Cell Phones Are Dangerous Essay Example for Free

Cell Phones Are Dangerous Essay Having a cell phone in today’s society has become a regular part of life. Even I have a cell phone and I’m really not a big talker. What’s astonishing to me is kids seem to all have cell phones by the time they get into middle school. We rely on these communication devices for every aspect of our daily lives, whether for personal use or for work. To me we rely so heavily on the cell phone that it is becoming dangerous. Think to a time when you were driving down the road and came up on a slower vehicle. They were swerving within their lane, couldn’t keep a constant speed and just seemed like they were completely distracted and not paying attention to the road and the seemingly easy task of driving. You want to get by the person but every time an opportunity to do so came into view it would quickly disappear because the other driver would speed up or do something to avert your opportunity. Finally you get your chance and go around the person. You look over in an attempt to quench your curiosity and see the person is talking on their cell phone. It all makes sense now; they are paying more attention to the conversation they have going on than to their driving. Driving is a dangerous activity in itself, but when you add other distractions like talking and or texting on a cell phone, the outcomes can be anything but pleasant and lead to extensive consequences. Drivers are far more distracted while talking on a cell phone than just talking to a passenger in the car. Recently my wife and I were going to a store. I have driven this route several times and knew exactly where to turn, but because of the distraction of talking, I missed my turn. This happened with just a passenger in the car. I can only assume if I had a cell phone up to my ear, or even using a hands free device that the outcome could have been worse due to the higher level of distraction. A study at the University of Utah in 2008, led by Frank Drews, PhD, analyzed the driving performance of mostly young adult drivers paired with friends who served as conversation partners. In the cell-phone conversation condition, drivers conversation partners were at another location. In the in-car conversation condition, partners sat next to their drivers. In each of the experiments, one person was randomly selected to be the driver and the other the conversation partner. Throughout the extensive study, drivers talking by cell phone drove significantly worse than drivers talking to passengers. The cell-phone users were more likely to drift in their lane, kept a greater distance between their car and the car in front, and were four times more likely to miss their designated turn. Passenger conversation barely affected all three measures (American Psychological Association, 2008). Another study by a University of South Carolina psychology researcher provides a better understanding of why talking and listening on a cell phone interferes with visual tasks such as driving. In two different experiments, associate professor of psychology Dr. Amit Almor found that planning to speak and speaking put far more demands on the brain’s resources than listening. The study measured drivers attention levels and found people were four times more distracted while preparing to speak or speaking than when listening (University of South Carolina, 2008). This all makes sense to me, you are trying to multi-task and when you do that you are splitting your attention between two or more things, thus reducing your overall awareness. Yet, there are a lot of people that still believe they drive just fine while talking on the phone. People also believe because they use a hands-free device while talking it doesn’t affect their driving. I agree, but your still talking on the phone while driving. The National Safety Council has done extensive research studies and has stated, â€Å"drivers using hands-free phones and those using handheld phones have a tendency to â€Å"look at† but not â€Å"see† objects. These distracted drivers experience what researchers call inattention blindness. The drivers are looking out the windshield but they are not processing everything in the roadway environment† (National Safety Council, 2010). This inattention blindness causes slower reaction times, which is going to cause problems if anything unexpected happens around you. I don’t know about you, but I don’t need to read a bunch of studies to know that slower reaction times will cause you to miss things when you are driving. Since I’ve showed you how talking on the phone can be distracting, what do you think texting is going to do? Texting is the craze now, and it seems everybody is doing it. Why not, with these new smart phones that almost everybody has now days, it has become very easy to do. Even I do it on occasion, which is surprising because before I had a smart phone, if someone texted me I would just call them rather than text back. Teenagers have this texting thing mastered. I watch my teenage daughter text and ould swear she is typing 100 words per minute or more. With teens being the default experts at texting, do you think only they are irresponsible enough to text message while driving? If your answer is yes, then you are wrong. Yes, teens text, but according to an article in USA Today, â€Å"youre looking at around 10 million teen drivers, but about 180 million other adult drivers. Almost half of all adults admit to texting while driving in a survey by ATT provided to USA today, compared with 43% of teenagers. More than 98% of adults — almost all of them — admit they know its wrong† (USA Today, 2013). We know its wrong, yet we still do it. Is this setting a good example for our teens? I think we are setting them up for failure. Think about how long it takes for you to do a text and take into consideration your doing it with one hand since you need to keep on hand on the steering wheel. How long did you take your eyes off the road? Shockingly, texting drivers take their eyes off the road for each text an average of 4. seconds, which at 55 mph, means they were driving the length of a football field without looking (Davis, 2010). Yes there are a lot of excuses such as traffic was light, or I’m going slow, or I’m at a light. To me these are â€Å"just excuses†. Each time you take your focus off the road, even if just for a split second, you’re putting your life and the lives of others in danger. According to the U. S. Department of Transportation distracted driving-related crashes caused at least 5,500 deaths and nearly 450,000 injuries in 2009 (Johnson, 2013). I imagine these numbers have gone up since then with the advancement in technology and the rise in popularity of cell phones. The University of North Texas Health Science Center has looked at traffic data from the Fatality Accident Reporting System and texting data from the FCC and CTIA, and came to the conclusion that texting while driving is responsible for accidents that claimed 16,141 lives during the period of 2001 – 2007 (Chester, 2010). Common sense should tell you that texting and driving is dangerous, but plenty of people continue to do it. In an article from Psychology Today, statistics from surveys report that 97 percent of teens admit that texting while driving is dangerous, yet they still do it and 43 percent of them teens actually admitted to texting while driving. According to the National Highway Transportation Safety Administration, texting while driving makes you 23 times more likely to be in an accident. The National Safety Council says texting while driving is to blame for 1,600,000 accidents per year. The Harvard Center for Risk Analysis Study accounts 330,000 injuries per year and 11 teen deaths every day according to the Institute for Highway Safety Fatality Facts (Lohmann, 2012). If these statistics don’t scare you and make you rethink how your possible bad habits affect other people then maybe you should just turn in your drivers license and take the bus. Due to all the distractions that cell phones create and the dangers associated with this, many states have established laws on cell phone use while driving. Eleven states, Washington D. C. , Puerto Rico, Guam and the U. S.  Virgin Islands prohibit all drivers from using hand-held cell phones while driving. No state bans all cell phone use for all drivers, but thirty seven states and Washington D. C. ban all cell phone use by novice drivers, and nineteen states and Washington D. C. prohibit it for school bus drivers. Washington was the first state to pass a texting ban in 2007. Currently, forty-one states, D. C. , Puerto Rico, Guam and the U. S. Virgin Islands ban text messaging for all drivers. An additional six states prohibit text messaging by novice drivers and three states restrict school bus drivers from texting. All but four states have primary enforcement, which means an officer may cite a driver for using a hand-held cell phone without any other traffic offense taking place (Governors Highway Safety Association, 2013). You can see that the states are cracking down on cell phone use while driving and it all is in response to the related dangers and safety concerns. Texting-while-driving penalties vary wildly from state to state and range from $20 to $10,000. These are the maximum penalties when no accident has occurred. In cases where texting while driving results in damage or injury, the punishment can go up quite sharply (Gareffa, 2013). In my home state of Colorado, per Colorado Revised Statute 42-4-239, drivers younger than 18 are prohibited from using cell phones (handheld or hands-free) while driving with a few exceptions for emergencies. All drivers are prohibited from texting while driving. A person who violates these laws commits a class A traffic violation and the fines would be fifty dollars for the first offense and one hundred dollars for a second or subsequent offense (Colorado Peace Officer’s Handbook, 2013). If you don’t know what the particular laws are in your home state, I strongly urge you to research that information. Conclusion As I stated in the beginning, we all rely on cell phones way too much and this is causing us to make some bad decisions. Due to our multi-tasking society we all tend to think we can handle using the cell phone while we’re driving. The reality is we are far more distracted when we talk on the phone while driving and this causes us to lose awareness of the environment around us. With the newer smart phones of today, texting has become a part of our existence. When we try to text while driving we have to take our eyes off the road, even if only for a second or two. This behavior endangers you and anybody around you. The statistics and data presented here and that is available at other various websites should be more than enough evidence to convince you that using your cell phone while driving is a bad idea. If its not and you want to continue your current behavior then you will be responsible for the consequences. The consequences will come from your particular state laws that have been established in response to safety concerns. As I previously stated: Driving is a dangerous activity in itself, but when you add other distractions like talking and or texting on a cell phone, the outcomes can be anything but pleasant and lead to extensive consequences. I hope my words here make you think twice the next time you pick up your cell phone while driving. I know I’m not perfect and I’m guilty of talking on the cell phone while driving, but after writing this I know my behavior will be changing.

The Extraordinary Family in Judith Guests novel, Ordinary People :: Judith Guest Ordinary People Essays

The Extraordinary Family in Judith Guest's novel, Ordinary People    Judith Guest's novel Ordinary People evinces some main principles of the modernist literary movement, such as the philosophy that modern man is beset by existential angst and alienation. According to Carl Marx, a renowned existentialist, alienation, as a result of the industrial revolution, has made modern man alienated from the product of his own labor, and has made him into a mechanical component in the system. Being a "cog in the wheel" prevents modern man from gaining a sense of internal satisfaction of intellectual and emotional pleasure. Further more, according to Sigmund Freud, there are two pleasures, work and love. Consequently, Freud would say that being disconnected from pleasure from work, half of the potential for psychological fulfillment would be lost. Modern man is suffering from alienation as a result of large institutions, and as individuals, modern man neither feels that they are part of them nor can understand them. Additionally, the existentialists say , man is shut out of history. Modern man no longer has a sense of having roots in a meaningful past nor sees himself as moving toward a meaningful future. The modern man also suffers from alienation in his relationships with other people. Since he lives life not authentically and not knowing who he is, he cannot relate to others authentically. Hence, there are no real relationships at work and there are no real relationships of love. Also, according to Sartre, modern man is absolutely not a victim of his environments, of his childhood, and the circumstances in his life. The events in life are only neutral and since modern man is free, he chooses the meanings of the facts of his life. Modern man lives in a constant state of existential angst, which is dread of the nothingness of human existence and the fact there is no underlying purpose to human existence or set of objective truths or morals by which to navigate life. According to Martin Heideggar, German existentialist philosopher, the unaware person tries to escape the reality of death by not living life to the fullest. However, death can be the most significant moment for the individual, his defining moment of personal potential, if accepted and confronted squarely will free the individual from anxiety of death. The Extraordinary Family in Judith Guest's novel, Ordinary People :: Judith Guest Ordinary People Essays The Extraordinary Family in Judith Guest's novel, Ordinary People    Judith Guest's novel Ordinary People evinces some main principles of the modernist literary movement, such as the philosophy that modern man is beset by existential angst and alienation. According to Carl Marx, a renowned existentialist, alienation, as a result of the industrial revolution, has made modern man alienated from the product of his own labor, and has made him into a mechanical component in the system. Being a "cog in the wheel" prevents modern man from gaining a sense of internal satisfaction of intellectual and emotional pleasure. Further more, according to Sigmund Freud, there are two pleasures, work and love. Consequently, Freud would say that being disconnected from pleasure from work, half of the potential for psychological fulfillment would be lost. Modern man is suffering from alienation as a result of large institutions, and as individuals, modern man neither feels that they are part of them nor can understand them. Additionally, the existentialists say , man is shut out of history. Modern man no longer has a sense of having roots in a meaningful past nor sees himself as moving toward a meaningful future. The modern man also suffers from alienation in his relationships with other people. Since he lives life not authentically and not knowing who he is, he cannot relate to others authentically. Hence, there are no real relationships at work and there are no real relationships of love. Also, according to Sartre, modern man is absolutely not a victim of his environments, of his childhood, and the circumstances in his life. The events in life are only neutral and since modern man is free, he chooses the meanings of the facts of his life. Modern man lives in a constant state of existential angst, which is dread of the nothingness of human existence and the fact there is no underlying purpose to human existence or set of objective truths or morals by which to navigate life. According to Martin Heideggar, German existentialist philosopher, the unaware person tries to escape the reality of death by not living life to the fullest. However, death can be the most significant moment for the individual, his defining moment of personal potential, if accepted and confronted squarely will free the individual from anxiety of death.

Synthetic Marijuana: the Legal Way to the Grave

Synthetic Narcotics- Georgia’s Growing Epidemic As if teaching our youth about the dangers of drugs isn’t hard enough, now we have company’s manufacturing a synthetic form of Marijuana, commonly referred to as â€Å"Spice† or â€Å"K-2†. These company’s target our youth by packaging it colorful, shiny packets and giving â€Å"cool† names like â€Å"magic monkey† or â€Å"purple passion†. They label these packages â€Å"herbal incense† and â€Å"not for human consumption† in an attempt to hide its intended use and avoid FDA regulations, yet for one package containing 5 grams it costs on average $15. 9-$21. 99. That’s pretty expensive for an â€Å"air freshener†. In 2011, 14. 4 percent of 12 graders admitted to experimenting with synthetic marijuana. Just last March, 16 year old honor student, and star soccer player from Fayette County, Ga. Chase Burnett died shortly after experimenting with this drug. This had law makers act quick and enact â€Å"Chases Law† , Georgia House Bill 370, which made this drug a Schedule 1 Controlled Substance and a felony to purchase, possess and distribute any form of this substance. Once this bill was signed by Gov.Nathan Deal, it took about 24 hours for police agencies, mine being one, to conduct search warrants all over metro Atlanta to get this deadly drug off the shelves. Although now illegal, and rightfully so, there are many retail stores, smoke shops and gas stations that still sell the drug all over Georgia and around the Metro Atlanta area. As quick as officers take it off the shelves, it’s being replaced just as fast. Shop owners feel it’s a violation of their civil rights and use excuses like â€Å"we can’t control what customers do with what they buy† or they tell officers they didn’t know it was illegal, â€Å"it’s just incense†.If they didn’t know it was illegal and didn’t think they were doing anything wrong, why do they keep it hidden behind the counter, out of sight and locked up? Why are they charging so much money for something that normally would cost about $2, if really used as an air freshener? These, as well as many more questions have been raised by not only Law Enforcement, but parents as well. As consumers, the best way to stop these shops and gas stations from selling this to our youth is stop buying your gas or any other items at these locations. It’s now and always will be about the money.Once they see customers going across the street to get gas, they will get the hint. Another way businesses are being put on notice is letting them know that their business license will be revoked if caught selling these and any other illegal substances from their stores. With the new laws enacted and parents working together with Law Enforcement, we are starting to get a tighter grip on this fast growing epidemic that is plaguing a re children. References Whitehouse. gov/ondcp http://georgia. gov/blog/2012-08-20/banning-synthetic-marijuana

Is Child Development Best Described as Gradual Change, or...

PSY1011/1111 Essay cover sheet Essay Title: Is child development best described as gradual change, or as a series of stages? Student number: M00330526 Word count (Excluding title and references section): 1076 Declaration By submitting this work I acknowledge that I am its author, that all sources consulted in its preparation are referenced appropriately in accordance with the referencing guide, and that I have not copied from any source. The development of children occurs from birth to adolescence. Children start developing their physical, intellectual, social, and emotional senses at an early age and while people change throughout their lives, the developmental changes occur mostly during childhood. All the way†¦show more content†¦It is commonly known today that aspects of child development are a product of both nurture and nature (Bee, 2004)1. The nature versus nurture disagreement present evidences of how each factor impacts on development. Nature, also known as heredity, is the genetic code of birth, which was passed on to by our parents. An example of the impact of nature on the development of children is the adoption of babies. Families with adopted children have the same environment, but do not share the same genes. (Myers, pg. 139)2 There are little similarities between adopted children and their family, and greater similarity between adopted children and their biological parents. Nurture, als o known as the influence of environment on our development is an accepted factor on the development of children. Environment plays a significant role in the development of humans. After considering a persons environment in influencing ability, nutrition plays an important role. For example, in the study of a group of children, the latter were provided vitamins and mineral supplements for eight months and they had to pass intelligence tests after the eight-month treatment. It was seen that these children had improvements in scores as compared to another group whom we not given vitamin and mineral supplements (Nature vs. Nurture, 2001)3. Therefore, the results put forward the fact that environment helps in theShow MoreRelatedAutism Spectrum Disorder ( Autism ) Essay1396 Words   |  6 PagesThe Center for Disease Control and Prevention’s latest statistics stated that about one in eighty-eight children have an Autism Spectrum Disorder (Allen Cowdery, 2015, p. 192). Autistic Disorder Autistic Disorder, also known as autism, was first described by Dr. Leo Kanner in 1943, he reported eleven children who exhibited an apparently congenital lack of interest in other people. The most obvious signs of autism and symptoms of autism tend to emerge between two and three years of age. Signs of autismRead MoreThe Different Stages Of Human Development1617 Words   |  7 PagesThe different stages of human development can be vast in dimension. 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Burns ‘conceives of learning as a relatively permanent change in behaviour, with behaviour including both observable activity and internal processes such as thinking, attitudes and emotions. Burns (1995) considers that learning might not manifest itself in observable behaviour until some time after the educational program has taken place. Learning helps us move from

Hawaii, Hawaii And Las Vegas - 1119 Words

People are always talking about how much fun visiting Hawaii or Las Vegas was. When they describe the sites and their best attractions, one can only assume that these are the best places. Some people would rather visit other sites that have different attractions or activities that fit their desires. Hawaii and Las Vegas both have everything you can want; they have everything from the outdoors to the casinos. While Hawaii is obviously a different type of fun than Las Vegas nonetheless they both are enjoyable places. Hawaii and Las Vegas both have some of the greatest tourist attractions in the world. Hawaii is known for its beaches and relaxing outdoor entertainment. While Las Vegas is known for its partying and casinos. Hawaii is fun for the family as relaxation trip and Las Vegas is fun for people who are looking for parties. There are similarities between the two considering they both are some of the greatest vacation trips. A person could enjoy both sites equally without feeling l ike they are missing out on something that they wanted to do. They have the best tourist sites and create a fun experience for the people who visit. Hawaii and Las Vegas are the best places to visit, sight see, have fun, and relax with friends and family. Hawaii is like the outdoor fun vacation that everyone wants to experience. It has so many activities that one could only wonder how they would be able to enjoy all of them. Hawaii is known for its beaches, but they also have great campingShow MoreRelatedLegalized Gambling in Hawaii1683 Words   |  7 PagesCasinos in Hawaii: A Good or Bad Gamble? The streets of Las Vegas Boulevard, which are littered with advertisements picturing naked girls willing to provide their services for a price, can be a scary place as someone takes a stroll. Drunk men stumble out of strip clubs and casinos, and girls in gaudy clothing and stilettos apply lipstick at their post. 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International Human Resource Management. Introduction.

International Human Resource Management Introduction Human resource managers, outlines, directs and facilitates the regulatory elements of an association. They supervise the selecting, meeting, and contracting of new staff; counsel with top officials on the key Strategic obligation; and fill in as a connection between an association s administration and its workers. To flourish in the disorderly and turbulent business condition, firms need to always enhance and be â€Å"on the ball† regarding business practices and methodologies. It is from this inspiration to be at the highest point of the pack that HRM turns into an important apparatus for administration to guarantee achievement. Banters about the significance of Human Resources†¦show more content†¦Relocation of employees has been frequently a need for the development and achievement of a business. Nevertheless, moving somebody can be costly and presents a few difficulties, especially if the individual has a family. When an HR manager based in Melbourne, Australia wants to relocate a manager to manage one of their subsidiary companies in London, there are challenges faced that must be considered. They include; Cost There will always be an expense when an employee is being relocated. The human resource manager has to consider the cost of relocating the manager to London. This includes travel expenses, housing, etc. It actually costs more to relocate an employee than to hire a new one. However, regardless of the cost, human resource managers will always opt for the most experienced with their company operations and objectives. This is, one of the main issues the HR manager will face while allocating the manager to London The willingness of the manager to relocate The human resource manager should be in the position to identify if the manager is willing to relocate. The employee is backed with strong laws that mitigate their rights and they cannot be abused by the employer. Nevertheless, there are also indicators that are strong determinants if the manager will agree to relocate.spouse or family is the most common of all. Employees with a family will analyze if relocation will beShow MoreRelatedExamples of Ihrm and Domestic Hrm Essay841 Words   |  4 PagesIntroduction The primary cause of failure in multinational ventures stem from a lack of understanding of the essential differences in managing human resources in foreign environments (Desatnick Bennett 1978). The world has become more globalized, competitive, dynamic and uncertain than ever before. 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Reflection Clinical Incident Hiv free essay sample

ABTRACT Central Venous Catheter Blood stream infections (CVCBSIs) is a major cause of morbidity and mortality in patients with end- stage renal disease treated with chronic haemodialysis (Jaber 2005). The purpose of this review is to determine whether the use of Biopatch on the exit site of central venous catheter (CVC) can help prevent infection. Before any research was undertaken, a focused question was formulated and a search strategy was then developed to compare the available evidence. A PICO (Sackett et al 1997) was undertaken using the terms Central Venous Catheter, Chlorhexidine, Biopatch and Infection. A Facet analysis (Ranganathan 1967, cited by Spiteri 1998) was performed and a literature search was conducted using four electronic databases. This databases searches, contains both nursing and medical research and reviews. The databases used were Medline (1982-2011), CINAHL (1996-2011), Embase (1982-2011) and BNI (1982-2011) Mckibbon and Mark (1998) states that CINAHL and Medline databases are the most appropriate methodological to identify studies that report high quality research which can be used for clinical application. Most of the search result, produced articles that were Control Randomised Trails (RCT). Torgerson and Torgerson (2008), states that RCT is the gold standard for research method and for addressing the what? question in ‘evidence-informed’ policy making and practice. The literature search in CINAHL generated 145 article and limited to 2 articles which did not answer the question directly, however before the limits were applied two articles were found to relate to the question but one article answer the question and was a crossover intervention trail. The searches in BNI yielded 14 results and were limited to 1 article which did not relate to the question. Further searches in Medline and Embase, produced 19 and 21 results consecutively and none of this search answered the question. BACKGROUND The purpose of this research is to analysed published researched article on the effectiveness of Biopatch for the prevention of central venous catheter. Working in an area where CVC is being used, prompted the need to look for the best evidence available for the prevention of CVC line infection. There has been a steady rise of CVC infection in the past months and this has raised concern for both patients and staffs, as some of those patients affected had to have their lines removed, and even ITU admissions. In view of this problem, the need to look for preventive method prompted the question of the efficacy of Biopatch for the prevention of CVC. The life line of haemodialysis (HDX) patients, remain their vascular access. People with end stage renal disease (ESRD), requires a reliable access for their circulatory system to receive life sustaining HDX. The ideal access would be long lasting, free of complication and permits adequate flow rates to deliver effective treatments (Schwab 1997). 25% of hospital admissions for HDX patients are for access problems and access failure is a major cause of morbidity (Levy et al 2005). Central Venous Catheter (CVC) is an important aspect in HDX vascular access with 46% to 70% of patients commencing HDX through CVC; however it is a known risk factor for staphylococcus aureus infection and bacteraemia, ( sattler et al). Catheter related bacteraemia (CRB) include exit site infection, tunnel line infection and bacteraemia. CRB are the most common and important infection associated with CVC use and may be cause by a wide variety of gram positive and gram negative organism (Jaber 2005). There has been several preventive measures introduced to try and reduce the rate of CRB at the catheter insertion site or lines, this include the use of prophylactic topical antimicrobial ointments at the catheter exit site, the use of prophylactic catheter locking solution for prevention of CRB, strategies for management of the catheter and the use of vascular access managers and quality initiative programmes and also a dressing consisting of a biopolymer composite foam with antimicrobial agents are also being used to prevent infections. For an effective databases search, a clear question must be formulated. Craig and Smyth (2007) states that a carefully formulated question maximises the likelihood that relevant, high quality evidence is identified and incorporated appropriately into decision making process. Formulating question is a fundamental skill for evidence base practitioner and this help to focus search learning time on evidence that is highly relevance to patients needs (Cullum et al (2008). Sackett et al (1997) cited in Craig and Smyth (2007)devise a framework known as PICO for making question to be more focused. By structuring a question, the answer may be found more efficiently. The PICO divide the question into four key parts which are then the focused of the targeted literature search. According to Cullum et al (2008), the four key parts are P- population or problem, population is the client group or clinical condition or problem, I- intervention is the aspect of health care of interest or a action plan, C- counter intervention, the counter intervention involves choosing between the alternative cause of action or no action and O – outcome, is the result that is hope to achieve. A PICO format helps with the term that can be use to begin a search for answers, it also helps to narrow down and refine the question to obtain relevant answers and outcome. See the table below. Table 1: PICO POPULATION| INTERVENTION| COUNTER INTERVENTION| OUTCOME| Central venous catheter| Chlorhexidine| None| Infection prevention| By putting each part of the question into the appropriate column, eases the task of developing a searchable question. Devising a focused question can save a great deal of searching time with the key words of the question becoming the key term for the search. Nursing research aspire to improve the quality of care given to patients which provide nurses the opportunity to ask question about their practice and look for ways to improve them and to ensure that it is achieved and also based on evidence. This forms the background to which the focused clinical question arose â€Å"Does chlorhexidine sponge dressing (Biopatch) prevent exit site infection in CVC for patient undergoing HDX? The paper chosen answered the question and was a crossover intervention trail as reference below : Camins et al (2010) A cross over intervention trail evaluating the efficacy of a chlorhexidine- impregnated sponge in reducing catheter- related bloodstream infections among patients undergoing haemodialysis. This paper is presented as appendix 1. METHOD Clinical evidence can be acquired from numerous areas, such as text books , bibliographic data, course article and even colleague. Greenhalgh (2006) suggested that providing evidence from systematic review of existing evidence is one contribution towards achieving clinical effectiveness. The main aim of searching is to find good quality valid evidence to support clinical decision making. Subsequently a search strategy was developed to identify appropriate literature. Any terms that could be used as alternatives to the key term were identified. This structured identification of alternatives search term is called Facet analysis (Ranganathan 1967, cited in Spiteri 1998). Facet analysis consist of the use of specific alternative spelling, abbreviations, plurals, word specific therapies, in relation to PICO word to help in analysing the search (Sackett et al 1998). The Facet analysis was translated into a search strategy by using three key index terms as heading for each of the three facets. Synonyms were added and truncations, wild card and Boolean Operators used, were necessary. Search engine uses two methods to identify information, the first is by searching the word entered as index term and the second is by free text term which has been prepared by the compliers of the databases (Gillespie and Gillespie 2003). Another search tool used was truncations and wild cards. The use of truncation during search helps to prevent time wasting by searching for different variation of the word and wildcard gives room to identify alternative spelling of the same word easily Craig and Smyth (2007). Truncation is represented by ($) in Ovid while wildcard is represented by (? ) and is used within or the end of a search term to substitute for one or no character An example of facet analysis is shown on the table below. Table: two POPULATION| INTERVENTION| COUNTER INTERVENTION| OUTCOME| Central venous catheter| Biopatch| None| Infection Prevention| FACET ANALYSIS INDEX TERMS| INDEX TERMS| INDEX TERMS| INDEX TERMS| Central venous catheter| Chlorhexidine/ Biopatch| None| Infection Prevention| FREE TEXT TERM| FREE TEXT TERM| FREE TEXT TERM| FREE TEXT TERM| Central venous cathe$| Chlorhe$| None| Infectio$| Central lines| Chloraprep| | Infect| Central line$| Antimicrobial dressing| | Exit site infection| Haemodialysis lines| Antiseptic dressing| | Cat? eter related infection| CVC| Antisep$| | | Intravascular cathete$| | | Catheter related bacteremia| Vascular access| | | Bactere| Intravasc$| | | | In health care the National Library of Medicine (NLM) has developed the Medical Subject Heading (MeSH) list which, specify terms to be used by the indexer compiling entries for Medline database. These index terms are arranged in a tree view with the specific term below more general ones. By using the MeSH system, the computer searches for relationships or connections on the basis of the initial search strategy (Gilbride2004). The literature database searches were carried out in CINAHL, MEDLINE, EMBASE and BNI as this gave wider and in-depth coverage of each element of the topic. CINAHL and Medline databases are the most appropriate methodology to identify studies that report high quality research which can be used for clinical applications (Marks 1998). CINAHL (cumulative index to nursing and allied health literature) data base covers nursing and health science, and related discipline from 1982 to present (Greenhalgh, 2001). The MeSH was used when searching the key terms by checking the â€Å"Map to Subject Heading† checkbox on the databases main page. This produce the Mapping display page and a list of subject headings including the key search term and various other terms based around it. By clicking on the key terms, example central venous catheter, â€Å"include Subheading† and â€Å"Explode. † The included Subject Heading option gives a choice of either adding subheading to the subject heading or making the subject the main focus of the article (Harris, 2000). Exploding the MeSH heading incorporates all the more specific MeSH heading shown in the tree search. This process was repeated for each of the 3 key search terms. Next a free text search of each facet was perform by un-checking the Map to Subject Heading checkbox. The free text search was necessary because according to Gillespie and Gillespie (2003), â€Å"one cannot rely solely on the accuracy of indexing, or there may not be an index term that specifically describes the concept of interest†. When this was completed, the combined searches with Boolean operator â€Å"OR† was selected, combining the terms within the same concept together and facilitating retrieval of citations containing any of the previous search term. This was carried out for each of the 3 key terms and their facets. Boolean refers to the 19th century British mathematician George Boole who in 1847 invented â€Å"linguistic algebra†, a mathematical logic that represent relationship between entities and ideas (Harris 2000). The results of each 3 search elements combined using Boolean operator â€Å"OR† were finally combine with the operator â€Å"AND† which combined the different concepts together resulting in retrieval of citations containing all of the three core search elements ( Levy 2004). The resulting list of the four data base search articles was limited to English language, human, randomised control trail and research paper thereby eliminating less relevant result. Medline is produced by United state National Library of medicine, Medline covers the international literature on biomedicine, allied health and Biological and physical sciences (Gray 1997). Embase focuses on pharmacology but include other biomedical specialities. It also contains information from 1974 to date and has a European bias. British Nursing Index, (BNI) produced in the UK, contains information from 1994 to date. The search history from CINAHL, Embase, Medline and BNI databases are shown in appendices 2, 3, 4 and 5. FINDINGS OF THE REVIEW The Camis et al (2010) paper was produced by CINAHL, Medline and Embase searches and is a Crossover Intervention Trial. Cross-over studies or crossover trials are a type of randomised control trial. Cross-over studies are studies comparing two or more treatments or interventions in which the subjects or patients, upon completion of the course of one treatment, re switched to another (Senn, 2002). In the case of two treatments, A and B, half the subjects are randomly allocated to receive these in the order A, B and half to receive them in the order B, A. A criticism of this design is that effects of the first treatment may carry over into the period when the second is given. In this study, 121 were enrolled, 2 withdrew and 119 were analysed. This particular study was chos en because of the larger sample size, as sampling error- the gap between a sample’s representativeness and the size of the sample increases (Thompson, 1999). However a randomised control trial show that the use of chlorhexidine-impregnated dressing with tunnelled central venous catheters resulted in fewer documented exit site infection. There has been no randomised control trial study on HDX patients. The Embase search produced the largest no of citation but did not answer the research question, in Medline, 19 citations was found, 2 were randomised control trials and 1 was relevant to the question but not answer the question. BNI found 1 citation and was not relevant to the question. However CINAHL found 145 citations and 1 answered the research question further limits were applied and this gave 2 citations which did not answer the question directly. Table three: TABLE OF FINDINGS Databases| Citations| Type of study| Relevant to question| Study population| CINAHL| 2| RCT : 2| 1| Central venous catheter| MEDLINE| 19| RCT :12| 1| Central venous catheter. | EMBASE| 21| RCT: 12| 2| Central venous catheter. | BNI| 1| RCT : O| 0| Central venous catheter. | CRITICAL APPRAISAL OF RESAERCH PAPER O’Rourke (2005)cited in Craig and Smyth (2007) defined critical appraisal as a discipline for increasing the effectiveness of one’s reading by encouraging systematic assessment of reports of research evidence to see which ones can best answer clinical problems and inform best practice. According to Burns and Grove (1993), critical appraisal is often related to critical thinking which requires carefully developed intellectual question. Craig and Smyth (2002) states that critical appraising allows us to make sense of research evidence and thus begins to close the gap between researchers and practice. Finally Chambers (1998) also states that critical appraisal is the assessment and interpretation of evidence by considering its systematic reviews, relevance validity and results for specific situations. In this critical appraisal, the critical appraisal skills checklist (CASP) 10 question to help make sense of randomised controlled trials by Guyatt et al (1993) was used to appraise the paper. Appendix 7 CASP is a multidisciplinary programme aimed at all those who make health care decision and all those who seek to influence the decision making process. It help people develop skills in finding and critically appraising evidence about the effectiveness in order to promote the delivery of evidence- base health care ( Public Health Resource Unit 2006). The purpose of this study was, to determined whether the use of Chlorhexidine sponge dressing (Biopatch prevent exit site infection in central venous catheter? This question was focused enquiring the effect an intervention (Biopatch) would have on the outcome (Infection) and the population studied was 121 patients who underwent HDX through tunnelled central venous catheters. This study was not a randomised control trial. RCT is the strongest design for questions of whether health care interventions are beneficial (Cullum et al 2008). This groups have been formed through random allocation or similar methods, this ensure that allocation bias is eliminated at baseline. This research paper was a Crossover intervention trial as stated by Senn (2002) that Cross-over studies or crossover trials are a type of randomised control trial. Cross-over studies are studies comparing two or more treatments or interventions in which the subjects or patients, upon completion of the course of one treatment, are switched to another. This trial was conducted in a 2 HDX centres and participates were allocated into group A which were the intervention group centre 1 and B group who where in the control group centre 2. The participants were group in the centre they dialysed in and had the same nurse to patient ratio and shared the same infection prevention specialist. The intervention was started in group A whilst group B continued with the same old routine for six months and then it was switch over where group B became the intervention group and group A control group. The participants and staff were not blinded to the study and every patient who had a tunnel central venous catheter receives the intervention. At the beginning of the trial, there were 121 patients enrolled for the study and 2 patients withdrew from the study as they develop dermatitis after 2 sessions and 119 remain on the study. All the remaining participants were followed up and the outcome was analysed by the group they were originally allocated. A 2 sided P-value of less than or equal to . 05 was considered to denote statistical significance. P- value is the probability the difference between the group has risen by chance (Peat et al 2008) In research this is used to indicate the likelihood that a result has occurred by chance, rather than because there is a relationship between variables. The result in this research was presented in a table and narrative form and reports that there were 37 catheter related blood stream infections (CRBSIs) during the intervention period (incidence, 6. 3 CRBISs per 1,000 dialysis session, and 30 CRBSIs during the control period (incidence, 5. 2 CRBSIs per 1000 dialysis session. Relative risk (RR) 1. 22 (95% confidence interval (CI), 0. 75-1. 97) P= 46. 2 patients less than 2% were discontinued due to adverse effect. The result of the studies did not show significant reduction in CRBSIs. The result shows that there was not a significant reduction in the incident of CRBSIs in the group. The difference between the two centres was the frequency of dressing changes 54% vs. 39%: P=. 1 and more patients with substance abuse 9% vs. 2%: P=. 1. This was a significant risk factor for development of CRBSIs on bivariate analysis. Two variables have a P- value of less than 1. Confidence interval, are a function of the sample size and out-come frequency, the smaller the sample size, the wider the confidence interval (Torgerson and Torgerson 2008). In this study the confidence interval was 95%. Although there is a plan to implement this, product at my area of work, these research paper has not shown any significant evidence to show the effectiveness of Biopatch for the prevention of CRBSIs although the patient and the relative might be interested in the product, a RCT needs to be done before any implementation is done. IMPLEMENTATION: SITUATIONAL ANALYSIS. Making any changes in clinical practice is a very challenging and complex matter. In finding evidence that Biopatch may not be helpful in reducing the incidence of CRBSIs, a challenge exit in actually implementing the practice. Clinical research helps to move away from the tradition approaches whilst increasing consistency of care as well as the understanding of treatment option (Thomas 1999). Given the complexity of behaviour change and the multiple factors that can influence it in positive and negative ways, there is a growing recognition that implementation efforts should be guided by conceptual models or framework (McDonald et at 2004) Grol and Wensing (2004) states that â€Å"one of the most consistent finding in health services research is the gap between best practice as (determined by scientific research) and actual clinical care†. They also affirmed the studies in United States and Netherland, suggest that 30%-40% of patients do not receive care according to current scientific evidence. To overcome obstacle and aid implementation of change, Grols 5 steps model of change (1997) was design. This design appears to be the right tool to use as a guide to implementing Biopatch dressings. These 5 steps are as follows, to develop a concrete proposal for changing clinical practice. This should involve drawing up a proposal and involving the multidisciplinary team members, to discuss the proposal. Identify obstacle to change, this will involve the process of making sure all the challenges that will prevent change to be implemented are identified as proposed by Hayes (2002). The third model was to link intervention to obstacle in clinical practice. Grol (1997) says that knowing the target group well is crucial, as is the understanding their needs and problem with changing. The obstacle to change can be address by education session and meeting in collaborative approach. Developing a plan, a key component of the plan will be staff and patients education about the product. The use of this product should be started in a small minority of the patients with a developed care plan in place to monitor any changes. Carry out the plan, the use of Biopatch will be evaluated and continuous audit will be carried out monthly and the result will be discussed with other multidisciplinary team. Carrying out an effective plan and evaluation of progress by performance of audit and survey as has been established by Greenhalgh (2006). CONCLUSION In conclusion, this research review has shown that Biopatch was not effective in the prevention of CRBSIs, however other studies by Timsit et al (2009) has demonstrated that Biopatch was effective in reduction of CRBSIs in critically ill patients and also another trial carried out on neutropenic patients also show significant reduction in CRBSIs, although there has been no research done, before this on patient undergoing HDX. The method used to find evidence include a focused question, planning the literature search using PICO and Facet analysis, using electronic databases for literature searches, appraising the evidence and developing an implementation strategy. Grol’s 5step model was found to be helpful and practical tool in planning the implementation. The method of search provided a good structure around to base clinical exploration or enquiry and has improved my knowledge in searching the databases for clinical evidence. REFERENCES Timsit JF, Schwebel C, Bouadma L. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter related infections in critically ill adults: a randomised controlled trial. JAMA 2009, 301: 1231-1241. Carmis BC, MD, MSCR,. Richmond M, RN, MHS, CIC,. Dyer KL, MPH. Zimmerman HN, MPH,. Coyne DW, MD. Rothstein M, MD. Fraser VJ, MD. ; Infection Control and Hospital Epidemiology, Vol. 31, No 11 (November 2010), pp. 1118-1123. Levy J, Morgan J, Brown E. 2005) A practical guide todialysis and how to manage end stage renal failure. Oxford handbook of dialysis (2nd edn) New York: Oxford University Press. Grol R, Wensing M. What drives change? Barriers to incentives for achieving evidence-based practice. Med J Aust 2004;180:S57-60. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Intervention for preventing falls in elderly people. Cochrane Database syst Rev 2003; CD000340. Guyatt GA, Feeny DH, PatrickDC. Measuring health-related quality of life. Ann intern Med 1993; 118:622-629. Levy MD. ;A new register for clinical trials information. Can Med Assoc J. 2000; 162-970-971. Gray J. (1997) Doing the right things in Evidence Base health-care. Churchhill Livingstone, New York ch2, P17.