Promote And Implement Health And Safety Essay

1.1 Legislation that relates to health and safety in a health/social care setting include the following. Control of Substances Hazardous to Health Regulations 2002, Management of Health and Safety at Work Regulations 1999, Personal Protective Equipment at Work Regulations 1992, Manual Handling Operations Regulations 1992 1.2 The main points of some health and safety policies or procedures such as control of substances hazardous to health COSHH are to make sure that any chemicals that are or could be dangerous to people’s health are used and stored in a correct way that minimises any potential risk to people. Manual handling operations regulations are to ensure that employees/employers are aware of the possible injury’s that can be caused by unsafety lifting procedures and has guidelines for manual handling procedures that greatly reduce the potential of a work related injury occurring due a manual handling operation. 1.3 Self: Any risks that you are aware of are checked and made save. You should also work to maintain a safe working environment. The employer or Manager: They are to make sure that those under their supervision are aware of hazards and possible risks. In addition they should make sure that these staff know how to deal with deal with the risks and hazards, and make sure they know how to ask for guidance for senior staff. These are in addition to the same responsibilities as myself. Others in the work setting: Colleagues have the same duty of care that I do. However ultimate responsibility lays with the Manager/Supervisor. 1.4 Tasks that require special training would include the restraining of a service user. Before undertaking this task a Positive Handling Techniques PHT training should be done. It is used to protect service users and others around them from harm. The administration of controlled medication or any other sort of medication is record on a medication administration sheet MARS, training is needed to follow this procedure to protect service users from medication administration errors. Before starting work in a social care  environment safe guarding training should be under taken, this is done for the protection of service users. 2.1One of the procedures used related to health and safety is a risk assessment. Risk assessments are to be followed for trips out reduce the risk of potential accidents and avoid hazards. They are done during the planning stage of an outhouse activity. The Positive handling techniques used, is an example of an agreed way of working to keep service users and emp loyees safe from physical harm. 2.2I have supported other to understand and follow safe practise when a new employee has started work. I have gone through the correct way to store and use cleaning products. I did this by talking the new employee though the practices used in the house while showing them where the products are stored and then demonstrating how to correctly clean. I have also help other members of staff when performing a practice fire drill by demonstrating the correct procedure to follow when the fire alarm is activated. 2.3I have reported potential health and safety risk by filling out a debriefing form. These are done after an unusual event has happened to make others aware of unusual event and help make action plans in the future to reduce risk if these events happen again. These debriefing forms have been bought up in individual meeting with my senior managers and we talk about the event. In the meeting it will be discussed if and action needs to be take. In cases where it was been agreed that procedures in place aren’t sufficient to deal with the event procedures have been changed then monitored to make sure that they are suitable to deal with the event if it was to happen again. 2.4I have used risk assessments to help plan a day trip for a service user. I made a schedule of the activities the service user wish to take part in, then looked at how they would be able to travel to the destination and what activities would be undertaken and the environment in which they were taking place. I t hen put this information on to a sheet and assessed each action and the potential risks and hazards involved and what could be done to reduce or avoid them. 2.5One way I have reduced the potential of risks and hazards at work was to wait for a service user to leave the house before using a steam cleaner in his room. I have also put up wet floor signs when mopping and will wait for the house to be as quiet as possible before starting to reduce slipping hazards. 2.6I have accessed additional support relating to health and safety before for the key policies files which are  stored in the office. 3.1Accidents could include common one such as slips, trips and falls. Others accidents could be cuts or burns common to kitchen environments. Head or back injuries are other examples of accidents that can happen in a health and social care work place, these can often occur when helping service users in times of distress. Sudden illness may happen at work may include strokes, heart attacks or asthma attacks. 3.2In the event of an accident or sudden illness the first person on the scene should make the area safe if it possible. A first aider should be found and once the situation has be assessed the relevant emergency services should be contacted if needed. Once the situation has been stabilised an accident form should also be completed by the person who has had the accident or be filled out on the behalf if they can’t do so themselves. 4.1When working with a service user it is important to promote good personal hygiene, such as washing hands before preparing food or after using the toilet. It is also important to fill in the infection control file to keep a check on what has been clean or needs to be cleaned. Also only use paper towels once when wiping down surfaces and separate ones for each door handle. Avoid coming in to work when ill to reduce the spread of the illness. Also make sure that anyone who prepare or works with food has had food hygiene training. 4.2I start by wetting my hands, if my hands are particularly soiled I will apply an appropriate specialist hand cleanser directly to the skin before wetting. I then will apply soap to my hands. Then clean my hands in the following stages. Rub hands palm to palm, rub palm over back of hand fingers interlaced on each hand, Palm to palm fingers interlaced, Fingers interlocked into palms, Rotational rubbing of thumb clasped into palm, Rotational rubbing of clasp ed fingers into palm. I then make sure my hands are thoroughly dried with clean paper towels. 4.3I ensure that I don’t pose a risk to others with my own health and hygiene by making sure that I am healthy enough to complete any task I undertaker safely. I also make sure that I wash my hands before preparing food and before and after helping a service user with self-care. I will also make sure I wear the correct clothing when performing these actions. I will covering my hand when coughing and use tissues when I sneezing or wash my hands if a tissue isn’t to hand. I will also stay out of work when ill to avoid spreading any infections. 5.12. Manual Handling Operations Regulations 1992 (MHOR) (as  amended 2002) The main points of The Manual handling Operations Regulations 1992 are as follows to reduce the risk of injury as far as is reasonably practicable, avoid hazardous manual handling operations so far as is reasonably practicable, assess any hazardous manual handling operations that cannot be avoided. The primary objective of PUWER 98 is to ensure that work e quipment should not result in health and safety risks, regardless of its age, condition or origin. Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) requires that all equipment used for lifting is fit for purpose, appropriate for the task, suitably marked and, in many cases, subject to statutory periodic ‘thorough examination’. Records must be kept of all thorough examinations and any defects found must be reported to both the person responsible for the equipment and the relevant enforcing authority. 5.2There are four main principles to keep in mind when moving and handling. It is important to keep your spine in line, maintaining a natural posture. Adopt a comfortable wide stance to give a stable base. Keep the load close to your vertical centre of gravity. Finally use the large legs and buttock muscles to lift during any manual lifting activity. The acronym TILE is also helpful. This is Task, Individual, Load and Environment. 5.3I move and handle objects safely by following the principles and ensuring the load is not too heavy, that the route is clear, I hold it close to me with a straight back and bent legs. If a load is too heavy for me to move by myself I will seek help and work with another colleague to move the object. 6.1There are a number of substances that are hazardous to health that can be found in a health and social care environment. These can include cleaning products such as bleach or chorine that such be clearly labelled and stored away safely. Other hazardous substances could include human waste. Food that is past its best before date or stored incorrectly could be classed as hazardous. Other could be found as part of the building such as asbestos. 6.2When I store hazardous substances such as bleach and chlorine tablets I make sure I follow COSHH regulations and store the said chemicals in the designated area. I will wear rubber gloves when I handle any hazardous substances, an example would be when using chlorine tablets and placing them in to a mop bucket. An example of when I disposal of hazardous substances at work would be when I take out used wipes and pads. I will place these in a bag using gloves then seal the  bag and take them to a yellow bin and then dispose of the gloves in the bin aswell. 7.1Practices to prevent fires starting include switching off any electrical equipment that is not in use. Any cooking is monitored and not left unattended. To prevent the spread of fire there are fire doors which should remain closed when not being used and never wedged open. 7.2I prevent fire from starting by making sure that when not in use electrical items are tur n off. I will also make sure that there aren’t lots of in extensions socks on a mains plug socket. When cooking I will not leave the area unattended to monitor the food and prevent burning and a possible fire hazard. I will also make sure the hob is clean and the surrounding area is clear of obstructions. Also I will make sure the area not rags above sources of heat and remove and rags if so. Also avoid over filling dryers and clean out lint catcher regularly. 7.3When a fire is discovered the alarm should be raised then everyone should be evacuated from the building and make their way through the nearest fire exit to the designated fire assemble point. The emergency services should be alerted and the on call team notified. A register should be taken to make sure everyone who was in the building at the time is accounted for. 7.4I make sure when moving items around the property that they don’t obstruct evacuation routes. When I find routes are blocked I will remove the obstructions or ask someone else to do so and make sure the route is clear and save to use. I also check that the doors are functioning correctly and can be opened with easy. 8.1When I person I do not know wishes to enter the property I will ask for the names and the propose of their visit. I will then ask to see some form of identity, if I am satisfied I will grant them entry and ask the person to enter their details in to the visitors sign in book. Any person who wishes to access information will again ask them for their names and the reason they wish to have the information. After seeing some identification I will gain them access. If I were to have any doubts on either of the above I would seek help form a senior team member. 8.2To protect my own security and the security of others I would alert people if there are unknown people on the property grounds and ask said person to provide identification. I would also make sure that dangerous items such as knifes and scissors are all accounted for and stored away safely. 8.3When talking about staff or visitors to the premise it is important that they aware of the own whereabouts so that  hazardous can be pointed out and avoid. Also they can also be made aware of the nearest fire exits in case of emergency. For service users it is important that they are made aware of the environment they are in, such as a kitchen or by a road side so staff can help them manage the risks of being in the environment. 9.1Common signs of stress can include symptoms such as headaches, trouble sleeping such as irregular sleeping patterns, muscle pains and a reduced concentration span. 9.2Signs of stress in myself would include trouble sleeping, smoking and trouble being patient with people. 9.3Factors that trigger stress for me are missing deadlines, not taking enough time to relax and being uncertain about my job security. 9.4 There are many strategies for people to manage their stress. Eating and drinking can help, a healthy diet and avoiding drinking too much caffeine or alcohol can help people deal with stress. Another way to help reduce stress is to get 6 to 8 hours sleep each day. Exercise has also been link to reducing stress, breathing exercises can help people who are stress. Each of these has there pro’s and con’s. Some while getting enough sleep can help reduce stress, stress can cause people to have trouble getting to sleep. Eating healthy is a good way to feel good which can help. Exercise can work well but people may not be able to find time to do it. Breathing exercises can be helpful and could be done anywhere and don’t take much time to perform.

China, India, and Wal-Mart: Issues of Price and Sourcing

Case 3: China, India, and Wal-Mart: Issues of Price, Quality, and Sourcing Introduction: Wal-Mart was the largest retailer in the United States and the largest corporation in the world because of the crusade, which meant all US products on the shelves by its creator, Sam Walton (Weiss, 2009, pp. 471). However, after he died in 1992, crusade evaporated, instead of US products, 98% of all of shelves throughout Wal-Mart (Weiss, 2009, pp. 471) are manufactured in China, Vietnam, South Korea, Taiwan and India. Too-cheap-to-beat Chinese products are killing the US manufactories, which cannot afford to make products anymore and still make a profit.Someone said that the Wal-Mart’s goal is only get the lowest price without regarding the quality which means Wal-Mart’s products from global markets are taking an increasingly vigorous public trashing because of product safety and quality concerns. Nonetheless, Wal-Mart still expands its purchases of Chinese goods (Weiss, 2009, pp. 4 72). Ethical Issues: According to this case, Wal-Mart’s ethical business management is related to the global environment, which consists of financial markets, cultures, technologies and government policies (Weiss, 2009, pp. 18). As the case indicates, the market also consists of hypercompetition from different countries such as China and India and regional players in the global environment. China has low cost offshore labor in the â€Å"flat world†, so that Chinese imports are so inexpensive to enter in U. S. So many factors lead most US manufactories to close the doors and eventually jobs are lost accelerate. The United States’ economic outlooks vary with regard to the global economy (Weiss, 2009, pp. 420).In my opinion, the labor force is one of technologies in a developing country and it supports the globalization process. China as a global manufacturer and U. S. partner is a great source of world-class offshore technology services. Wal-Mart has its own exter nal and internal stakeholders. The largest benefit able external stakeholder is a customer. As Wal-Mart, it sacrifices product quality in order to offer customers low prices. It is hard to justify that Wal-Mart is unethical without further investigation of overall impacts that brings to the customers.As its internal stakeholders, the employees have more job opportunities because of expending its business scope and shareholders can benefit more in the global trade. In my opinion, moreover, the government as its external stakeholder, it can control the quality when the products import to the U. S. The technological environment comprises factors related to the materials and machines used in manufacturing goods and services. Wal-Mart has no control over its international suppliers, which should be controlled by the U. S. overnments, although it has ability to control its threats in the global environment. In conclusion, globalization makes hypercompetition and challenges to new and cont inuing leaders and professionals in organizations (Weiss, 2009, pp. 423). As the case indicated, the critic asserts that U. S. must stop Wal-Mart to continue to grow. However, I think it is not practical in a â€Å"flat world†, it provides the lowest price of the products for the customers after all. References Weiss W. Joseph. Business Ethics: A Stakeholder & Issues Management Approach. 5e

"This I Believe" Essay Example | Topics and Well Written Essays - 500 words

"This I Believe" - Essay Example hen I was in elementary class fifth division I made a decision that I was going to start leading in my class although many people did not believe in me including my class teacher. Going as per my performance in previous exams nobody could believe that I could even manage to appear among the top ten. I had to put my faith into practice and demonstrate to everyone that nobody could limit me. When the results for the mid-term exams were released I was not the first but I was among the top five and I could see everyone could then believe that it was possible, from bottom ten to top ten. When we sat for the end of year exams I did it passionately with a lot of conviction in my heart that I could make it. When results were finally released it was not a surprise for me that I was named as the best student except for the few Doubting Thomases’s who had refused to believe in my hard work, commitment and dedication. I continued to lead in class right from the fifth division until when I completed the elementary education. When I joined high school competition became extremely high but I could still appear among the best because I continued to believe in myself. Some of my friends and relatives call me a go-getter while others say I am too aggressive but what I know is that nothing is impossible in world. I am a true believer of self-motivation and inner drive. Many a times people said negative things trying to discourage me from getting whatever I want in life but I have never listened to their discouragements instead I have continued to believe in what I know about myself. Holding on to my belief has not been easy. At times I may desire to achieve something that is beyond my ability. It then becomes a problem because it means I have to strain. However, I learnt a lesson that sometimes life may not go as we wish but we should always demonstrate resilience even though we fail at some point. I learnt that even greatest men and women who have made a huge impact in this

Analyzing Financial Statements of Actual U.S. Companies Term Paper

Analyzing Financial Statements of Actual U.S. Companies - Term Paper Example Finally, the analysis will be relied on to determine in which company to $ 20,000. Back in the seventies, the airline industry in the U.S was highly regulated. During the period, the government implemented strict policies to new entrants. The regulations put by the government set very high standards, which attracted more entry fee. As a result, the entry into the industry became more expensive. Potential entrants withdrew their entry plans. The consequences of the strict regulations were low competition, high prices, reduced quality of the airline services and decline in sales volume. Since the U.S. Government lifted the regulations, the entry of new players has been on the rise. Competition in the industry has increased leading to a rise in services standards. The quality of airline services increased as the competition grew tight. Companies had to improve their competitive standards, and one of the effective competitive strategies is constant quality delivery. Deregulation of the airline industry lead to the reduction of the fare prices, which made the airline s ervices more affordable (Airline Deregulation, Revisited par. 1-7). Currently, most airline companies have a new plan that most analysts refer to as anti-competitive strategies. The consolidation strategy that has seen many airline companies merge is not supported by various authorities such as the Department of Transport. Companies following companies have merged into one: Air Trans merged with Southwest, the American airline merged with U.S Airways, United airline merged with Continental among other examples. The recent consolidation causes many fears as it could lead to monopoly. As a result, in 2013, the District of Columbia and Antitrust Division’s civil enforcement program legally challenged the consolidation strategy on the grounds that free competition and the quality level of services would be compromised (Airline Deregulation, Revisited par.

Biography of Copernicus Research Paper Example | Topics and Well Written Essays - 500 words

Biography of Copernicus - Research Paper Example After attaining the age of eighteen, Copernicus was sent for further studies in the University of Bologna (Weatherly 47). His uncle had excellent connections not only in Poland, but also in other foreign countries around Europe. This made it easier for him to secure Copernicus’s place at the prestigious University of Bologna. Astronomy was widely considered as one of the most important subjects of study among priests and clerics. Roman Catholics believed that astronomy would enhance the priests’ abilities to forecast the future. Additionally, it was considered as an essential area of knowledge for interpreting events. This ensured that Copernicus gad to study astronomy. While at the University of Bologna, Copernicus also studied mathematics and advanced sciences. It is during his time in Italy that he questioned some heliocentric principles that had been formulated by other scholars. This formed an excellent basis of his research. He learnt a lot from his professor at the university and also applied this knowledge in his research work after moving back to Poland. His findings and theoretical formulations on the heliocentric model were not published until a few days to his death in 1543 (Andronik 69). While his findings had some flaws, they were immensely crucial towards future studies in astronomy and earth sciences at large. The contributions of Copernicus to astronomy are evident in his heliocentric theory. Within the framework of this theory, Copernicus stipulated that the earth revolves around the sun. This is one of the most significant aspects of astronomy. During the 1400s and 1500s, people believed that the earth was the center of the universe. However, the extensive research work of Copernicus was instrumental towards addressing this misconception. At first, this stipulation was considered as highly controversial. However, additional research and studies by other scientists helped in validating

My way through the ECMO Essay Example | Topics and Well Written Essays - 500 words - 3

My way through the ECMO - Essay Example The large community base has only made me realize the kind of understanding and oneness a society can have within its folds. Therefore I appreciate the unity that exists within such realms and attribute my success to my elders and the society essentially. I recently made my way through with the ECMO (the Extracorporeal Membrane Oxygenation) Lab at the University of Michigan. My work within this project has been for a period of about six months now. It has enabled me to act and react to a number of varying situations and circumstances and has thus leased a fresh life within me. It has taught me quite a lot about the different aspects of health and human sciences, and has instilled in me the confidence to move ahead further with the passage of time. I look forward to being a part of the Health and Human Sciences, and this is the reason that I wish to apply at the University of Michigan as a freshman to the college of literature, science and arts. It would further my future with the kin d of understanding that I have desired for myself. This deems more significance as I will be able to put forth my wish towards accomplishment. Basically, I have volunteered for this role at the laboratory which has put solid faith within me that I can make my way through and learn the nuances with such fields today and apply them for a better use in the coming times. My experience with different people at the laboratory has made me realize that one needs to appreciate the little moments of happiness that life brings within it. And this is the reason why I would like to pursue my up coming education within the same quarters. It would instill in me a sense of pride and achievement that I have not yet attained in my life.

British Welfare State Essay Example | Topics and Well Written Essays - 2000 words

British Welfare State - Essay Example This essay discusses that for those in power, it had the benefits of gaining socialist support. Not only liberal politicians but both Lloyd George and Churchill encouraged social policy as a means of avoiding socialism and when labor came into power they were criticised for, ‘failing to introduce a distinctively socialist policy in the field of education.’The government response to poverty in the 1940s is the culmination of different attempts to overcome and replace the Poor Law since the 1820s. The legislation before the 1940s is similar in character to the legislation in the 1940s. It is so similar that most historians and even those bringing about the new laws have commented on the welfare state being just a socially acceptable version of the Poor Law. In addition, the Acts passed can be shown to be a result of the political maneuverings and practical responses to the events of that decade. However, there are some revolutionary aspects that lie behind the governmentâ €™s response. These are the fundamental changes in the perception and understanding of the nature of mankind, the state and the relationship between them. The state took on a responsibility for welfare that involved a greater involvement in its citizen’s lives. Furthermore, the general definition of poverty expanded to include everyone in need, not just those who could not subsist. Beveridge’s report is revolutionary as being the first completely planned social document which envisages Disease, Idleness, Want, Squalor and Ignorance as being the state’s responsibility.... All the features of liberal social policy were actually already covered by the older law yet the reorganisation made using the services socially acceptable. 'A person who was sick, hungry, unemployed or old could in fact turn to the Poor Law for help, and almost all the categories of social need for which the Liberals were now catering for were already being dealt with by the Poor Law Guardians.' (Fraser, 162) Significantly Beveridge himself formulated his proposals around, 'the pre-war system of contributory insurance No other system was seriously considered on the ground that it would be a 'departure from existing practice''. (Lowe, The Welfare State in Britain since 1945, 122) Chronological development before the Welfare State Moreover, the policy developments in the 1940s look like the result of the increasing intervention of the state in issues of welfare alongside the increasing awareness of poverty that had been taking place since the 1830s. The search for a replacement for the Poor Law began as early as the 1820s. In 1834 a report on the law was published investigating and suggesting solutions for the escalating problems of the Poor Law. Moreover in the 1840s a society of doctors envisaged a system of free health care. Movement later in that century began to provide assistance, outwith the Poor Law, for the sick and temporarily unemployed. This was through the Medical Relief Act (1885) and Chamberlain's Circular (1886). Here were the beginnings of assistance from a source outside of the Poor Law. This is the drift which could still be recognised in 1940s policy. More legislation was passed at the beginning of the twentieth century including more and more people in

Should All College Courses Be Specifically Related to a Future Essay

Should All College Courses Be Specifically Related to a Future Occupation - Essay Example Most college students, therefore, have their outstanding aspiration of settling for their future careers after graduation as their core objective. It becomes indisputable that the number of citizens served by college graduates, in their areas of specialization, is high. The nature of the professions handled by graduates is that of a highly critical endeavor, sometimes involving health and international relations issues. The fact that many colleges prioritize future occupation of learners rather than enhancing students with extensive comprehension of other skills becomes worrying. The effect of this mode of education can spread to bring extensive implications, some negative and irreversible. Teaching in colleges should not only include training in future occupation but also other complementary life skills. Unless such complementary skills appear among college courses, the value of education gets to a compromising situation. There is no doubt the importance of college education in ensu ring a solution to life problems and challenges as climate change and economic crisis, among others, is great. In fact, there is a high demand for innovation that makes the quality of life better than it is, or even cheap to afford. All these are possible with intensive training, of college students, in their future occupation. ... Besides the knowledge of research, college students should learn other skills as oratory speech delivery, among other courses. A case in point would be a college student pursuing international relations or political science courses. If, for instance, the student lacks the knowledge of oratory speech delivery, it becomes a challenge. Others may argue that such skills, mentioned, form part of the lesson plans of their related courses. It is true they do. However, it is questionable how many graduates can apply the skills, exceptionally and in an outstanding way.  Ã‚  

Investment Advisors Small Business - Business Plan Essay

Investment Advisors Small Business - Business Plan - Essay Example Institutions, which would be discussed in this section, are Royal Bank of Canada, LBMC and FiduciaryVest. Royal Bank of Canada (RBC): Established back in the year 1869, RBC is Canada’s largest bank in terms of asset value and market capitalization. The institution consistently receives high credit ratings both from Moody’s Investor Services and Standard & Poor’s. This has helped the company to gain the trust of the prospective investors. The advisory service of RBC caters to the high net worth private clients and niche corporate and institutional clients across the globe. Other than investment advice, they offer complimentary financial plans and wealth consultations, guided by RBC experts (RBC, 2010, p.1-2). LBMC: LBC Investment Advisors, LLC, has been ranked among the top financial planning firms in US. The ranking was done by CPA Wealth Provider on the basis of assets under management. The financial institution has more than $ 300 million under its management and it has been experiencing sustainable and continual growth in the industry (LBMC, 2010). FiduciaryVest: FiduciaryVest is an employee owned independent investment advisory firm. They offer consulting service and advice which is in accordance to the interests of the clients. They assist their clients to analyze the assets, develop investment policy, goals and guidelines and design the investment portfolio by fulfilling the objectives of the investors only to optimize their profitability (FiduciaryVest, 2007). So, it seems that there are many institutions which are ready to challenge the new entrants in this industry. The new institution must possess some competitive advantage to sustain its existence in the long run. The company was established by three people, Carol Buckalew, Arnold Jones and Richard Small. Carol is a CFA with more than 15 years of

Economic control Essay Example for Free

Economic control Essay Traditionally the reasons of the rules and regulations were to control human relations in an effort to make the behaviors of other individuals known (Pennell, pp3). rules are also employed to provide other purposes, these includes punishing offenders, providing social economic control, banishing private retribution, deterring criminal acts and reflecting public opinions (Pennell, pp3). Conventionally prevention of crime was intended provide advice on defensive behaviors and security. On the other hand laws are supposed to be malleable and should serve as a tool of social engineering (Pennell, pp4). They are supposed to be transformed with arrival of new thoughts and societal changes. The human rights and needs of victims of crime are essential aspects of criminal justice systems, especially currently, as the issues of victims have emerged since 1970s. Since 1970s, legal and emotional reactions of the nation have changed dramatically and currently more attention is being paid on restorative justice. There are many activities that are involved in restorative justice (Pennell, pp6). In order to give an insight of the various forms that restorative justice is taking and the activities that are involved this paper will focus on practices, origin context and limitations of restorative justice (Pennell, pp6). Victims Rights The current legal codes in federal government evolved from the conventional codes and attempts to define and deal with criminal behaviors. The aim of the codes is to focus on the deviant behaviors of the criminals and they rarely focus on the victims and their needs. The primary focus of the law is to deter the criminal activities (Aldana-Pindell, pp45). Several decades ago within the federal government when reconciliation for victim offenders was being set restorative justice did not exist within the criminal justice system (Brown Bunnell, pp87). Restorative justice has evolved currently within the criminal justice system in recent years following philosophical writings of van ness and others. Various debates which have been held have facilitated the emergence of processes within the restorative justice such as impact panels, conferences, sentencing circle etc (Aldana-Pindell, pp45). Since 1970s several practices and programs have assisted to develop the restorative justice moments. Early practices for restorative justice were focusing on the moderated meetings involving the offenders and the victims (Aldana-Pindell, pp46). As time went by the meetings were expanded and included friends and family members from the two parties. The meetings also included professionals and other individuals who had access of public resources. In recent years the system has paid much attention on the participation and involvement of members of the community (Normandeau, pp34). In 1970s some practitioners and scholars believed that offenders are victims of social neglect, poor societies and racial, ethnic and gender discrimination. As a result the advocates of restorative justice focused to change the conditions in the prison, reduce incarceration use and eliminate prison and jails as institutions (Normandeau, pp34). In this regard there are some individuals who were seeking to make a caring society instead of prisons and jails that would address the issues of victimizers and victims (Brown Bunnell, pp92). The activists of caring communities brought the issue of interests of the victims in the criminal justice system in a progressive manner rather than focusing on the right of the victims (Meister, pp54). In 1970s and 1980s the population of people in the prisons in United States was becoming progressively overcrowded and contributed to the use and popularity of intermediary sanctions (Aldana-Pindell, pp47). However, during this time restorative justice and mediation of victim offenders were not common within the criminal justice systems as alternatives. The establishment of boards of societal justice and centers for neighborhood justice in the federal government reflected their wishing to achieve more justice and this was characterized by public participation and casualness (Aldana-Pindell, pp49). These were new forms of resolution of conflicts in the late 1970s and they showed a developing disenchantment which involved trial procedures of adjudication and finding facts in accordance to adherence to strict legal principles. On the other hand the systems in resolution of conflicts placed much importance on negotiation, agreements between the disputants and placed less importance on the role of legal professionals (Aldana-Pindell, pp49). In mid 1970s reconciliation programs in the United States were introduced for victim offenders. These programs were based on the principles of Mennonite that focuses on dialogue and exchange (Marshall, pp20). Reconciliation programs involved offenders and crime victims meetings after being sentenced and included impartial third party. Reconciliation programs for offenders and victims aimed at restoring good relationship that is supposed to exist between the parties. The proponents of these programs were focusing to establish a good working relationship and use of principles of religious institutions and also as an option to incarceration (Marshall, pp21). In the rate 1970s advocates and the victims increasingly focused on mediation rather than reconciliation programs for offenders and victims’ interactions. However, the model of the mediation program was similar to models of reconciliation program, although additional individuals affected by the differences would be involved in the meeting, especially when addressing serious crimes (Meister, pp57). Mediation programs for offenders and victims were developed in western part of Europe, Scandinavia and England in the end of 1970s and early 1980s, and were use primarily to handle justice cases for the youths. Since 1980s the programs have shown a significant growth in the United States and other nations (Marshall, pp22). Progressive voices and conservatives suggest that victims of crimes do not have the voice in the criminal justice system. In late 1970s and early 1980s activists of feminists and social scholars of legal doctrines paid more attention on making courts and law enforcement officers to be accountable to children and women who may be physically or sexually abused (Marshall, pp22). The groups that advocated for victims right focused on compensation for crime in the processes of courts, using formal voice and on safety of the society. In early 1980s Reagan organization released a report of task force on victims of crimes that facilitated the development of groups that advocated for the rights of the victims. Since 1990s there is a tremendous growth of alliances between groups that focuses on the reforms of criminal justice and victim support. This tremendous growth has been as a result of realizing the common interests among the offenders and victims based groups (Anwander, pp71). In 1980s New Zealand government started reassessing Waitangi treaty focusing on the implications of the relationship between the whites i. e. Pakeha and indigenous people the Maori. In 1986 a report that was prepared by ministers recommended for structural changes in the practices and policies of the government towards the indigenous people (Marshall, pp24). In 1989 the administration had great structural changes in the way matters regarding family welfare and justice for the youths was handled. Before introduction of these changes indigenous people were overrepresented in prisons and jails and decision making processes were dominated by the whites (Meister, pp58). These structural changes employed in youth justice can be used in various juvenile offenses, but mostly they are used in serious cases and minor cases solved trough diversions of police. Family welfare and youth justice programs are different from offenders and victim reconciliation and mediation programs since they involve more community members in the discussion of the offense, pay more attention on participation of the family and recognize more victimized individuals. Family welfare and youth justice programs also reduce the intervention of the state and changes the roles of professionals in problem solving (Marshall, pp26). Youth justice and family welfare programs were introduced first in Australia in late 1991 and formed part of law enforcement operations that focused on one jurisdiction. Conferences run by the police were also introduced in the capital city of Australia and later on the northern states (Meister, pp59). In late 1993 and early 1994, conferences for handling juvenile cases were introduced in the southern and western part of Australia and they were involving non professional police to run the conference. In Queensland and south wale conferences to handle juvenile cases, have been recently introduced and they are mostly employed in Queensland schools (Meister, pp59). Circles of sentencing were established in Canada in 1980s, and were the fist groups of the nation to respond to offenders (Marshall, pp26). The aim and objectives of circles of sentencing are resolution of conflicts, restoring harmony and order, and healing of offenders, victims and family (Anwander, pp73). Circles of sentencing involves processes of consensus and includes all the victims of crimes and families of the victims, their next of kin, and community members in order to respond to the behavior and formulate sanctions that addresses all the needs of those involved. Circles of sentencing are currently being used in United States and in Canada by non indigenous groups that include blacks in Minnesota. Since 1980s, there are other practices which have emerged and use the principles of restorative justice (Marshall, pp27). Compensation boards in Vermont involve the members of the community and design penalties for offenders of juvenile. These penalties involve service of the community and rarely involve offender and victim mediation. The meetings do not involve the victims (Anwander, pp76). Panels of victim impact have also been introduced by mothers and focuses on drunk driving. The panels give a room for the victims and the members of the family to give their suggestions about the impact of driving when drunkard to the offenders who have been ordered by the court to attend. However, these panels for victims are different from most of the processes of restorative justice, since they do not employ voluntary attendance (Marshall, pp29). On the other hand they have an important element of bringing contact of offenders and victims in the process, which lacks in traditional proceedings of criminal justice. These panels are employed extensively across the United States. On the other hand research and theories have contributed to the development of restorative justice. In 1970s scholars of social and legal doctrines developed several theories focusing on formal and informal justice. Theoretical and empirical studies of formal and indformal justice which have been conducted in industrialized countries and in less developed countries suggest that, it took less one decade to change optimism for pessimism. With emergence of theories and research disillusionment had already set in by 1990s (Marshall, pp30). In late 1970s and early 1980s there were arguments from the criminologists in Netherlands, Norway and from elsewhere to abolish prisons. During this time the activists paid more attention on decarceration and alternatives to jails and prisons. However, currently there are few individuals who would argue for complete abolition of prisons although few people argue for their minimal use (Marshall, pp31). In 1996 there was an international conference to address penal abolition held in New Zealand and supported resolutions and discussions to facilitate restorative justice. Scholars have also attempted to focus on the merits of informal methods that can be applied in social set ups to regulate order in the society (Marshall, pp31). This involves reintegrative shaming in response to a crime that may be integrative and not stigmatizing. These ideas have been employed in conferencing models such as in wagga, in Australia. Before the wagga conference these ideas were not included in youth justice and family welfare programs and they did not form part of many conference held across the globe. The united states are currently employing the wagga model, although there are some arguments on the issue of shame and whether it should be the central issue in processes of conferencing (Marshall, pp32).

Does Palliative Care provide a peacefull death

Does Palliative Care provide a peacefull death Palliative care was traditionally considered something done just for the dying patient and patients with cancer, but times have changed. Today it is a form of care that can be administered to not just someone facing the end of life, but also to people with terminal illnesses. At the end of life many patients will receive palliative care and comfort measures which are intended to keep the patient comfortable with pain medications, turning, suctioning, oral care, etc. Comfort is something all nurses want to achieve for their patients. Comfort also means different things to different people; therefore it is difficult to gauge and deciphering concrete ways to provide comfort is not easy. In the acute care setting, researchers have focused solely on physical comfort care interventions for end of life, but research for interventions for overall holistic comfort care measures are lacking. This paper demonstrates that because comfort is the top priority for a dying patient receiving palliative care, holistic comfort measures that take care of the body as a whole should be achieved to ensure maximum comfort. The purpose of this evidence-based literature review was to explore health care providers and patients views on palliative and comfort care at end of life, examine current comfort care and palliative care practices and evaluate whether palliative and comfort care measures allow the patient to have a peaceful dying experience. Research indicated that the patients care needs to be individualized, that patients should be assessed, and personalized interventions implemented to ensure a holistic comforting dying experience. Palliative care order sets are helpful, but they are just a guideline or tool to help provide consistently good quality care. Hospice has been known for their excellent holistic comfort care for the dying patients, hospitals would benefit from learning some of their interventions and modifying them for use in the hospital. Some comfort interventions include music therapy, hand massage, utilization of visual analog scales such as the faces, and guided imagery to measure comfort. These methods are some of the ways hospitals can utilize the findings from the research into daily practice to ensure quality holistic patient comfort is achieved. Research Question Does the use of Palliative Care and comfort measures during End-of-Life provide the patient a more peaceful death experience? Relevance to Nursing Practice Research supports the need for providing holistic comfort measures using palliative care during end-of-life care. Registered nurses working in the acute care hospital setting along with Advanced practice nurses (APNs) and palliative care physicians should utilize the many other specialties such as integrative medicine to ensure holistic patient comfort. Palliative order sets are a great tool to help manage pain and anxiety levels but each patients comfort care needs to be individualized to fulfill their needs. Registered nurses need to make sure the patients comfort needs are addressed, so that the patient may have a peaceful dying experience. This Literature review advocates that holistic patient comfort during end-of-life is achieved by attending to its many physical, mental, and social states. Therefore, a nursing definition of comfort can be described as the physical and/or mental state of relief or contentment achieved as a result of holistic nursing interventions, which ensure a satisfying, peaceful, good dying experience. Review of Literature In Comfort Measures: A Qualitative Study of Nursing Home-Based End-of-Life Care, Waldrop and Kirkendall (2009) used a qualitative study method to survey employees from a 120-bed suburban, nonprofit nursing home. The researchers goals were to explore how their staff recognized a dying patient and to identify applicable standards of palliative care. The sample consisted of 42 employees, including nurses, chaplains, social workers, nursing assistants, housekeepers, and administrators. Employees in various roles were interviewed to provide multiple perspectives on the dying experience. The survey was a 30-minute interview conducted in a quiet location of the nursing home away from the nursing unit (Waldrop Kirkensall, 2009). An affiliated research assistant or investigator who has had training in conducting interviews and qualitative data analysis conducted the interviews. The interviewer asked the employees open-ended and objective questions about frequency and standards of care for dying patients and their families. All interviews were audio taped, transcribed by a professional transcriptionist, and labeled with a letter number combination (e.g., N[urse]-1). The transcripts were entered into Atlas ti software for data organization and management (Waldrop Kirkensall, 2009, p.720). The survey identified physical, behavioral, and social factors as the three main indicators of impending death. Physical indicators included altered breathing patterns (including apnea), anorexia, or increase in pain; behavioral indicators included mood changes and diminished activity level. Social indicators sometimes included withdrawal from interaction with staff or family (Waldrop Kirkendall, 2009). During the survey, the staff explained that comfort care is initiated when patients began to exhibit these signs. At this nursing home, standard order sets were not used and comfort care measures were described as being very patient-individualized and holistic. Comfort care includes an interrelationship of symptom management, family care, interpersonal relationships, and interdisciplinary cooperation in which each member of the healthcare team participates in the care of the patient, according to their scope of practice (Waldrop Kirkendall, 2009). The survey revealed that health care employees deliver comfort care in different ways. The study has several limitations including that it was conducted in only one nursing home, lacked direct physician perspectives, lacked family and resident opinions, and a possible response bias. This studys findings identified the need for more comparison studies to explore standards of care in other facilities. It also raised the questions whether or not palliative care includes comfort measures and how palliative care is defined across the healthcare settings (Waldrop Kirkendall, 2009). By further comparing nursing homes that use different models of care, comfort care standards and/or improvements can be made. This survey was conducted in a nursing home setting, but its results reflect on hospital end-of-life care. At the present time, the standard of care for dying patients in hospital settings usually consists of pre-printed order sets that are not individualized to the specific needs of the patient. This study promotes use of the holistic, individualized care approach to ensure a more satisfying and comforting dying experience. Jarabek, Cha, Ruegg, Moynihan, and McDonald, (2008) began a study within the Internal Medicine Residency Program at Mayo Clinic in Rochester, Minnesota. The researchers hypothesized that standard palliative order sets within a hospital setting would enhance physician comfort with managing 4 aspects of end-of-life care, pain, secretions, agitation, and dyspnea. A 5-question, pre-intervention web-based survey regarding physician comfort in diverse aspects of palliative care was given to 144 internal medicine resident physicians before the release of the palliative order set, which would later be used within the hospital. Each question included a 5-item Likert response scale, ranging from 1, very comfortable to 5, very uncomfortable(Jarabek et al., 2008). Three months later, an educational e-mail was sent to all house staff and faculty addressing end-of life-care along with the initiation of the order set, which consisted of physical ailment provisions. Another 3 months was spent allowi ng staff to use and or work with the order sets at which point a post-intervention survey was performed. Results of the post-intervention survey were that 88% had utilized the palliative order sets and 63% stated that they felt increasingly comfortable with palliative care (Jarabek et al., 2008). There was an overall 10% increase in resident comfort regarding the 4 aspects of palliative care with the initiation of order sets, but no change in social or communication-related comfort (Jarabek et al., 2008). One weakness of the General comfort Questionnaire (GCQ) is that each item is scored on a scale of 1 to 6 and not weighted based on importance to the patient. Some items are more significant than others in determining overall comfort level and the patients score on the GCQ as a whole may not be an adequate indicator of their overall comfort level. For example, if a patient answers 1, strongly disagree to the statement my body is relaxed right now, the patient will get 1 point for th e question, but if they score high on the rest of the GCQ, the results could show an overall high comfort level even though the patient is really uncomfortable and in pain. The GCQ is a very useful tool because it can be given to patients verbally if they are weak or lack dexterity. Because the survey addresses all aspects and levels of comfort it is a valid tool for nurses to use to make interventions to provide holistic patient care. The survey concluded that palliative order sets can increase physician comfort in providing care to patients during end-of-life, but it also revealed that the order sets do not address the psychosocial needs of the patient when providing comfort care. Although physicians find comfort in having order sets as guidelines for end-of-life care, they are only guidelines and open communication needs to be initiated between the health care team and the patient to ensure all the comfort care needs of the patient and family are met in a holistic way so that the y may have a peaceful dying experience. Teno et al., (2004) evaluated 1578 adult patients with different, chronic illnesses end of life experiences by surveying the decedents loved ones and determining whether their perspectives on quality end-of-life care were influenced by the environment where the patient spent their last 48 hours of life. A survey was devised from a conceptual model for patient-focused, family-centered medical care and the calculation of scores and psychometrics of the measures were taken from an online tool formulated by Brown University. Within 9 to 15 months from the time of death a close family member or informant whom was listed on the death certificate was surveyed and was asked about the quality of care their loved one received during their last 48 hours of life. Five different domains were used in the survey, including whether healthcare workers provided patient physical comfort and emotional support, supported collaborative decision-making with the physician, treated the patient with respect, attended to family needs, and provided coordinated care with other healthcare workers or facilities (Teno et al., 2004). Teno et al., (2004) concluded that 69% of the decedents site of death and last place to receive care was in a hospital or nursing home setting, 31% home, 36% without nursing service, 12% home nursing, and 52% home hospice. The survey showed that family perceptions of the quality of care were different according to where their loved one last received care. Families of patients who were in nursing homes or had home health had a higher rate of unmet needs for pain (Teno et al., 2004). Over half of the families in hospital or nursing home settings reported unmet emotional needs. In addition, 70% of families receiving home health care reported inadequate emotional support in comparison to 35% in families who utilized home hospice care. Patient and family respect was also a concern to families and varied in different settings. Only 68% of nursing home residents families felt they had been treated with respect and consideration compared to the 96% of families receiving hospice care (Teno et al., 2004). Survey participants felt that physical symptom management was adequately managed so it was comparably equal throughout all patient settings. Although families did not experience a difference in pain or dyspnea management in comparison to other nursing services families who used hospice services overall, 71% reported excellent care (Teno et al., 2004). The survey suggests that although patient care settings such as hospitals, home health, nursing homes all try to provide comfort care during end-of-life that it can be inadequate in meeting the emotional needs of the patient who is dying and their families. The survey supports the hypothesis that hospitals and other care settings need to start utilizing holistic comfort measures similar to the measures hospice incorporates to achieve psychosocial and emotional patient satisfaction and a comfortable dying experience. Kolcaba, Dowd, Steiner, and Mitzel (2004) identified the need for comforting interventions for patients at end of life that are simple, easy to learn and administer, and require minimal effort on behalf of the patient. Bilateral hand massage is a good intervention because it is noninvasive, easy to do, does not take long, and relies on caring/healing touch (Kolcaba et al., 2004). The purpose of their study was to determine empirically if a bilateral hand massage provided to patients near end of life twice per week for 3 weeks was associated with higher levels of comfort and less symptom distress. Thirty-one adult hospice patients from 2 hospice agencies participated in the study. Each patient was English-speaking and expected to remain alert and oriented for the duration of the trial, 13 months. Data collectors who were unknown to the patients called the homes of the patients, explained the study, and then scheduled an appointment for a research visit. Data was collected at the patients homes and at the hospice centers(Kolcaba et al., 2004). After informed consent, participants were randomly divided into the treatment group (with 16 patients) and the comparison group (with 15 patients). All participants were asked to complete a modified General Comfort Questionnaire (GCQ), tailored for end-of-life patients, once a week for 3 weeks. After completing the questionnaire each week, the treatment group then received the hand massage intervention twice a week for 3 weeks. The comparison group received the intervention once at the end of the study period. The researchers concluded that there was no significant difference between the treatment and comparison groups in regard to enhanced comfort or decreased symptom distress over time (Kolcaba et al., 2004). However, comfort did increase some in the treatment group even as the patient approached death. The study also revealed that the hand massage seemed to allow more time for therapeutic or face to face communication allowing the patients to talk about how they feel and their feelings on transitioning to death, and patients receiving the intervention reported it to be a personalized experience something they could engage in that feels good, and family members were appreciative of the care and attention their loved one was getting (Kolcaba et al., 2004). Because this intervention is easy to learn and requires minimal time for the caregiver to do and minimal effort for the patient it is an excellent intervention that can even be taught to the family. This study identifies interventions t hat can be used within the hospital setting and any other setting to enhance comfort during end-of-life. Nurses and family members can use this intervention to increase communication by using caring touch, which provide psychosocial care and therefore holistic comfort for the patient. Bakitas et al., (2009) using project ENABLE {[Educate, Nurture, Advise, Before Life Ends]} combined with a nurse-led intervention with ongoing assessment, coaching, symptom management, crisis prevention, and timely referral to palliative care and hospices hypothesize that patients newly diagnosed with advanced cancer if exposed to this intervention right away would become informed, active participants in their care, and would experience an improved quality of life, mood, and have better symptom relief. The study protocol and data and safety monitoring board plan were approved by the institutional review boards of the Norris Cotton Cancer Center and Dartmouth College in Lebanon, New Hampshire, and the Veterans Administration (VA) medical center in White River Junction, Vermont. All patient and caregiver participants signed a document confirming their informed consent.(Bakitas et al., 2009). Participants completed baseline questionnaires when they were enrolled and then completed a fol low-up one month later. Using a stratified randomization scheme patients and their caregivers were randomly assigned to the interventions or usual care group. One of 2 advanced practice nurses with palliative care experience conducted 4 structured educational problem solving sessions first one lasting 41 minutes and sessions 2 through 4 approx 30 minutes each and at least monthly telephone follow-up sessions until the participant died or the study ended (Bakitas et al., 2009) The advanced practice nurse began all contacts with an initial assessment by administering the Distress Thermometer, an 11-point rating scale recommended by the National Comprehensive Cancer Network guidelines. It identifies sources of distress in the 5 areas of practical problems physical problems, family problems, spiritual, emotional problems or religious concerns. If distress intensity was higher than 3, the advanced practice nurses then identifies the sources of distress and checks to see if the participan t would like to problem/solve to take care of their issue. The nurse then covers the assigned module for that session. The participants clinical teams are responsible for all medical decisions and inpatient care management, however the advanced practice nurse was readily available by telephone for the participants and they could also facilitate ancillary resources. The participants also were able to participate in group shared medical appointments (SMAs), which are led by certified palliative care physicians. The usual care participants were allowed to use all oncology and supportive services without restriction. Follow-up questionnaires were mailed every 3 months until the patient died or study completion in December 31, 2007. Quality of Life was measured with a 46-item tool called the Functional Assessment of Chronic Illness Therapy for Palliative Care. It measures the participants physical, social, emotional, and functional well being along with the concerns of a person whom has a life-threatening illness. Of 1222 screened, 681 were eligible and were approached and 322 were enrolled (47% participation rate). There were a total of 134 participants in the usual care group and 145 participants in the intervention group. A systematic review of specialized palliative care identified 22 trials (16 from the United States) between 1984-2007 with a median sample size of 204, half exclusively with cancer patients. There was lack of evidence due to contamination, adherence, and recruitment etc. The trial addressed these issues and contributed to the increasing evidence that palliative care may improve quality of life and mood at the end of life. In our study, intervention participants higher quality of life and lower depressed mood may be attributed to improved psychosocial and emotional well being. Mood is a determinant of the experience of quality of life and suffering despite a mounting burden of physical symptoms(Bakitas et al., 2009). However, while patients in the intervention group had improvement in these outcomes, we conservatively planned our original target trial enrollment of 400 based on a significance level of .01. Statistical inferences based on this stringent critical value would lead to the conclusion that there were no statistically significant differences between groups in quality of life or mood(Bakitas et al., 2009). A number of limitations were found in the study, first there was limited racial and ethical representation in the study, which recognizes the need for duplicate studies with more diverse populations. Second, the interviews were conducted by telephone, in-person interactions (such as those seen in another successful outpatient palliative care intervention study may have produced a more robust effect, particularly in reducing symptom intensity(Bakitas et al., 2009). In person consultation was not often feasible for the debilitated population whom usually live more than an hour away from the cancer center. More re search is needed on optimal care delivery systems for this population(Bakitas et al., 2009). The researchers concluded that compared with participants receiving usual oncology care those receiving a nurse-led, palliative care-focused interventions that takes care of the patient holistically provided at the same time with oncology care had higher scores for quality of life and mood, but did not have improvements in symptom intensity scores or reduced days in the hospital (Bakitas et al., 2009). Characteristics of Comfort Even though nursing scholars have extensively researched and described various aspects of comfort, perceptions of the characteristics of comfort vary from personal perspectives and situations. After reviewing literature and research relevant to achieving comfort, it is clear that its characteristics extend beyond its physical attributes and are indeed a state of ease, relief, and transcendence (Kolcaba Kolcaba, 1991). To achieve holistic comfort at end-of-life there needs to be patient participation to enhance comfort with the use of comforting interventions. Kolcaba et al. (2004) described a peace of mind with a reduction in undesirable dying symptoms as important indicators of comfort while researching the efficacy of hand massage in hospice patients. Nursing interventions at end-of-life should be individualized to the patient to meet their comfort needs, as comfort is vital in palliative care. Novak et al. (2001) postulated that comfort consist of holistic properties which includ e a soothing environment, social support, conflict resolution, and spiritual harmony. Waldrop et al. (2009) also proposed similar qualities he studied comfort measures in a nursing home setting and described comfort care as the combination of the integration of symptom management, family care, interpersonal relationships, and interdisciplinary cooperation. Comfort in this study was a result of holistic interventions focused on achieving enhanced patient comfort, thereby allowing a good death (Waldrop et al., 2009). Application of the Literature to Practice Findings from the literature and research support the need for providing holistic comfort measures using palliative care during end-of-life care. Registered nurses working in the acute care hospital setting along with Advanced practice nurses (APNs) and palliative care physicians should utilize the many other specialties to ensure holistic patient comfort. Palliative care nurses (PCRNs) are an excellent resource to consult for any questions regarding end-of-life care. Registered nurses need to make sure the patients comfort needs are addressed; they need to talk with the patient and their families to get a better understanding of their comfort level expectations. Palliative order sets are a wonderful tool with which to help manage physical discomfort, but Registered Nurses should assess the environmental, psychospiritual, and social comfort needs in order to create adequate interventions to help achieve enhanced holistic comfort. To achieve the physical aspect of comfort during end-of-life care pain medication can be prescribed, and to help relieve anxiety, ativan may also be given. Music is also a relaxation therapy that may also have a calming effect and can be encouraged to help bring relaxation, peaceful environment, and help the patient to forget their illness for a short time. To facilitate the psychospiritual aspect of comfort care the Registered nurse can consult a chaplain, social work, or a family therapist who can help the family and patient address the feelings of grief, fear, anxiety, and help promote resolving of family issues, which ultimately assists the patient in overcoming any negative feelings to gain closure and to achieve peace. The hospital room can be stressful, room lighting, dà ©cor, and music can be modified to help provide a more peaceful and soothing environment to relax and reflect during their last hours. The social aspect of comfort may be fulfilled by consulting social servic es to help provide support by addressing any communication issues within the family and helping the patient and their family fined courage and strength in times of need and despair. Using feedback from all the aspects of holistic comfort care is important in promoting consistent and continuous comfort during the patients dying experience. Registered nurses must determine the wishes of the patients for achieving comfort and using the many interventions the nurses should evaluate ad make adjustments accordingly. Providing holistic comfort care is an integral part of palliative medicine and it is continuously being changed to fit the needs of the patient and their families, and therefore is an excellent way to approach end-of-life care in the acute care setting of a hospital. Conclusions The research presented reveals while palliative care order sets provide a helpful guideline or tool which reassures health care providers in giving consistent good quality care, patients care needs should be assessed and individualized orders and interventions should be implemented to ensure a peaceful and comforting dying experience. Hospice care settings have been shown to provide excellent holistic care for dying patients and they have also been shown to show compassion to the family as well. The comfort interventions from these facilities can be modified for application in the hospital for use in the acute care setting. Holistic comfort care interventions include hand massage, music therapy, or the utilization of a visual analog scale the faces to measure comfort. These are some of the ways hospitals can utilize the findings from this research into daily practice to ensure quality holistic patient comfort is achieved and ultimately a peaceful death.