Motor Cyclists Essay Example for Free

Motor Cyclists Essay Psychological and social factors influencing motorcycle rider intentions and behaviour Barry Watson Deborah Tunnicliff Katy White Cynthia Schonfeld Darren Wishart Centre for Accident Research and Road Safety (CARRS-Q) Queensland University of Technology August 2007 Psychological and social factors influencing motorcycle rider intentions and behaviour i Published by: Postal address: Office location: Telephone: Facsimile: E-mail: Internet: Australian Transport Safety Bureau PO Box 967, Civic Square ACT 2608 15 Mort Street, Canberra City, Australian Capital Territory 1800 621 372; from overseas + 61 2 6274 6440 02 6274 3117; from overseas + 61 2 6274 3117 [emailprotected] gov. au www. atsb. gov. au  © CARRS-Q, Queensland University of Technology 2006 To encourage the dissemination of this publication, it may be copied, downloaded, displayed, printed, reproduced, and distributed in unaltered form (retaining this notice). Subject to the provisions of the Copyright Act 1968, no other use of the material in this publication may be made without the authorisation of the Queensland University of Technology. ii Psychological and social factors influencing motorcycle rider intentions and behaviour DOCUMENT RETRIEVAL INFORMATION Report No. RSRG 2007-04 Publication date August 2007 No. of pages 152 ISBN 978 0 642 25564 8 ISSN Publication title Psychological and social factors influencing motorcycle rider intentions and behaviour Author(s) Barry Watson, Deborah Tunnicliff, Katy White, Cynthia Schonfeld, Darren Wishart. Organisation that prepared this document Centre for Accident Research and Road Safety Queensland University of Technology GPO Box 2434 Brisbane QLD 4001. Sponsor [Available from] Australian Transport Safety Bureau PO Box 967, Civic Square ACT 2608 Australia www. atsb. gov. au Project Officer John Collis Reference No. Aug2007/DOTARS 50323. Abstract This report documents two studies undertaken to identify and assess the psychological and social factors influencing motorcycle rider behaviour. The primary aim of the research was to develop a Rider Risk Assessment Measure (RRAM), which would act as a tool for identifying high-risk riders by assessing rider intentions and self-reported behaviour. The first study (n = 47) involved a qualitative exploration of rider perceptions utilising a focus-group methodology. This study identified six key aspects of rider behaviour considered to influence safety: motorcycle handling skills; rider awareness; riding while impaired or not; and the tendency to bend road rules, push limits, and ride at extreme speeds or perform stunts. Study two (n = 229) was survey-based and examined the psychological and social factors influencing these behaviours, utilising the theory of planned behaviour (TPB) and other relevant psychological constructs, such as sensation seeking and aggression. This study indicated that risky rider intentions were primarily influenced by attitudes and sensation seeking, while safer intentions were influenced by perceived behavioural control. While intentions significantly predicted all six types of behaviour, sensation seeking and a propensity for aggression emerged as significant predictors, particularly for the volitional risk-taking behaviours. The measures of intention and behaviour comprising the RRAM were not found to be significantly correlated with self-reported crash involvement, possibly indicating shortcomings in the measurement of crashes. However, significant correlations were found between the components of the RRAM and self-reported traffic offence involvement. While further work is required to refine and validate the RRAM, it represents a potential tool for informing and evaluating motorcycle rider safety countermeasures. Keywords Motorcycle safety, theory of planned behaviour, sensation seeking, aggression Notes (1) (2) ATSB reports are disseminated in the interest of information exchange. The views expressed are those of the author(s) and do not necessarily represent those of the Australian Government or the ATSB. Psychological and social factors influencing motorcycle rider intentions and behaviour iii CONTENTS Executive summary EXECUTIVE SUMMARY Background Motorcycle riding is rapidly increasing in popularity in Australia, attracting a much wider demographic of people than in decades past. Unfortunately, whilst the overall number of road deaths in Australia has generally been reducing, the proportion of motorcycle-related fatalities has been rising in recent years. Further, the proportion of motorcycle-related fatalities in Australia is unacceptably high compared with other OECD countries. To reduce motorcycle-related fatalities on Australian roads, there is an urgent need to consider motorcyclists as distinct from other road users. This program of research facilitates the understanding of safety issues from a motorcyclist perspective and provides important information on factors influencing safe and unsafe rider intentions and behaviour. The aims of this program of research were to: †¢ develop a better understanding of the psychological and social influences on rider behaviour in an Australian context; †¢ guide the development of future motorcycle safety countermeasures; and †¢ develop a tool (the Rider Risk Assessment Measure – RRAM) to inform the evaluation of motorcycle safety countermeasures, particularly in the area of training and education. To achieve these aims, two particular studies were undertaken: a qualitative study of motorcycle rider perceptions utilising a focus-group methodology and a survey-based quantitative study of selfreported rider intentions and behaviour. Both studies were underpinned by a theoretical framework drawing on the theory of planned behaviour (TPB), identity theory, social identity theory, and other relevant psychological concepts such as sensation seeking and aggression. Key findings Study 1 explored motorcyclists’ perceptions relating to ‘safe’ and ‘risky’ riding and the different personal and social factors that influenced their behaviour. A total of 43 people participated in this study, either as part of a focus group or as an interviewee. This exploratory process revealed six types of behaviours which were commonly believed to influence the safety (or riskiness) of motorcycle riding. These six behaviours are discussed below. Two behaviours were identified as being particularly essential to rider safety. The first was the necessity of being able to handle the motorcycle proficiently and skilfully. The second related to the need for riders to maintain a high level of concentration whilst riding and to stay aware of the changing road environment. In contrast, there was some debate about the inherent safety or riskiness of the two next behaviours commonly identified. Firstly, some riders believed that obeying the road rules was essential to their safety, whilst others reported that it was often necessary to break the road rules in order to stay safe. Secondly, the definition of what constituted ‘riding whilst impaired’ differed amongst riders. Most riders agreed that ‘drinking and riding’ was dangerous. However, for some, even one alcoholic drink before riding was considered dangerous, whilst others would ride after drinking provided they did not consider themselves to be over the legal BAC limit. Some riders stated that riding when viii Psychological and social factors influencing motorcycle rider intentions and behaviour they were tired was dangerous; however, fatigue was not considered a serious safety issue for many participants. Two further behaviours identified by participants were often associated with their accounts of crash involvement, yet not seen as intrinsically ‘unsafe’ by most riders. The first of these was the concept of ‘pushing your limits’. Most riders interviewed appeared to enjoy pushing the limits of their ability on a motorcycle. Whilst agreeing that pushing the limits too far was dangerous, pushing them to a point that tested a rider’s abilities was often reported to facilitate safety as this process developed a rider’s skill. The second behaviour that was often mentioned in connection with crashes was extreme riding (e. g. , performing stunts and riding at extreme speeds). The act of perfecting a stunt was often reported to result in the crashing of the motorcycle, although these crashes were usually accepted as a normal part of the learning process. Once perfected, performing stunts did not appear to be considered an intrinsically unsafe behaviour, unless performed in traffic or other unpredictable situations. A sizable minority of both male and female participants reported riding at extreme speeds. These riders often argued that they could ride extremely fast, safely, on public roads provided certain conditions were met (e. g. good visibility, minimal traffic, weather, road, and motorcycle maintenance). Study 2 involved 229 active motorcyclists who completed a questionnaire assessing: their riding intentions and self-reported behaviour; the psychological and social factors influencing these intentions and behaviour; and their self-reported involvement in road crashes and traffic offences over the last two years. The questionnaire was structured around the six types of rider behaviour identified as important in Study 1. Key results of this study are discussed below. In order to obtain an insight into the factors underpinning both ‘safe’ and ‘risky’ behaviour, the six areas of interest were operationalised as three ‘safer’ behavioural intentions (i. e. handle the motorcycle skilfully, maintain 100% awareness, not ride impaired) and three ‘riskier’ intentions which represented more volitional risk-taking (i. e. bend the road rules, push the limits, perform stunts or ride at extreme speeds). Hierarchical multiple regression analyses were then performed to assess the influence of different psychological and social factors on these intentions. These analyses indicated that a greater proportion of variance could be explained in the case of the riskier riding intentions [R2 ranging from 57% – 66%] than the safer riding intentions [R2 ranging from 22% – 36%]. The TPB construct of perceived behavioural control (PBC) significantly predicted all three ‘safer’ intentions, while attitude was a significant predictor of the three riskier intentions. In terms of the social influences, the TPB construct of subjective norm (which assesses the influence of others considered important) proved a relatively weak predictor of behaviour. However, the measure of specific subjective norm (i. e. the influence of the people that someone rides with) emerged as a significant predictor of three of the six intentions. Over and above this, a propensity for sensation seeking was found to be significant predictor of the three risky intentions. Overall, a similar pattern of results emerged when the self-reported behaviours of the participants were examined. Firstly, while the various psychological and social variables examined in the study significantly predicted all six behaviours, considerably larger amounts of variance were explained for the three volitional risk-taking behaviours, i. e. bend road rules to get through traffic [R2 = . 67], push my limits [R2 = . 59] and perform stunts and/or ride at extreme speeds [R2 = . 69]. Secondly, the results were largely consistent with the tenets of the TPB, with intentions proving a significant predictor of all six behaviours. Thirdly, sensation seeking, along with rider aggression, emerged as a strong predictor of all six behaviours. Indeed, together, these two variables accounted for between 7 – 20% of additional variance in the six behaviours. Not surprisingly, these two variables accounted for relatively large amounts of additional variance in the ride while impaired [R2 ch = . 20] and the perform stunts and/or ride at extreme speeds [R2 ch = . 15] variables. Unfortunately, no significant correlations were found between the various measures of intention and behaviour operationalised in Study 2 and the self-reported crash involvement of the participants. It Psychological and social factors influencing motorcycle rider intentions and behaviour ix is possible that this indicates that the six behaviours of interest, in reality, do not have a close relationship with crash involvement. However, this conclusion does not seem consistent with either the findings of Study 1 or the research evidence reviewed in Chapter 2. More likely, the findings highlight shortcomings in the size of the sample and/or the way that crash involvement was measured in the study. In particular, given that crashes are relatively rare events, crashes were measured over a two year period in order to ensure that (some) participants would have experienced a sufficient number of crashes to facilitate the analyses. However, this raises the possibility of recall problems that may have reduced the accuracy and reliability of the data, while the two year period may have been too long to accurately reflect the current intentions and behaviour of the participants. In contrast, the majority of the intention and behaviour measures were found to be significantly correlated with self-reported traffic offence involvement. In particular, significant associations were found between self-reported traffic offences and the three ‘riskier’ intentions examined in the study (i. e. those relating to more volitional risk-taking, namely, bend the road rules, push my limits and perform stunts and/or ride at extreme speeds). In addition, significant associations were found between traffic offence involvement and five of the six self-reported behaviours examined (the only exception being for awareness errors). These results don’t necessarily confirm the inherent ‘riskiness’ of the behaviours examined, since engaging in an illegal behaviour may not always result in a crash. However, they do provide prima facia evidence supporting the validity of the intention and behaviour measures developed in this study. Strengths and limitations of the research This program of research featured a number of strengths. Firstly, it was firmly grounded in theory; secondly, it utilised both qualitative and quantitative methods to obtain a broad insight into the factors influencing motorcycle rider behaviour; thirdly, the design of the research was informed by input from active motorcyclists; and finally, it adopted a balanced approach to motorcycle safety by examining both safe and risky riding intentions and behaviour. Nonetheless, the program of research also had a number of limitations. Both Studies 1 and 2 consisted of participants primarily recruited from South East Queensland. In addition, the participants were volunteers who were generally older in age. As a result, the samples used in this research may not be representative of Australian motorcyclists in general, but instead reflect a subset of older, primarily recreational, riders. This should be borne in mind when interpreting the results. Furthermore, a number of other potential limitations in the Study 2 questionnaire design emerged during the analysis of the results. These included the way that fatigue was grouped with alcohol and drugs to assess intentions and behaviour relating to riding while impaired and, as noted above, the manner in which crash involvement was measured. Implications of the research At a theoretical level, this program of research has confirmed that the predictive utility of the theory of planned behaviour (TPB) can be substantially improved by the addition of other variables. In particular, this research demonstrated that subjective norm (SN) was a relatively weak predictor of intentions and that the specific subjective norm (SSN) (i.e. assessing the influence of those people that someone rides with) performed relatively better as a measure of social influence. Moreover, both sensation seeking and the propensity to ride aggressively proved significant predictors of all six behaviours examined, over and above the TPB and other social influence variables. The findings relating to sensation seeking are consistent with previous research in the traffic psychology area. x Psychological and social factors influencing motorcycle rider intentions and behaviour. However, the results relating to aggression warrant more attention, since this variable proved a relatively stronger predictor than sensation seeking of the error-based behaviours (i. e. handling errors and awareness errors), the ride while impaired behaviour, and the perform stunts and/or ride at extreme speeds behaviour. This suggests that the propensity to ride aggressively has a broader influence on rider behaviour, which is not limited to the more volitional risk-taking types of behaviours. At a practical level, this program of research has identified a number of ways to enhance current motorcycle safety countermeasures, particularly in the area of rider training and education. Most particularly, it has identified a range of psychological and social influences on rider intentions and behaviour that appear to be beyond the scope of current skills-based approaches to motorcycle training and education. Consequently, further work is required to develop and trial new approaches to rider training and education that more effectively address the attitudinal and motivational influences on riding, both of a personal and social nature. To assist in this process, this research has undertaken the first steps in the development of the Rider Risk Assessment Measure (RRAM). This tool is intended to act as a means of identifying high-risk riders by assessing their intentions and self-reported behaviour (in relation to both ‘safe’ and ‘risky’ riding). While further work is required to refine and validate the RRAM, it represents a tool that can be used in a variety of ways to enhance motorcycle safety countermeasures, including informing the design and content of training programs and evaluating the impact of different  initiatives on rider behaviour. Psychological and social factors influencing motorcycle rider intentions and behaviour xi ACKNOWLEDGEMENTS The authors would like to acknowledge the funding support provided by the Australian Government, through the Australian Transport Safety Bureau’s (ATSB) Road Safety Research Grants Programme. The development and conduct of this study has involved the contribution of a large number of people. While it is difficult to acknowledge all the individuals that have contributed, the authors would like to thank: †¢ †¢ Mr John Collis from the ATSB for his ongoing advice and support; those people who assisted us organise the focus groups, from organisations such as Queensland Transport, Motorcycle Riders Association Queensland, Ulysses, and Q-Ride providers; personnel from the Queensland Police Service, particularly the Logan and Brisbane West Districts, who assisted in the distribution of the pilot and main questionnaires at various motorcycle events; The ongoing support for motorcycle research from Morgan and Wacker Pty Ltd; and the assistance of Morgan Wacker Motorcycle Training Centre, particularly Mr Fred Davies, in the finalisation and distribution of the Study 2 questionnaire.   xii Psychological and social factors influencing motorcycle rider intentions and behaviour GLOSSARY OF TERMS AND ACRONYMS ABS ATSB BAC Australian Bureau of Statistics. Australian Transport Safety Bureau [formerly Federal Office of Road Safety (FORS)]. Blood Alcohol Concentration. In Australia, the legal amount of alcohol that may be present in the blood is 0. 05% if the driver or rider is on an unrestricted licence. It is usually measured either by a police breathalyser or a by a blood test (see also Over the limit). A person who identifies with, and belongs to, an organised outlaw motorcycle club. Club members ride motorcycles and often wear jackets with ‘patches’ which identify the club they belong to (Veno, 2002). A motorcycle enthusiast. May or may not belong to a motorcycle club (Krige, 1995a). Centre for Accident Research and Road Safety Queensland. A study design which collects data on the perceptions or behaviours of subjects at one point in time, as opposed to a longitudinal.

Job Satisfaction Among Ghanaian Mental Health Nurses

Job Satisfaction Among Ghanaian Mental Health Nurses 1.1 Background Study The main objective of this research is to evaluate the attitudes of Ghanaian mental health nurses and the level of job satisfaction in the three government psychiatric hospitals in Ghana. It has been identified that most people who suffer from mental illness are always vulnerable and at high risk of suffering from stigmatisation and discrimination. Mental health professionals such as nurses are always in contact with patients and their attitudes towards these patients can play a major factor in their recovery. This aspect of study has been neglected especially in developing countries like Ghana. This study is to try as much as possible to find out how the nurses’ attitudes affect their patients and the role job satisfaction plays. Over the years mental health has changed in many faces including the establishment of mental institutions, which has also gone through several changes in different countries thereby drastically reducing the number of psychiatric admissions in general hospitals. However, it is important for one to know if these changes reflect the attitudes of people towards mental illness especially mental health nurses. The perception of mental illness plays a major role in the psychiatric medical profession which several disputes on what should be classified as pathological and which should be seen as normal. These disputes have several consequences on the diagnosis, research, and policies concerning psychiatry and may also have some form of bias on the selection of treatments and prognosis due to the widespread of unauthentic ascriptions of the causes of the illness (Wakefield, 2007). According to World Health Organisation (WHO), mental health is â€Å"a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community† (WHO 2001). There are several definitions by researchers on mental health, which is a fundamental aspect of well-being and quality of life and also a basic element of social structure, productivity, peace and stability in the environment (WHO, 2005). This definition by WHO stresses on the positive scopes of mental health and Shives (2008) also states that mental health is a positive state in which each and everybody is responsible, self-directive and displays self-awareness where ones behaviour is generally accepted within a group. However Bryne (2000) stated that multiple factors influence the level of mental health of person at any point in time and one of the major hindrances to the realisation of positive health and well being leads to stigma. Mental illness is a psychological response to stress that interferes with or inhibits a person’s ability to easily meet human needs and functions within a culture (NSW, Department of Health, 2007). Moreover, the American Psychiatric Association also defines mental illness as a â€Å"clinically significant behaviour and psychological syndrome or pattern that occurs in an individual associated with present distress, disability or loss of freedom† (Bryne, 2000). Mental illness is a major contributor to the burden of disease internationally, which has a major influence on the disability, co-morbidity, and mortality being experienced globally (CAMIMH 2007, Lauber Sartorius 2007). World Health Organisation (WHO) estimates that about 450million people will suffer from some form of mental disorder with 13% of the global disease burden being made of schizophrenia, depression, epilepsy, dementia, alcohol dependence, neurological and substance-abuse disorders which exceeds both cardiovascular disease and cancer (National Institute of Health) moreover people with mental illness are more likely to be at risk of other health conditions as well. It is estimated that at least one member in every four families has a mental disorder and the primary caregivers of those affected are the family members and this brings some form of burden to these families, which are mostly ignored (WHO, 2010). Depression is estimated to be the second highest cause of disease burden in middle-income countries and the third highest in low-income countries by 2030 (WHO, 2010). Moreover, in addition to the health and social cost, which is a problem, there is also the victimisation of human rights violation, stigmatisation and discrimination of people with mental illness, which occurs both inside, and outside of psychiatric institutions (WHO, 2010). According some researchers, people with mental illness are at increased risk of drifting into or remaining in poverty through increased health expenditure, reduced stigma and loss of employment and associated earnings (Lund et al, 2911). This puts lots of pressure on people with mental illness and their families especially in low income or developing countries where it is more stressful (NSW, Department of Health, 2007). People diagnosed with mental illness are looked at differently in the world as compared to people who are diagnosed with general health problems. Thus most people have the impression that mental illness patients are strange, frightening, unpredictable, aggressive and lack self-control especially those diagnosed with mental disorders such as schizophrenia which is always associated with negative stereotypes of being very aggressive and dangerous (Crisp et al, 2000). Individuals suffering from mental illness for some time now have been at a higher risk of experiencing prejudice and discrimination and most of these prejudice leads to stigmatisation even within health institutions (Linden and Kavanagh, 2011). Prejudice can be said to be an emotional response to stereotypes which is tolerated where stereotypes are mostly unfavourable intercessions used to describe a group or persons based on their merits thus leading to discrimination which is the real behaviour based on prejudice (Lauber et al, 2006). Stigma and prejudice mostly play a basic role in the abuse of human right, which is sadly still being practiced, in some psychiatric institutions and care homes and remain the basis of mental health organisations in some developing countries in the world. Goffman (1963) cited in (Newton-Howes et al, 2008) describes stigma as a mark of shame or dishonour which can have a negative self esteem and appraisal on a the person thereby becoming a hindrance to recovery, moreover Gray (2002) also stated that, stigma was originally used to mark Greek slaves separating them from men. The stigma of mental illness although more often is related to context than to person’s appearance, still remains a powerful negative attribute in all social relations (Bryne, 2000) and the stigma of mental illness comes from the possession of a devalued attribute of an individual which is seen by society as a hostile response (Goffman, 1963) cited in (Newton-Howes et al, 2008). World Health Organisation (2011) states that stigmatisation of mentally ill patients by the healthcare providers is the worst form of stigma which affects the quality and rate of recovery. There are several evidence from other studies conducted by researchers from other populations which proves that stigma can sometimes been seen to pervade professional groups including mental health nurses. Research by Read and Harre (2001), found that negative attitudes are mostly displayed by mental health nurses towards patients who are disturbed which is mostly present in the patients at acute level of their illness. Health professionals mostly come into contact with people with mental illness regularly and they play an important role in shaping attitudes towards mental ill people. Moreover, these health professionals serve as a role model on how to approach people with mental illness however Schulze (2007), states that healthcare professionals have been identified to assume three main positions when it comes to stigmatisation and these include people with mental illness being stigmatised, they being stigmatised by their own association with mental illness and finally playing the role of advocator’s or de-stigmatises. Stigma affects the progression and healing of people with mental illness according to Perlick et al, (2001) and the loss of income, low self-esteem, loneliness, isolation, delayed seeking of treatment and many more are the results of stigma and discrimination towards people with mental illness (Sharac et al, 2010; illac et al, 2011). Creating major campaign of the awareness of stigmatising attitudes will support healthcare workers to be more reflective in the treatment methods towards people with mental illness. Sartorius (2007) stated that, people who suffer from mental illness do not frequently pursue treatment due to the fact that healthcare professionals including nurses are considered prime contributors of stigma and discrimination. Some staff who have been given special training in taking care of people with mental illness do hold negative stigmatising attitudes towards their patients as well which proves that stigma is not only held by individuals with lack of knowledge about mental illness even though educational intervention can help reduce its effect in the community or country as a whole (Burti and Mosher, 2003; Pinfold et al, 2003). Mental health services in Ghana are not well recognised as there are lots of inequalities in the provision of resources for this sector as compared to the needs of the general hospitals. Moreover there is still lack of knowledge about mental illness, which is a major contributor of stigma towards people affected with mental illness and the healthcare professionals who even take care of them. The population of Ghana has increased extremely since the country’s independence from 1957 resulting in the growing number of people suffering from mental illness (Ghana Statistical Service, 2003). Mental health service in Ghana is mostly available in primary health care yet the majority of care is provided through specialised psychiatric hospitals of which there are three (3) all located in the southern part of the country providing 7.08beds per 100,000 populations (Ghana Health Service, 2012). The WHO estimates that out of the 21.6 million Ghanaians, about 650, 000 are believed to be suffering from some form of severe mental disorder and 2,166, 000 are suffering from moderate to mild form of mental illness (WHO, 2007). Nevertheless, this estimate has not been recognised as a serious health issues and Ghana has not yet developed facilities and public health services including mental health care to keep up with the growing demand of these services and population expansion (Offori-Attah et al. 2010). According to the WHO Atlas Survey about 65% of beds in the psychiatric hospitals, are extremely unsatisfactory. The ratio of these beds in Accra the capital city of Ghana is 6.21:1 thus the total number of beds to the rest of the country indicating a high intensity of resources in the capital (Ofori-Atta et al, 2010). WHO has also reported that most psychiatric hospitals have scarce, undignified, and even harmful practices as well as unhygienic and inhuman living conditions (WHO, 2003). The main focus of psychiatric care today in the world is mainly on a number of key conditions such tolerance and non-discrimination being one of the most important aspect (Hannigan, 1999). Inadequate knowledge about mental illness and negative attitudes mostly towards individuals suffering from mental illness has been noted to be prevalent in the general public (Nordt, Rossler and Luber, 2006) thus most major research of attitudes towards people with mental illness has been mainly focused on the general public with the opinions of professionals who come into contact with the mentally ill specifically mental health workers recently being highlighted (Angermeyer Dietrich, 2006). Numerous challenges faced by mental health institutions such as lack of resources, increased work load and shortage of staffs put lots of burden on the nurses which negatively affects the quality of nursing care given to these patients therefore positive changes in mental health services will go a long way to impact on the role and practice of mental health nursing (Cleary, Walter and Hunt, 2005). Low job satisfaction plays a major role in the outcome of patients’ care and there have been lack of research in the country concerning this. Job satisfaction of healthcare professionals is a very important aspect that should not be neglected as it can affect the outcome of care given to these patients. Moreover, there are lots of evidence gaps in the country concerning mental health issues and that is the why it is important to conduct this research in order to fill some of these gaps. Job satisfaction is a complex situation, which can be construed, and it involves the absence of pain, oppressiveness and intolerance as well as enjoyment (Sultana and Begum, 2001). Studies on job satisfaction are mostly based on fountains of emotional response of the employees which is linked with some socio-cultural institutions and the personal elements such as pay, promotion, supervision, benefits, nature of work, co-workers, working condition, social status and many more (Sultana and Begum, 2001). 1.2 RATIONALE Research fills a very important aspect in the society where discoveries are made as well as confirming or rejecting ideas, controlling or predicting events and developing or refining theories. Thus one develops knowledge as a result of these functions from research. It is unsurprising that human right abuse is mostly related to the poor standard of mental health care in low-income countries such as Ghana and the need for ways to restraint is the most obvious choice for healthcare professionals in the absence of neuroleptics (Read, Adiibokah and Nyame, 2009). Studying the attitudes of healthcare professionals especially in the field of mental illness is important. According to Baker et al (2005), attitudes are made of cognitive, affective, and behavioural components, which are activated due to exposure of stimulus or objects. Moreover, the quality of nursing care provided by mental health professionals can be influenced by the attitudes of the nurses towards these patients (Baker, 2008). There have been several campaigns to change negative attitudes and promote positive attitudes towards mental health problems by some countries, which include the United States, New Zealand, United Kingdom, and India (Royal College of Psychiatrist (2001) and World Psychiatrist Association (2001). Ghana health service (GHS) is the main provider of biomedical care for mental illness in the country however there are just three government psychiatric hospitals in the country providing free healthcare for patients which are all located in the south of the country serving over 21million Ghanaians. All three hospitals have suffered from lack of resources to overcrowding with the end results being poor quality of healthcare. The status of mental health nurses in some communities is low and the advantage of being part of this profession has been dent with some form of stigma such as stigma by association or courtesy stigma (Hinshaw 2007, Thornicroft 2007, Halter 2008) whereby professionals associated with the care of people suffering from mental illness are judged by the same stereotyping stigma. It is therefore very important to explore the theoretical relationship between job satisfaction and professionals stigma towards mental illness. The focus of this study is to address some of the gaps in mental health concerning stigma and job satisfaction mental health nurses are facing in Ghana. The findings of this study will be a stepping stone to address issues that will come out as a result of the study or re-enforce any positive findings as well. The outcomes of this study may allow a greater understanding of how these attitudes are connected and the realistic outcomes can help to the strategize anti-stigma campaigns such as identifying shortfalls of certain groups or identifying logical way 1.3 RESEARCH QUESTION To what extent do mental health nurses in Ghana stigmatise people with mental illness? What personal and professional background factors (including job satisfaction) explain the attitudes that Ghanaian mental health nurses have towards mental illness? What characteristics are associated with nurses’ attitudes towards mental illness? What is the rate of job satisfaction in mental health nursing and does it affect the care patients receive? 1.4 OBJECTIVES The main objective of this research is to evaluate the attitudes of psychiatric nurses in Ghana towards the care of mentally ill patients. The specific objectives are as follow: To identify the relationship and levels of job satisfaction and stigma towards psychiatric patients among Ghanaian mental health nurses. To determine prevalence of stigma among mental health nurses in Ghana. To explore the rate of job satisfaction in mental health nursing and the impact it has on the attitudes of nursing providing care for patients. To examine the characteristics associated with the attitudes on mental health nurses in Ghana. To disseminate findings to increase awareness and knowledge among healthcare professionals’ especially mental health nurses. The findings of this study will be used to: Develop programs and strategies to reduce stigma. Help create awareness of stigma in healthcare professionals. Develop policies to reduce stress in the hospitals. Suggest improvements/amendments to existing mental health policies. 1.5 RESEARCH HYPOTHESIS The following research hypothesis was formulated for testing: the researcher hypothesised that the more psychiatric nurses are satisfied with their job, the more they will exhibit positive attitude towards mental ill patients. The researcher also hypothesise that the more psychiatric nurses are stigmatised about their job, the quality of care they provide will be less and they will exhibit negative attitudes towards their patients

Inventing a Writing Technology :: Invention Writing Technological Papers

When I first started thinking about this assignment, lots of different ideas ran through my head from sticks and sand to pond muck to baking, but I kept running into the fact that almost everything that I thought of utilized some sort of manufactured tool. Ultimately, since I have a soft spot for anything edible, and since fruit is a ready resource in nature, I went to the produce section of the grocery store for some berries and a surface. My problem then though was the fact that paper and traditional writing surfaces are also a technology. It was actually much more difficult for me to come up with an appropriate surface than to find a way to make letters. Letters are essentially stains or scratches or rubbings, which can be created by a wide array of different natural resources, but finding a surface that has some permanent qualities as well as allowing for the writing to be legible is tough. I ended up with a honeydew melon because the surface was smooth and pale so that the berry juice would show up clearly. Another characteristic of a successful writing surface is that it absorbs or retains the writing, and that was the problem with my melon. The surface wasn’t porous enough to receive the berry ink, and I was compelled to use a knife to make the project successful. I rationalized the knife by thinking that it is one of the simplest tools that humans use, since it is essentially a sharp wedge. Also, it is po ssible to make a knife if one wants to take the time to do so by scraping a stick with a rock or a softer rock on a harder one. With the use of a precise tool like a knife, I was able to create very clear and legible letters that became even more pronounced with the blueberry dye. Ong states that â€Å"writing is a technology, calling for the use of tools and other equipment,† (Tribble 321) and my difficulty in writing with crude rocks and sticks only made this point more resonant for me. I did try to carve the melon with a sharp stick, but it was a frustrating and painstaking process that I quickly abandoned in favor of the tried and true knife. Without this tool, I do not believe that my writing sample would have looked as â€Å"normal† as it did, and it probably would have been very difficult to read. Inventing a Writing Technology :: Invention Writing Technological Papers When I first started thinking about this assignment, lots of different ideas ran through my head from sticks and sand to pond muck to baking, but I kept running into the fact that almost everything that I thought of utilized some sort of manufactured tool. Ultimately, since I have a soft spot for anything edible, and since fruit is a ready resource in nature, I went to the produce section of the grocery store for some berries and a surface. My problem then though was the fact that paper and traditional writing surfaces are also a technology. It was actually much more difficult for me to come up with an appropriate surface than to find a way to make letters. Letters are essentially stains or scratches or rubbings, which can be created by a wide array of different natural resources, but finding a surface that has some permanent qualities as well as allowing for the writing to be legible is tough. I ended up with a honeydew melon because the surface was smooth and pale so that the berry juice would show up clearly. Another characteristic of a successful writing surface is that it absorbs or retains the writing, and that was the problem with my melon. The surface wasn’t porous enough to receive the berry ink, and I was compelled to use a knife to make the project successful. I rationalized the knife by thinking that it is one of the simplest tools that humans use, since it is essentially a sharp wedge. Also, it is po ssible to make a knife if one wants to take the time to do so by scraping a stick with a rock or a softer rock on a harder one. With the use of a precise tool like a knife, I was able to create very clear and legible letters that became even more pronounced with the blueberry dye. Ong states that â€Å"writing is a technology, calling for the use of tools and other equipment,† (Tribble 321) and my difficulty in writing with crude rocks and sticks only made this point more resonant for me. I did try to carve the melon with a sharp stick, but it was a frustrating and painstaking process that I quickly abandoned in favor of the tried and true knife. Without this tool, I do not believe that my writing sample would have looked as â€Å"normal† as it did, and it probably would have been very difficult to read.

Crytosporidia :: Essays Papers

Crytosporidia Life History: Once thought to be rare and host specific, Cryptosporidia is now believed to be one of the top three diarrheal causing pathogens in the world. Cryptosporidia muris was recognized in 1907 by E. E. Tyzer. Since then twenty (20) species of Cryptosporidium have been discovered and named although recently sixteen (16) of those twenty (20) have come under speculation due to recent cross-transmission studies. Cryptosporidia is a protozoan parasite which lives in the intestines and respiratory epitheliums of many types of animals including mammals, birds and reptiles. The disease caused by Cryptosporidia is known as Cryptosporidiosis. Cryptosporidia is found all over the world and is transmitted via fecal oral contact. Usually this is due to water contaminated by animal feces. Infected calves excrete up to 10 billion Cryptosporidium oocysts (infectious stage) per day. The infectious dose in humans is only 10-100. However, contaminated food or direct contact with feces can also cause infectio n. Microbial Characteristics: Cryptosporidia are small coccidian spore-forming protazoans. When in oocyst form they are 4-6 um in size. GRAPH Disease: Cryptosporidia are encountered and transmitted through fecal oral transmission. Once a host ingests an oocyst, sporozoites are released. The sporozoite then can enter the epithelial cells in the small intestine where it will develop into a trophozoite. Inside of a trophozoite, merozoites begin to form. When released, a merozoite can either infect another epithelial cell or it can evolve into a sexual gamete. These gametes then join to form an oocyst and will be excreted in the feces. While in the host’s body, Cryptosporidia carries out its entire life cycle in the microvilli of the small intestine. The most common symptom of Cryptosporidiosis is watery diarrhea. Other symptoms include: - Dehydration - Weight loss - Stomach cramps or pain - Fever - Nausea - Vomiting Some people with Cryptosporidiosis will have no symptoms at all. While the small intestine is the site most commonly affected, Cryptosporidium infections could possibly affect other areas of the digestive or the respiratory tract. (CDC) Symptoms usually begin 2-10 days after becoming infected and last 1-2 weeks on average. In immunocompetent individuals, Cryptosporidiosis is not life threatening.

Richard Avedon: Changing the Future Through Art Essay -- essays resear

Bright lights, flashes going off, beautiful and famous people everywhere, creative set designs, and everyone working to make the photo shoot perfect. This was the life of famous Richard Avedon. Avedon is one of the most successful photographers of the 20th Century. He is known for his fashion, advertising, exhibitions and book photographs that he has done.   Ã‚  Ã‚  Ã‚  Ã‚  Richard Avedon was born in 1923, in New York City. Avedon attended DeWitt Clinton High School in the Bronx. He never completed his high school career, and in 1942 Avedon joined the U.S. Merchant Marine Photographic Department. When he returned he joined the Design Laboratory taught at The New School by famous art teacher Alexey Brodovitch. Through this class he started to become well known for his stylistically fashion work that often took place in exotic and vivid locations. Avedon was married in 1944 to Dorcas Nowell, a model known professionally as Doe Avedon. They divorced after five years. In 1951, he married Evelyn Franklin. The pair later separated. In 1945 his photography career began.   Ã‚  Ã‚  Ã‚  Ã‚  He began his career in fashion photography in 1945 with Harper's Bazaar, switching to Vogue magazine in 1966. A retrospective exhibition of his work was mounted in 1978 at New York City's Metropolitan Museum of Art. Richard Avedon was the first staff photographer in the history of The New Yorker in 1992. Avedon’s work was a very unique and new way of photography. He was wid...

Charter Accounting Essay

Mr John Potts is a chartered accountant who owns his own firm. Potts works in all fields associated with business and finance in the private sector. He also employs workers to work in his firm assisting him in all aspects of his work. His office is just a five minute drive from his house which is an advantage as he can go to and from his house when necessary. He usually works from 9am to 7pm however, these hours are flexible. Mr Potts has a choice of working at his office or working at home. The activities he does include maintaining accounting records and preparing accounts and management information for small businesses (accountancy); advising clients on business transactions, such as mergers and acquisitions (corporate finance); advising clients who are in financial difficulty to help them turn the business around or to handle the disposal of the business (corporate recovery/insolvency); detecting and preventing fraud (forensic accounting) and much other activities. In order for Mr Potts to be able to complete his tasks, he uses some technologies which assist him with his work life, social life and personal life. Technology 1 – CCTV Closed Circuit Television (CCTV) is the use of video cameras to transmit signals to a certain place so an area is fully monitored for safety of others and crime. The most measurable effect of CCTV is not on crime prevention, but on detection and prosecution. Several notable murder cases have been solved with the use of CCTV evidence, making the environment a safer place for the public. CCTV – Work Related Use John Potts has many CCTV cameras around his workplace. The signal is sent to many monitors in his office and his study at home. This is so he can monitor outside activities and keep an eye out for any crimes that may occur. When Potts is not able to attend his office, he is still able to access the images from his study at home. Using the images, he can contact his security guards to check a specific area in his building. The advantages of having installed cctv cameras is that he can see what is going on around his building, therefore he does not have to be everywhere at all times. Another advantage is that he can access the images from home when he is unable to go to his office. This technology also has some disadvantages. One of these is that he will occasionally get worried of any crimes near his building which forces him to constantly check his monitors. This may be interfering with his social life as he would be too worried about his workplace. Another advantage is that the signals may not be received all the time due to incomplete installation of the cameras. This technology has improved the working style of Mr Potts as he is able to keep an eye out for any unusual events taking part around his building. Technology 2 – Personal Digital Assistant (HP iPAQ 200 Enterprise Handheld) The HP iPAQ 200 Enterprise Handheld (PDA) has many features which aids many businessmen. First of all, the PDA has a 4 inch touch screen display and has a stylish design making it a great deployment platform for enterprise applications. Secondly, using the integrated 802.11b/g wireless networking, Mr Potts is able to connect to the Internet and access his email. He is also able to connect Bluetooth peripheral such as headsets or keyboards. He is also able to use applications like Word, PowerPoint and Excel Word, PowerPoint and Excel on his PDA using Microsoft Office Mobile. Also, Mr Potts is able to store his business-critical information with high-capacity SDIO and Compact Flash. The advantages of this device are that it’s very ideal for businessmen as it is like five devices in one. Having many uses, the PDA benefits mostly businessmen who need access to the computer while on the move. A disadvantage of this device is that it is an ideal item that is of interest to many muggers in the world today putting you in danger due to being in possession of this device. Personal Digital Assistant – Personal Use Mr Potts is always on the move, around the city and very often he travels abroad for job purposes. When he is waiting for his flight, he does not need to carry his laptop with him all the time as his HP iPAQ 200 Enterprise Handheld (PDA) is an equivalent to his laptop. He is able to connect to the internet using Wifi which allows him to browse the internet to entertain herself by listening to music and watching videos. The advantages of this device are that it is more ideal as it is much smaller. He is still able to access his emails and many documents without the need of carrying a laptop. A disadvantage of this device is that he will need to extend his memory capacity constantly as he uploads a lot of information to his device which helps him with his job. Another disadvantage of this device is that he has to be very careful as the device is very fragile; the screen can be cracked. Also he is in danger of having his personal information known if he is not careful with his device. Personal Digital Assistant – Social Use Due to the wireless technology, Mr Potts can connect to the internet and use his email address to sign into Windows Live Messenger and chat to his friends. His device works exactly like a computer as he often sends, to his family, many photographs of famous landmarks that he took while he was abroad. Other than this, Mr Potts uses his PDA mostly for work related activities. Personal Digital Assistant – Work Related Use When it comes to Mr Potts’s job related activities, his PDA is the ideal device. While he is away abroad, his personal secretary sends him copies of documents by email. He later retrieves these documents from his PDA. He very often makes many spreadsheets on his laptop. This is also possible to do on his PDA which he does. His PDA can also create word documents which is very beneficial to him as he doesn’t need to go to his computer at all times or carry a laptop when he can carry a palm sized device which enables him to do everything that he can do on his laptop. But unfortunately, Mr Potts is required to expand his memory as the capacity may not be enough after having many documents on his PDA. When Mr Potts has access to his computer, he usually sends documents that he believes that he will need later to herself by email. He has sent almost all important files to herself by email. This is done so he can access and download them onto his PDA when he is away from home or access to a computer. Mr Potts’s PDA consists of important details of his clients, individual clients and business clients, such as phone numbers, addresses etc. If he did not have this device however, he would have had to carry a small notepad, writing in the details every time. This wastes paper and time as he has to search for a client’s details. This device is ideal to store information like this on it as he can quickly find someone’s details by entering a few letters of their name. The PDA will then narrow down the search until Mr Potts can view the details. A disadvantage of having a PDA in possession is that he has to take it almost everywhere with him as it contains relevant information. He has to be very careful with his valuable device as it may contain confidential information which can be accessed by anyone if he loses or misplaces his device. Technology 3 – Mobile Phone (Nokia N95) Another device used by Mr Potts is his mobile phone, Nokia N95. The Nokia N95 is a smart phone with many unbelievable features. First of all, the multimedia abilities. The N95 has an outstanding music player that supports MP3, WMA, RealAudio, SP-MIDI, AAC+, eAAC+, MIDI, AMR, M4A and True Tones. Next is the Internet. The N95 has built in Wi-fi which can be used to gain access to the internet. The web browser displays the webpage in full whereas other phones display simplified versions of the webpage. Another feature of this smart phone is the integrated GPS. Below the 0 key on the N95’s keypad is an integrated GPS receiver. The phone is shipped with navigation software and maps are free to download over the internet. Mobile Phone – Personal Use Mr Potts is really into his music. He listens to his mp3 tracks via the music player on his Nokia N95 which supports the formats mentioned above. He also uses his phone to entertain herself by watching many videos at DVD like quality on the 2.6 inch screen. Another feature on this phone widely used by Mr Potts is the 5 mega pixel camera located at the back of the device. With this, he is able to capture great pictures at amazing quality. An advantage of this is that when he is away and needs to take photos, he does not need to take another device, a camera; instead he can take his phone which enables him to take many pictures at an equivalent quality of his own camera. The smart phone also has a Flash Player. With this software in the phone, Mr Potts is able to put many games onto his phone which will keep him busy entertaining herself for a long time. Mobile Phone – Social Use As he is often out and about he is not seen at home for many hours. While he is on his lunch break, Mr Potts uses his time to make quick phone calls home to chat to his wife and his son. An advantage of this device is that when Mr Potts has not got his laptop or PDA, he is still able to talk to his friends over Windows Live Messenger by connecting to the mobile internet. Another advantage is that he saves a lot of coins as with his phone, he has many free minutes which allows him to make many calls whereas if he was not in possession of a mobile phone, he would have had to carry coins around with him to use a payphone. A disadvantage of this device however is that this can increase his phone bill. Mobile Phone – Work Related Use Mr Potts is a very busy man, always working. He needs to make many phone calls, which is part of his day to day life, spending many hours on the phone to his clients. Without his N95 it is almost impossible for Mr Potts to go to work as he receives many phone calls often concerning his job. If he is ever in a situation where he has forgotten his laptop or PDA and cannot access his email account to download files, he is still able to do so with his phone by connecting to the mobile internet. He can also make quick notes on his phone which remind him what he needs to do and when he needs to complete specific tasks by if he has forgotten to take his PDA with him. Technology 4 – Microsoft Office Excel 2007 Microsoft Office Excel 2007 is an influential software used to produce and format spreadsheets and to analyze and distribute information to make more informed decisions. This new software has many features which include ? Chart Formatting tools which help create and format professional-looking charts with greater ease using fewer clicks. ? Support for PDF and XML Paper Specification (XPS) file formats helps convert spreadsheets into a fixed file format for easier sharing. ? Report management features help protect confidential business information while ensuring people can view the data they need. ? Chart Formatting tools help you create and format professional-looking charts with greater ease using fewer clicks. Microsoft Office Excel 2007 – Personal Use Mr Potts records his day to day spending on a spreadsheet using Microsoft Office Excel 2007 to calculate a budget for his family to spend so he can cut down costs for unnecessary things. He first records the amount spent for a couple of months. He then calculates and produces a budget and attempts to stick to that budget for a couple of months. He then records this and then compares both spreadsheets and sees where the unnecessary spending has occurred. Microsoft Office Excel 2007 – Social Use During his breakfast, Mr Potts spends his time doing many crossword puzzles and also does these puzzles in his spare time. He expands his interest by making his own crossword puzzles on Excel. He then sends them to his friends making them spend their spare time completing the puzzles and requesting them to send back reviews via email so he can improve his work. Also, Mr Davison buys and sells many shares on the stock market and keeps tracks with his data by recording his information onto a spreadsheet. Mr Potts has an interest in gaming and creates many games using excel. Along with the crossword puzzles, he sends it off to his friends and again receives many reviews which suggest ideas which may lead to him improving the games and enhancing gaming experience. As mentioned previously, Mr Potts sends documents to herself to his email so he can access them later. These documents also include the crossword puzzles and games. He plays them on his laptop while on his lunch break. Whenever he does not have access to his laptop, he plays the game with his friends on his PDA. The game opens up as a spreadsheet file which is supported by his HP iPAQ 200 Enterprise Handheld as it has Microsoft Office Mobile. Microsoft Office Excel 2007 – Work Related Use Mr Potts produces spreadsheets for many of his clients (individuals and businesses) advising them on tax planning within current legislation to enable them to minimise their tax liability and he also calculates clients’ tax liabilities. Some of the activities that Mr Potts performs that may use Microsoft Office Excel 2007 are ? Producing reports and recommendations following internal audits or public sector ‘value for money’ audits. # ? Preparing financial statements, including monthly and annual accounts. ? Preparing financial management reports, including financial planning and forecasting. ? Advising on tax and treasury issues and many other tasks. To perform activities using Microsoft Office Excel 2007, Mr Potts needs access to his computer. He produces these files on his computer at home or at his office. Mr Potts produces spreadsheets with the company of his client to provide him with any certain information. This is done by inviting his client to his office and working at his computer or he meets up with his client at their house and works on his laptop. As mentioned before, Mr Potts sends important files to herself by email so he can access them later. When he is free, he often spends time finishing off his spreadsheets. Occasionally, as he is on the move he does not take his laptop, however he is still able to complete his tasks by connecting to the internet by the integrated wireless technology on his HP iPAQ 200 Enterprise Handheld and accessing the files from his email account and downloading them onto his PDA. He is able to complete this spreadsheet as his PDA has the Excel application provided by Microsoft Office Mobile. In conclusion, I suppose that without the help from the above technologies and other technologies, Mr John Potts will find it very difficult to complete his day to day life. As mentioned previously, he is not able to perform many tasks without the aid of the above technologies. For example, without the help of his PDA Mr Potts cannot easily access his client’s personal details. Also, without his computer/laptop he is not able to complete any other tasks. Due to the aid provided by these technologies, Mr Potts has been able to develop his personal, social, and work life.

Health care challenges Essay

Our country is set to face a new way of managing health which could potentially change the environment on how nurses deliver care. As our nation prepares for the implementation of Patient Protection and Affordable Care Act, nursing as a healing profession has to be open to what the future of health management holds. The goal is to have all registered nurses reach a high level of understanding and acquire tools necessary to provide the best possible way at a low cost. It is both moral and professional obligation of our leaders to ensure that highly competent and well trained nurses are available throughout this transition. To achieve this goal, nurse educators are the key players to train both novice and seasoned nurses to the change based on the new policies and evidence-based research. However, our Nurse Educators are overwhelmed with their current workload hence causing faculty shortage in the country. A recent study published on 2011 aimed to explore the relation of nursing faculty shortage to their workload, determine if there are evidences that the faculty workload is not equitable and the implication/effect to the nursing research and nursing academic. According to this study, there are multiple factors that influence the nursing faculty shortage such as lack of interest from the nurses to try academic careers, time spends to clinical practice defers pursuance into academic positions, low salaries, high educational costs, nursing education dissatisfaction and most importantly low institutional funding for additional nurse educator positions. Nancy Falk stated in her article that â€Å"despite current critical shortage and growing demand for nurses and nurse educators, federal funding falls far short of addressing these healthcare workforce challenges. Workforce projections suggest that the US will face a shortage of 285,000 nurses by 2015 and 500, 000 by 2025.† (Mason, Leavitt & Chaffee, 2012, p 58). Also, American Association Colleges of Nursing reported on 2011-2012, that nursing schools turned away 75,587 applicants who are qualified for baccalaureate and graduate nursing programs because of inadequate nursing faculty including clinical preceptors. These challenges ultimately impact the future of patient care if not addressed. Faculty leaders must work in partnership to create a strategy that will help prevent further faculty shortage by focusing on balanced faculty workload to avoid burnout. This article emphasized on the continuous support by government officials especially adequate funding to nursing education. AACN is allocating its resources to protect federal funding for academic development programs, identify strategies to prevent nursing educator shortage. Additional solution is to create a mentorship program for nurse faculty. This strategy was confirmed by various literature and studies to promote nursing faculty recruitment and retention. Mentorship brings encouragement and direction to clinical educators who are new to the role and prevent burnout. Health care system will be lost without nurses in our society. Statistic shows that there are currently 2.9 million nurses in the United States but nurses with special skills such as in education is extremely needed. Nurse Educators, in some ways, affect the lives of everyone. It is through this role where highly competent, compassionate healers such as nurses are produced. â€Å"The future of the nursing profession depends on a steady supply of nurses to provide the quality care to patients† (Cowen & Moorhead, 2011, p. 60)