Gibbs-Donnan Effect on Resting Membrane Potential

Gibbs-Donnan Effect on Resting Membrane Potential How the Gibbs-Donnan equilibrium conditions and diffusion through a semipermeable membrane are involved in creating the resting membrane potential Introduction The resting membrane potential (RMP) is an electrical potential difference in cells, occurring across their plasma membranes. The cytoplasm of the cell is electrically negative in comparison to the surrounding extracellular fluid, this difference in electrical charge gives rise to the RMP. The RMP is essential for the functioning of many electrically excitable cells including, neuronal cells, smooth and skeletal muscle cells, as well as cardiac myocytes, which through electrical impulses control the contractility of the heart. During this essay the generation of the resting membrane potential will be explored, including the effects of the Gibbs-Donnan equilibrium conditions, the structure and function of the plasma membrane, and how, with the diffusion of ions through a semi permeable membrane they give rise to the RMP. (Levy, N. et al.2006) Plasma Membrane The plasma membrane asserts tight control over the interstitial environment of the cell, this is achieved through the formation of a phospholipid bilayer containing protein constituents (ref). Phospholipids are distributed into two leaflets within the bilayer, with the hydrophobic portions facing inwards and the hydrophilic tails of the phospholipids facing the aqueous environment, the presence of phospholipids give the membrane its capacitance. Integral membrane proteins and ion channel proteins span the length of the membrane, like that of the Na+-K+ pump and Sodium-Potassium leak channels discussed later, which aid in the conductance of the cell membrane. The inter and extracellular surfaces of the membrane are negatively charged, due to the presence of acidic phospholipids and the anionic nature of proteins at biological pH, this negative charge on the outer membranes with respect to extra and intracellular fluid is known as the zeta potential, which causes the formation of a sma ll electrical field (ref); This electrical field works to achieve electroneutrality with opposing charged particles, and by doing so aids in the formation of concentration gradients. Changes to surface charges within the plasma membrane, such as ionic concentrations, can therefore effect the resting membrane potential and the ability of a cell to reach threshold (Sperelakis, N. 1998). Concentration gradient and Electrical Potential To understand how the flow of ions contribute to the RMP, the formation of a concentration gradient and electrical potential must first be understood. Molecules diffuse from an area of high concentration to an area of lower concentration, if two aqueous compartments separated by a membrane were formed, containing equal concentrations of the X molecule then no diffusion would occur between compartments (Figure 1). However if the concentration of X increased in compartment A, then the ion would flow down its concentration gradient into compartment B until equilibrium is reached between compartments. However diffusion is more complexed in biological compartments as ions are found in the form of cations and anions. If an X+ion was placed in compartment A, which contained a higher concentration of X+than compartment B, then X+ would again flow down its concentration gradient into compartment B, however X+ now also flows against its concentration gradient back into compartment A, due to th e electrical potential difference across the membrane, generated by the loss of cations from compartment A, causing an increase in negativity, and an increase in X+in compartment B, increasing electrical charge opposing cations (Figure 2); This movement of ions causes a potential difference to arise between compartments, increased movement of X+ down its concentration gradient, increases the potential difference, and decreases the ability of X+ to move against its electrical gradients, thus an equilibrium is reached between the concentration gradient and electrical gradient, known as the equilibrium potential (Aidley, D.1989). Gibbs-Donnan Equilibrium The cytoplasm of eukaryotic cells contain permeable ions as well as many impermeable ionised molecules that cannot penetrate the cell membrane, such as proteins, nucleic acids and glycoproteins. Many of these intracellular molecules are negatively charged at physiological pH, causing a notable effect on the concentration gradient and electrical potential of permeable cations and anions across the plasma membrane. The effect of impermeable intracellular anionic molecules therefore influences the resting membrane potential, this is known as a Gibbs-Donnan equilibrium. Again consider two aqueous compartments separated by a semi permeable membrane, compartment A contains Na+ and proteins (Pr-), compartment B contains Na+ and Cl- (Figure 3a). The semi permeable membrane is permeable to Na+, Cl- and Water but impermeable to Pr-. Compartment A and B contain 0.1 molar solutions of Na protinate and NaCl respectively, as the concentration of Cl- is higher in compartment B it diffuses down its concentration gradient into compartment A, this is turn causes the creation of an electrical potential as compartment A increases in negativity due to the anionic properties of Cl-, prompting a flux of K+ down its electrical gradient from compartment B to A. Equilibrium will eventually occur between compartments so that the concentration of Na+ and Cl- are equal (Figure 3b): [Na+]A[Cl-]A= [Na+]B[Cl-]B This is known as Gibbs-Donnan equilibrium conditions (Sperelakis, N.1998). However it must be noted from the equations that only the permeate ions satisfy the gibbs-donnan equilibrium conditions, the impermeable Pr- are not included as they are unable to diffuse and reach equilibrium (Sperelakis, N.1998). Applying the Nernst equation for either Na+ or Cl- results in a negative electrical potential, this is due to the impermeable protein ions in chamber A (Sperelakis, N.1998), these negative impermeable intracellular anions therefore contribute to the negativity of the cytoplasm in relation to the extracellular fluid, contributing to the resting membrane potential (Donnan, F). Another property of Gibbs-Donnan equilibria should be noted, looking at figure 3b it can be seen that the net concentration of NaCl in chamber A is greater than that of chamber B, this is due to the presence of protein anions in chamber A when establishing electrochemical equilibrium between ions, and is a general property of Gibbs-Donnan equilibria (Levy, N. et al.2006). Finally it is important to mention the equilibrium state of water, as previously mentioned chamber A contains a higher concentration of ions than chamber B, therefore there is a large osmotic gradient between the two chambers; This leads to a flux of water from chamber B to A, however, the osmotic effects of water influx on chamber A acts to dilute ion concentrations building up within the chamber, therefore hydrostatic pressure in chamber A would be insufficient to oppose water influx, leading to a depletion of water and NaCl ions from chamber B (Sperelakis, N.1998); However this situation does not resemble true Gi bbs-Donnan equilibrium conditions, where by the build up of osmotic pressure in chamber A would resist the further osmotic influx of water, resulting in swelling of the chamber, if it were to be enclosed, such as a living cell (Sperelakis, N.1998). If unopposed gibbs-donnan equilibrium would cause the cytoplasm of living cells to have an osmotic pressure greater than that of the surrounding extracellular fluid, as water enters cells, control over cell volume may be lost (Sperelakis, N.1998). However this is not the case due to the cells ability to transport ions (Levy, N. et al.2006). Ion transport The resting membrane potential within skeletal muscle cells is around -80mV, this is due to the differing ion concentrations between the cytoplasm and surrounding extracellular fluid (ref), this difference in ion concentrations is maintained by the active transport of ions against there electrochemical gradient, powered by metabolic energy (ref). The ion pump of most importance to preserving potential difference across the cell membrane is the Na+/K+ATPase, this pumps out three Na+ in exchange for two extracellular K+, through the hydrolysis of a membrane bound ATPase, this ratio of 3:2 leaves the cytoplasm negative in respect to the extracellular fluid, and is therefore termed an electrogenic pump (Huang, F.et al.2009). Although the Na+/K+ATPase is responsible for only a small amount of the RMP between 12-16mV in skeletal myoblasts (Sperelakis, N.1998), overtime inhibition can lead to lack of cell excitability due to the accumulation of small depolarisations. Ion Diffusion To understand how Na+, K+ diffuse across the plasma membrane causing the RMP, their intra and extracellular concentrations must be established (Figure 4). Each ion is capable of establishing a RMP, therefore the potential depends on several factors, the permeability of the membrane to each ion, the intra and extracellular concentrations of each ion and the polarity of the ions (Guyton and Hall.2000). Firstly if the membrane is only permeable to a certain ion then that ion will be solely responsible for the generation of the RMP, for example, in a nerve fibre K+ concentration is greater in the cytoplasm than the extracellular fluid, if the membrane were only permeable to K+, then K+ would diffuse down its concentration gradient into the extracellular fluid until opposed by its electrical gradient, this would leave the cytoplasm with a negative charge of around -94mV with respect to the extracellular fluid, thus K+ would be responsible for a resting membrane potential of -94mV, as this is the Nernst potential for K+ (Guyton and Hall.2000). However the RMP cannot be caused by one ion alone, as the nerve cells has a RMP of -90mV, and the Nernsts potentials for K+ and Na+ are -94mV and +61mV respectively, therefore if the RMP was caused by one univalent ion it would be equal to that of their Nernst potential (Guyton and Hall.2000). Due to the Nernst potential of K+, it can be assumed that this ion is the major contributor to the RMP, the cytoplasmic concentration of K+ is 35times higher than that of its extracellular concentration, and it diffuses through the membrane via Potassium-Sodium leak channels in which its is 100 times more permeable to than Na+ (Guyton and Hall. 2000). However Na+ also contributes to the RMP by low amounts of Na+ diffusing through the Potassium-Sodium leak channels, this small amount of diffusion leads to a ratio of 0:1 Na+ in the cytoplasm to the extracellular fluid, giving a Nernst potential of +61mV (Guyton and Hall. 2000). Using the Nernst potentials for Na+ and k+ in theGoldman-Hodgkin-Katz equationtheir contribution to the RMP can be established, this results in an internal membrane potential of -86mV (Guyton and Hall. 2000). The remaining -4mV comes from the contribution of the previously mentioned electrogenic Na+-K+ pump, leading to a RMP of -90mV in nerve fibres (Guyton and Hall. 2000). Conclusion To conclude, the RMP arises due to a combination of several factors most of which have been covered in the preceding discussions. The cell membranes structural properties allow for the capacitance and conductance of electrical charges, as well as the generation of electrical fields due to the negatively charged outer membrane, this works to aid in the formation of concentration gradients by which ions flow. In the presence of ionic species which are unable to permeate the cell membrane, such as anionic intracellular proteins, a Gibbs-Donnan equilibrium occurs, in which the distribution of permeable ions favour the intracellular environment due to the presence of impermeable anionic molecules, this disruption of ionic concentrations across the plasma membrane coupled with the presence of impermeable anionic molecules, brings about a negative intracellular environment, and thus a potential difference across the membrane. However in a closed system such as the eukaryotic cell, the Gibbs -Donnan equilibrium leads to a greater intracellular osmotic pressure, if unopposed this would lead to a loss of control over cell volume, therefore ion transporters are in place to dissipate ion concentration, like that of the Na+-K+ ATPase. The exchange ratio of 3:2 potassium for sodium respectively, performed by the Na+-K+ ATPase also contributes to the electronegative intracellular environment, and thus the resting membrane potential. The major cause of the RMP is however down to the diffusion of potassium into the extracellular fluid via Sodium-Potassium leak channels, coupled with the low extracellular diffusion of sodium and the aforementioned Na+-K+ ATPase and Gibbs-Donnan equilibrium conditions, the resting membrane potential is formed. References Sperelakis, N. 1998. Cell Physiology Source Book. Second edition. Californa: Academic Press. Aidley, D. 1989. The Physiology of Excitable Cells. Third Edition. Cambridge: Cambridge University Press. Levy, N. et al. 2006. Principles of Physiology. Fourth edition. Philadelphia: Elsevier Mosby. Huang, F. el al. 2009. Distribution of the Na/K pumps turnover rates As a function of membrane potential, temperature, and ion concentration gradients and effect of fluctuations.Journal of Physical Chemistry B113(23), pp. 8096-8102.

Can Yahoo Still Attract Tech Workers?

Can Yahoo Still Attract Tech Workers? Travis Bell Susan Knapp Presentation Techology organization are likewise searching for approaches to better theirself and their representatives. The interest for brilliant new workers in this field is high yet this is the point at which they keep running into issues. Managers are attempting to keep the product specialists they have and having issues with contracting new ones. With techolongy changing each day and consistently these organizations are discovering it is difficult to pull in the workers they require in this innovation world. It is not about getting new workers it is likewise about keeping the ones you have. These workers are searching for more pay and in the event that they discover it in another organization they may very well stopped and accept the other position. Audit/Investigation of the Case There are a wide range of organizations in the innovation world that is having these issues. Yahoo is one of those organizations and is one of the most seasoned web look organization. Starting today, Yahoo is not only a web index, they have moved into publicizing, news, and email. At the point when a recently crisp granduate understudy comes into the workforce the are seeking work for the most needed organization in innovation. Yahoo is no longer that and the representatives they do have are beginning to leave to different organizations. Yahoo has been battling with the technique for development for quite a while and there must be a few changes. The supply for work is going to new organizations like Google and Microsoft. Yahoo will need to roll out improvements in the organization to get the new understudy intrigued into the organization once more. With regards to the request they are searching for some representative and the workers they have are leaving as well. The methodology the y are utilizing is quite recently not working. Searching for newcomers will be hard for Yahoo. They will need to make quick move and roll out a few improvements within the organization. This will help with the workers they do have. The primary enormous stride would redesign the organization. Yahoo is by all accounts an organization that is passed its prime, Some may state. Making the present workers glad will get the organization great surveys and the representatives wont go to different organizations searching for an occupation. Strengthing the organization will prompt to better inward enlisting of workers. Susan Burnett, Senior compete leader of ability and association advancement, has begun on making a situation in which workers can learn new attitudes to help better themselves and the organization. These representatives with new attitudes can now climb and have more duties. The distinctive systems and preparing she is doing will reinforce Yahoos inward recuiting and may even help with getting new representatives. Another work er is not going to work for an organization if the employyes they as of now have are not cheerful. Beginning inside the organization first is ideal. Recuiting the correct representative straight out of school to come and work at Yahoo will take some imagination. Begin by utilizing a procedure in which the school will have the capacity to get some awesome expertise in an organization that has been around for quite a while. Yahoo is a built up organization and is searching for new thoughts from new faces in the organization. Additionally select in schools or colleges that cover data innovation and building projects or degree. Another point is to express Yahoo is searching for new worker to assist and develop with the organization. Synopsis and Conclusions With the free market activity of work changing not only for Yahoo but rather for all innovation organizations, they will need to think of an approach to keep the representatives cheerful and attract new agents. This will help in strengthing the team. Upbeat representatives work increasingly and fulfill different representatives. Yahoo has a major stride in front of them however putting their best foot forward and selecting in the opportune place will get yippee back on track. References Noe, R. (2013-01-17). Fundamentals of Human Resource Management, 5th Edition. [Kaplan]. Retrieved from https://kaplan.vitalsource.com/#/books/0078095654/ Yahoo! executive links learning to growth. (2017). Svenonia Blog. Retrieved 30 January 2017, from https://svenonia.wordpress.com/2011/08/31/yahoo-executive-links-learning-to-growth/

A Psychological Analysis of My Writing :: Writing Education Teaching Essays

A Psychological Analysis of My Writing "God! I've always hated this stupid shrink's office. Everything is placed so god damned precisely. Everything is so god damn clean. It's as if the bastard is striving for perfection. Strive. That's all he can do. Thinks he knows everything. Thinks he knows how I think, when even I don't know how I think..." "Man, this fellow's office is immaculate. I can't see a speck of dust anywhere. Christ, this guy is really anal. Holy Ghost! Now, I'm starting to sound like freakin' Freud. The man's got me thinking like a shrink. This isn't good. No, not at all..." "Hey! What's that!?! It's my flippin' file. The anal-retentive bastard left out my flippin' file. Well, it's about me...and I have a right to see what he's saying about me--don't I? Heck yes!" "Let's see here. What's this? Oh, it's that stupid exercise he had me do. Geez! I wrote that over twelve weeks ago. I don't know why I had to do that moronic exercise. It's like he's going to find out anything about me in a two page piece of exposition using an extended metaphor for my conception of life at a university. Jesus, I can't even remember what metaphor I used. I hope I compared the university to a colon, because of all the crap I have to deal with. Alright, maybe school isn't that bad. Well, since the shrink is usually fashionably late, I might as well read the damn thing..." -------------------------------------------------------------------------------- Last summer, a few of my friends and I went on a canoe trip in the Quetico. I had never been on a canoe trip prior to this excursion, so I only had a vague idea of what I would be subjected to on such a trip. I naively believed that the whole affair would be something like a vacation absent the amenities, but, as I soon discovered, it was anything but a vacation. At the end of our first day of paddling, I was wet and exhausted. From this rather inauspicious beginning, my vacation devolved quickly into a hellacious "forced march." You see, my friend, who planned the trip, had set a destination that he thought that we should reach by the end of the third day and that if we didn't reach this destination we couldn't claim to be men. Initially, I thought that the whole trip was a waste of time and money; I couldn't believe that anyone, masochists excluded, would want to participate in such an affair.

Graduation Speech -- Graduation Speech, Commencement Address

I'm sure everyone here has seen a picture of a mother duck leading her ducklings. Imagine the mother duck taking her ducklings up some stairs. The mother duck easily climbs the first stair and waits for the other little ducks to climb up. The first duckling stretches its wings as high up in the air as it can and stands on the tips of its little webbed feet. With a little help from its beak it manages to barely make the first step. Sometimes it requires a little help from mama duck to boost itself up. Despite the cute and rather funny part of this picture, it is possible to learn a lot from the ducks. The two ideas we can gain from them are leadership and following. In life each one of us is a leader and a follower at some point. Leadership is of key importance to the Christian, and also simply to every person. It is easy to imagine the kind of world that would ensue as a result of no leadership. There would be utter chaos and nothing positive would get done. Often we think of leaders as people with great authority such as the President of the United States, bosses of major corporations, and in the case of school, the principal and teachers. But the fact that does not readily present itself to us is that each one of us in some way or another is a leader. Everyone leads at some point in their life whether they realize it or not. Younger generations always look up to and follow older generations. Although they may not admit it, I am sure the underclassmen at our school have followed the lead and example of the Class of 2006. This is an awesome task to undertake: that of leadership. It is important to constantly remind yourself that someone is watching and following your lead. Paul wrote in 1 Corinthians 11:1, "Follow my examp... ...e tool in dealing with the problems that life throws our way. As a follower we must choose wisely who we associate with. A close group of friends can provide many things that help us along life's path in the Christian walk. Good Friends can provide support through tough times, accountability, and good fellowship. Leadership and following are not generally thought of as interconnected, though each one of us is both a leader and a follower. As a leader we must be a good example and a servant. As a follower we must choose wisely who to look up to and associate with and ultimately we must follow the perfect lead of Jesus Christ. I encourage everyone here, and especially the graduating class of 2006, to remember you are a leader, leading others to know Christ and His perfect plan for them, and a follower, learning to follow Christ and His perfect plan for ourselves.

Racial Profiling by Police Essay -- Race Racism Prejudice Essays

Racial profiling has become a severe obstacle in the U.S. today though most Americans know very little of this vital issue. Every day, people are being pulled over, harassed, and even killed for being of a certain race. There are new laws that politicians are trying to pass that promote racial discrimination. Racial profiling is immoral and does not increase public safety. Incarceration rates are a definite proof that racial discrimination occurs. â€Å"Incarceration rates in the United States have risen sharply since 1980†, stated Filip Spagnoli, â€Å"the racial distribution of inmates in the U.S. is highly negative for black Americans. Whereas they only make up 12% of the total U.S. population, they represent more than 40% of inmates† Black Americans are one of the many races that are accused of many crimes that they are innocent of and being imprisoned for them. Addy Bareiss, a five-year volunteer and worker at the ACLU of Arizona affirmed, â€Å"A 2008 report by the ACLU of Louisiana found that people of color were arrested at higher rates than their representation in the population in every town, city and parish examined† Imprisonment of innocent people has to come to a stop. When officers are focusing mainly on a certain group they overlook criminals of other races who deserve to be in prison. She also stated, â€Å"b lack and Hispanic residents were stopped, frisked, searched, and arrested by Los Angeles Police Department officers far more frequently than white residents, and that these disparities were not justified by local crime rates or by any other legitimate policing rationale evident from LAPD’s extensive data† (Bareiss, Addy). Stereotypes play a significant part of racial profiling. When officers see a black or Hispanic man... ...on=1.0>. "Jose Serrano." BrainyQuote.com. Xplore Inc, 2010. 30 November. 2010. Kennedy, Randall. "Racial Profiling Should Be Abolished." Current Controversies: Racism. Ed. Mary E. Williams. San Diego: Greenhaven Press, 2004. Opposing Viewpoints Resource Center. Gale. Raymond S Kellis High School. 29 Nov. 2010 . "Motivated Quotes." Brainy Quote. Xplore, Inc., BrainyQuote, 2001 - 2010. Web. 5 Dec 2010. . "The First 10 Amendments to the." n. pag. Web. 2 Dec 2010. . Spagnoli, Filip. http://filipspagnoli.wordpress.com/stats-on-human-rights/statistics-on-freedom/statistics-on-prisoner-population-rates/

Organizational Ethics Issue Resolution Paper Essay

This paper aims to describe an ethical issue and apply it to six ethical decision making steps namely issue clarification, stakeholder analysis, values identification, issue resolution, addressing objections and resolution implementation. Main Body The ethical issue that will be discussed is giving out unacceptable levels of air and water pollution during the production process by an organization’s factories. In order to effectively resolve the issue, the organization needs to change its production processes so that its social cost is not that high and at the same time the organization will profit from it. Issue Clarification The first step in resolution of organizational ethics issue is to properly defining the problem in detail and discussing it with all the related members of the organization. The definition must be clear, specific and based on the best available information. Then all the people who are getting affected by this issue must be identified. Once this is done, the consequences of this issue must be discussed in detail. Another very important matter that must be dealt with is information needs. This will help the organization understand the nature of the issue at hand. Lastly, the importance of solving this issue must be evaluated so that it can be given a priority. (Michigan State University Extension, 1994) In our case, the issue at hand is pollution. The company’s factories give out a lot of smoke in the atmosphere and also the rivers and canals around the factories are being contaminated by the dumping of chemical waste in them. Because of the rising problem of global warming, air pollution is an issue of great concern. The water from the rivers and canals around the factory is not usable any more. The dumping of chemical waste in the river waters has resulted in no clean water for the housing societies in the locality. After seeing all this, a lot of Non Government Organizations have suggested measures that will reduce the pollution that is given out. In addition to this, the government is also planning on imposing laws that will limit the amount of pollution that is given out. Organizations that give out pollution above the acceptable level will be heavily taxed. Those involved and who are affected include the people of the neighborhood, environmentalist, government and the society as a whole. Stakeholder Analysis Stakeholder Analysis is a process in which the Stakeholders are defined and their importance in the whole decision making process is evaluated. Stakeholders are all those groups that will affect and get affected by an organization’s decisions. Examples include government, community, employees, shareholders etc. In order to resolve organizational ethics issue effectively, it is absolutely essential for an organization to win support from these groups. There are four steps to how this procedure must be carried out. First of all, your stakeholders must be identified. Secondly, you will prioritize them and next the organization will attempt to understand their most important stakeholders (MindTools, 2008). Lastly, all the support that we can get from these stakeholders will be assessed and ways to reduce opposition from some of them will also be considered. The stakeholders involved in our case will be the public, senior executives, press, government and non-government organizations, customers, prospective customers, and lastly trade unions. This list is prioritized, the first one being the most important. They are prioritized according to the amount of interest and power they have on the organization. The stakeholders with high levels of power and interest must be managed closely and be kept satisfied. All these groups are affected by the organization’s decisions and they also have influence over these. The organization will also get support from all these stakeholders. Public will be supportive because decrease in pollution will directly benefit them. Senior executive will also supportive because through press, the company’s brand image will improve and because of this, the customers and potential customers will go for the company’s products. Lastly, we will try to understand these stakeholders and how they feel about the decision and the ethical issue. This can be done with the help of interviews and other means of communication. This understanding will help in more accurately prioritizing the stakeholders. Values identification The third step in the decision making process would be identification of the organizational values. Every organization has its own values. These values set standards according to which every individual in the organization must behave. If these standards are not set, everyone will behave according to their individual values which will disrupt the workplace’s environment. Therefore, it is essential to identify and understand the importance of these values. These values could include honesty, professionalism, teamwork, etc. These values differentiate between the right from wrong, therefore only once we have identified these values, we will be able to resolve organizational ethics issues. (National Defense University, 2006) These values will help us decide whether the issue unethical or not and if the actions of the organization are against the organization’s moral values. In our hypothetical situation, the organization will come together in order to identify its organizational values. The possible values that could be identified would be responsibility, accountability, and professionalism. The organization must realize its responsibility towards the society, be accountable for its actions and lastly be professional in the way they handle the issue at hand. Spreading of pollution by the organizations factories is unethical because it is against its ethical values. Issue resolution This includes compiling everything discussed in the first three steps to come up with a resolution which will resolve the issue. It will include a detailed solution which will cover all the aspects of the ethical issue. This is the most important step in the whole decision making process because this step outlines the complete strategic plan of the organization. After considering the issue, stakeholders and the moral values of the company, the next step is coming up with a resolution. The organization must firstly change its production process so that the pollution it is giving out can be limited. This will require a lot of capital. The Organization at this stage must decide on how this capital will raised. Also, another way of the getting rid of chemical waste that is dumped in rivers must be employed. Next, the organization should ensure that greener products are produced and recycled material should be used for packaging. It should involve the press, so that the community will know about this operation of the organization. Addressing objections The next step in decision making is one of the most difficult to handle as it involves understanding others. This step includes efficiently, powerfully, professionally and competently addressing objections to the decision or the resolution the organization has come up with. There are various groups that might object to this decision. It is the goal of the decision-makers to carefully listen and understand these objections and then addressing to them appropriately. This step is not over until the ones objecting are satisfied with the justification given to them. In our case, one important group that might object to this decision would be the senior executives or the investors who will have to provide for this new project. They might object because the capital required for this new project would be very high and they would want to be satisfied before they invest. These groups need to be assured that this project might cost a lot to the company, but in the long term, it will not only benefit the society but will also benefit the organization itself. Decreasing pollution will improve the brand image of the company which might increase its market share. Plus, in future, when the government will impose laws and taxes on giving out of pollution, the organization will benefit as they will be able to avoid it. They must be given confidence in their investment. Resolution implementation After all the five steps, one very important step is resolution implementation. The decision must be implemented in order for it to be effective. The organization officials can do so by arranging a meeting that will involve everyone working for the organization. Especially, those who are new to the organization must attend these. In this meeting, the resolution must be discussed with everyone in the organization. They must be told the drill and how the organization plans on tackling the situation. At this stage, suggestions from everyone from the organizations would be welcomed as these might help the organization to come up with a better decision. Along with this, the importance of it must be emphasized. It must be made clear that it is important to follow these guidelines at all times, otherwise serious measures will be taken against those who breech it. Finally, workers must be monitored and supervised to know if the ethical standards are being met. At the same times, the effectiveness of the measures introduced must also be checked. The workers could be given feedback on how they are doing keeping up with it, good or bad. They must be appreciated and a reward system must be developed if they manage to follow them. This will motivate them to follow the instructions without supervision in future. An ethics performance evaluation should be developed. This will look at how the organization has behaved. This would enable the organization to examine whether its actions and decisions are consistent with its purpose and moral values. (Miriam Schulman, 2008) Also training must be giving if it is required. Conclusion The new policy will definitely have a positive effect on the organization. It gives a good impression of the organization where ethics and values are of the utmost importance. It gives employees the impression that the organization is serious about meeting ethical standards. This promotes values amongst them. However, on the other hand, it may cause dissent. It could be too hard to follow. This could lead to the workers being discouraged to perform even basic work. The reactions of the employees should be positive but it could be anything depending on the code. After all the discussion, the importance for an organization to meet ethical standards is very clear. Therefore, the organization must do all it takes to meet these standards before they make a decision. During decision making, an organization will greatly benefit if it follows a systematic procedure to develop these ethical standards by following the steps given above.

Accreditation Audit Task Essay

The Joint Commission defines the Periodic Performance Review as an assessment tool created to assist health organizations improve and monitor their performance throughout the year. This tool focuses on the processes that influence patient care and safety while providing the structure for unremitting standards fulfillment. Nightingale Community Hospital is compliant with most standards as set forth by the Joint Commission. However, upon inspection and in an effort to stay focused on compliance, our standards committee has located a few discrepancies that must be resolved to maintain our accreditation with the Joint Commission. Rather than focus on the discrepancies found within each unit, we will look at the trends that affect the hospital’s compliance with the Joint Commissions recommendations regarding patient care. Armed with the trends, we will then explore staffing patterns and how they relate to patient care in order to establish a plan that will assist our hospital to minimize patient safety issues as they relate to falls, pressure ulcers, pneumonia, and the general safety of our patients. See more:  Manifest Destiny essay NON-COMPLIANT TRENDS Although the Joint Commission standards clearly define the requirements for an organization to remain in compliance with the patient care and safety criterion for accreditation, Nightingale Community Hospital’s policies are not being routinely followed throughout each unit. The policy that states verbal orders must be authenticated within 48 hours is not being followed in several units and there seems to be little, if any consistency throughout the hospital with regards to policy observations. Generally, the compliance rate in the second quarter was steady and the best of all quarters, while the third quarter compliance results were very poor. Policy must be reviewed and standards improved in order to bring the hospital into compliance. Policy that should be implemented include a form in which the nurse who takes the order must sign and date the form and place it on outside of the patients chart to alert the physician that actions are  required of him regarding this patient. Only two abbreviations were monitored in ICU, Telemetry, 3E, and 4E because they are the most frequently used forbidden abbreviations. These forbidden abbreviations are â€Å"cc† and â€Å"qd†. The audit revealed â€Å"cc† was most often used in the months of April and September. The abbreviation â€Å"qd† was used much more sparingly but was used most often during the months of June and July. The second and third quarters proved to be the quarters when the two prohibited abbreviations were used the most. To increase awareness of prohibited abbreviations, a list will be posted in the nursing station in close proximity to where the charting takes place. Nurses and nursing staff will receive education regarding the use of approved abbreviations as set forth by the Joint Commission. Additionally, everyone who documents in the patients chart will be required to sign and date the entry at the time of documentation. The pain assessment audit was another standard that was out of compliance with the Joint Commission recommendations. The ED, 3E, and PACU were the units focused on for this portion of the audit. Clearly, the Emergency Department was the least compliant throughout the year for pain assessment. This may be due to the urgency or life threatening events in which pain assessment is not a priority. Regardless of the reason for neglecting to assess for pain, it is a requirement for accreditation. Each assessment should be documented in the patient’s record of care and all personnel responsible for patient care must receive education regarding the necessity of the pain assessment. The Nurse Managers of each department has the responsibility of implementing a corrective action plan based on the particular department standard of care. The Joint Commission’s focus is on safety. At Nightingale Community Hospital, safety is also important and the policies and procedures are reviewed to ensure the hospital is compliant with the Joint Commission’s recommendations. The hospital policy for fire drills requires one drill per shift per quarter. The audit shows that there are some compliancy concerns regarding the fire drills. During third shift, for the first and third  quarters, no fire drill occurred. Also, there was no fire drill on the second shift during the fourth quarter. Obviously, there should be further study to determine the cause for the compliancy issue vs. staffing deficiencies during third shift. Additionally, each department will have a safety monitor assigned to ensure the fire drills occur as per hospital policy. The safety monitor will complete a form documenting the staff involved in the fire drill, date, and time the drill took place and will keep a copy in the safety manual to be inspe cted monthly. Other safety concerns that were identified during the PPR rounds include clutter in the hallways, smoke wall penetrations, master alarm panel for medical gasses was not tested, and the gift shop did not have the required 18† clearance from the sprinklers. The maintenance department manager will need to implement a corrective action plan and be held accountable for the discrepancies identified. Additionally, the Moderate Sedation Monthly Audit of the Endoscopy Department shows some compliancy issues regarding pre-procedure events. Mallampati classification, ASA, Sedation plan documentation, and completion of reassessment are consistently below 90% for all four quarters. However, the actions that must occur during the procedure and post procedure rated at 90% or higher with regards to the Joint Commission recommendations for compliancy. Per the Joint Commission, compliancy should idealistically be 100%, therefore, the majority of the pre-procedure events are out of compliance and a corrective action plan to improve consistency must be implemented. Patient falls continue to be a concern throughout the healthcare industry because many times the fall results in injury. Other concerns of patient safety that are addressed by the Joint Commission are related to pressure ulcers and ventilator associated pneumonia. The Intensive Care Unit had an increase in falls but no correlation was found between the numbers of falls to nursing care hours. However, ventilator associated pneumonia increased this year. Corrective actions were put into place to improve the VAP numbers. On the Oncology Unit, 3E, both falls and pressure ulcer rates  decreased. There were no trends identified with falls and ulcers in relation to nursing care hours or overtime. On 4E, patient falls and pressure ulcers increased when nursing care hours increased. To determine the causes of non-compliance, the committee should look into the events that occurred during the fourth quarter. While there are trends during the second and third quarter, the fourth quarter appears to have been when the majority of falls, pressure ulcers, and VAP’s occurred. Otherwise, hospital-wide, the trend seems to show a decrease in compliancy during the third quarter. STAFFING PATTERNS The Joint Commission depicts staffing effectiveness as ensuring a proper mix of expertise and numbers of proficient staff necessary to effectively provide for the needs of the patient population in a hospital setting. Although costs incurred due to staffing levels consume a considerable portion of the hospitals revenue, studies have shown that sufficient staffing has a direct effect on quality and safety. (Joint Commission, 2010) Dall, Chen, Seifert, Maddox, and Hogan discovered financial benefits for increasing nursing staff levels. They determined that nosocomial infections and hospital length of stays were decreased when there was adequate nursing staff available. They also determined that mortality rates decreased as a result of increased nursing staff. (Dall, 2009) Nursing hours indicate the quantity and complexity of patients for each area in the hospital. In order to determine how many nurses and other nursing staff will be necessary to care for the patients, one must determine the nursing hours per patient day. This is calculated by comparing the amount of nursing staff providing care to the total number of patients requiring care. Nightingale Community Hospital has combined staffing effectiveness with performance improvement in order to demonstrate sustained improvements throughout selected clinical units. The units selected are based on the clinical and human resource indicators such as patient population,  historical staffing issues, and input from staff and existing data. Traditionally, the clinical indicators have been falls, falls with injury, pressure ulcer prevalence, and ventilator associated pneumonia (VAP). Additionally, the human resource indicators include overtime and nursing care hours. Although the Joint Commission has not directed specific staffing levels or ratios, hospitals and other organizations are expected to ascertain their own levels with regard to their experience and history. Based on the data from 3E – Oncology, no trends were identified with regard to falls, falls with injury, pressure ulcer prevalence, nursing hours, or overtime indicators. In fact, 3E experienced a decrease in falls and pressure ulcers. This may be the result of the nursing staff focusing on these indicators due to their patient population. Also, increasing awareness, improving education, and providing a skin care representative has improved patient safety. The Intensive Care Unit (ICU) experienced an increase in falls without regard to nursing care hours. However, the unit did show an increase in ventilator associated pneumonia events. This occurred during the month of September when nursing care hours decreased. Prior months showed an increase in overtime hours for nursing staff which caused fatigue and burnout to become noticeable later. Due to increases in both falls and VAP’s, corrective actions were implemented to reduce these statistics for the coming year. The Unit, 4E, data proved just the opposite as this unit encountered increases in both falls and pressure ulcer prevalence. According to the date obtained regarding falls, it is apparent that nursing care hours showed a relational trend with falls. In other words, when the nursing care hours decreased, falls increased. In comparison, when nursing care hours increased, the falls rate decreased. Drastic increases in falls occurred during June, September, November, December and February. Nursing hours during this time averaged 15 hours per shift. It appears the overtime hours occurred as a result of the holiday season and therefore caused nursing burnout. Due to vacations, holidays, and absenteeism, nurses are often required to work overtime. This pattern is obvious again during the summer  months when accommodations for vacations are necessary. However, the opposite is true with regards to pressure ulcers vs. nursing care hours. When the nursing care hours increased, the occurrences of pressure ulcers increased as well. This is possibly caused due to increased overtime hours resulting in the fatigue and burnout. This is a perfect environment for errors or the potential to cause harm. A more extensive study in the nursing care hours must be implemented in order to establish an aggressive corrective action plan to reduce the occurrences of pressure ulcers and falls. If the study shows the nursing staff to be working overtime, additional staff may be necessary as part of the corrective action plan. Hiring additional nurses will improve patient care, result in decreased turnover rates, and lead to increased job satisfaction which will ultimately lead to positive outcomes in patient care. STAFFING PLAN Hiring and retaining an adequate number of competent nurses is the greatest challenge facing hospitals and other healthcare organizations. Nursing has to work with the human resources department to improve hiring procedures. Human resources should implement plans to recruit competent nurses with the skills and education necessary to provide the care Nightingale is known for. Human resources will perform an analysis to determine the best qualities for nursing candidates and will recruit according to that standard. Additionally, alternative plans for additional staffing during known periods of absenteeism such as vacations and holidays will be constructed. It is imperative that nursing coverage does not become impaired due to absenteeism. In order to attract and retain the best nurses, Nightingale needs to improve the benefit package. Nurses have often stated that caring for their patients is a joy, but administrative duties, non-nursing activities, and poor staffing practices results in low job satisfaction. Increased job satisfaction in turn, results in improved patient care and increased positive outcomes. Studies have shown that unhappy nurses have unhappy patients. Other strategies that Nightingale Community Hospital can implement are to encourage nurses to cross train in multiple units in order to fill positions in other units when staffing shortages occur. Inadequate staffing levels can cause considerable harm to the patients but is also a financial burden to the organization. Adverse events are more common when staffing levels are low which are associated with increased costs due to the need for more intensive nursing care. (Stanton, 2004) The Utilization Guide for the ANA Principles for Nurse Staffing suggests the use of patient classification systems. (Utilization guide for the ANA principles for nurse staffing, 2005) Utilizing a patient classification system provides guidelines for difficult staffing issues by identifying processes and procedures for improved staffing. Organizations benefit by supporting nursing judgment regarding individual patient needs, incorporating sources that reinforce standards of nursing practice, encouraging nursing participation evaluating products that may be used in staffing decision making, and champion the use of patient classification systems. Works Cited Dall, T. C. (2009). The Economic Value of Professional Nursing. Medical Care, 97-104. Joint Commission. (2010). Management of Human Resources. CAMH: Comprehensive Accreditation Manual for Hospitals, Hr-1 – HR-10. Stanton, M. R. (2004, March). Hospital Nurse Staffing and Quality of Care. Research in Action. Rockville, MD, USA: Agency for Healthcare Research and Quality. (2005). Utilization guide for the ANA principles for nurse staffing. Washington, DC: American Nurses Association.