Policy Effects with Exchange Rates

Nouns in Spanish and How They Are Used

Nouns in Spanish and How They Are Used Nouns are an essential part of speech in Spanish and English and can be found in most sentences. Definition of ‘Noun’ In English and Spanish, a noun is a word that refers to and names a person, place, thing, concept, entity, or action. By itself, a noun does not indicate any action or indicate how it relates to other words. Grammatically, a noun can serve as the subject of a sentence or the object of a verb or preposition. Nouns can also be described by adjectives or replaced by  pronouns. Similarities and Differences Between Nouns in Spanish and English Nouns function in much the same way in Spanish and English. They typically but not necessarily come before a verb and relate to other parts of speech in similar ways. They can be singular or plural. But there are at least three major differences: Spanish nouns have gender. Nouns listed as such in dictionaries are either masculine or feminine. The designation is often arbitrary - some words associated with males are feminine, and a word such as persona (person) is feminine whether it refers to males or females. Some words can be masculine or feminine depending on the meaning. The significance of gender is that masculine nouns are accompanied by masculine adjectives, and feminine nouns use feminine adjectives.Complete sentences in Spanish do not need nouns (or even pronouns)  if the meaning remains clear without them, in part because verb conjugation and gendered adjectives give more information about the subject in Spanish than they do in English. For example, rather than saying Mi coche es rojo for My car is red (coche is the word for car) you could say merely Es rojo if its clear what youre talking about.In English it is very common for nouns to function as adjectives; such nouns are called attributive nouns. For example, in dog leash, dog is an attributive noun. But with rare exceptions, Spanish connects the descriptive noun to the main noun using a preposition, often de. Thus a dog leash is either correa de perro (literally, leash of dog) or correa para perros (leash for dogs). Types of Spanish Nouns Spanish nouns can be classified in numerous ways; six types are listed below. The categories listed here are not exclusive - most nouns in fact fit into more than one category. And since Spanish and English both come from Indo-European, these categories apply to English as well. Common nouns are the most common type of noun. A common noun refers to things, being or concepts without referring to a specific one of them. For example, humano (human) is a common noun, but Catrina is not, because it refers to a specific human. Other examples of common nouns include ordenador (computer), valle (valley), felicidad (happiness), and grupo (group).Proper nouns refer to a specific thing or being. As in English, Spanish proper nouns are typically capitalized. Examples of proper nouns include Casa Blanca (White House), Enrique (Henry), Panam (Panama), and Torre Eiffel (Eiffel Tower). Some nouns can be either common or proper, depending on the context. For example, Luna is a proper noun when referring to the moon that circles the Earth (note the capitalization), while luna is a common noun when it refers to a planetary satellite in general.Countable nouns refer to entities that can be counted. Examples include casa (house), loma (hill), mà ³vil (cellphone), and nariz (nos e).Uncountable nouns, sometimes called partitive nouns, refer to things that cant be counted, such as concepts. Examples include tristeza (sadness), indignacià ³n (anger), and opulencia (opulence). Many nouns can be countable or uncountable depending on how they are used. For example, leche (milk) is countable when it refers to types of milk but uncountable when referring to quantities. Collective nouns are used to represent a group of individual nouns. Examples of collective nouns include rebaà ±o  (flock),  multitud (multitude), and equipo (team).Abstract nouns refer to qualities or concepts rather than things or beings. Examples include inteligencia (intelligence), miedo (fright), and virtud (virtue). Key Takeaways Nouns in English in Spanish function in sentences in very similar ways and can be classified in the same ways.A key difference between the nouns of the two languages is that Spanish nouns have gender.Pronouns sometimes substitute for nouns, and in Spanish subject nouns are frequently omitted from complete sentences.

Operational Management Business Plan of a Special Event Essay

Operational Management Business Plan of a Special Event - Essay Example Siegel (2009, Pg. 21) says that this domain constitutes an important and critical part of business that governs the efficiency and quality with which products are manufactured or services are provided and involves numerous human intensive procedures. In fact, operations management also encompasses the effective distribution and supply of goods to customers. The history of operations management can be traced back to the Second World War when various researchers undertook complex studies to understand the various basic processes that influenced the course of army operations such as logistics, troop movement, supply routes etc (Pycraft, 2009, Pg. 43). This extensive focus on analyzing the pattern of military operations led to the evolution of military systems and provided the much needed insight into understand multilateral and interdisciplinary process that constitute the field of operations research. The discipline of operations research thus encompasses various scientific domains and depends on solutions like statistics, modeling and structured algorithms to provide some useful answers to complex problems that pertain to various business processes and operations within an organization. In this context, operations research does not rely much on considering the exact nature or area of specialization of the organization. According to McMahon (2007, Pg. 87), the sole purpose of employing operations research methods is to determine a scientific answer to a given complex scenario that can enhance the performance of the company and thus requires the collaboration of experts from several disciplines to understand the problem from a quantitative perspective. Thus, operations research provides numerous tools, methods and procedures that help solve many issues pertaining to operations management (Wagen, 2009, Pg. 63). Operations management is also influenced by industrial engineering that helps understand a given problem area from an engineering perspective and develop re quisite solutions. The current paper describes the usefulness of operations management in organizing special events like seminars and conferences. Various issues pertaining to event management like planning, purchasing, inventory management, logistics, budgeting and quality will be considered when describing the applicability of operations management to this particular business area. The manner in which different components work together in organizing a successful event and the role of operations management in reducing costs and ensuring profitability has been highlighted. Specifically, the paper discusses the usefulness of operations management in organizing a networking event for reputed firms such as an investment bank. Investment banks regularly organize such events to interact with potential customers, forge new contacts with major players in different industries and strengthen relationships with existing customers. Typical attendees to these events included high profile repres entatives from several prominent companies operating in various industries. Role of operations management in organizing events A networking event, such as the one discussed in this paper, is not just a luxurious business party, but is in fact an important marketing exercise for investment banks that is aimed at promoting their services through personal interaction with potential clients. While the event has to display the reputation and prominence of the investment bank, the primary goal of the event

Literature review on ethical issue between employees and their Essay

Literature review on ethical issue between employees and their manegars - Essay Example The daily interaction, collaboration and interpersonal relationships required from managers and employees create tensions and issues that are considered normally pervading the working environment. Apart from operational concerns, managers and employees are faced with contrasting beliefs, values and preferences that occur because of the diversity in personalities, traits, cultural orientations and demographical factors that form each individual in the organization. These beliefs fall under ethical issues in business, defined as â€Å"â€Å"the principles and standards that guide behavior in the world of business† (Ferrell, Fraedrich & Ferrell, 2009, 6). In this regard, the current study aims to proffer a review of related literature on the subject of ethical issues between managers and employees. The theoretical framework and impetus for the review came as a result of an interview with a legal researcher for the Saudi – Central Bank, who identified problems which are et hical in nature and existed in their organization, currently affecting job satisfaction and productivity of employees. Ethical Issues in Business Organizations Ethical behavior have been identified to manifest actions that are â€Å"morally accepted as "good" and "right" as opposed to "bad" or "wrong" in a particular setting† (Sims, 1992, 506). ... According to Martires and Fule (2004), the culture of an organization influences the ethical climate that pervades. Organizational culture is a set of symbols, myths, ceremonies that reflect the underlying values and beliefs of the organization or its work force. This statement is supported by Hunt (1991) and Schneider and Rentsch (1991) who emphasized that there are factors that influence diversity in ethical climates of organizations, to wit: â€Å"personal self-interest, company profit, operating efficiency, individual friendships, team interests, social responsibility, personal morality, rules and standard procedures, and laws and professional codes† (cited in Sims, 1992, 510). As such, more detailed ethical issues facing human resources in organizations, particularly between managers and employees, are revealed by CiteHR (n.d.) to wit: (1) â€Å"discrimination issues include discrimination on the bases of age (ageism), gender, race, religion, disabilities, weight and att ractiveness; (2) issues surrounding the representation of employees and the democratization of the workplace: union busting, strike breaking; (3) issues affecting the privacy of the employee: workplace surveillance, drug testing; (4) issues affecting the privacy of the employer: whistle-blowing; (5) issues relating to the fairness of the employment contract and the balance of power between employer and employee: slavery, indentured servitude, employment law; and (6) occupational safety and health† (CiteHR, n.d., par. 1). In the case of the legal researcher for the Saudi – Central Bank, the ethical issue that existed between managers and employees was manifested in the way the manager discriminated against underperforming employees which further

Endotracheal Intubation to Supraglottic Airway Device

Endotracheal Intubation to Supraglottic Airway Device Discussion Response 1 Much debate has occurred recently about high failure rates and adverse effects associated with pre-hospital paramedic endotracheal intubation. Should ETT be removed entirely and replaced with supraglottic airways? Maintaining an airway in a safe and effective manner is critical in pre-hospital management of the patient in respiratory distress. The debate regarding the most appropriate device to manage this situation in the pre-hospital setting will continue as devices and education and training of paramedics continues to improve. This discussion compares the failure rates and adverse effects of endotracheal intubation to supraglottic airway devices and discusses the possibility of removal of endotracheal tubes in favour of the use of supraglottic airways. The indications for endotracheal intubation for Victorian Paramedics are cardiac arrest, respiratory arrest, GCS greater than or equal to 10 with suspected airway burns (a consult is required), GCS less than 10 due to respiratory failure, neurological injury, overdose, status epilepticus, hyperglycaemia with blood glucose level reading high or suspected airway burns. The paramedic requires clinical experience to recognise the 5 main indicators for intubation failure to ventilate, failure to oxygenate, inability to protect against aspiration, inability to maintain airway patency or predicting patient deterioration to respiratory failure (Lafferty Dillinger, 2016). Intubation success rates range from 69% to 98.4% the variation accounts for the level of education, training and case exposure. The success rate or lack thereof is directly proportional to the amount of education, training and case exposure received (Jacobs Grabinsky, 2014 and Piegeler, et al., 2016). In Australian studies it was found that Victorian HEMS based paramedics who underwent extensive training that included hospital based practice (Bernard S. A., et al., 2015) attained 97% (Bernard S. , Smith, Foster, Hogan, Patrick, 2002) 100% (Andrew, et al., 2015) success rate. These intubations showed improvements with oxygen saturation, end tidal carbon dioxide levels, blood pressure (Bernard S. , Smith, Foster, Hogan, Patrick, 2002) and pain scores (Andrew, et al., 2015). There is a recommendation from the European Resuscitation Council that only well trained and experienced paramedics should perform endotracheal intubation and alternate airway devices should be used by less trai ned paramedics (Schalk, et al., 2012). Failure to maintain competency of this skill increases the risk of errors eliminating the benefits of endotracheal intubation and results in a negative patient outcome (Tiah, et al., 2014). Endotracheal intubation is performed to ensure adequate ventilation and oxygenation also to avoid aspiration of gastric contents or blood during cardiopulmonary resuscitation (Piegeler, et al., 2016) and when the airway is threatened due to oedema in the setting of facial burns or suspected inhalation burns (Price Milner, 2012). Improved patient outcomes were demonstrated when endotracheal intubation was successfully achieved compared to those with a supraglottic device, there was a higher incidence of return of spontaneous circulation, survival to hospital admission, neurologically intact, survival to hospital discharge. (Benoit, Gerecht, Steuerwald, McMullan, 2015). Temporary harm from airway management is common however serious injury is not (Cook MacDougall-Davis, 2012). Complications attributed to endotracheal intubation are commonly hoarseness and sore throat, however patients can also experience lip swelling, laceration and bleeding, tongue laceration and bleeding, oral bleeding, dental damage, gingival bleeding, and pharyngeal bleeding (Toda, Toda, Arakawa, 2013). Failed intubation is associated with oxygen desaturation, hypertension, admission to ICU and complications at extubating (Cook MacDougall-Davis, 2012). The risks associated with out of hospital endotracheal intubation are pulmonary aspiration, delay in transport due to several attempts, tube misplacement or difficult airway management. In these cases, where an invasive and time consuming technique may delay definitive care it may be more appropriate to utilise a supraglottic airway device as an alternative (Piegeler, et al., 2016). The indications for the use of a supraglottic airway device are unconscious patient without gag reflex, ineffective ventilation with BVM and oro- or nasal-pharyngeal airway, predicted greater than 10 minutes assisted ventilation required, or unable to intubate or difficult intubation (Ambulance Victoria, 2016). Many studies indicate a less than 1% failure rate of supraglottic airway devices (Cook MacDougall-Davis, 2012) this is due to the lower education and training requirement and the device being less invasive (Jacobs Grabinsky, 2014). The failure rates were contributed to airway soiling and aspiration before paramedic treatment commenced. Proficiency of use is quickly attained (Haske, Schempf, Gaier, Niederberger, 2013), the device is faster to insert with higher success rate (Duckett, Fell, Kimber, Taylor, 2014) decreasing interruptions during a cardiac arrest and ventilation is possible with continuous compressions (Haske, Schempf, Gaier, Niederberger, 2013). The i-gel is a 2nd generation supraglottic airway device that exerts very low pressures on the pharyngeal mucosa resulting in low incidence of airway complication such as hoarseness and sore throat (Michalek, 2013). The major concerns of the use of any supraglottic airway device is the potential for air leak, airway, vocal cord and soft tissue injury, hypoxemia, and hypercapnia (Jacobs Grabinsky, 2014) and aspiration of gastric contents (Piegeler, et al., 2016). This generation of device is designed with a channel to insert a gastric tube to drain the stomach contents or air (Michalek, 2013) to prevent aspiration. Comparing placement success and time to ventilate when comparing unassisted endotracheal intubation and supraglottic airway device (Frascone, et al., 2011), hospital admission and survival to hospital discharge, and neurological or functional status (Tiah, et al., 2014) there is no significant difference between the two types of devices (Frascone, et al., 2011 and Tiah, et al., 2014). In the metropolitan setting of paramedic practice there is a solid argument for the cessation of endotracheal use in favour of a supraglottic device. The low level of education and training required to ensure proficiency, fast insertion time and the addition of the gastric tube channel along with the shorter transport times to definitive care indicates that a supraglottic airway is most appropriate airway device. References Ambulance Victoria. (2016). Clinical Practice Guidelines for Ambulance and MICA Paramedics (Revised Edition ed.). Doncaster, Victoria, Australia: Ambulance Victoria. Retrieved March 19, 2017 Andrew, E., de Wit, A., Meadley, B., Cox, S., Bernard, S., Smith, K. (2015, July/September). Characteristics of patients transported by a paramedic-staffed helicopter emergency medical service in Victoria, Australia. Prehospital Emergency Care, 19(3), 416 424. doi:10.3109/10903127.2014.995846 Benoit, J. L., Gerecht, R. B., Steuerwald, M. T., McMullan, J. T. (2015). Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arret: A meta-analysis. Resuscitation, 93, 20 26. doi:10.1016/j.resuscitation.2015.05.007 Bernard, S. A., Smith, K., Porter, R., Jones, C., Gailey, A., Cresswell, B., . . . St Clair, T. (2015). Paramedic rapid sequence intubation in patients with non-traumatic coma. Emergency Medicine Journal, 32, 60 64. doi:10.1136/emermed-2013-202930 Bernard, S., Smith, K., Foster, S., Hogan, P., Patrick, I. (2002, December). The use of rapid sequence intubation by ambulance paramedics for patients with severe head injury. Emergency Medicine Australasia, 14(4), 406 411. doi:10.1046/j.1442-2026.2002.00382 Bernhard, M., Mohr, S., A., W. M., Martin, E., Walther, A. (2012, February). Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiologica Scandinavica, 56(2), 164 171. doi:10.1111/j.1399-6576.2011.02547 Cook, T. M., MacDougall-Davis, S. R. (2012). Complications and failure of airway management. British Journal of Anaesthesia, 109(S1), i68 i85. doi:10.1093/bja/aes393 Duckett, J., Fell, P., Kimber, C., Taylor, C. (2014). Introduction of the i-gel supraglottic airway device for prehospital airway management in a UK ambulance service. Emergency Medicine Journal, 31, 505 507. doi:10.1136/emermed-2012-202126 Frascone, R. J., Russi, C., Lick, C., Conterato, M., Wewerka, S. S., Griffith, K. R., . . . Salzman, J. G. (2011). Comparison of prehospital insertion success rates and time to insertion between standard endotracheal intubation and supraglottic airway. Resuscitation, 82, 1529 1536. doi:10.1016/j.resuscitation.2011.07.009 Haske, D., Schempf, B., Gaier, G., Niederberger, C. (2013). Performance of the i-gel during pre-hospital cardiopulmonary resiscitation. Resuscitation, 564, 72 77. doi:10.1016/j.resuscitation.2013.04.025 Jacobs, P., Grabinsky, A. (2014, January March). Advances in prehospital airway management. International Journal of Critical Illness and Injury Science, 4(1), 57 64. doi:10.4103/2229-5151.128014 Lafferty, K. A., Dillinger, R. (2016, December 30). Rapid Sequence Intubation. (R. P. Byrd, Ed.) Retrieved March 19, 2017, from Medscape: http://emedicine.medscape.com/article/80222-overview#a1 Michalek, P. D. (2013). The I-Gel Supraglottic Airway. Nova Science Publishing Inc. Retrieved March 3, 2017, from http://ebookcentral.proquest.com/lib/vu/detail.action?docID=3022405 Piegeler, T., Roessler, B., Goliasch, G., Fischer, H., Schlaepfer, M., Lang, S., Ruetzler, K. (2016, May). Evaluation of six different airway devices regarding regurgitation and pulmonary aspiration during cardiopulmonary resuscitation (CPR) A human cadaver pilot study. Resuscitation, 102, 70 74. doi:10.1016/j.resuscitation.2016.02.17 Price, L. A., Milner, S. M. (2012). The totality of burn care. Trauma, 15(1), 16 28. doi:10.1177/1460408612462311 Schalk, R., Auhuber, T., Haller, O., Latasch, L., Wetzel, S., Weber, C. F., . . . Byhahn, C. (2012, January). Implementation of the laryngeal tube for prehospital airway management: training of 1,069 emergency physicians and paramedics. Der Anaethesist, 61(1), 35 40. doi:10.1007 Tiah, L., Kajino, K., Alsakaf, O., Bautista, D. C., Ong, M., Lie, D., . . . Gan, H. N. (2014, November). Does Pre-hospital Endotracheal Intubation Improve Survival in Adults with Non-traumatic Out-of hospital Cardiac Arrest? A Systematic Review. Western Journal of Emergency Medicine, XV(7), 749 757. doi:10.5811/westjem.2014.9.20291 Toda, J., Toda, A. A., Arakawa, J. (2013, October 17). Learning curve for paramedic endotracheal intubation and complications. International Journal of Emergency Medicine, 6(38). doi:10.1186/1865-1380-6-38

Harvey Wasserman’s ‘Robber Baron’: Criticizing Essay

â€Å"Robber Barons† Harvey Wasserman’s â€Å"Robber Baron† is a harsh critic of not only legendary titans in the American business history, but also of the politics and politicians of the Gilded Age. In his monograph, the images of â€Å"robber barons†, corrupt politicians and laissez-faire government is conjured in the era wherein many important sectors of the American economy were dominated by a handful of firms as cut-throat business competition were compounded by frequent economic contractions that gripped the nation. Wasserman accused the captains of industry of financial trickery and of political corruption with the bribing of legislatures, and attacking them for the inhumane treatment of labor which included the imposition of heavy hours, unhealthy working conditions and using cheap immigrant labor to undercut wage rates. But above all, Wasserman condemned them as merciless monopolists who engaged in ruthless competition by choking off rivals using railroad rebates, controlling raw materials and money supply, and the forced purchase of competing firms. According to Wasserman, Carnegie, Rockefeller, Morgan, and Vanderbilt all had something in common – they were all â€Å"Robber Barons† who monopolize the railroad, petroleum, banking, and steel industries, profiting massively and gaining personally, but not doing a whole lot for the common wealth. Many of the schemes and techniques that are used today to rob people of what is rightfully theirs, such as pensions, stocks, and even their jobs, were invented and used often by these four men. Wasserman’s narrative relentlessly pursue troubling and crippling side effects of the Gilded Age: high levels of political corruption, the arrogance of global economic power, the twisting of the U. S. tax code, and the voter belief in the captivity of government to private interests. But is it fair to consummate in totality, as per Wasserman, these early industrialists as â€Å"robber barons† and the business practices of the Gilded Age as completely corrupt and pointless? The stereotype is indeed irresistible, especially so that it resonates in our time with the Enron, WorldCom and other corporate debacles. But nonetheless, Wasserman’s critique of capitalism is one-sided and obscures other dimensions of corporate activity and opportunity during the era. Take for instance, the doubling of the number of farms and the amount of land in cultivation during the period, the increased size of the workforce, especially in the manufacturing sector, the increased railroad track mileage and the swelling of steel production – all pointed to a surging Gross National Product (GNP). With increased life expectancy, economic data proved that industrialization indeed did raise the standard of living for the majority of Americans during that era. The railroads that became the point of contention between business moguls, was the definite symbol of industrialization as it lowered the cost of shipping freight, which in turn permitted the reduction in the prices consumers paid for food and durable items, thus creating the evolution of national markets that stimulated new levels of competition, opportunity and further growth. Although it still remains an endless debate as to the exact preposition that beholds the likes of Carnegies, Rockefeller, Morgan and Vanderbilt, it is beyond doubt that corporations, a number of which were owned by these men, were the engines of economic growth. In the 40 years following Appomattox, the United States amazed European investors and bankers with the speed at which she changed from a backward agricultural republic to the most powerful industrial force in the world. During the years of the so-called â€Å"robber barons†, America outpaced other nations by large margins when it came to growth in per-capita income, industrial production and rising values generally. Moreover, the Gilded Age also saw economic participation at all levels of society, including numerous previously disenfranchised constituencies. Thus, it is worth noting, Wasserman’s narrative, along with that of Charles Beard and Matthew Josephson (the original creator of the â€Å"robber barons† dichotomy), needs a further reassessment. From Wasserman’s narrative, it is easy to reach the conclusion that the post Civil War program providing subsidies to western railroads was a disaster, a way of transferring millions of the people’s wealth to a few politically well-connected plutocrats. Seemingly, it would have been attempted. But when all the dust settled, the United States did have a transcontinental railroad. Without the offer of mammoth government subsidies, such railroad construction would not have happened for decades.

Compassion fatigue in nursing and how it relates to home health nurses Essay

Compassion fatigue in nursing and how it relates to home health nurses Introduction                   Compassion fatigue is the psychological, spiritual, and bodily exhaustion of nurses, especially those that provide care to patients suffering from high levels of physical and emotional pain (Anewalt, 2009). The phenomenon has been reported in many specialized lines of nursing care, including emergency care, cancer care RNs and casualty staffs (Lombardo & Eyre, 2011). Compassion fatigue has been commonly reported in Care giving nurses, as a unique burnout that limits their ability to show compassion or perform excellently in other spheres of care delivery. The phenomenon of compassion fatigue has been commonly reported among the nurses that provide care at home, especially where the nurse feels that they are not able to stop the pain of their patient (Yoder, 2010). The feelings of being desperate about the inability to manage or halt the suffering of the patient trigger the feelings of distress and guilt among the doctors and patients (Ward-Griffin, St-Am ant & Brown, 2011). This paper will explore the phenomenon of compassion fatigue among the nurses that provide care at home, and the relevance of the subject to nursing practice. Significance and background of Study                   There have been concerns that the nurses that provide home health care to parents, relatives, and friends, especially those providing care to their aging parents are more vulnerable to compassion fatigue. From the Canadian and the US environment, observations include that the years of many nurses have been increasing. The increment of the average nurse’s age further implies advancements in the mean years of their parents. The advancing age of parents and relatives increases their burden of delivering home health care (Aiken, 2007; Newson, 2010). There has also been growing threat that the personal balance between the responsibilities of carrying out their duties at the hospital and caring for their aging parents has been a major issue for healthcare organizations.                   Unfortunately, there are no statistics showing the prevalence of double-duty delivery of care among these nurses. In the current study, the phenomenon of double-duty is conceptualized as working in a healthcare organization or setting, and then offering care at home, to parents or other relatives. However, the studies in the area, give indications that between one-third and half the number of nurses care for their aging relatives and friends (Ward-Griffin et al., 2009). Taking into account that the problem of an aging nursing population and the necessity to provide care to aging relatives correspond with one another. It became apparent that studying the issue of compassion fatigue was necessary (Ward-Griffin et al., 2009; Hsu, 2010). The problem of compassion fatigue in care delivery                   Compassion fatigue is often the effect of finding distinctive constraints in the way of care delivery, whether the limitations are of a psychological, institutional or personal nature (Epstein & Hamric, 2009). These constraints are those that are likely to hinder the process of care delivery, because they inhibit the capacity to do what is considered morally right. One of the individual-based manifestations of the phenomenon includes the feelings of anger, aggravation and guilt/ self-blame, at being unable to deliver maximum care of the sickly or aged patients at home. The root causes of the problem in a nurse’s work and professional life include the self-professed violation of professional or individual-based responsibilities and core values. The problem is usually overtly expressed or manifested, whenever it coincides with the experience of being inhibited from taking the decision and/or action that is thought of, as ethically appropriate.                   From a personal point of view, as a nursing practitioner, the principal values that I feel that I must devote myself to, including my God, family, work, and community. Among the four top focal points that demand my attention emotionally and physically, I have the inherent feeling that is serving the requirements of God and my family are the first priorities, because these social spheres are irreplaceable. The delivery of service to my workplace and the community is different, in that it is a personal choice. For example, it is personal, whether I am satisfied with the work offered by a healthcare facility. The same situation applies to the community of residence because the lack of satisfaction with the social fabric or the values of one society can be solved by moving into another one. One of the unfortunate events that demonstrated the experience of compassion fatigue, was the case that forced me to call in an oncologist friend, so that she could deliv er care to my mother, after I was called in for an emergency at the healthcare centre (McCarthy & Deady, 2008). After being called for the emergency duty, I tried to avoid the task so that I could deliver care to her, but it was unfortunate that the hospital reported having attempted to reach other nurses unsuccessfully.                   At that point, the decision and the emotional turmoil resulted from the feelings that I would be turning away from delivering the best care that I wanted my mother to receive. The home health (personal) responsibility also had to be balanced off with the need to provide care to the at-risk patient facing the risk of death at the hospital. At the end of the ordeal, I had to call the friend, so that she could check on my mother, as I rushed to the hospital to save the patient under emergency care (McCarthy & Deady, 2008). The phenomenon has also been apparent in the cases where I have had to be called in for the facility, while delivering care to the home health clients that have contacted me to offer care outside my official hours of work (Hamric & Blackhall, 2007). Knowledge development around the problem of Compassion fatigue                   In order to continue to develop knowledge for practice improvement in this core area of service delivery, I will explore the fields of nursing that are at higher risks of suffering from compassion fatigue. One of the studies that have been instrumental, and one that will continue to be, is that by Bourassa (2009). The study pointed out that some nursing groups are more vulnerable. The groups that are at a higher risk of suffering from compassion fatigue include social workers, support staff for the victims of domestic violence, oncologists, genetic consultation nurses, and palliative care nurses (Bourassa, 2009). Through the study of the various fields of nursing care delivery, I discovered that they all share some common characteristics, including that they are caregivers for vulnerable groups. The sources of the compassion fatigue are that they all tend to internalize the suffering of the patients suffering from life-threatening conditions and the abus es experienced by the victims of ill-treatment. Other groups that are at high levels of vulnerability to developing compassion fatigue include those that deliver care to helpless patients. These lines of nursing care include those working in the conditions of mental care; end-of-life and pediatrician care (McCarthy & Deady, 2008).                   Towards developing more knowledge and exposure in the professional skills and the discipline needed to deal with the problem of compassion fatigue, I have enrolled in courses on compassion fatigue. Apart from starting a course on compassion fatigue, with the Traumatology Institute, I have joined their professional network, which offers its members with updated information from practice-based research and changing practice dynamics (Traumatologyinstitute, 2014). Further, from a study done by Potter and colleagues (2013), it was found that the training and development delivered through compassion fatigue hardiness courses were effective in increasing a nurse’s knowledge stock. More importantly, the study reported that the programs were effective in improving the nurse’s ability to counter the adverse effects of compassion fatigue. The findings of the study showed that secondary trauma effects reduced drastically, immediately after starting th e resiliency training. Therefore, this will be another important source of education and development, as well as knowledge development for more advanced care delivery. The measures of progress will be the number of training hours accessed, and the scores attained on a variety of scales. This includes the â€Å"IES-R (Impact of Event Scale-Revised) and the ProQOL (professional Quality of Life† levels (Potter et al., 2013). The ProQOL measurement model will be the most critical test, and the analysis tool is included as an appendix at the end of this paper (Baranowsky & Gentry, 2010). Outside resources for knowledge development                   Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncol Nurs Forum, 40 (2), by Potter and colleagues will be an imperative resource for improving my knowledge of compassion fatigue and updated care models. The source will be very helpful because it has reported the effectiveness of resiliency training, which is an important piece of my quality improvement plan.                   The Traumatology Institute, apart from being the provider of the courses I plan to take, on compassion fatigue is paramount. The benefits to be enjoyed from being a member of the institute include that I will get access to their periodic publications, which reported evidence and practice-based findings and information (Traumatologyinstitute, 2014). Potential barriers to knowledge development                   The first primary hindrance is lacking enabling resources and structures. For example, at the health facility I am attached to, there are no resources that can offer useful information on compassion fatigue (Shariff, 2014). The second barrier is monetary, because my finances will limit me from joining more professional institutions and courses like Traumatology Institute. Conclusion                   Compassion fatigue has been defined in many ways, but its key features are psychological and physical exhaustion, due to the provision of care to patients or groups suffering from high levels of pain and suffering. The phenomenon is common among oncologists among other lines of nursing. The issue is crucial to my practice, as a nurse, because I often encounter conflicts between caring for my family and meeting professional demands. Towards the expansion of the knowledge developed around the issue of compassion fatigue, I have joined a learning institution and will be self-administering tests to gauge my levels of compassion fatigue. References Aiken, L. (2007). U.S. Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency. Health Serv Res, 42 (3 PT 2), 1299-1320. Anewalt, P. (2009). Fired up or burned out? Understanding the importance of professional boundaries in home health care hospice. Home Healthcare Nurse, 27 (10), 591-597. Baranowsky, A.B., & Gentry, E.J. (2010). Trauma Practice, Tools for Stabilization and Recovery (2nd Ed). Oxford: Hogrefe Publishing. Bourassa, D.B. (2009). Compassion fatigue and the adult protective services social worker. Journal of Gerontological Social Work, 52, 215-229. Epstein, E., & Hamric, A. (2009). Moral Distress, Moral Residue, and the Crescendo Effect. J Clin Ethics, 20 (4), 330-342. Hamric, A. B., & Blackhall, L. J. (2007). Nurse-Physician Perspectives on the Care of Dying Patients in Intensive Care Units: Collaboration, Moral Distress, and Ethical Climate. Critical Care Medicine, 35 (2), 422-429. Hsu, J. (2010). The relative efficiency of public and private service delivery. World Health Report (2010) Background Paper, 39, 4-9. Lombardo, B., & Eyre, C. (2011). Compassion Fatigue: A Nurse’s Primer. The Online Journal of Issues in Nursing, 16(1), 1-8. McCarthy, J., & Deady, R. (2008). Moral Distress Reconsidered. Nursing Ethics, 15(2), 254-262. Newson, R. (2010). Compassion fatigue: Nothing left to give. Nursing Management, 41(4), 42-45. Potter, P., Deshields, T., Berger, J. A., Clarke, M., Olsen, S., & Chen, L. (2013). Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncol Nurs Forum, 40(2), 180-7. Shariff, N. (2014). Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC Nursing, 13, 20. Traumatologyinstitute. (2014). Compassion Fatigue Courses. Traumatology Institute. Retrieved from: http://psychink.com/training-courses/compassion-fatigue-courses/Ward-Griffin, C., St-Amant, O., & Brown, J., (2011). Compassion Fatigue within Double Duty Caregiving: Nurse-Daughters Caring for Elderly Parents. The Online Journal of Issues in Nursing, 16(1), 1-9. Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., Brown, J.B., & Oudshoorn, A. (2009). Development and validation of the double duty caregiving scale. Canadian Journal of Nursing Research, 41(3), 108-128. Yoder, E. (2010). Compassion fatigue in nurses. Applied Nursing Research, 23,191-197. Source document