomes
The patient will maintain infection free status as evidence by afebrile status.
CHEO Placement Care Plan
November 24, 2004
Care Plan
About the Patient
Patient is a nine year old African American girl previously diagnoses with sickle cell anemia. Patient admitted for a laparoscopic spleenectomy at CHEO. Patient deals with pain and procedures best with distraction and adequate medication. Patient requires lots of encouragement to move in bed and for use of the incentive spiro meter. When receiving this patient post operative, she had a nasogastric tube and a peripheral intravenous in each hand; one for replacing NG losses and the other for fluid maintenance. She also had 5 small dressings on her abdomen. She was on bedrest and NPO. Parents were both present and supportive at the bedside post operation.
Medical Diagnosis
Hyperspleenism (spleen destroys, in excessive numbers, blood cells) secondary to sickle cell anemia. She was at CHEO for a laparoscopic spleenectomy.
Nursing Diagnosis (A)
Acute pain related to surgical procedure.
Nursing Interventions
Rationales
(i) Assess pain level using a self-report measurement tool (scale from 1-10).
(i) Use of tool promotes communication and evaluation of pain control.
(ii) Administer pain medication as ordered, and assess effectiveness. (acetaminophen)
(ii) Use of opioids which bind to opiate receptors to decrease sensations of pain.
(iii) Instruct patient about the importance of pain control prior to pain becoming severe (re use of PCA Morphine).
(iii) A preventative approach to pain control reduces anxiety and promotes a consistent level of relief and overall comfort.
(iv) Use nonpharmacologic pain reduction measures.
(iv) Distraction (movies, etc), proper positioning can increase the effects of pain medication therefore increasing comfort level.
Outcomes
The patient will be more comfortable, as evidence by verbalizing that discomfort is reduced, and moving in bed with less pain.
Nursing Diagnosis (B)
Risk for infection related to surgical wounds, increased environmental exposure to pathogens in hospital, immobility and inadequate secondary defenses.
Nursing Interventions
Rationales
(i) Administer antibiotics as ordered and monitor effectiveness. Monitor vital signs especially temperature and surgical wound sites.
(i) Use of antibiotics decreases likelihood of developing infection. Early detection of infection allows for early interventions to decrease severity.
(ii) Turn patient in bed as ordered and monitor skin integrity paying special attention to pressure points.
(ii) Skin breakdown may occur if patient lies immobile. With skin breakdown risk of infection increases.
(iii) Keep patient clean with regular bed baths and change soiled linen. Monitor dressings to eliminate possible contamination of surgical sites.
(iii) All patients are at risk for nosocomial infections in hospitals. Regular washing eliminates bacteria and decreases risk for infection.
(vi) Ensure immunizations are up to date.
(vi) With the removal of the spleen special attention to immunizations is important.
Outcomes
The patient will maintain infection free status as evidence by afebrile status.
Nursing Munchausen Syndrome by Proxy
NSG 3320: Nursing and Mental Health
Nursing Munchausen Syndrome by Proxy
March 21, 2005
Nursing Munchausen Syndrome by Proxy
Imagine meeting a young family wherein the child has suffered from many painful medical treatments and procedures as a result of many illnesses. The mother is intelligent, attentive and always involved in the care of her child. This child is a survivor, beating the odds and goeing through painful procedures, testing and surviving multiple surgeries. Appropriately your heart goes out to this family. You hope for the best and as a nurse provide professional care for the child and family. The mother is always helpful and attentive with the care of her child. You develop a therapeutic relationship with her. Now how would you feel if you were discovering that this mother was inducing the ailments onto her child? This child is perfectly healthy. But has undergone multiple procedures and surgeries because of induced or feigned symptoms. Unfortunately this is a profile that has been proven to be reality. This is an illustration of Munchausen Syndrome by Proxy.
There have been highly publicized cases of MSBP. “Hillary Rodham Clinton chose Jennifer Bush to represent her campaign for health care reform” (Dowdell & Foster, 2005). Afterwards Jennifer’s mother was charged with inducing medical problems on her that could not otherwise be explained. As a result of her mothers actions Jennifer was subjected to more than 200 hospitalisations and 40 surgeries (Dowdell & Foster, 2005). MSBP is now recognised to be “an unusual and potentially lethal form of child abuse” (Dowel & Foster, 2005). The victim is the child. In Jennifer’s case she suffered physical consequences needlessly and now lives without her gallbladder, appendix and part of her intestines as they were surgically removed.
First identified in 1951, Munchausen syndrome was named for Baron van Munchausen, an eighteenth century German aristocrat infamous for his tall tails (Smith-Alnimer & Papas-Kavalis, 2003). The syndrome was named for its characteristic lies. Individuals with Munchausen syndrome induce or invent elaborate and contradictory symptoms and demand medical treatment for themselves (Yonge & Haas, 2004). Closely related is Munchausen syndrome by Proxy (MSBP). Roy Meadow first described MSBP in 1977 (Schreier, 2002). MSBP is catalogued in the American Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a fictitious disorder. However MSBP “has yet to be recognized as an official separate category in the DSM-IV” (eMedicine, 2002). It is recognised in section 300.19; Factitious Disorder not otherwise specified.
There are four specific criteria for the diagnosis of MSBP. MSBP involves the fabrication or induction of an illness in one person by another (US National Library of Medicine, 2004). The motivation for the behaviour is to assume the sick role by proxy. All external incentives, such as economic gain are absent and the behaviour is not otherwise accounted for by another mental disorder (eMedicine, 2002). As with most mental disorders the pathophysiology is unclear. There is no test that indicates a positive diagnosis of MSBP; a diagnosis is reliant on many accumulated factors or evidence.
Individuals diagnosed with MSBP are found in all socio-economic classes and ninety five percent of the time the mother is the perpetrator. The majority of the families with an MSBP diagnosis are dysfunctional but have a tendency to be intact. A family history of Munchausen syndrome or MSBP is also a risk factor of MSBP (Dowel & Foster, 2005). The perpetrator may have Munchausen Syndrome herself and have a complicated health history. Cases usually start in infancy and up to six years of age. If it continues as the child ages, the child may accommodate to the deceptions. Older children are more likely to reveal the truth about their symptoms as they are out of the home for school (Dowel & Foster, 2005). Considering all of these characteristics the nurse caring for a child suspected of being affected by MSBP should be mindful of such signs and document any findings objectively.
The subtle characteristics of this disorder make it difficult to diagnose. “Nurses play a vital role in the observation and confirmation of the profile of MSBP” (Dowdell & Foster, 2005). A diagnosis is based on the observations of the signs and symptoms, as there is no known pathophysiology. Signs and symptoms leading to the diagnosis of MSBP are not easily recognised. MSBP “frequently goes undiagnosed-the true incidence is not known” (Thomas, 2003). This is a direct result of the unfamiliarity of the syndrome as well as the failure to consider the diagnosis. A “better knowledge of the disorder and analysis of large number of homogeneously and detailed reported cases” (Szoke, 2000) is needed. Health care professionals especially nurses need to keep updated on current literature. Knowing about the possibility is the first step in achieving a diagnosis and getting help for the victim.
Diagnosis alone may take months or years. “The average length of time to the diagnosis of MSBP generally exceeds six months” (Dowdell & Foster, 2005). With time the perpetrator becomes more convincing and practised at being deceitful. This also impacts the process of detection and proving an MSBP diagnosis. Increasing the difficulty of catching the perpetrator in the act of deceit or inflicting harm.
One apparent sign of MSBP is the fact that the child is ill with the perpetrator but when separated the child’s condition improves. As noted by Huynh, the acute signs and symptoms decrease when the child is separated from the parent. Given this fact observation and documentation of such characteristics by the nurse is key. Another sign is a family history, including death of a sibling. “There is a high incidence of unexplained sibling mortality” (PhycNet-UK, 2003). In most instances the death of a sibling is what triggers the investigation to a MSBP diagnosis. The perpetrator uses the excuse that the symptoms “run in the family”. A detailed and accurate family history is important, as is communication amongst the health care team. Since deception is a characteristic of MSBP it is likely that a history taken from the perpetrator will not be accurate (Huynh, 1998). A detailed medical history from the parents in this case is rendered invalid. Discrepancies between clinical findings and the parents’ history should raise suspicion and warrants documentation. The nurse needs to pay special attention to conflicting detail and discuss concerns with the multidisciplinary team. A combined effort and high suspicion is required to make the diagnosis of MSBP.
A multidisciplinary team, that meets regularly, is important for maintaining continuity. A team consisting of nursing staff, physicians and any other professionals that are directly involved in the care of the child need to have good communication channels. Congruent care is important. MSBP is abuse and therefore matters of law are linked with the health care. The multidisciplinary team should therefore also include members from legal professions such as law enforcement and Children’s Aid Society (CAS) when the suspicion of MSBP begins. The safety of the child or children is of utmost importance.
The use of video surveillance is useful in diagnosing MSBP. A multidisciplinary team must agree that covert surveillance is needed prior to beginning the procedure in most facilities. Covert monitoring was determined to be a necessity for diagnosing MSBP over half of the studied cases by Hall et al. The use of video surveillance causes conflict with patient privacy and confidentiality (Smith-Alnimer & Papas-Kavalis, 2003). In addition Smith-Alnimer & Papas-Kavalis described how the act of abuse was not to be intervened by the nurse as to obtain evidence for legal matters. This is a direct conflict between nursing care and obtaining legal evidence to try the case. Watching someone inflict harm on a child would be difficult for anyone. The question of how much evidence is enough to take to a court of law as abuse. Is it right to let the harm be inflicted in order to have sufficient evidence for a jury? Overall the nurse often finds his or herself with ethical and legal dilemmas when dealing with MSBP. “Great distress among nurses when nurses’ sincere efforts to support and comfort the sick are exploited” (Yong & Haas, 2004) is felt. Above all the nurse must maintain a neutral status. The perpetrator has the legal right to obtain non-judgmental health care just as any other parent. Being suspected of or diagnosed with MSBP does not give the right to the nurse to treat the parent any different. As professionals, nurses must be aware of but not feed into personal biases. These persons are suffering from an illness and are deserving of compassion.
When using covert monitoring and suspecting illegal activities, the fear of litigation may be an issue for nurses. Clinical and legal standards change over time and can be difficult to be aware of. It is most important to keep focused on the patient in attempts “to provide best clinical care to guide practise, not fear of litigation” (Barloon, 2003). Sound clinical judgement is the most important characteristic to have. Barloon also states that keeping up with current literature and continuing education are crucial assets pertaining to safe and acceptable clinical psychiatric nursing practice. From a legal point of view documentation is most important. For the safety of the child a sound legal case is important. The onus is mainly on the nurse to document key findings and use sound judgement to intervene.
The perpetrator tends to have medical knowledge often from previous education and or experience in a health care field. In the study by Hall et al fifty five percent of the perpetrators had previous health care training or work and interestingly twenty five percent worked in a day care if they did not have previous health care experience. Individuals with this condition are attracted to helping professions such as nursing (Dowdell & Foster, 2005). An article written by Young and Haas describes a case in which a nursing student presented with Munchausn syndrome and the students’ daughter was a victim of MSBP. The main focus of this article was the fact that most faculties are not prepared for the possibility of encountering Munchausen syndrome in students. The knowledge of this disorder is beneficial for the detection as well as the outcome. Being a nurse in such a situation as to help a student do harm to a child is very difficult. The faculty who helped this perpetrator felt hostility after learning of the deceit and feeling exploited. Some felt guilt for teaching the perpetrator medical knowledge that potentially aided in the harm done to the child.
Treatment of this disorder typically does not have very favourable outcomes. Emphasis is put on managing rather than curing. The first step is confronting the perpetrator. Admission to the deceit may occur but more often denial is the result. The purpose is to stop the abuse and protect the child. The next step theoretically is developing a stable therapeutic relationship. With a stable relationship working, the focus of care goes to the management of the disorder including orientation to avoid unnecessary hospitalizations and medical acts (PhycNet-UK, 2003). There are no known cases of successful treatment of MSBP (Huynh, 1998). In most cases the fictitious disorders are more convincing than real cases of psychosis. The use of pharmacotherapies for MSBP is not well known. There has been some use of antipsychotic drugs with some indication of benefit (PhycNet-UK, 2003). Since “psychiatric disorders are common, in particular, personality disorders and depression” (Huynh, 1998) treatment of these disorders is the primary focus. As for psychotherapy and counselling, analytical and cognitive-behavioral approaches have been used with patients that accept and engage in treatment.
The role of the nurse in relation to MSBP is important in many ways. Close observations and documentation leads to the recognition of suspicious findings. In combination with knowledge of MSBP recognition of the signs and symptoms may lead to a diagnosis. Nurses may be the only persons to whom a mother makes statements that can be incriminating. The close professional relationship resulting from the care and ‘being there’ creates a bond between nurse and mother that no other member of the multidisciplinary team tends to develop. This trust sometimes allows for the mother to say suspicious things to the nurse. The nurse is the one who provides direct care for the child and is a fundamental member of the health care team. In a situation of caring for a child victim to MSBP the nurse must be vigilant and only intervene based on professional judgment and fact, not the demands of the parent. Support for the nurse is important. The use of a multidisciplinary team helps to support the nurse. Having others aware of the situation able to discuss details otherwise confined by confidentiality privileges is important. Nursing is a caring profession. Working with a case of suspected or diagnosed MSBP is very trying for nursing staff.
A diagnosis of MSBP is child abuse. MSBP is not a form of child abuse that is well known nor is it easily detected. Overall further research and study is needed in this area of mental health disorders. The nursing role related to the assessment, diagnosis, and treatment of MSBP is important throughout the process of detection to treatment. The most important thing is to be able to recognise and diagnose MSBP. This is accomplished firstly with increased awareness, especially nurses that care for children. With a heightened awareness nurses may be able to help the young victims from further abuse associated with MSBP. There are many ethical dilemmas and legal difficulties when gathering evidence to determine a diagnosis. The demands on nursing staff are high therefore they need strong support systems.
References
American Psychiatric Association. (2000). Quick reference to the Diagnostic Criteria from DSM-IV-TR™. American Psychiatric Association: Washington, DC.
Dowdell, E., Foster, K. (2005). Munchausen Syndrome by Proxy: Recognizing a Form of Child Abuse. Nursing Spectrum. Retrieved March 14, 2005, from http://nsweb.nursingspectrum.com/ce/ce209.htm
Barloon, L. (2003). Legal aspects of psychiatric nursing. The Nursing Clinics of North America, 38(1), 9-19.
eMedicine. (November, 2002). Factitious disorder. Retrieved March 5, 2005, from http://www.emedicine.com/med/topic3125.htm
Hall, D., Eubanks, L., Kenney, R., Johnson, S. (June, 2000). Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons From 41 Cases. Peadiatrics, 105(6), 1305-1312. Retrieved March 5, 2005, from http://pediatrics.aappublications.org/cgi/content/full/105/6/1305
Huynh, K. (December, 1998). University of Iowa physician Assistant Program: Munchausen Syndrome by Proxy. Retrieved March 5, 2005, from http://www.medicine.uiowa.edu/pa/sresrch/Huynh/Huynh/
PhycNet-UK. (July, 2003). Factitious Disorder by Proxy – Munchausen Syndrome by proxy. Retrieved March 5, 2005, from http://www.psychnet-uk.com/dsm_iv/factitious_disorder_by_proxy.htm
Schreier, H. (November 2002). Munchausen by Proxy Defined. Pediatrics, 110(5), 985-988. Retrieved March 5, 2005, from http://pediatrics.aappublications.org /cgi/content/full/110/5/985
Smith-Alnimer, M., Papas-Kavalis, H. (June, 2003). Child Abuse by a Different Name: How to recognize Munchausen syndrome by proxy. American Journal of Nursing, 103(6), 56F-56J
Szoke, A. (Otober, 2000). Facticious Disorders (Munchausen syndrome). Retrieved March 5, 2005, from http://andreisz.club.fr/index.html
Thomas, K. (2003). Munchausen syndrome by proxy: identification and diagnosis. Journal of Pediatic Nursing, 18(3), 174-180.
Turner, J., Reid, S. (2002). Munchausen’s syndrome. Lancet, 359, 346-349. Retrieved March 5, 2005, from http://www.thelancet.com/
US National Library of Medicine. (December, 2004). MedlinePlus Medical Encyclopedia: Munchausen syndrome by proxy. Retrieved March 4, 2005, from http://www.nlm.nih.gov/medlineplus/ency/article/001555.htm
Wilsey, D. (2001). Munchausen Syndrom by Proxy: The Ultimate Betrayal. American Prosecuters Research Institute Update Newsletter, 14(8). Retrieved March 5, 2005, from http://www.ndaa-apri.org/publications/newsletters /update_volume_14_number_8_2001.html
Yonge, O., Haase, M. (July/August, 2004). Munchausen Sydrome and Munchausen Syndrome by Proxy in a Student Nurse. Nurse Educator, 29(4), 166-169. Retrieved March 4, 2005, from Ovid database.
Nursing Munchausen Syndrome by Proxy
March 21, 2005
Nursing Munchausen Syndrome by Proxy
Imagine meeting a young family wherein the child has suffered from many painful medical treatments and procedures as a result of many illnesses. The mother is intelligent, attentive and always involved in the care of her child. This child is a survivor, beating the odds and goeing through painful procedures, testing and surviving multiple surgeries. Appropriately your heart goes out to this family. You hope for the best and as a nurse provide professional care for the child and family. The mother is always helpful and attentive with the care of her child. You develop a therapeutic relationship with her. Now how would you feel if you were discovering that this mother was inducing the ailments onto her child? This child is perfectly healthy. But has undergone multiple procedures and surgeries because of induced or feigned symptoms. Unfortunately this is a profile that has been proven to be reality. This is an illustration of Munchausen Syndrome by Proxy.
There have been highly publicized cases of MSBP. “Hillary Rodham Clinton chose Jennifer Bush to represent her campaign for health care reform” (Dowdell & Foster, 2005). Afterwards Jennifer’s mother was charged with inducing medical problems on her that could not otherwise be explained. As a result of her mothers actions Jennifer was subjected to more than 200 hospitalisations and 40 surgeries (Dowdell & Foster, 2005). MSBP is now recognised to be “an unusual and potentially lethal form of child abuse” (Dowel & Foster, 2005). The victim is the child. In Jennifer’s case she suffered physical consequences needlessly and now lives without her gallbladder, appendix and part of her intestines as they were surgically removed.
First identified in 1951, Munchausen syndrome was named for Baron van Munchausen, an eighteenth century German aristocrat infamous for his tall tails (Smith-Alnimer & Papas-Kavalis, 2003). The syndrome was named for its characteristic lies. Individuals with Munchausen syndrome induce or invent elaborate and contradictory symptoms and demand medical treatment for themselves (Yonge & Haas, 2004). Closely related is Munchausen syndrome by Proxy (MSBP). Roy Meadow first described MSBP in 1977 (Schreier, 2002). MSBP is catalogued in the American Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a fictitious disorder. However MSBP “has yet to be recognized as an official separate category in the DSM-IV” (eMedicine, 2002). It is recognised in section 300.19; Factitious Disorder not otherwise specified.
There are four specific criteria for the diagnosis of MSBP. MSBP involves the fabrication or induction of an illness in one person by another (US National Library of Medicine, 2004). The motivation for the behaviour is to assume the sick role by proxy. All external incentives, such as economic gain are absent and the behaviour is not otherwise accounted for by another mental disorder (eMedicine, 2002). As with most mental disorders the pathophysiology is unclear. There is no test that indicates a positive diagnosis of MSBP; a diagnosis is reliant on many accumulated factors or evidence.
Individuals diagnosed with MSBP are found in all socio-economic classes and ninety five percent of the time the mother is the perpetrator. The majority of the families with an MSBP diagnosis are dysfunctional but have a tendency to be intact. A family history of Munchausen syndrome or MSBP is also a risk factor of MSBP (Dowel & Foster, 2005). The perpetrator may have Munchausen Syndrome herself and have a complicated health history. Cases usually start in infancy and up to six years of age. If it continues as the child ages, the child may accommodate to the deceptions. Older children are more likely to reveal the truth about their symptoms as they are out of the home for school (Dowel & Foster, 2005). Considering all of these characteristics the nurse caring for a child suspected of being affected by MSBP should be mindful of such signs and document any findings objectively.
The subtle characteristics of this disorder make it difficult to diagnose. “Nurses play a vital role in the observation and confirmation of the profile of MSBP” (Dowdell & Foster, 2005). A diagnosis is based on the observations of the signs and symptoms, as there is no known pathophysiology. Signs and symptoms leading to the diagnosis of MSBP are not easily recognised. MSBP “frequently goes undiagnosed-the true incidence is not known” (Thomas, 2003). This is a direct result of the unfamiliarity of the syndrome as well as the failure to consider the diagnosis. A “better knowledge of the disorder and analysis of large number of homogeneously and detailed reported cases” (Szoke, 2000) is needed. Health care professionals especially nurses need to keep updated on current literature. Knowing about the possibility is the first step in achieving a diagnosis and getting help for the victim.
Diagnosis alone may take months or years. “The average length of time to the diagnosis of MSBP generally exceeds six months” (Dowdell & Foster, 2005). With time the perpetrator becomes more convincing and practised at being deceitful. This also impacts the process of detection and proving an MSBP diagnosis. Increasing the difficulty of catching the perpetrator in the act of deceit or inflicting harm.
One apparent sign of MSBP is the fact that the child is ill with the perpetrator but when separated the child’s condition improves. As noted by Huynh, the acute signs and symptoms decrease when the child is separated from the parent. Given this fact observation and documentation of such characteristics by the nurse is key. Another sign is a family history, including death of a sibling. “There is a high incidence of unexplained sibling mortality” (PhycNet-UK, 2003). In most instances the death of a sibling is what triggers the investigation to a MSBP diagnosis. The perpetrator uses the excuse that the symptoms “run in the family”. A detailed and accurate family history is important, as is communication amongst the health care team. Since deception is a characteristic of MSBP it is likely that a history taken from the perpetrator will not be accurate (Huynh, 1998). A detailed medical history from the parents in this case is rendered invalid. Discrepancies between clinical findings and the parents’ history should raise suspicion and warrants documentation. The nurse needs to pay special attention to conflicting detail and discuss concerns with the multidisciplinary team. A combined effort and high suspicion is required to make the diagnosis of MSBP.
A multidisciplinary team, that meets regularly, is important for maintaining continuity. A team consisting of nursing staff, physicians and any other professionals that are directly involved in the care of the child need to have good communication channels. Congruent care is important. MSBP is abuse and therefore matters of law are linked with the health care. The multidisciplinary team should therefore also include members from legal professions such as law enforcement and Children’s Aid Society (CAS) when the suspicion of MSBP begins. The safety of the child or children is of utmost importance.
The use of video surveillance is useful in diagnosing MSBP. A multidisciplinary team must agree that covert surveillance is needed prior to beginning the procedure in most facilities. Covert monitoring was determined to be a necessity for diagnosing MSBP over half of the studied cases by Hall et al. The use of video surveillance causes conflict with patient privacy and confidentiality (Smith-Alnimer & Papas-Kavalis, 2003). In addition Smith-Alnimer & Papas-Kavalis described how the act of abuse was not to be intervened by the nurse as to obtain evidence for legal matters. This is a direct conflict between nursing care and obtaining legal evidence to try the case. Watching someone inflict harm on a child would be difficult for anyone. The question of how much evidence is enough to take to a court of law as abuse. Is it right to let the harm be inflicted in order to have sufficient evidence for a jury? Overall the nurse often finds his or herself with ethical and legal dilemmas when dealing with MSBP. “Great distress among nurses when nurses’ sincere efforts to support and comfort the sick are exploited” (Yong & Haas, 2004) is felt. Above all the nurse must maintain a neutral status. The perpetrator has the legal right to obtain non-judgmental health care just as any other parent. Being suspected of or diagnosed with MSBP does not give the right to the nurse to treat the parent any different. As professionals, nurses must be aware of but not feed into personal biases. These persons are suffering from an illness and are deserving of compassion.
When using covert monitoring and suspecting illegal activities, the fear of litigation may be an issue for nurses. Clinical and legal standards change over time and can be difficult to be aware of. It is most important to keep focused on the patient in attempts “to provide best clinical care to guide practise, not fear of litigation” (Barloon, 2003). Sound clinical judgement is the most important characteristic to have. Barloon also states that keeping up with current literature and continuing education are crucial assets pertaining to safe and acceptable clinical psychiatric nursing practice. From a legal point of view documentation is most important. For the safety of the child a sound legal case is important. The onus is mainly on the nurse to document key findings and use sound judgement to intervene.
The perpetrator tends to have medical knowledge often from previous education and or experience in a health care field. In the study by Hall et al fifty five percent of the perpetrators had previous health care training or work and interestingly twenty five percent worked in a day care if they did not have previous health care experience. Individuals with this condition are attracted to helping professions such as nursing (Dowdell & Foster, 2005). An article written by Young and Haas describes a case in which a nursing student presented with Munchausn syndrome and the students’ daughter was a victim of MSBP. The main focus of this article was the fact that most faculties are not prepared for the possibility of encountering Munchausen syndrome in students. The knowledge of this disorder is beneficial for the detection as well as the outcome. Being a nurse in such a situation as to help a student do harm to a child is very difficult. The faculty who helped this perpetrator felt hostility after learning of the deceit and feeling exploited. Some felt guilt for teaching the perpetrator medical knowledge that potentially aided in the harm done to the child.
Treatment of this disorder typically does not have very favourable outcomes. Emphasis is put on managing rather than curing. The first step is confronting the perpetrator. Admission to the deceit may occur but more often denial is the result. The purpose is to stop the abuse and protect the child. The next step theoretically is developing a stable therapeutic relationship. With a stable relationship working, the focus of care goes to the management of the disorder including orientation to avoid unnecessary hospitalizations and medical acts (PhycNet-UK, 2003). There are no known cases of successful treatment of MSBP (Huynh, 1998). In most cases the fictitious disorders are more convincing than real cases of psychosis. The use of pharmacotherapies for MSBP is not well known. There has been some use of antipsychotic drugs with some indication of benefit (PhycNet-UK, 2003). Since “psychiatric disorders are common, in particular, personality disorders and depression” (Huynh, 1998) treatment of these disorders is the primary focus. As for psychotherapy and counselling, analytical and cognitive-behavioral approaches have been used with patients that accept and engage in treatment.
The role of the nurse in relation to MSBP is important in many ways. Close observations and documentation leads to the recognition of suspicious findings. In combination with knowledge of MSBP recognition of the signs and symptoms may lead to a diagnosis. Nurses may be the only persons to whom a mother makes statements that can be incriminating. The close professional relationship resulting from the care and ‘being there’ creates a bond between nurse and mother that no other member of the multidisciplinary team tends to develop. This trust sometimes allows for the mother to say suspicious things to the nurse. The nurse is the one who provides direct care for the child and is a fundamental member of the health care team. In a situation of caring for a child victim to MSBP the nurse must be vigilant and only intervene based on professional judgment and fact, not the demands of the parent. Support for the nurse is important. The use of a multidisciplinary team helps to support the nurse. Having others aware of the situation able to discuss details otherwise confined by confidentiality privileges is important. Nursing is a caring profession. Working with a case of suspected or diagnosed MSBP is very trying for nursing staff.
A diagnosis of MSBP is child abuse. MSBP is not a form of child abuse that is well known nor is it easily detected. Overall further research and study is needed in this area of mental health disorders. The nursing role related to the assessment, diagnosis, and treatment of MSBP is important throughout the process of detection to treatment. The most important thing is to be able to recognise and diagnose MSBP. This is accomplished firstly with increased awareness, especially nurses that care for children. With a heightened awareness nurses may be able to help the young victims from further abuse associated with MSBP. There are many ethical dilemmas and legal difficulties when gathering evidence to determine a diagnosis. The demands on nursing staff are high therefore they need strong support systems.
References
American Psychiatric Association. (2000). Quick reference to the Diagnostic Criteria from DSM-IV-TR™. American Psychiatric Association: Washington, DC.
Dowdell, E., Foster, K. (2005). Munchausen Syndrome by Proxy: Recognizing a Form of Child Abuse. Nursing Spectrum. Retrieved March 14, 2005, from http://nsweb.nursingspectrum.com/ce/ce209.htm
Barloon, L. (2003). Legal aspects of psychiatric nursing. The Nursing Clinics of North America, 38(1), 9-19.
eMedicine. (November, 2002). Factitious disorder. Retrieved March 5, 2005, from http://www.emedicine.com/med/topic3125.htm
Hall, D., Eubanks, L., Kenney, R., Johnson, S. (June, 2000). Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons From 41 Cases. Peadiatrics, 105(6), 1305-1312. Retrieved March 5, 2005, from http://pediatrics.aappublications.org/cgi/content/full/105/6/1305
Huynh, K. (December, 1998). University of Iowa physician Assistant Program: Munchausen Syndrome by Proxy. Retrieved March 5, 2005, from http://www.medicine.uiowa.edu/pa/sresrch/Huynh/Huynh/
PhycNet-UK. (July, 2003). Factitious Disorder by Proxy – Munchausen Syndrome by proxy. Retrieved March 5, 2005, from http://www.psychnet-uk.com/dsm_iv/factitious_disorder_by_proxy.htm
Schreier, H. (November 2002). Munchausen by Proxy Defined. Pediatrics, 110(5), 985-988. Retrieved March 5, 2005, from http://pediatrics.aappublications.org /cgi/content/full/110/5/985
Smith-Alnimer, M., Papas-Kavalis, H. (June, 2003). Child Abuse by a Different Name: How to recognize Munchausen syndrome by proxy. American Journal of Nursing, 103(6), 56F-56J
Szoke, A. (Otober, 2000). Facticious Disorders (Munchausen syndrome). Retrieved March 5, 2005, from http://andreisz.club.fr/index.html
Thomas, K. (2003). Munchausen syndrome by proxy: identification and diagnosis. Journal of Pediatic Nursing, 18(3), 174-180.
Turner, J., Reid, S. (2002). Munchausen’s syndrome. Lancet, 359, 346-349. Retrieved March 5, 2005, from http://www.thelancet.com/
US National Library of Medicine. (December, 2004). MedlinePlus Medical Encyclopedia: Munchausen syndrome by proxy. Retrieved March 4, 2005, from http://www.nlm.nih.gov/medlineplus/ency/article/001555.htm
Wilsey, D. (2001). Munchausen Syndrom by Proxy: The Ultimate Betrayal. American Prosecuters Research Institute Update Newsletter, 14(8). Retrieved March 5, 2005, from http://www.ndaa-apri.org/publications/newsletters /update_volume_14_number_8_2001.html
Yonge, O., Haase, M. (July/August, 2004). Munchausen Sydrome and Munchausen Syndrome by Proxy in a Student Nurse. Nurse Educator, 29(4), 166-169. Retrieved March 4, 2005, from Ovid database.
Monday, November 13, 2006
Women’s Health and Reproductive Hazards
Assignment Four
Industrial Relations (308)
Occupational Health and Safety
November 15, 2005
Women’s Health and Reproductive Hazards
Workplace hazards are connected to health. Julie Tisdale and Christine Sofge define reproductive hazards for women as substances or agents that affect the reproductive health, ability to become pregnant, or the future health of children. Some of theses hazards found in the workplace are well known. However there are many unknown substances that cause birth defects such as low birth weight and miscarriages. The health effects of reproductive hazards are variable often according to when the woman is exposed. There are laws and regulations that help to protect the health of women. Women need to learn their rights and learn about possible hazards in order to protect themselves.
Women’s health and reproductive hazards are not limited to just pregnancy and birth defects. This topic encompasses all aspects of women’s health as it applies to ability to become pregnant as well as the health of the fetus. Women’s health concerns include things like “hazards encountered using equipment designed for male workers of larger statures” (Tisdale & Sofge, 1998, p 651). In this case the extra strain on the woman is a health hazard. Work hazards are not simply the tangible physical aspects the psychosocial aspects are equally important. Studies have shown the stress is a major factor. Stress can affect hormones in the body and thus the reproductive system. Hormones are very important in the reproductive system. General fatigue itself could also cause difficulties in pregnancy affecting the overall health of woman and fetus.
Often the focus is on fixing the problems in the workplace after an issue arises. Health promotion in the workplace ideally should be considered equally important to understanding and managing health problems as Sara Cox, Tom Cox and Joanna Pryce stated in Work-related reproductive health: a review. With health promotion an upstream kind of approach is utilised thus eliminating risks of injury or disease. By identifying the causes of problems prior to harm and using this knowledge, prevention of injury and or disease is possible. Upstream thinking focusing on health promotion is where health professionals such as nurses would like to focus in order to prevent.
Women’s roles in the workplace have changed over the years. There has been an increase in the number of professional women. The roles in both home and workplace have various possible hazards. “Three quarters of women of reproductive age are in the workforce (Tisdale, et al, 1998, p 652).” Women work and therefore are at risk for reproductive health problems. “Although often overlooked, the workplace can have a profound impact on a worker’s health, ranging from cancer in factory workers to carpal tunnel syndrome in computer users.” (Tisdale et al, 1998, p 651) There are many health hazards in the workplace both known and many unknown.
What we can protect ourselves from right now are the known hazards. The known harmful substances are for the most part seen and therefore we are able to protect against them. We know that certain substances and viruses cause reproductive problems for example lead and rubella also known as German measles. “More than 100 years ago lead was found to cause miscarriages, stillbirths and infertility…” (NIOSH, 1999, p 3). Thus avoiding lead and viruses is important for pregnant women.
There are many unknown causes of infertility, miscarriage and birth defects. “We know that the health of an unborn child can suffer if a woman fails to eat right, smokes, or drinks alcohol during pregnancy” (National Institute for Occupational Safety and Health, 1999, p 1). The most harmful are the unknown. “The causes of most reproductive health problems are still not known. Many of these problems –infertility, miscarriage, low birth weight –are fairly common occurrences” (NIOSH, 1999, p 3). Further research is needed to ensure the reproductive safety of women in both in the workplace and in the home. For now being careful and using personal protective equipment is essential.
All health hazards are potentially dangerous to the reproductive system. Exposure to certain hazards may cause infertility or spontaneous abortion. What is known from understanding the female reproductive system? Women are born with a set number of eggs. Thus if her eggs are harmed there is no way to replace them rendering her incapable to reproduce. Once a woman becomes pregnant there are different difficulties that may arise during the pregnancy. During the first three months also known as the first trimester of pregnancy, exposure may cause a birth defect or miscarriage; this is the most likely time to have DNA altered in the unborn child. The first trimester is when the major fetal organs are formed. In the remainder of the pregnancy the organs mature and grow thus exposure in the last six months of pregnancy is more likely to affect the development of the brain and or slow the growth possibly causing premature labour. The overall health of a woman is important to maintain and promote to gain the result of healthy mothers and healthy children.
Laws and policies for equality and health have been developed. “Three basic human rights: the right to health care, non-discrimination, and reproductive self-determination” (Center for Reproductive Rights, 2005) all give the right to be healthy and survive pregnancy and childbirth. Governments are liable for the enforcement and accountability of women’s health as it applies to basic human rights. In Canada the Charter of Rights and Freedoms, 1982 outlines reproductive rights in general terms. Women need to know their rights and fight for their rights. If their employer chooses to overlook the possible hazards for the reproductive health of women point out the hazards and use the knowledge of women’s rights to rectify the problem.
Reproductive health is of utmost importance. There are multiple known and unknown health hazards and therefore the use of personal protective equipment and being safe is very important. Women need to know the basics about pregnancy and reproductive health to help protect them. Knowing that the first trimester is when the major organs are formed is important in understanding the importance of being healthy and avoiding viruses and agents that could possibly alter DNA.
The basic human right laws help to protect reproductive health however the abilities to enforce them are limited. Therefore being informed of the rights and options is important as is advocating for your rights to work in a safe environment for yourself and for unborn children. Ultimately the onus is on the individual to discuss situations with their employer to make special arrangement to ensure workplace health and safety. Reproductive health is dependant on many factors. Since many harmful substances and agents are still unknown further research is needed. Preventing reproductive health hazards is important for the overall welfare of women. The more we know about the outcomes of exposure to chemicals, viruses and other agents the better we can protect ourselves.
Bibliography
Center For Reproductive Rights. (January, 2005). Surviving Pregnancy and Childbirth: An International Human Right. Retrieved on November 17, 2005 from http://www.reproductiverights.org/pdf/pub_bp_surviving_0105.pdf
Cox, S., Cox, T., Pryce, J. (2000). Work-related reproductive health: a review. Work & stress, vol 14, no 2, pp 171-180.
National Institute for Occupational Safety and Health (NIOSH). (February, 1999). The effects of workplace hazards on female reproductive health. No. 99-104.
Tisdale, J., Sofge, C. (1998). Women and Work: Highlights of NIOSH Research. Journal of Women’s Health. Vol 7, no 6.
World Health Organization. (1999). Women and occupational health. Retrieved November 10, 2005 from http://www.who.int/occupational_health/publications/womendoh/en/
Industrial Relations (308)
Occupational Health and Safety
November 15, 2005
Women’s Health and Reproductive Hazards
Workplace hazards are connected to health. Julie Tisdale and Christine Sofge define reproductive hazards for women as substances or agents that affect the reproductive health, ability to become pregnant, or the future health of children. Some of theses hazards found in the workplace are well known. However there are many unknown substances that cause birth defects such as low birth weight and miscarriages. The health effects of reproductive hazards are variable often according to when the woman is exposed. There are laws and regulations that help to protect the health of women. Women need to learn their rights and learn about possible hazards in order to protect themselves.
Women’s health and reproductive hazards are not limited to just pregnancy and birth defects. This topic encompasses all aspects of women’s health as it applies to ability to become pregnant as well as the health of the fetus. Women’s health concerns include things like “hazards encountered using equipment designed for male workers of larger statures” (Tisdale & Sofge, 1998, p 651). In this case the extra strain on the woman is a health hazard. Work hazards are not simply the tangible physical aspects the psychosocial aspects are equally important. Studies have shown the stress is a major factor. Stress can affect hormones in the body and thus the reproductive system. Hormones are very important in the reproductive system. General fatigue itself could also cause difficulties in pregnancy affecting the overall health of woman and fetus.
Often the focus is on fixing the problems in the workplace after an issue arises. Health promotion in the workplace ideally should be considered equally important to understanding and managing health problems as Sara Cox, Tom Cox and Joanna Pryce stated in Work-related reproductive health: a review. With health promotion an upstream kind of approach is utilised thus eliminating risks of injury or disease. By identifying the causes of problems prior to harm and using this knowledge, prevention of injury and or disease is possible. Upstream thinking focusing on health promotion is where health professionals such as nurses would like to focus in order to prevent.
Women’s roles in the workplace have changed over the years. There has been an increase in the number of professional women. The roles in both home and workplace have various possible hazards. “Three quarters of women of reproductive age are in the workforce (Tisdale, et al, 1998, p 652).” Women work and therefore are at risk for reproductive health problems. “Although often overlooked, the workplace can have a profound impact on a worker’s health, ranging from cancer in factory workers to carpal tunnel syndrome in computer users.” (Tisdale et al, 1998, p 651) There are many health hazards in the workplace both known and many unknown.
What we can protect ourselves from right now are the known hazards. The known harmful substances are for the most part seen and therefore we are able to protect against them. We know that certain substances and viruses cause reproductive problems for example lead and rubella also known as German measles. “More than 100 years ago lead was found to cause miscarriages, stillbirths and infertility…” (NIOSH, 1999, p 3). Thus avoiding lead and viruses is important for pregnant women.
There are many unknown causes of infertility, miscarriage and birth defects. “We know that the health of an unborn child can suffer if a woman fails to eat right, smokes, or drinks alcohol during pregnancy” (National Institute for Occupational Safety and Health, 1999, p 1). The most harmful are the unknown. “The causes of most reproductive health problems are still not known. Many of these problems –infertility, miscarriage, low birth weight –are fairly common occurrences” (NIOSH, 1999, p 3). Further research is needed to ensure the reproductive safety of women in both in the workplace and in the home. For now being careful and using personal protective equipment is essential.
All health hazards are potentially dangerous to the reproductive system. Exposure to certain hazards may cause infertility or spontaneous abortion. What is known from understanding the female reproductive system? Women are born with a set number of eggs. Thus if her eggs are harmed there is no way to replace them rendering her incapable to reproduce. Once a woman becomes pregnant there are different difficulties that may arise during the pregnancy. During the first three months also known as the first trimester of pregnancy, exposure may cause a birth defect or miscarriage; this is the most likely time to have DNA altered in the unborn child. The first trimester is when the major fetal organs are formed. In the remainder of the pregnancy the organs mature and grow thus exposure in the last six months of pregnancy is more likely to affect the development of the brain and or slow the growth possibly causing premature labour. The overall health of a woman is important to maintain and promote to gain the result of healthy mothers and healthy children.
Laws and policies for equality and health have been developed. “Three basic human rights: the right to health care, non-discrimination, and reproductive self-determination” (Center for Reproductive Rights, 2005) all give the right to be healthy and survive pregnancy and childbirth. Governments are liable for the enforcement and accountability of women’s health as it applies to basic human rights. In Canada the Charter of Rights and Freedoms, 1982 outlines reproductive rights in general terms. Women need to know their rights and fight for their rights. If their employer chooses to overlook the possible hazards for the reproductive health of women point out the hazards and use the knowledge of women’s rights to rectify the problem.
Reproductive health is of utmost importance. There are multiple known and unknown health hazards and therefore the use of personal protective equipment and being safe is very important. Women need to know the basics about pregnancy and reproductive health to help protect them. Knowing that the first trimester is when the major organs are formed is important in understanding the importance of being healthy and avoiding viruses and agents that could possibly alter DNA.
The basic human right laws help to protect reproductive health however the abilities to enforce them are limited. Therefore being informed of the rights and options is important as is advocating for your rights to work in a safe environment for yourself and for unborn children. Ultimately the onus is on the individual to discuss situations with their employer to make special arrangement to ensure workplace health and safety. Reproductive health is dependant on many factors. Since many harmful substances and agents are still unknown further research is needed. Preventing reproductive health hazards is important for the overall welfare of women. The more we know about the outcomes of exposure to chemicals, viruses and other agents the better we can protect ourselves.
Bibliography
Center For Reproductive Rights. (January, 2005). Surviving Pregnancy and Childbirth: An International Human Right. Retrieved on November 17, 2005 from http://www.reproductiverights.org/pdf/pub_bp_surviving_0105.pdf
Cox, S., Cox, T., Pryce, J. (2000). Work-related reproductive health: a review. Work & stress, vol 14, no 2, pp 171-180.
National Institute for Occupational Safety and Health (NIOSH). (February, 1999). The effects of workplace hazards on female reproductive health. No. 99-104.
Tisdale, J., Sofge, C. (1998). Women and Work: Highlights of NIOSH Research. Journal of Women’s Health. Vol 7, no 6.
World Health Organization. (1999). Women and occupational health. Retrieved November 10, 2005 from http://www.who.int/occupational_health/publications/womendoh/en/
plagiarism
I am posting my original works written when I was completing my university degree as well as new writings. Please do not commit academic fraud. Thank you.
A Question of Compliance for Hand Hygiene
Selected Acute Illnesses
A Question of Compliance for Hand Hygiene
March 14, 2005
A Question of Compliance for Hand Hygiene
Is there a problem with compliance related to hand hygiene in acute care clinical settings? The importance of cleanliness related to good health dates back to Nightingale (Nightingale, 1969). Proper hand hygiene is the most important factor to prevent cross contamination of microorganisms and thus communicable diseases (college of Nurses of Ontario, 2004). Yet hand washing is done less than fifty percent of the time between patients as found in most studies from the past twenty years (McGuckin, 2003). Health care workers willingly admit to neglecting hand hygiene.
Nurses often neglect to use appropriate hand hygiene between patients and prior to drawing up medications as observed in various clinical settings. With the implementation of alcohol based cleansers there has been an small increase in compliance however there is a reluctance to accept alcohol based cleansers as a substitute for hand washing (Girou, 2002). There are many factors that contribute to this non-compliance. There are also many interventions appropriate to promoting compliance. With an increase in hand hygiene compliance cross transmission of microorganisms will be prevented, consequently the number of communicable diseases will be decreased.
The accepted way to effectively wash hands includes the use of warm water and soap. Start by wetting both hands then with one to three millilitres of soap and start scrubbing. Scrub both hands, wrists and under finger nails for a minimum of ten seconds preferably longer. The soap dissolves oil and breaks the germs’ connection to the skin so they can be rinsed off with the soapsuds. Rinse off the suds one hand at a time and dry with disposable towels or a hand dryer. Use a paper towel to turn off the taps as to not contaminate your clean hands. A more detailed procedure is found on the Canadian Centre for Occupational Health and Safety (CCOHS) website. With hand washing the nurse must go to a sink and stay there to complete hand hygiene. This fact proves to be the main problem with compliance as nurses have hectic work schedules that do not always have the time and readily available washing area.
Hand hygiene using alcohol based cleansers is much less time consuming. With the alcohol based cleanser there is only one step. Rub the cleanser between both hands covering all surfaces until the alcohol evaporates completely. Alcohol based cleansers are fast acting and significantly reduce the number of micro organisms (Centres for Disease Control Prevention, 2004). There is no need to remain stationary while cleansing with the alcohol-based solution therefore nurses can perform hand hygiene while on their way to their next patient. The only indication against using alcohol-based cleansers is when hands are visibly soiled. Washing with soap and water is the only way to properly clean when hands are visibly soiled.
To wash hands effectively time, knowledge, supplies and care is needed. Nurses do not always have the time and therefore alcohol-based cleansers have been made available. As a new knowledge and practise there is a reluctance to accept the alcohol-based cleansers as a substitute for hand washing. “There is a reluctance to accept handrubbing as a substitute for hand washing, even among some infection control practitioners” (Girou, 2002). A survey indicated that the lack of confidence in the alcohol based cleansers efficacy was the main concern among health care professionals. The results of a randomized clinical trial by Girou discovered that hand rubbing with an alcohol based cleanser was more effective in reducing bacterial contamination of health care workers’ hands than hand washing. This knowledge is important to convey to nurses to help increase the confidence in alcohol based cleansers.
Using either method of hand hygiene repeatedly, as nurses do, tends to irritate and cause skin dryness. With the use of alcohol-based cleansers, use of hand lotions is recommended to minimize skin irritation and dryness (Ontario Ministry of Health and Long-term care, 2004). Since hand washing tends to dry skin more than alcohol cleansers the importance of skin integrity is clear for both methods. When selecting hand lotions it is important to consider one that will not compromise glove efficacy (Wilson, 2004). With skin irritation the use of gloves will help to avoid getting bacteria into damaged areas of skin. However the use of gloves is not a substitute for hand hygiene nor is hand hygiene a substitute for the use of gloves (CCOHS, 2004). The knowledge of the importance of hand hygiene is fundamental as is healthy skin. A combination of hand washing, the use of alcohol based cleansers, the use of gloves and moisturizing lotions must be used to maintain hand hygiene in the clinical setting.
In summary hand hygiene compliance is decreased for the following contributing factors. Hand washing is time consuming, requiring the nurse to stand stationary at a sink. Hand washing also requires warm running water, soap and paper towels which are not always readily available. The knowledge deficit related to alcohol based cleanser efficacy. Skin irritation and dryness due to repeated washing and or hand rubbing with alcohol based cleansers. All of these issues have various solutions for increasing compliance of hand hygiene in the clinical setting.
The following outlines five main interventions beneficial to promoting hand hygiene compliance in the clinical setting. Address restricted time issues with emphasis on using alcohol-based products. Convenient placement of alcohol based cleanser dispensers. Include educational interventions such as newsletters, videos, and classes. Frequent reminders including but not limited to posters, signs, and patients reminding staff. Personal, peer, and non-personalized performance feedback regarding hand hygiene practice given frequently. Finally, providing suitable hand lotions within the work environment. All of these interventions have been supported with studies performed in various different clinical settings all with positive results.
Studies have shown an increase in hand hygiene compliance with the use of alcohol-based cleansers. Most importantly further research has also proven this increased compliance to be maintained with the use of alcohol-based cleansers (Beyea, 2003). The introduction of alcohol-based cleansers addressed the ‘not enough time’ issue regarding hand hygiene. Alcohol based cleansers are convenient, rapid acting and less contact time is required. Nurses do not need to stand at a sink; they can sanitize their hands and walk at the same time. In addition there is a greater reduction in bacterial contamination of hands than conventional hand washing (Girou et al, 2002). Implementation of alcohol based cleansers within the acute care clinical setting is an overall effective approach to increasing hand hygiene compliance.
Knowledge is power. By increasing and reinforcing the knowledge base an increased compliance may be obtained. A hand hygiene intervention done by the University of Geneva using “emorational” education resulted in a twenty percent increase in compliance over a period of four years (Pittet, et al, 2000). This intervention consisted of many components such as the use of a multidisciplinary team to promote hand hygiene within the facility. Providing short on-going educational sessions for staff regarding various aspects of hand hygiene such as the efficacy of alcohol-based cleansers, acceptable hand hygiene techniques, the safe removal of gloves avoiding contamination, the risks of transmission, and the costs of health care associated infections. Making the information sessions fun and interactive by involving the staff in poster development. All of these educational elements support and reinforce hand hygiene on an on going basis. With the inclusion of frequent reminders and feedback both verbal and written the compliance is reinforced further. With positive reminders nurses are encouraged by peers and patients to properly sanitize their hands. Feedback regarding noscomial infection and rates of transmission are also encouraging. Decreasing numbers of Methicillin-resistant Staphylococcus Aureus (MRSA) were reported with the intervention implemented by the University of Geneva (Pittet, et al, 2000). This positive result reinforces the importance of increased compliance.
Have hand lotions available for nurses within the clinical setting. More importantly choose an alcohol-based product that has moisturizers and emollients already. Studies have shown that skin integrity has in fact improved with the use of such alcohol-based products (Wilson, 2004). Skin irritation and dryness is counteracted with the addition of moisturizers and emollients in the alcohol based cleansers. Traditional hand washing dissolves the oils in your hands to separate the bacteria and wash them down the drain apposed to alcohol based cleansers that kill the bacteria. With the loss of the natural oils, hands tend to become irritated and the use of lotions is beneficial to maintain skin health.
Using all of the above interventions simultaneously addressing the issues of compliance is most effective. “Performance is mainly influenced by external stimuli, and can be changed by feedback, incentives, modelling, and external reinforcement” (Grol, and Grimshaw, 2003). The most effective strategy was found to be multifaceted interventions, the combination of various teaching and reinforcing techniques (Girou, et al, 2002). Implementing programs within facilities to enhance the knowledge base and stimulate nurses to sanitize their hands regularly is within reach. With implementation evaluation must follow to complete the intervention (Pittet, et al, 2000). Evaluating an intervention that is implemented helps to reaffirm and maintain sustainable outcomes.
In acute care clinical settings nurses are strained with heavy workloads. This fact complicates certain interventions such as teaching sessions that would require time. Starting a program is the biggest step, getting a multidisciplinary team motivated. From a nurses perspective most interventions would be realistic to achieve. With a focus on increased use of alcohol-based cleansers nurses can optimize their time and ensure to perform hand hygiene appropriately. Most importantly the placement of alcohol based cleansers throughout the facility. Convenient location of hand sanitizers including every bedside and at every door is crucial to increasing compliance. Posting information sheets or posters in nursing stations and other convenient locations on the floor would increase knowledge base and encourage hand hygiene. Positive feedback and reinforcement on an ongoing basis is also important.
Increased compliance of hand hygiene in acute care clinical settings is the overall preferred outcome. Thus resulting in the prevention of cross transmission of micro organisms and communicable diseases. This is theoretically and realistically possible with the use of multifaceted interventions, continuous monitoring and re-evaluations. Positive results have been achieved with the use of multifaceted on-going interventions.
References
Beyea, S. (2003). Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operated faucets. Association Of Operating Room Nurses. Aorn Journal, 77(3), 671. Retrieved November 9, 2004, from ProQuest Nursing Journals database.
Canadian Centre for Occupational Health and Safety. (November, 2004). Hand Washing: Reducing the Risk of Common Infections. Retrieved March 5, 2005, from http://www.ccohs.ca/oshanswers/diseases/washing_hands.html
Centres for Disease Control and Prevention. (October, 2004). Hand Hygiene Guidelines Fact Sheet. Retrieved March 5, 2005, from http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
College of Nurses of Ontario. (2004, June). Practice Standard: Infection Prevention and Control. Retrieved November 7, 2004, from http://www.cno.org/docs/prac/41002_infection.pdf
Girou, E., Loyeau, S., Legrand, P., Oppein, F., BrunBuisson, C. (2002, August). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomized clinical trial. BMJ, 325(362). Retrieved November 8, 2004 from http://bmj.bmjjournals.com/cgi/content/full/325/7360/362
Grol, R., Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients' care. The Lancet, 362(9391), 1225-1230. Retrieved November 8, 2004, from ProQuest Nursing Journals database.
McGuckin, M. (2003). Hand hygiene accountability. Nursing Management, 34(4), H2. Retrieved November 8, 2004, from ABI/INFORM Global database.
Nightingale, F. (1969). Notes on nursing: What it is and what it is not. New York: Dover.
Ontario Ministry of Health and long term care. (2004, October). Public Health: Hand Washing. Retrieved November 9, 2004, from http://www.health.gov.on.ca/english/public/pub/pubhealth/handwash.html
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., Perneger, T. (2000). Hand Hygiene Campaign. Lancet, 356, 1307-1312. Retrieved November 8, 2004, from http://www.hopisafe.ch/doc/8b.doc
Public Health Agency of Canada. (2003, January). Alcohol for Hand Hygiene: New Comparative Studies Add to the Evidence Base. Retrieved November 5, 2004 from http://www.phac-pc.gc.ca/publicat/ccdr-rmtc/03vol29/dr2901eb.html
Solumed, Inc. (1998, May). Chlorhexidine Gluconate: Technical Report Review of the Literature. Retrieved November 8, 2004, from http://www.solumed.net/sm.engl/gluc.html
Wilson, S. (2004). Changing Hand Hygiene Behavior; Improving Infection Protection. The Safe Angle, 6(2),1. Retrieved November 9, 2004, from http://www.hchsa.on.ca/products/newsltrs/sa_f2004.pdf
A Question of Compliance for Hand Hygiene
March 14, 2005
A Question of Compliance for Hand Hygiene
Is there a problem with compliance related to hand hygiene in acute care clinical settings? The importance of cleanliness related to good health dates back to Nightingale (Nightingale, 1969). Proper hand hygiene is the most important factor to prevent cross contamination of microorganisms and thus communicable diseases (college of Nurses of Ontario, 2004). Yet hand washing is done less than fifty percent of the time between patients as found in most studies from the past twenty years (McGuckin, 2003). Health care workers willingly admit to neglecting hand hygiene.
Nurses often neglect to use appropriate hand hygiene between patients and prior to drawing up medications as observed in various clinical settings. With the implementation of alcohol based cleansers there has been an small increase in compliance however there is a reluctance to accept alcohol based cleansers as a substitute for hand washing (Girou, 2002). There are many factors that contribute to this non-compliance. There are also many interventions appropriate to promoting compliance. With an increase in hand hygiene compliance cross transmission of microorganisms will be prevented, consequently the number of communicable diseases will be decreased.
The accepted way to effectively wash hands includes the use of warm water and soap. Start by wetting both hands then with one to three millilitres of soap and start scrubbing. Scrub both hands, wrists and under finger nails for a minimum of ten seconds preferably longer. The soap dissolves oil and breaks the germs’ connection to the skin so they can be rinsed off with the soapsuds. Rinse off the suds one hand at a time and dry with disposable towels or a hand dryer. Use a paper towel to turn off the taps as to not contaminate your clean hands. A more detailed procedure is found on the Canadian Centre for Occupational Health and Safety (CCOHS) website. With hand washing the nurse must go to a sink and stay there to complete hand hygiene. This fact proves to be the main problem with compliance as nurses have hectic work schedules that do not always have the time and readily available washing area.
Hand hygiene using alcohol based cleansers is much less time consuming. With the alcohol based cleanser there is only one step. Rub the cleanser between both hands covering all surfaces until the alcohol evaporates completely. Alcohol based cleansers are fast acting and significantly reduce the number of micro organisms (Centres for Disease Control Prevention, 2004). There is no need to remain stationary while cleansing with the alcohol-based solution therefore nurses can perform hand hygiene while on their way to their next patient. The only indication against using alcohol-based cleansers is when hands are visibly soiled. Washing with soap and water is the only way to properly clean when hands are visibly soiled.
To wash hands effectively time, knowledge, supplies and care is needed. Nurses do not always have the time and therefore alcohol-based cleansers have been made available. As a new knowledge and practise there is a reluctance to accept the alcohol-based cleansers as a substitute for hand washing. “There is a reluctance to accept handrubbing as a substitute for hand washing, even among some infection control practitioners” (Girou, 2002). A survey indicated that the lack of confidence in the alcohol based cleansers efficacy was the main concern among health care professionals. The results of a randomized clinical trial by Girou discovered that hand rubbing with an alcohol based cleanser was more effective in reducing bacterial contamination of health care workers’ hands than hand washing. This knowledge is important to convey to nurses to help increase the confidence in alcohol based cleansers.
Using either method of hand hygiene repeatedly, as nurses do, tends to irritate and cause skin dryness. With the use of alcohol-based cleansers, use of hand lotions is recommended to minimize skin irritation and dryness (Ontario Ministry of Health and Long-term care, 2004). Since hand washing tends to dry skin more than alcohol cleansers the importance of skin integrity is clear for both methods. When selecting hand lotions it is important to consider one that will not compromise glove efficacy (Wilson, 2004). With skin irritation the use of gloves will help to avoid getting bacteria into damaged areas of skin. However the use of gloves is not a substitute for hand hygiene nor is hand hygiene a substitute for the use of gloves (CCOHS, 2004). The knowledge of the importance of hand hygiene is fundamental as is healthy skin. A combination of hand washing, the use of alcohol based cleansers, the use of gloves and moisturizing lotions must be used to maintain hand hygiene in the clinical setting.
In summary hand hygiene compliance is decreased for the following contributing factors. Hand washing is time consuming, requiring the nurse to stand stationary at a sink. Hand washing also requires warm running water, soap and paper towels which are not always readily available. The knowledge deficit related to alcohol based cleanser efficacy. Skin irritation and dryness due to repeated washing and or hand rubbing with alcohol based cleansers. All of these issues have various solutions for increasing compliance of hand hygiene in the clinical setting.
The following outlines five main interventions beneficial to promoting hand hygiene compliance in the clinical setting. Address restricted time issues with emphasis on using alcohol-based products. Convenient placement of alcohol based cleanser dispensers. Include educational interventions such as newsletters, videos, and classes. Frequent reminders including but not limited to posters, signs, and patients reminding staff. Personal, peer, and non-personalized performance feedback regarding hand hygiene practice given frequently. Finally, providing suitable hand lotions within the work environment. All of these interventions have been supported with studies performed in various different clinical settings all with positive results.
Studies have shown an increase in hand hygiene compliance with the use of alcohol-based cleansers. Most importantly further research has also proven this increased compliance to be maintained with the use of alcohol-based cleansers (Beyea, 2003). The introduction of alcohol-based cleansers addressed the ‘not enough time’ issue regarding hand hygiene. Alcohol based cleansers are convenient, rapid acting and less contact time is required. Nurses do not need to stand at a sink; they can sanitize their hands and walk at the same time. In addition there is a greater reduction in bacterial contamination of hands than conventional hand washing (Girou et al, 2002). Implementation of alcohol based cleansers within the acute care clinical setting is an overall effective approach to increasing hand hygiene compliance.
Knowledge is power. By increasing and reinforcing the knowledge base an increased compliance may be obtained. A hand hygiene intervention done by the University of Geneva using “emorational” education resulted in a twenty percent increase in compliance over a period of four years (Pittet, et al, 2000). This intervention consisted of many components such as the use of a multidisciplinary team to promote hand hygiene within the facility. Providing short on-going educational sessions for staff regarding various aspects of hand hygiene such as the efficacy of alcohol-based cleansers, acceptable hand hygiene techniques, the safe removal of gloves avoiding contamination, the risks of transmission, and the costs of health care associated infections. Making the information sessions fun and interactive by involving the staff in poster development. All of these educational elements support and reinforce hand hygiene on an on going basis. With the inclusion of frequent reminders and feedback both verbal and written the compliance is reinforced further. With positive reminders nurses are encouraged by peers and patients to properly sanitize their hands. Feedback regarding noscomial infection and rates of transmission are also encouraging. Decreasing numbers of Methicillin-resistant Staphylococcus Aureus (MRSA) were reported with the intervention implemented by the University of Geneva (Pittet, et al, 2000). This positive result reinforces the importance of increased compliance.
Have hand lotions available for nurses within the clinical setting. More importantly choose an alcohol-based product that has moisturizers and emollients already. Studies have shown that skin integrity has in fact improved with the use of such alcohol-based products (Wilson, 2004). Skin irritation and dryness is counteracted with the addition of moisturizers and emollients in the alcohol based cleansers. Traditional hand washing dissolves the oils in your hands to separate the bacteria and wash them down the drain apposed to alcohol based cleansers that kill the bacteria. With the loss of the natural oils, hands tend to become irritated and the use of lotions is beneficial to maintain skin health.
Using all of the above interventions simultaneously addressing the issues of compliance is most effective. “Performance is mainly influenced by external stimuli, and can be changed by feedback, incentives, modelling, and external reinforcement” (Grol, and Grimshaw, 2003). The most effective strategy was found to be multifaceted interventions, the combination of various teaching and reinforcing techniques (Girou, et al, 2002). Implementing programs within facilities to enhance the knowledge base and stimulate nurses to sanitize their hands regularly is within reach. With implementation evaluation must follow to complete the intervention (Pittet, et al, 2000). Evaluating an intervention that is implemented helps to reaffirm and maintain sustainable outcomes.
In acute care clinical settings nurses are strained with heavy workloads. This fact complicates certain interventions such as teaching sessions that would require time. Starting a program is the biggest step, getting a multidisciplinary team motivated. From a nurses perspective most interventions would be realistic to achieve. With a focus on increased use of alcohol-based cleansers nurses can optimize their time and ensure to perform hand hygiene appropriately. Most importantly the placement of alcohol based cleansers throughout the facility. Convenient location of hand sanitizers including every bedside and at every door is crucial to increasing compliance. Posting information sheets or posters in nursing stations and other convenient locations on the floor would increase knowledge base and encourage hand hygiene. Positive feedback and reinforcement on an ongoing basis is also important.
Increased compliance of hand hygiene in acute care clinical settings is the overall preferred outcome. Thus resulting in the prevention of cross transmission of micro organisms and communicable diseases. This is theoretically and realistically possible with the use of multifaceted interventions, continuous monitoring and re-evaluations. Positive results have been achieved with the use of multifaceted on-going interventions.
References
Beyea, S. (2003). Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operated faucets. Association Of Operating Room Nurses. Aorn Journal, 77(3), 671. Retrieved November 9, 2004, from ProQuest Nursing Journals database.
Canadian Centre for Occupational Health and Safety. (November, 2004). Hand Washing: Reducing the Risk of Common Infections. Retrieved March 5, 2005, from http://www.ccohs.ca/oshanswers/diseases/washing_hands.html
Centres for Disease Control and Prevention. (October, 2004). Hand Hygiene Guidelines Fact Sheet. Retrieved March 5, 2005, from http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
College of Nurses of Ontario. (2004, June). Practice Standard: Infection Prevention and Control. Retrieved November 7, 2004, from http://www.cno.org/docs/prac/41002_infection.pdf
Girou, E., Loyeau, S., Legrand, P., Oppein, F., BrunBuisson, C. (2002, August). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomized clinical trial. BMJ, 325(362). Retrieved November 8, 2004 from http://bmj.bmjjournals.com/cgi/content/full/325/7360/362
Grol, R., Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients' care. The Lancet, 362(9391), 1225-1230. Retrieved November 8, 2004, from ProQuest Nursing Journals database.
McGuckin, M. (2003). Hand hygiene accountability. Nursing Management, 34(4), H2. Retrieved November 8, 2004, from ABI/INFORM Global database.
Nightingale, F. (1969). Notes on nursing: What it is and what it is not. New York: Dover.
Ontario Ministry of Health and long term care. (2004, October). Public Health: Hand Washing. Retrieved November 9, 2004, from http://www.health.gov.on.ca/english/public/pub/pubhealth/handwash.html
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., Perneger, T. (2000). Hand Hygiene Campaign. Lancet, 356, 1307-1312. Retrieved November 8, 2004, from http://www.hopisafe.ch/doc/8b.doc
Public Health Agency of Canada. (2003, January). Alcohol for Hand Hygiene: New Comparative Studies Add to the Evidence Base. Retrieved November 5, 2004 from http://www.phac-pc.gc.ca/publicat/ccdr-rmtc/03vol29/dr2901eb.html
Solumed, Inc. (1998, May). Chlorhexidine Gluconate: Technical Report Review of the Literature. Retrieved November 8, 2004, from http://www.solumed.net/sm.engl/gluc.html
Wilson, S. (2004). Changing Hand Hygiene Behavior; Improving Infection Protection. The Safe Angle, 6(2),1. Retrieved November 9, 2004, from http://www.hchsa.on.ca/products/newsltrs/sa_f2004.pdf
tambour door
I decided to make a tambour door for an opening in the kitchen where the milk door used to be. This house had been built in 1974 and at that time milk was still delivered thus requiring a milk door. I have insulated and filled in the exterior hole but needed to do something with the space in the kitchen.
How I made the tambour.
Since I was not staining the door the material I used did not need to be expensive. I chose to use MDF as it is easy to find and relatively inexpensive.
I made my measurements and ripped 1/4 inch strips with the table saw. I then put double sided tape onto a solid surface with the dimensions marked for assembling the tambour. I placed the strips onto the tape ensuring the door was square and even.
I used regular wood glue to fasten the fabric to the strips of MDF. I carefully painted the glue on ensuring not to use too much then placed the fabric onto the tambour and pressed it. I allowed the glue to dry for 24 hours then removed the tambour from the double sided tape. I sanded the hole thing and then rounded all of the edges.
How I made the tambour.
Since I was not staining the door the material I used did not need to be expensive. I chose to use MDF as it is easy to find and relatively inexpensive.
I made my measurements and ripped 1/4 inch strips with the table saw. I then put double sided tape onto a solid surface with the dimensions marked for assembling the tambour. I placed the strips onto the tape ensuring the door was square and even.
I used regular wood glue to fasten the fabric to the strips of MDF. I carefully painted the glue on ensuring not to use too much then placed the fabric onto the tambour and pressed it. I allowed the glue to dry for 24 hours then removed the tambour from the double sided tape. I sanded the hole thing and then rounded all of the edges.
wallpaper
Yuk! Wallpaper everywhere. This needed to be remedied immediately also. It is a messy and time consuming job but it needed to be done. All of the wallpaper on the walls in the main floor was removed within a week of obtaining ownership of the house. This was accomplished with the help of my inlaws and lots of hot water and scraping. Wall by wall the wallpaper was removed.
Some of the wallpaper came off without much fuss but other parts required some chemical help and lots of scraping.
The resulting clean walls required a lot of finishing work but are much better now.
In the end all I can say is thank go there was no wallpaper in the living room as it is the largest room at approx 13 feet by 26 feet.
Some of the wallpaper came off without much fuss but other parts required some chemical help and lots of scraping.
The resulting clean walls required a lot of finishing work but are much better now.
In the end all I can say is thank go there was no wallpaper in the living room as it is the largest room at approx 13 feet by 26 feet.
living room
We had waited a month for possesion of the house but the time had finally came when we picked up the keys from our lawyer. We owned a house. A big house. A house that had been build in 1974 and was in need of some help.
As we walked around our house thinking about how we would like to decorate and move in we noticed a bad spot in the ceiling of the living room. It looked as though someone had tried to repair a water damaged spot. It was so bad that the decision to take the ceiling out and investigate was easily made. Before moving anything in the ceiling came out. Good thing too. After the messy removal of the stucco plaster and loose insulation we discovered that a couple of the supporting 2 X 8 's were rotted. It was obvious that at some point this house had a very bad leak and the roof had been fixed but the damage had not been fixed properly. So we bought some 2 X 8 's and glued and screwed them to the damaged ones before fixing the strapping, insulating and putting up new drywall.
The living room had origianl crown molding made of plaster and we liked it so we tried our best to keep it. This proved to increase the work involved but the end product was worth it. We had to cut around the ehole perimeter of the crown molding with a recipricating saw to make a clean edge for the drywall to be fastened and then plastered. The room is roughly 13 feet by 26 feet so this was a big job. Throughout this we tried our best not to wreck the hardwood floor.
After hours of plastering and sanding we finally were able to paint. We decided on painting the walls peppertree and leaving the ceiling white and painting all of the trimm a semi gloss white.
As we walked around our house thinking about how we would like to decorate and move in we noticed a bad spot in the ceiling of the living room. It looked as though someone had tried to repair a water damaged spot. It was so bad that the decision to take the ceiling out and investigate was easily made. Before moving anything in the ceiling came out. Good thing too. After the messy removal of the stucco plaster and loose insulation we discovered that a couple of the supporting 2 X 8 's were rotted. It was obvious that at some point this house had a very bad leak and the roof had been fixed but the damage had not been fixed properly. So we bought some 2 X 8 's and glued and screwed them to the damaged ones before fixing the strapping, insulating and putting up new drywall.
The living room had origianl crown molding made of plaster and we liked it so we tried our best to keep it. This proved to increase the work involved but the end product was worth it. We had to cut around the ehole perimeter of the crown molding with a recipricating saw to make a clean edge for the drywall to be fastened and then plastered. The room is roughly 13 feet by 26 feet so this was a big job. Throughout this we tried our best not to wreck the hardwood floor.
After hours of plastering and sanding we finally were able to paint. We decided on painting the walls peppertree and leaving the ceiling white and painting all of the trimm a semi gloss white.
University
I have completed a four year University program in nursing. I am a graduate nurse. Now if you have read my profile you also know that I am unemployed. Now you might say to yourself why is this? Is there not a nursing shortage? This is a topic that I intend to address just not in this particular posting. Stay tuned for a discussion about beginning a nursing career.
I began my post secondary education obtaining my secondary school diploma including OAC's with honors. This sadly dates me since OAC's are no longer. Throughout high school I never took any spares and therefor was able to finish quickly. Thinking back I wish I had taken some spare classes and taken the time to breath, taken time for myself. But I did not so that is enough of the should haves, would haves and could haves.
Following high school I entered into the Canadian armed forces with a Regular officer training plan (ROTP) contract. My contract was for a total of nine years. The first four were for completing a degree in civil engineering at the Royal Military College in Kingston. The other five would I would have worked as an engineer in the army. I completed Basic Training and went to RMC.
I enjoyed my time at RMC. Even though it was difficult it was a challenge and I learned many things in the atmosphere there. RMC offers only two strains of degrees either engineering or arts. I did not really think about engineering too much prior to applying but know I had no need or wish to obtain a degree in arts. After an unsuccessful first year academically I chose to honorably discharge from the Canadian armed forces. I enjoyed the military life but was not interested in engineering nor arts.
I left RMC and moved in with grandma. I had no plans as to what I was going to do, I needed to figure out what I wanted.
I decided that I would like to get into some sort of profession where I could help others. I have always been intrigued with search and rescue type jobs and thought I would try to pursue a career as a paramedic or something similar. In the end after researching the education requirements I decided to pursue a Degree in Nursing.
I applied and was accepted into the University of Ottawa four year nursing program. I have since graduated.
I began my post secondary education obtaining my secondary school diploma including OAC's with honors. This sadly dates me since OAC's are no longer. Throughout high school I never took any spares and therefor was able to finish quickly. Thinking back I wish I had taken some spare classes and taken the time to breath, taken time for myself. But I did not so that is enough of the should haves, would haves and could haves.
Following high school I entered into the Canadian armed forces with a Regular officer training plan (ROTP) contract. My contract was for a total of nine years. The first four were for completing a degree in civil engineering at the Royal Military College in Kingston. The other five would I would have worked as an engineer in the army. I completed Basic Training and went to RMC.
I enjoyed my time at RMC. Even though it was difficult it was a challenge and I learned many things in the atmosphere there. RMC offers only two strains of degrees either engineering or arts. I did not really think about engineering too much prior to applying but know I had no need or wish to obtain a degree in arts. After an unsuccessful first year academically I chose to honorably discharge from the Canadian armed forces. I enjoyed the military life but was not interested in engineering nor arts.
I left RMC and moved in with grandma. I had no plans as to what I was going to do, I needed to figure out what I wanted.
I decided that I would like to get into some sort of profession where I could help others. I have always been intrigued with search and rescue type jobs and thought I would try to pursue a career as a paramedic or something similar. In the end after researching the education requirements I decided to pursue a Degree in Nursing.
I applied and was accepted into the University of Ottawa four year nursing program. I have since graduated.
First blog, first post...
As I sit at my dest contemplating what to say I am overwhelmed with thoughts.
I have recently been "blessed" with free time. In other words I am currently unemployed and bored.
I decided to put some of my personal thoughts and experiences on paper for others to read. If nothing else this will be a venue for dumping my fears and frustrations as well as my successes and accomplishements.
Please enjoy and feel free to email any comments.
I have recently been "blessed" with free time. In other words I am currently unemployed and bored.
I decided to put some of my personal thoughts and experiences on paper for others to read. If nothing else this will be a venue for dumping my fears and frustrations as well as my successes and accomplishements.
Please enjoy and feel free to email any comments.
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