Nigerian Out Of Wedlock Births Health And Social Care Essay

Nigerian Out Of Wedlock Births Health And Social Care Essay The concept of childbearing, fertility and marriage house constantly been linked together in Nigeria. In the 1990s, out of wedlock birth was rapidly increasing despite Nigerians cultural influence on its population. Nigerians marry to have children, and marriage has meaning only when a child is born or in fact survives (Uche C. Isiugo-Abanihe, 1994). According to Olusanya(1982), marriage in Nigeria is so closely linked with childbearing that a change in the pattern of marriage necessarily influence birth rate and the rate of population growth. Data presented in this report are derived from the Demographic and Health Surveys conducted in Nigeria in 1990. This was done by Federal Office of Statistics, Nigeria, and IRD/Macro International, United States. This survey interviewed 8,781 women aged 15-49. All statistical data and sample in this project was obtained from this article. In this dissertation, we will focus on the high level of unwanted pregnancy and out of wedlock birth occurring in Nigeria as a result of low levels of contraceptive use among women in many parts of the country. This project will reveals wide variation in levels of contraceptive use among married and sexually active unmarried women. Both groups have a significant unmet need for family planning, but the reasons for their need differ. we will use old and previous data and surveys collected and conducted during the 1990s by the Nigerian federal office of statistics to explain and solve theoretically and statistically the purpose of this project which is to explain the out of wedlock birth per woman between 1950s and 1980s in Nigeria. All statistical element of this project will be done using sampling and standard error. Selection from the entire country to determine the fertility, determinants of fertility and fertility regulations that led to an increase in out of wedlock birth during t he 1970s to 1990s. Relatively, little empirical work has been conducted for out of wedlock birth in Nigeria. The statistical used in this project has been conducted by the NDHS(Nigerian Demographic Health Survey) mostly drawn from the National Master Sample for the 1987/1992 National Integrated Survey of Households (NISH) and the 1973 Nigerian census result. There is wide regional variation in the timing of marriage among Nigerian women. More than nine in 10 women aged 20-24 in the North East and North West had married by age 20, compared with half to three fourths of women in the three southern regions (The Alan Guttmacher Institute, 2005 series, No4). Nigeria is one of the largest countries in Africa and the most populated Black Country in the world with a population of over 100 million people, nearly twice the size of any other African country. The North East and North West regions are predominantly Muslim, the South East and South regions are mostly Christians, each with its own values and traditions regarding marriage, sexual behaviour, education and childbearing. There are major regional and educational differences in fertility. Women in the north have, on average, one child more than women in the south and women with no education have two children more than women who completed secondary or higher schooling. According to the NDHS survey, the fertility rate of a Nigerian woman between the ages of 15-49 from 1978-1990 moved from 5.9 to 6.0 significantly with an average of 6 children. Source: : Nigeria Demographic and Health Survey, 1990. Source: : Nigeria Demographic and Health Survey, 1990. The project reveals a big difference in levels of contraceptive use among married and sexually active unmarried women. Both groups have a significant unmet need for family planning, but the reasons for their need differ. The study directs attention toward far-reaching health policy and program responses that affect birth rate in Nigeria. The numerous ethnic groups found in Nigeria contribute considerable cultural diversity. In 1960s, Many article described the growth in Nigerias out of wedlock birth rate as a brief excitement amongst the Nigerian people that they had achieved independence finally, some presumed it to be illiteracy but a close study proved otherwise (study show that out of wedlock birth was more frequent among the most educated women (meekers, 1994b; Calves2000; Emina 2005), excitement of motherhood amongst teenage girls played a minor role, and also the brief civil war that began in 1967 and ended in 1970 played a bigger role in the whole analysis. The Nigerian ferti lity survey during 1981/82 put the average number of child birth per woman at 6.4 %( mostly out of wedlock). Although the data here suggest a slight decline from in the 1970s rate, the level is still relatively high.(www.onlinenigeria.com). During the civil war, many women were reluctant in getting married to prevent bearing the pain of being widows and war casualties. This effected their judgement and led to more pregnancies among women that are unmarried. According to some data analysed during that period by Donald Jonathan, Approximately 45% of children born among teenage women in Nigeria at that time were conceived outside of marriage; double the level recorded during the same period among women aged 18 and older (Donald 1979). This was a huge jump in the growth of the countries fast growing general population. The World Bank estimated Nigerias annual growth rate was rising during the 1950s. Although other sources differed on the exact figure, virtually all sources agreed that t he annual rate of population growth in the country had increased from the 1950s through most of the 1980s. The government estimated a 2% rate of population growth for most of the country between 1953 and 1962. For the period between 1965 and 1973, the World Bank estimated Nigerias growth rate at 2.5%, increasing to 2.7 percent between 1973 and 1983. Before 1970, the stigma of unwed motherhood was so great that few women were willing to bear children outside of marriage. Total fertility rate for the three years preceding the survey end mean number of children ever born to women age 40-49, by selected background characteristics, Nigeria 1990 Background characterises NDHS NFS Mean number Mean number of children of children Total ever born Total ever born Fertility to women fertility to women Rate age 15-49 rate age 15-49 Residence Urban 5.03 6.01 5.79 4.81 Rural 6.33 6.61 5.98 5.56 Region Northeast 6.53 5.75 5.95 4.34 Northwest 6.64 6.21 6.38 4.49 Southeast 5.57 6.99 5.72 6,53 Southwest 5.46 6.84 6.25 5.30 Education No education 6.50 6.41 6.14 5.45 Some primary 7.17 7,3 6.81 5,99 Completed primary 5.57 6.54 7.59 5.71 Some secondary 5.07 6.44 3.90 4.31 Completed 4.18 5.82 NA NA Total 6.01 6.49 5.94 5.41 Source: : Nigeria Demographic and Health Survey, 1990. Premarital sexual activity is most common among more educated women, who tend to postpone marriage the longest. In the southern regions, where educational levels are highest and the smallest proportions of young women are married, 41-69% of women aged 20-24 had had premarital intercourse by age 20. This compares with only 6-14% in the North West and North East, where educational levels are lowest and marriage before 20 is most common. The above diagram compares three-year total fertility rates as estimated by the NDHS and NFS. The two surveys, nearly a decade apart, yield almost the same total fertility rates (5.9 for the NFS and 6.0 for the NDHS. Both surveys do indicate that the fertility of uneducated women is fifty percent higher than the fertility of the most educated women. Reasons for increase in out of wedlock birth Three quarter of Nigerian women in the 1990s were married. Age at first marriage differed by region. In the north, women married early, at an average of 15 years of age. In the south, however, women are marrying later in life. Among younger women, the average age at first marriage is over 19 in the southeast and over 20 in the southwest. Women who marry later in life are more likely to have premarital sex which is a clear example of out of wedlock birth. Although the society does not approve of this behaviour, in regions where women stay in school longer and are, therefore, less likely to marry at a young age, premarital sexual behaviour is common. In the Southwest, where a great proportion of women aged 19-49 have completed secondary/ higher education and about one-fourth had not married by age 20, 69% had had premarital sex by this age. In contrast, in the less developed North West region, where only one in five women aged 19-49 have completed secondary/higher education, only a han d full said they had had premarital sex by age 20. These findings illustrate that in the northern regions, where most women in their early 20s have received no more than primary schooling, most sexual activity occurs within the context of marriage. In 1978-1982, Nigerias total fertility rate was 6.4 children per woman. By 1990, it had dropped to 6.0. The distribution of women by number of children ever born within the 1960s to 1980s is presented in the table below for all women and married women. This survey was conducted by the NDHS and documented statistically. The mean number of children ever born for all women increases rapidly with age, so that by the end of her childbearing years; a woman has given birth to almost seven children. The distribution of women by number of births indicates that almost one quarter of teens have already borne a child, and nearly one-third of women age 45 and over have borne nine or more children. Nationally and in all regions of the country, women aged 15-49 are having more children than he want. Source: Nigeria Demographic and Health Survey, 1990. Rural women have about one child more than their urban counterparts (6.1 vs. 4.9), and women in the less developed northern regions also have more children than women in the south. Yet women in the South South and South East regions have the largest gaps between their wanted and actual fertility rates, while women in the North West are nearly matching their fertility goals. Overall, women living in both rural and urban areas have more children than they want. Contraception Knowledge and Use: in the survey conducted by the NDHS, it indicates that less than half (46 percent) of all Nigerian women age 15-49 know of at least one method of family planning. This means that over half of the women reported that they did not know any method of family planning. Knowledge of methods was slightly lower among married women and higher among never-married. Although the level of contraceptive knowledge in Nigeria is low, there has been improvement over time. In the 1981/82 Nigerian Fertility Survey (NFS), only 34 percent of all women reported that they had heard of any method Thus, in the 10 years between the NFS and the NDHS, the level of contraceptive knowledge increased by 35 percent. There were also large increases in the proportion of women who knew and used specific methods. Contraceptive use among married and sexually active unmarried women aged 15-49 Married women sexually active Unmarried women % using % using a % using % using a An effective traditional an effective traditional Modern method modern method Method method Total 7 6 33 14 Region North Central 9 4 32 5 North East 2 2 10 3 North West 2 3 23 3 South East 12 10 20 27 South South 12 13 35 16 South West 21 11 53 13 Education â‚ ¬Ã‚ ¾7 years 16 11 38 17 Source: Nigeria Demographic and Health Survey, 2003.Contraceptive Use A small proportion of married women in Nigeria use a contraceptive method as seen on the above diagram. Contraceptive use in Nigeria is rare probably because of the preference for large families. In 2003, only 7% of married women aged 15-49 were using an effective modern method of contraception (implants, IUDs, the pill, the male condom, and female or male sterilization). Another 6% were relying on withdrawal, periodic abstinence, lactational amenorrhea or traditional folk methods. There are wide regional differences in overall levels of Contraceptive use: Only 2% of married women in the North East and North West regions are using effective modern methods, and 2-3% is using traditional methods. In the South West, in sharp contrast, 21% of married women are using effective modern methods, and an additional 11% are using traditional methods. In the remaining three regions, 9-12% of married women are using an effective modern method. It is noteworthy that overall contraceptive use is mo re than three times as high among married women with seven or more years of education as among those with less education (27% vs. 8%).(The Alan Guttmacher Institute, 2005 series, No4). Other case of ctraception Contraceptive use is much higher among sexually active unmarried women. In all regions of the country, probably because of widespread societal disapproval of out-of-wedlock pregnancies and births, sexually active unmarried women are more likely than married women to use a contraceptive method (47% vs. 13%-Table 2). In the South West region, 53% of sexually active unmarried women are using an effective modern method and 13% a traditional method, compared with 10% and 3%, respectively, in the North East region. And unmarried women with seven or more years of education are more than twice as likely to be practicing family planning as their less educated counterparts (55% vs. 22%). In addition, 46% of unmarried women who use contraceptives choose condoms, compared with only 15% of married users (not shown). Low awareness, disapproval and uncertain supply keep contraceptive use low. Various factors help explain the low level of contraceptive use among married Nigerian women. Foremost among these is that women generally want large families. Yet low awareness of family planning, conservative cultural attitudes and uncertain contraceptive supply are also important influences. More than 20% of women aged 15-49 have never heard of any method to prevent pregnancy, traditional or modern. The women who are most aware of contraception live in urban areas, have at least seven years of education, or listen to the radio or watch television regularly (about 90% of each group). Even if women have heard of family planning, many do not know where to obtain contraceptives: Of the 78% of women who are aware of any method, only half know where they can get it. In the North East and North West regions, only 28-36% of married women and 24 28% of sexually active unmarried women who are aware of family planning know where to go for contraceptive services. A much higher proportion of a ware women in the South West region know a possible source of methods-77% of married women and 82% of sexually active unmarried women. Low contraceptive use is also partly attributable to the fact that four in 10 married women disapprove of family planning. A data survey conducted by the NDHS shows the reasons for not using contraception given by women who do not intend to use a method. Of the 68 percent of married nonusers who say they do not intend to use family planning in the future, almost half say they do not intend to use because they want children (47 percent). Other reasons given are religion (12 percent), lack of knowledge (12 percent), and fatalism (6 percent), which encompasses responses that imply that there is nothing the woman can do about the number of children she will have. Women under age 30 are more likely to say that they do not intend to use because they want children, while those age 30 and over are more likely to cite reasons such as being menopausal or lack of knowledge. SAMPLE METHOD NDHS sample method used in this project is as a result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulas. The computer package CLUSTERS, developed by the International Statistical Institute for the World Fertility Survey, was used to compute the sampling errors with the proper statistical methodology. The CLUSTERS treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: Sampling errors for the NDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for the four health zones: Northeast, Northwest, Southeast, and Southwest. For each variable, the type of statistic (mean or proportion) and the base population are given in Table B. 1. Tables B.2 to B.8 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R~SE), for each variable. In general, the relative standard errors of most estimates for the country as a whole are small, except for estimates of very small proportions. There are some differentials in the relative standard error for the estimates of sub-populations such as geographical areas. For example, for the variable EVBORN (children ever born to women aged 15-49), the relative standard error as a percent of the estimated mean for the whole country, fo r urban areas and for the Southeast zone is 1.5 percent, 2.3 percent, and 2.7 percent, respectively. The confidence interval (e.g., as calculated for EVBORN) can be interpreted as follows: the overall average from the national sample is 3.311 and its standard error is .051. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.311+.102. There is a high probability (95 percent) that the true average number of children ever born to all women aged 15 to 49 is between 3.209 and 3.413. 148 Conclusion: According to the NDHS, fertility remained high in Nigeria during the1980s. The total fertility rate may actually be higher than 6.0, due to underestimation of births. This is why out of wedlock birth has constant increased during these periods. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong in Nigeria. Half of women with five chil dren say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by womens educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20 .Although fertility rates are declining as modernization is increasing, Many women are still experiencing unwanted and unplanned pregnancies, with consequences ranging from interruption of schooling to health risks and economic hardship, all of which hinder efforts to improve their socioeconomic status. By educating and empowering both married and sexually active unmarried women to make informed and responsible decisions about contraceptive use and their desired fertility, the Nigerian government can improve both the health and the economic productivity of its citizens. BIBLOGRAPHY REFERENCE: Federal Ministry of Health [Nigeria]. 1988. NationalPolicyonPopulationforDevelopment, Federal Office of Statistics [Nigeria]. 1963. Population Census of Nigeria, 1963 Combined National Figures. Lagos, Nigeria Frank Falkner and J.M. Tanner, Vol. 3, 241-262, New York: Plenum Press. NIGERIAN DEMOGRAPHIC AND HEALTH SURVEY 1990 -federal office of statistics. Lagos Nigeria Unity,Progressand Self-Reliance. Lagos, Nigeria: Department of Population Activities. London, Kathy A., Jeanne Cushing, Shea O. Rutstein, John Cleland, John E. Anderson, Leo Morris, and Sidney H. Moore. 1985. Fertility and Family Planning Surveys: An Update. Population Reports, Series M, No. 8. Baltimore, Maryland: Johns Hopkins University, Population Information Program. Martorell, R. and J.P. Habicht. 1986. Growth in Early Childhood in Developing Countries. In Human Growth: A Comprehensive Treatise, ed. by National Population Bureau [Nigeria] and World Fertility Survey. 1984. The Nigeria Fertility Survey 1981/82: Principal Report. Vol. 1: Methodology and Findings. Lagos, Nigeria: National Population Bureau. National Population Bureau [Nigeria[ and Institute for Resource Development/Westinghouse [1988]. National Demographic Sample Survey (NDSS) 1980: Nigeria National Report. Columbia, Maryland: IRD/Westinghouse. Ransome-Kuti, O., A.O.O. Sorungbe, K.S. Oyegbite, and A. Bamisalye, eds. [ 1989] Strengthening Primary Health Care at Local Government Level: The Nigerian Experience. Lagos, Nigeria: Academy Press Ltd. Rutstein, Shea Oscar and George T. Bicego. 1990. Assessment of the Quality of Data Used to Ascertain Eligibility and Age in the Demographic and Health Surveys. In An Assessment of DHS-I Data Quality, 3-37. Institute for Resource Development/Macro Systems. DHS Methodological Reports, No.1. Columbia, Maryland. REDUCING UNWANTED PREGNANCY IN NIGERIA BY the Alan Guttmacher Institute

Hypocrisy in The Enormous Radio Essay -- Enormous Radio Essays

Hypocrisy in The Enormous Radio  Ã‚     Ã‚  Ã‚   In the short story, "The Enormous Radio," by John Cheever, the radio acts as a wake up call for Jim and Irene Westcott. Even though they believe that their life is better than their neighbors’ lives, the radio proves them wrong. The Westcott’s life can be compared to a freshly painted ten-year-old car: nice and shiny on the outside but falling apart on the inside. In the beginning, Jim and Irene seem to have a good life with no problems; they seem to be average, ordinary people. The story states, "The Westcotts differed from their friends, their classmates, and their neighbors only in an interest they shared in serious music" (Cheever 812). This already hints that they might have their share of problems, especially since they are almost exactly like everyone they know. One reason why they might think they have a better life is because of their music, but in actuality, this is where their conflicts arise. Once they get the new radio, everything seems fine, even though they can hear all of the neighbors’ conversations. The Westcotts ...

Emergency Department Bottleneck Proposal

Emergency Department Bottleneck Proposal Middletown Hospital is a 200-bed, not-for-profit-general hospital that has an emergency department with 20 emergency beds. The emergency department handles on an average 100 patients per day. The hospital’s CEO has authorized the Six Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00 p. m. and 10:00 p. m. The complaints are centered on waiting times and poor service. During this time the data indicates that approximately 70% of the department’s admissions occur (University of Phoenix, 2009, Course Syllabus). To address these complaints and improve performance of the emergency department the Six Sigma Team must understand process improvement proposals. The process must identify the reason of the bottleneck; identify the correct data collection method; the use of capacity planning; accurate analysis of the scheduling and controlling techniques; and identify a recommendation on staffing or alternative sources of care. Process Improvement Proposals A process improvement proposal is a mechanism to define the opportunities needed to reduce the number of steps, interactions, decision points, reports, and the length of the defined practice (Langabeer, 2008). Three key areas need to be addressed when improving a current practice. According to Langabeer (2008), these areas include increasing capacity, reducing the use of resources, and reducing the amount of variation (p. 79). For example, if the emergency department is currently seeing patients at a rate of four per hour during normal business hours, and this rate drops to one per hour during the period listed a bottleneck will result. To address this issue the department needs to provide the resources necessary to avoid the problem. However, when the reason for the bottleneck is known the correction must include steps to preserve resources. These steps must address reducing the cost per patient, removing excessive steps, and exposures that are unnecessary. Because the data shows the bottleneck occurring after normal business hours the third key area is equally important for successful performance. This area involves the development of control tools. These tools will assist the department when variation occurs, these tools can include the development of contingency plans to use other hospital resources available after normal business hours; for example the use of clinical examination rooms for patient overflow. Process of Improvement Method Edward Deming introduces a method known as the Deming Cycle to identify bottlenecks within organizational structures. The Deming Cycle comprised of a continuous process cycle that involve planning, implementation, assessment and decision-making. Deming postulated that â€Å"business processes should be analyzed and measured to identify sources of variations that cause products to deviate from customer requirement† (Arveson, 1998, para 1). Each step gives operation managers the feedback needed to determine if they are meeting current objectives. Arveson also suggest that this checklist will help reduce bottlenecks from happening while increasing productivity within every department. Comparing the Middleton Hospital use of Six Sigma methodology to Deming Cycle both methods can help reduce bottlenecks issues with waiting time that occurs during interval time of 6:00 p. . to 10:00 p. m. Six Sigma methodology uses phases of defining a problem and provide an alternative solution to the problem. The next phase includes measuring the solution’s outcomes, analyzing the outcomes’ goals and effectiveness, improving any flaws that was identified in the improvement process, and controlling any costs or activities to contain cost and resource deficiency (National Association of Health Care Quality, 2009). The Six Sigma system addresses each problem measuring a quantitative solution to be addressed by upper management and delivered to department heads for implementation. Appropriate Collection Methods Middletown Hospital needs to look at different ways of collecting data. Data collection can be subdivided into three categories with service type, department, and floor. This collection of data is valuable tool that managers need to have in order to understand the flow of business within each department. With the collection of data it will allow managers to calculate the volumes of patients during specific times. The SST will require data collected from all computers used to monitor access to the admission system. Additional data will have specific times at which the patient reported to various stations of treatment, and when the patient was discharged. A multivariate trend forecasting method will be more appropriate in this setting; the use of multiple variables about the item being forecasted allows seasons and cycles to be combined with other variables and improve forecast accuracy (Langabeer, 2008). This will give operation managers better forecasting abilities as they will be able to see trends. Finally, the SST will need to analyze the amount of resources or assets available to serve demand (Langabeer, 2008). Quantitative data needed to measure capacity will include: the number of available beds and treatment rooms, the number of key providers and other staff available at each point of care between 6:00 p. m. and 10:00 p. m. , and availability of key medical technologies and equipment. Examples of key medical equipment are diagnostic imaging, X-ray and laboratory equipment. Methods to Analyze The first step in analyzing the cause of Middletown Hospital’s emergency department bottleneck is to perform a capacity analysis that will help to identify appropriate assets and resources to serve the increased need within each emergency department. The analysis should capture statistical data in time series format that will show sequential data recorded during different time periods throughout the day. Data should be included from time periods when the emergency room is successful in handling demand as well as occurrences of the bottleneck. Creation of a control chart can also be useful in discovering areas of daily operations that are contributing to the current issue of meeting demand. Middletown Hospital is aware that they can not keep up with the demand placed upon each department with current needs. In knowing the limitations, data from the other 20 hours in which emergency department is in operation can be used to obtain values for a mean and average to be used to create a control limit. Taking data from the entire day can be used to obtain a standard deviation value as well. Data and observations that show a large deviation from the mean will alert the staff to areas that need to be updated or streamlined. The control data that is being recorded should be able to define staff ratios, numbers of patients seen, time of day, day of the week, equipment or technology malfunctions, ime of patient visit, reason, and duration. A control chart can help Middletown Hospital distinguish normal and abnormal processes within their patient delivery service. Bottlenecks Operation managers need to handle many different jobs at once. These jobs can be dealing with bottlenecks, and forecasting. Operation managers need to look at current flow of business to determine the proper amount of staffing needed to handle problems in the future. By working with an accurate forecast managers are able to see what is expected and when the flow of business will occur. When increasing staffing in any department the profitability will decrease at start, but soon will rebound as more patients realize they are receiving treatment at a faster pace. According to Langabeer (2008), one of the keys to increase throughput or capacity is to remove these obstacles or bottlenecks, which is called de-bottlenecking (p. 96). Increasing the number of staff on during peak times it will be easy to reduce the number of complaints and increase the profitability of every department. Being able to remove the barriers will allow managers to see the results within days instead of weeks. Within any department comes demand and being able to predict the demand allows managers to become better forecasters. According to Langabeer (2008), â€Å"forecasting is a collaborative process that estimates the volume of patients that will be served over a specific time period. More precisely, it is a projection of demand that will occur along three dimensions: service type, location, and time dimensions† (p. 97-98). Managers will have to better look at the forecasting they are doing in order to make sure they are using the most current data in order to predict flow and handle problems. Recommendation on Staffing Middletown hospital’s ability to move patients smoothly through the emergency department has become a conversation of complaint for patients. Due to the high volume of patients being seen during the hours of 6:00 p. m. and 10:00 p. m. changes need to be made to optimize waiting times and efficiently treat patients. The emergency department is averaging 100 patients per day which, means that 70 of them are coming through the emergency department between 6:00 p. m. and 9:00 p. m. According to Langabeer (2008), in health care, wait times are frequently a source of poor patient satisfaction and process inefficiency (p. 10). The hospital emergency department is currently plagued with a lack of staff scheduled at key times and needs to look at alternatives to better manage the movement of patients. Creating a solution for Middletown hospital means using multiple channel servers to reduce check in time and maximize on hand staff’s time management. Because a majority of the iss ues arise at a key time in the day the revision of the patient routing and flow is required. According to Hall (2006), therefore, by altering patient routing and flow, it may be possible to minimize patient waiting times and increase staff utilization (p. 221). Bottlenecks occur in a hospital emergency department because of the triage concept of putting most significant injuries first. This means many minor care issues will be pushed back. Combating this issue creating a fast track lane to handle minor care issues will decrease patient complaints and wait time. These concepts should reduce the wait time of patients within this three hour block and maximize their experience in the emergency department at Middletown hospital. Conclusion Bottleneck is often the result of an organization lacking the capacity to meet the needs of clients in delivering a particular service. Middletown hospital was given a recommendation to review its current organization capacity by examining their processes, resources, technology. Middletown hospital was able to define other available resources which could be used to assist with meeting their patient demand. Reference Arveson, P. (1998). The Deming Cycle. Retrieved November 27, 2009, from http://www. balancedscorecard. org/TheDemingCycle/tabid/112/Default. aspx Hall, R. (2006). Patient flow: reducing delay in healthcare delivery. Los Angeles, CA: Springer Science Business Media, LLC. Langabeer, J. (2008). Health care operations management: A quantitative approach to business and logistics [University of Phoenix Custom Edition e-text]. Sudbury,MA: Jones and Bartlett Publishers, Inc. Retrieved November 28, 2009, from University of Phoenix, OPS/HC571 Health Care Operations Management Web site. National Association of Healthcare Quality. (2009). JHQ 174: Lean Six Sigma in health care. Retrieved November 27, 2009, from http://www. nahq. org/journal/ce/article. html? article_id=250 University of Phoenix. (2009). OPS/HC571 course syllabus. Retrieved November 28, 2009, from University of Phoenix OPS/HC571- Course Materials Web site.

Unit HSC31 Promote Effective Communication for and About...

1. Identify THREE specific aids to communication. Knowledge specification 11 1. Eyes using eye contact can inform the speaker you are listening to them eyes also enable us to read we can communicate with items such as communication boards, pictures. 2. Ears listening attentively show the speaker you are interested in what they are saying. This encourages the speaker to talk more by making them feel you are interested in what they say. We can also improve hearing with hearing aids which help people with hearing problems. 3. Speech is the main aid to communication you should speak clearly and calmly to ensure you are understood. Use the tenant’s language by this I mean use words that will be clearly understood no†¦show more content†¦She will also relay on other people to speak for her. This causes embarrassment at times for her. She will not look at the listener. She will often stand behind her bedroom door to avoid eye contact. Service User B Reasons for difficulties in communicating effectively The main issues for this tenant is written communication the tenant has problems with reading and writing this is due to leaning difficulty that the tenant has. There are also problems at time with verbal communication the tenant’s speech at times is difficult to understand the cause of this is due to again learning difficulties that the tenant has and also issues with his alcohol problem. Resultant behaviour This causes embarrassment at times it also makes the tenant feel frustrated and upset this also means that he will avoid taking to people and spend a lot of time alone. Because of difficulties with reading the tenant also misses appointments because he has not understood the letter he has received and has not asked anybody to help him with it. 7. Give TWO examples of how power can become an issue when communicating sensitive or difficult information to others. Knowledge specification 8d 1. Power in a support relationship can be an issue at times because the tenant sees the worker as having power because they provide the support advice and information that tenants require to live independently. A worker should always be aware of this and give the