The San Diego Symphony Hall - 2612 Words

On the weekend of Friday, October 17, 2014, to Sunday, October 19, 2014, the San Diego Symphony presented Van Cliburn Gold, a Jacobs Masterworks Concert of the 2014-15 Season. The performance was held at the Jacobs Music Center’s Copley Symphony Hall and featured works from Ludwig Van Beethoven, Serge Prokofiev, and Piotr Ilyich Tchaikovsky. The conductor for the performance was Jahja Ling, and Vadym Kholodenko performed on the piano (Bromberger, 2014, p. 13). Born approximately on December 16, 1770, in Bonn, located in the Electorate of Cologne, a principality of the Holy Roman Empire, Ludwig Van Beethoven was a composer and pianist, and is arguably the greatest composer of all time. Uncertain of his exact birthdate, based on his†¦show more content†¦Musical studies included the violin and clavier, as well as additional lessons from organists around Bonn. His first public recital was on March 26, 1778, at the age of 7, but unfortunately, though he played impressively , Beethoven received no press or recognition at the time (Biography.com). He attended the Latin grade school Tirocinium, but in 1781, at the age of 10, Beethoven withdrew from the school to study full-time under the Court Organist, Christian Gottlob Neefe. Under Neefe’s instruction, Beethoven was introduced to Johann Sebastian Bach. At the age of 12, Beethoven published his first composition, piano variations based on a theme by composer and music theorist Gallus Dressler. Beethoven was later officially appointed as Assistant Court Organist, and in 1787, the court sent him to study with Wolfgang Amadeus Mozart in Vienna, Austria. During his audition, Mozart commented on the young Beethoven’s performance, â€Å"Keep your eyes on him; some day he will give the world something to talk about.† But his time under Mozart’s tutelage was cut short when Beethoven returned only a few weeks later to Bonn after learning that his mother was desperately ill. Her death a few months later sent Beethoven into a fit of depression that would last for years (Biography.com). The composition titled Cantata on the Death of Emperor Joseph II and created by Beethoven in remembrance of the death of the Holy Roman Emperor in

Animal Rights And The Rights Movement Essay - 1035 Words

Is the human race ready to sacrifice lives in order to protect the welfare of animals? Is the human race ready to justify trading human lives for animal lives? Even though we should make every effort ensure that animals are not wantonly harmed in research, animals certainly do not have the same rights as humans do. Many animal rights activists condemn research on animals, citing that it is inhumane. But prohibiting research on animals would be even more inhumane. Research on animals has eradicated many diseases and saved the lives of millions, and discontinuing doing so will generate disastrous consequences. Because of extremely advantageous health advancements that have benefited, and will continue to benefit, the lives of human beings, research on animals should continue to be allowed. In 1877, the American Human Society was founded in order to improve the lives of human beings, but it expanded to include advocating for humane treatment of animals (Yount 42). Animal rights movement gained momentum during the 1960s, when a widespread mistreatment of animals in labs was uncovered (Yount 47). In response to wide public discontent, Congress passed the first animal welfare law – the Laboratory Animal Welfare Act in 1966 (Yount 42). The act itself did little to help the animals that were being mistreated in labs, but it did establish a frontier for the animal rights movement. The act had little practical applications, because it did not cover rats, mice, and birds, whichShow MoreRelatedThe Nonhuman Animal Rights Movement1588 Words   |  7 Pagesof its accomplishments has a purpose: to foster a particular way for supporters to see themselves in the nonhuman animal rights movement, namely as donors and consumers of PETA, its tactics, and its selection of â€Å"cr uelty-free† products. 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According to the US HistoryRead MoreThe Animal Rights Movement (Arm) Comes From One Simple1999 Words   |  8 PagesThe Animal Rights Movement (ARM) comes from one simple question, should animals live freely and be treated humanely? If animals were to be free then that would mean they couldn’t be experimented on or be forced to live in captivity for they would be free creatures. Also, humanely by definition means to be treated in a way that â€Å"shows compassion or benevolence,† so animals are to be treated equally as humans given the ARM. This is where the discussion for Animal Rights kicks in, with those who supportRead MoreThe Fight For Animal Rights1660 Words   |  7 PagesRise of the Movement why did it come about? why did it appeal to people? The fight for animal rights is one that has been going on for centuries. â€Å"The new emphasis upon animals feelings of sensation in the eighteenth century brought growing criticism of some forms of cruelty. Doubts about the ethics of castrating domestic animals were raised as early as 1714. (Guither, 1998, p.1) According to Guither (1998), London was the first to encourage the prevention of animal cruelty in 1824 where itRead MoreAnimal Cruelty And Animal Justice Essay717 Words   |  3 Pagesharm animals or do not concern themselves with animal rights often have no idea what happens at slaughterhouses and the effects that harming animals can have on individuals both personally and environmentally. A variety of documentaries, reports, and information regarding these issues are quite accessible through many organizations and groups. Some include: - PETA - Mercy for Animals - AWFC (Animal Welfare Foundation of Canada) - Animal Justice - World Animal Protection - PAWS (Peoples Animal WelfareRead MoreThe Origin Of Speciesism By Peter Singer1025 Words   |  5 PagesHugh and Shanks, Niall (1996). 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Synthetic biology combines   the elements ofRead MoreAnimal Cruelty Should Not Be A Big Deal1415 Words   |  6 PagesAnimal Cruelty Almesha Jones (Mesha) Introduction and Background All around the world, people are abusing animals. Animal cruelty is a big deal because some people do not look at animals as being important; some people do not see a problem with hurting them. Animal cruelty can be define as being a malicious treatment that can cause undue pain or being mistreated. Seeing an animal get brutalize by some humans seems to be cruel. Getting kicked in the ribs, left for starvation and even used for entertainmentRead MoreCan The Human Methods Of Slaughter Act And The Prop 2 Standards1480 Words   |  6 Pagesthe Prop 2 Standards for Confining Farm Animals Protect Farm Animals from Inhumane Treatment? According to the anthropologist Professor Henry Bunn of Wisconsin University the use of animals for food dates back to two million years ago, when, â€Å"our human ancestors were small brained ape-men† (McKie, 2012). The use of animals for a source of food, clothing, and even entertainment is not something new to us. But what is fairly new are the animal rights movement groups as well as legislation that haveRead MoreProud to Be a Speciesist Stephen Rose1467 Words   |  6 PagesRose I research on animals. I study the intimate chemical and electrical processes that are the brains mechanisms for storing information, for learning and memory. To discover those mechanisms, I analyse the cellular changes that occur when young chicks learn and remember simple tasks. An anti-vivisectionist once asked me whether my research didnt make me feel rather like Dr Mengele. No, it doesnt, though I cant resist pointing out that the only country ever to ban animal experimentation was

Heparin Flushes Maintaining Central free essay sample

A recent heparin shortage allowed examination of heparin effectiveness in reducing C.V. thrombosis. Many studies have been performed during periods when heparin flushes (1 0 units/ml) were used and when saline flushes were used instead because of a nationwide heparin shortage. The studies have shown no significant evidence that using heparin over saline in central lines is more effective. .Heparin Flushes Maintaining Central Line Potency Maintaining the function of central venous catheters is an important nursing responsibility, which should be carried out following the best available scientific evidence.These central lines include peripherally inserted central theaters (Epics), tunneled catheters, and implanted ports. Once placed, the central lines may be left in place for days and if they become occluded by clotted blood or some other mechanical obstruction they cannot be cleared by flushing agents. While a person is hospitalized, the nurse needs to check the IV site to make sure the catheter remains in the vein and is delivering a continuous solution. The nurse also needs to flush the catheter routinely to prevent it from clotting.Heparin sodium is used as an anticoagulant in intravenous catheters in order to prevent clotting and minimize the incidence f phlebitis. Heparin infusion prolongs the duration of peripherally inserted central venous catheter usability, which permits a higher percentage of therapy completion without increasing adverse effects (Jennet Robertson 1994) and other studies also found heparins saline solution as a superior flushing agent to normal saline for IV lines in randomized control trials.However, although health caregivers believe that small doses of heparin used in flushing of peripheral intravenous lines is harmless, heparin could cause many side effects like hemorrhage, allergic reactions, thermodynamic, infection, and pain at the injection site. Heparin could also have interactions with many other frequently used medications, like ecstatically acid. Heparin is thought to prevent clots developing in the catheter which would decrease or prevent flow through it but might create a potential locus for infection.It can also interfere with promoting time and other lab results, creating an increased amount time spent my medical staff interpreting those results. Some research suggested using a normal saline flush was sufficient (American Association of Critical Care Nurses, 1993). If the studies show that alien is as effective as heparin when flushing central lines, then the use of saline would avoid patient exposure to heparin-associated risks such as hypersensitivity reactions, local tissue damage, bleeding, and heparin induced thermodynamic (HIT).Saline will also increase the accuracy of the patients coagulation profile, enhancing patient management. And saline is more cost effective for institutions. But there are some studies that have shown an increase in infections when using saline over heparin. A study was done to establish guidelines on flushing central line catheters and is summarized in Table 6 (Mitchell M. D. Anderson B. J. Williams K. And miscued C. A. Peg. 2012). The guidelines are important to know because each institution has different protocols and policies that can affect the results.For example, how often an institute flushes central lines could lead to more occlusions or less occlusions regardless of what is being used to flush. Then primary studies were done to compare institutions and their findings or results when flushing with heparin versus saline. Their results are found in tables 7 and 8 (Mitchell M. D. Anderson B. J. Williams K. And Miscued C. A. Peg. 2013 2016). In studies of peripheral and arterial catheters, rates of thrombus formation were equivalent, whether saline or a heparin solution was used for flushing.Randomized trials found that flushing with heparin had no significant effect on catheter potency rates compared with flushing using saline (Gogh). The studies that have been done have not shown a significant difference in the use of heparin versus saline but that could be due to the way the studies were done or by who was participating in them. Some studies were done only on certain types of catheters. Others had more females to males, older to monger, or had patients that needed more frequent flushing than others. Also, the amount of flushing solution according to institution policies and how often to flush.Most facilities have updated their central line care policies according to their best medical recommendations. Last year Yale New Haven Hospital sent out an urgent practice alert to medical staff stating changes in the central venous catheter device (C.V. ) flushing guidelines. They are following recommendations that they are to follow the manufacturer of the catheters guidelines whether to flush with heparin or saline. And they listed each type of device and the preferred method of flushing according to manufacturers (Yale New Haven Guidelines attached).Most common practice we have used in clinical is flushing with heparin 5 units/ml with each use and once every 24 hours. The evidence base on heparin flushing is small. The studies have been inconclusive as to which flushing agent should be preferred. Without this evidence, we do not know how well heparin flushes prevent occlusions or reduce the risk for catheter-related blood stream infections. Further research is needed to determine the effectiveness of saline ND heparin flushes in maintaining central lines for better clinical practice.

Qualitative Research in Public Health for Nature - myassignmenthelp

Question: Discuss about theQualitative Research in Public Health for Dynamic Nature. Answer: Background: It has been observed that , in emergency department staff retention is very less due to stress as result of transforming and dynamic nature of the department. Lower rate of staff retention is also due to the non-cooperation from the management and dissatisfaction in pay scale. Identifying reasons behind poor morale and higher turnover is helpful in finding solutions to prevent higher turnover and to avoid higher burnout of experienced staff members. Poor morale and higher staff turnover directly affects patient care. Incompetent nurses and handling of critical patients are important factors responsible for the higher turnover rate in the emergency and accident department1. Sequential events can occur from poor morale to nurses burnout to the effect on the management of organisation. Nurses burnout lead to nurses turnover to adverse effects on the patient care and finally effect on the management of the hospital. There are varied dimensions for nurse burnout like physical, personal an d social2. Physical environment of the organisation can adversely affects perceived stress and job satisfaction. Environmental aspects in the facility like noise, air quality, light, toxic exposures, temperature, humidity, and aesthetics can affect nurse turnover and patient care3, 4. Physical factors also affects social factors for nurses. Accommodative physical environment gives nurses satisfaction of social support in caring patients. Leadership and collaborative work are the important aspects of the social factors of nurse turnover. Leadership aspects which can lead to poor morale include work scheduling, staffing and promotion opportunities. Collaborative work include support from the all the stakeholders in the hospital. Work/home interface, age and pay scale can be considered as the personal factors responsible for the poor morale and higher nurse turnover5. It has been observed that older nurse leave job more in number as compared to the younger nurses. It has been established that in n ursing, professional reasons are predominant than personal reasons for poor morale and higher turnover. In the literature, following are the reasons mentioned with high frequency for nurse turnover in emergency and accident: higher patient-to-nurse ratios, job dissatisfaction, reduced patient safety and adverse perception of the nursing profession. Factors mentioned with comparatively less frequency are : severe sickness of older patients, rude behaviour of patients, low morale, management problems, augmented workload and more amount of work nor related to the nursing profession. Management should give more focus on improving morale of nurses and stopping nurse turnover because replacement of one nurse can cost huge financial impact on the management. It has been observed that replacement of one nurse can cost management approximately 2.5 % salary of one nurse. Higher turnover can adversely affect patient outcome. There is possibility of increased medical procedure error and medication administration error. Injury may also occur due to falls of the elderly patients. Higher patient-to-nurse ratio can lead to longer duration of wait period and inefficiency of the nurses to provide adequate care to the patients6. Nurse burnout is one of the prominent reason for poor morale and higher nurse turnover. Burnout may be due to emotional exhaustion, decreased personal accomplishment and depersonalization. Burnout can lead to reduced morale, raised absenteeism as result of sickness, reduced efficiency and productivity, inadequate job performance and patient care. In emergency and accident department, approximately 50 % nurses reach clinical level burnout7. Needs of the department should be identified. More number of full-time nurses should be recruited as compared to the travel nurses. Orientation strategies should be identified and areas should be identified with requirements of change. Nurses should be given opportunity to develop professionally. Financial aspects, time, management perceptions and staff stigma should be considered in assessing reasons behind poor morale and higher nurse turnover. Staff can reduce turnover by accepting change and working in co-ordination with management, by understanding qualities of good and bad preceptor, by identifying requirements of the department, by making efforts to reduce fatigue, by working in co-operation with other staff members and by not forgetting willingness to help patients to improve their quality of life8,9,10. Research questions: Phenomenological approach will be implemented in identifying reasons behind reduced morale of staff. This approach establishes precise, complete, and clear description and understanding of the experiences of the persons11. In this qualitative study, experiences of staff members in the emergency department need to be understood. In this approach, findings emerge from the participants and not imposed by the investigator. It has been well established that emergency department is affected due to high turnover rate of staff members. Gaps need to be understood, in retaining staff members in the emergency department. It is evident that low morale can result in reduced staff retention. Qualitative research based on identification of high turnover rate, will focus on following research questions : What are the experiences of staff members in the emergency and accident department? What are the perceptions of staff members ? What are the perceptions of nurses about facility and management ? By raising these questions, we aim to know the reasons behind poor morale of the staff members in the emergency department which is responsible for the high turnover. Along with this we aim to identify correlation between poor morale of staff and patient outcome and management role in poor morale. Physical, social and personal reasons are responsible for the low morale of the staff members. It will be helpful in identifying solutions for low morale and higher turnover. Effective training and orientation can be developed to address issue of higher turnover. Population and sampling method: In qualitative research, population is a group of people from which data need to be collected. People in the participant population should meet the criteria of the study12. This study will be conducted in the urban hospital comprising of emergency and accident department. This emergency and accident department comprising of 200 beds. This study will be specifically focused on the nurses. This study will incorporate nurses of all age group and both the sexes. In this study, nurses in the emergency department will be specifically focused because it has been observed that nurses in the emergency department experiences more turnover due to poor morale. Hence, relevant data can be obtained from the nurses in the emergency department. In this study, purposeful sampling method will be implemented for the data collection. In purposeful sampling, data can be collected from all the selected participants and these will be selected based on the inclusion criteria13. This is the most common method of sampling in the qualitative research. Maximum variation sampling is one of the methods of the purposeful sampling and it will be used in this qualitative research of staff of emergency department. Maximum variation sampling can collect data from varied insights of phenomenon by considering varied angles14,15. In this study, 30 nurses will be enrolled. Number of nurses in this hospital are less than standard ratio of 1 : 3 ; nurse : patient ratio in the emergency department. This number participants may vary slightly based on the turnover of the staff. In qualitative studies, number of participants can vary until robust data gathered and saturation point occurred. Hence, in this study, data will be collected and analysed simu ltaneously to understand progress of the study. Premature saturation can be avoided by improving sampling frame and methodology. It includes selection of suitable population, elimination of biases and analysis of data on regular basis16. Inclusion criteria: Nurse having job change in not less than 1 year period. Nurses having total experience in the emergency and accident department. Nurses between age 22 to 50 yrs. Nurse residing in the same city of hospital. Participants without attending training programme for staff retention in last one year. Exclusion criteria : Participants travelling from the other cities for the job. Participants about 50 yrs of age. Participants unaware of the English language. In this research, most relevant data can be obtained from the hard-to reach participants. It is difficult task to involve this population in the research study. Involvement of hard-to reach group can be improved by understanding characteristics of the participants. Understanding characteristics of the population is also useful in selecting sampling method for the hard-to reach participants 17. Research ethics: Consideration of ethical issues in the research proved beneficial in protecting human rights. Interaction between the researcher and participant is considered as challenging aspect for researcher in the qualitative studies because researcher should use ethically appropriate language. Hence, ethical guidelines should be established for the conduct of the study. However, there is no requirement of ethical approval in this qualitative research. These guidelines have more importance because there is no statistical analysis in the qualitative studies. Hence, ethical guidelines are useful for accurate data collection and interpretation18. Researcher should maintain anonymity and confidentiality of the participants. In this study, researcher should not make public the personal reasons of participants for poor morale. Hence, these rules should be properly defined in guidelines and protocols of the qualitative study. Researcher may face ethical dilemmas with the participants in the qualitativ e research in the form of establishment of honest and open interactions, and avoiding misrepresentations. Informed consent is the integral part of the research, however in this study informed consent from the participants is not required19. Proposed methods: Qualitative research is useful in explaining, clarifying and elaborating varied aspects of participants experiences. Hence, researcher can interpret participants experiences. Personal information of the participants can be protected by securing data storage methods, removing identifier components and amendments in the biographical details. Researcher should protect participants from the harmful consequences because it can affect outcome of the research. Recruitment: 30 participant nurses will be selected for the study. Prior to initiation of the study, participants will be informed about the aims and objectives of the study. These participants will be interviewed by the head of the emergency and accident department and administrative officer of the hospital. Interviews will be audio-video recorded for the future references and for the interpretation of the data. Interviews will be conducted in the closed doors with presence of three people comprising of two interviewers and a participant. Interview will last for 1 hour for each participant. Questions related to social, physical and personal reasons for the poor morale will be asked to the participants. After completion of the interviews, training will be provided to the participants for improving morale of the participants. Training will be provided by professional trainers in social life and medical profession. Training will be provided for all the participants at the same time and it will last s for the period of five days. These training sessions will comprise of theoretical lectures and case studies in the form of videos. All the training programmes will be organised in the English language. Different strategies will be demonstrated in improving morale of the participants. After completion of the training programmes feedback will be collected from the participates. In case, participants remain less educated after completion of the programme, training will be arranged for these participants for the second time. Data collection: In mentioned qualitative research, data will be available mainly in the form of subjective expression of the participants. In this type of qualitative research, usually data is subjective20. This data is the expression and experiences of participants in the form of feelings. Data collection can be direct and indirect in qualitative research21. In direct data collection, data can be collected by one to one interaction between interviewer and participant. On the other hand, in indirect data collection data can be collected in a group. In this research on staff of emergency department data related to reasons of poor morale can be collected by direct data collection method. Data related to feedback of the training session can be collected by indirect method of data collection. Interviews are the active interactions between interviewers and participants to get insight of thoughts and feelings of the participants. Interviews can also be useful in getting in-depth understanding of participa nts authentic experiences. In this qualitative research, experiences of staff members about emergency and accident department need to be collected. Hence, interviews can be most effective method of data collection in this qualitative research. Interviews will be conducted by two specialist experts. One will from medical field and other from the administrative field. Hence, thoughts and experiences of the participants from all the perspectives can be understood. Validated questionaries from the literature will be used in this qualitative research. Based on these questionaries interview guidelines will be prepared to conduct interviews. These interview guidelines can serve as guiding tool for the interviewers as a future reference and it will be properly documented in the archives of the organisation. Approval will be taken for interview guidelines form the management of the hospital. Interview guideline will comprise of each topic like physical, personal and social and under each topic 2-3 questions will be mentioned. These questions will be short and in simple English. Open ended questions will encourage participants to express their thoughts and feelings in detail. Closed-ended and leading questions will be avoided in thi s interview process. Closed-ended questions will allow participants to answer questions in one or two words. Leading questions will force participants to give desired answer. Leading questions can also encourage bias in the qualitative research. As these interviewers are unknown to the participants, there is no question of bias in the data collection. It will also be helpful in maintaining confidentiality. Interview schedule will be decided, after taking approval from both interviewer and participants22. Semi-structured frame-work of interview will be implemented in this research. In this type frame-work, interviewer can modify structured questions to enable discussion between participants23. Discussion can provide more comfort level during interview and encourage them to express themselves more freely. Topics of the interview can vary based on the different participants. Collected data will be duly signed by both participants and interviewers. This data will be stored in the form of paper and electronic form. Codes will be given for the identification of each participants data. Data will be stored in the archives of the hospital and permission for the access of data will be given upon approval from the management. Data analysis: In qualitative data, analysis of the data comprises of understanding exact meaning of the collected data and explanation of the thoughts of the participants. Data collection and analysis should run concomitantly in qualitative research. Broadly four steps should be incorporated in the data analysis in the qualitative research like examining, categorising, tabulating and recombining. In this qualitative research, thematic analysis will be used analysis of the data. Thermatic analysis mainly based on different themes and topics identified in the collected data. Data analysis in qualitative analysis can be completed in the six-steps. Information collected during interview will be transcribed word to word. Field notes collected during interviews will be incorporated in the transcripts. One expert each from medical and administrative field will be appointed to read the transcripts and understand it and discuss among themselves. These experts will be allowed to re-read these transcripts and prepare reflection of content in the transcripts. Collected data will be summarised and segregated in smaller sections. These segregated smaller data will be labelled with specific words or phrases. This process is known as coding and words and phrases are called as codes. Different coding systems like open coding, axial coding and selective coding will be used in the research. App lication of different types of coding will be helpful in the arranging the data and interconnecting the data with other topics. In this qualitative research, different factors can influence outcome of other factors. NVivo software will be used make this coding system more clear and effective. In qualitative data analysis, NVivo software can be used to organise, store and code the collected data. After generating codes for every data, verification will be done for accuracy of codes and sub-codes for each topic. These codes will explain data of each topic. Codes and related topics will be reviewed for 2 3 times to improve accuracy of the collected data. This data will be documented in tabulated form by using separate table for each code and its respective data. All the collected data will be recombined in one document and final conclusion of the analysis will be written24,25. Implications: Poor morale and higher turnover is associated with different factors like physical, social and personal. Hence, multidimensional study should be designed to address all these factors. Health care administrators should focus on nursing staff retention by promoting leadership qualities in the staff and by implementing comprehensive career development programs. Identifying reasons behind poor morale and high turnover would be helpful in preventing compassion fatigue which is beneficial in reducing higher staff turnover. It would be helpful in maintaining visibility of management, promoting open and respectful communication and encouraging staff involvement in decision making, assessing relation between pay scale and turnover rate and creating optimum orientation programme for new nurses26. Orientation programme would be created based on the nursing education and universal education theory and requirements of the orientees would be considered. Internship and residential programmes would be helpful in increasing retention rate. Discussion among the group members, counselling related to work/home balance and social involvement would be augmented. Productive team spirit and adequate colleague support would be evident in the emergency department. Traumatic events would be dramatically reduced27. Time-out facilities would be developed and support would be provided to the affected nurses. There would be improvement in the self-scheduling and pay scale. Lunch breaks, guaranteed nurse-to-patient ratio and debriefing sessions would be implemented in the identification of reasons behind poor morale and high turnover rate 28. References : Rhiannon Talbot and Anthony Bleetman. Retention of information by emergency department staff at ambulance handover: do standardised approaches work? Emerg Med J. 2007 Aug; 24(8): 539542. Isabelle Bragard, Richard Fleet, Anne-Marie Etienne, Patrick Archambault, France Lgar, Jean-Marc Chauny, Jean-Frdric Lvesque, Mathieu Ouimet, Julien Poitras, Gilles Dupuis. Quality of work life of rural emergency department nurses and physicians: a pilot study. BMC Res Notes. 2015; 8: 116. 2015 Apr 1. doi: 10.1186/s13104-015-1075-2 Yen-Ko Lin, Wei-Che Lee, Liang-Chi Kuo, Yuan-Chia Cheng, Chia-Ju Lin, Hsing-Lin Lin, Chao-Wen Chen, Tsung-Ying Lin. Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: a quasi-experimental study. BMC Med Ethics. 2013; 14: 8. 2013 Feb 20. doi: 10.1186/1472-6939-14-8. Tracey J. Weiland, Sean Ivory, Jennie Hutton Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review. West J Emerg Med. 2017 Jun; 18(4): 647661. Suzanne Mason, Colin O'Keeffe, Angela Carter, Chris Stride. A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements. Emerg Med J. 2016 Feb; 33(2): 9198. Jesse M. Pines, Joshua A. Isserman, John J. Kelly. Perceptions of Emergency Department Crowding in the Commonwealth of Pennsylvania. West J Emerg Med. 2013 Feb; 14(1): 110. Natasha Khamisa, Karl Peltzer, Brian Oldenburg. Burnout in Relation to Specific Contributing Factors and Health Outcomes among Nurses: A Systematic Review. Int J Environ Res Public Health. 2013 Jun; 10(6): 22142240 Mohammed J Almalki, Gerry FitzGerald, Michele Clark. The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia. BMC Health Serv Res. 2012; 12: 314. 2012 Sep 12. doi: 10.1186/1472-6963-12-314. Yong Lu, Xiao-Min Hu, Xiao-Liang Huang, Xiao-Dong Zhuang, Pi Guo, Li-Fen Feng, Wei Hu, Long Chen, Huachun Zou, Yuan-Tao Hao. The relationship between job satisfaction, work stress, workfamily conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study. BMJ Open. 2017; 7(5): e014894. 2017 May 12. doi: 10.1136/bmjopen-2016-014894. Agezegn Asegid, Tefera Belachew, Ebrahim Yimam. Factors Influencing Job Satisfaction and AnticipatedTurnoveramongNursesin Sidama Zone Public Health Facilities, South Ethiopia. Nurs Res Pract.2014;2014: 909768.2014 Feb 24.doi:10.1155/2014/909768. Annette Sofie Davidsen. Phenomenological Approaches in Psychology and Health Sciences. Qual Res Psychol. 2013 Jul; 10(3): 318339. Blackmore A. Sampling. In Blackmore A, editors. 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