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bihari ias essay Online edition of India's National Newspaper. Hr Strategy Workbook | March | Voice | Ceridian! Sunday, Mar 03, 2002. Of Authenticity! 'He is the Workbook 2015 Newsletter | Ceridian same like God' THE other day I received by e-mail one of 20-26) Nutrition, those Internet jokes that constantly do the Workbook | March rounds, particularly among expatriate Indians, whose appetite for Personal Personal desi humour, usually self-deprecating, knows no bounds. It purported to be an essay written by Hr Strategy Workbook | March | Ceridian a Bihari candidate at Three Powerpoint Templates, the Union Public Service Commission (UPSC) examinations for the Indian Administrative Service. The sender quoted what was allegedly the Hr Strategy Workbook 2015 Newsletter candidate's essay on (january Nutrition the subject of the Indian cow, which, for the benefit of those fortunate enough not to be assailed daily by the Internet, I reproduce below almost in Hr Strategy Workbook 2015 | Voice | Ceridian full: He is the cow. Doc.#600642: Reference Template Personal! The cow is a successful animal.

Also he is four footed. And because he is female, he give milks, but will do so when he is got child. He is same like-God, sacred to Workbook | Voice, Hindus and Weekly Workouts, useful to man. But he has got four legs together. Two are forward and two are afterwards. Workbook! His whole body can be utilised for use. More so the Certificate Proposal Forms milk.

Milk comes from 4 taps attached to his basement. Horses do not have any such attachment. What can it do? Various ghee, butter, cream, curd, why and Hr Strategy | March, the condensed milk and so forth. Also he is Umbrella - Apigram.com useful to cobbler, watermans and Workbook | March 2015 | Voice Newsletter | Ceridian, mankind generally. Letter Template! His motion is Hr Strategy | Voice slow only Red Candy On Beautiful Templates because he is Workbook | March 2015 Newsletter of lazy species. Also his other motion (gobar) is Resume For Hostess Proposal much useful to 2015 | Voice Newsletter, trees, plants as well as for making flat cakes like Pizza, in hand, and drying in the sun.

Cow is the Report Cover only animal that extricates his feeding after eating. His only attacking and Hr Strategy Workbook | March | Voice Newsletter | Ceridian, defending organ is the horns, specially so when he is got child. Three Cane On Beautiful Powerpoint! This is 2015 done by Printable Umbrella Template knowing his head whereby he causes the weapons to Workbook | March | Voice | Ceridian, be paralleled to the ground of the Template earth and | March 2015 | Voice Newsletter | Ceridian, instantly proceed with great velocity forwards. He has got tails also, situated in Cover the backyard, but not like similar animals. It has hairs on the other end of the other side. This is done to frighten away the flies which alight on his body whereupon he gives hit with it. '' It goes on for a few sentences more in similar vein, and then the e-mailer added the Hr Strategy 2015 | Ceridian following footnote: We are reliably informed that the candidate passed the exam and is now an IAS officer somewhere in Art | Proposal Bihar.'' Now let's put aside the obvious implausibilities of Hr Strategy | Voice Newsletter, this story #151; the Use Root Cause Analysis To Identify Lessons | Rick Wilkinson unlikelihood of an Hr Strategy Workbook | March | Voice Newsletter | Ceridian IAS exam paper being posted on the Web, the Doc.#600642: List Template – Doc600642 even greater unlikelihood that the IAS would ask its examinees to Hr Strategy Workbook 2015 | Voice | Ceridian, write an essay on the cow #151; and Umbrella Template - Apigram.com, consider the sneering that lies behind it. Hr Strategy Workbook | March | Voice! The anonymous candidate is, of course, supposed to be from Doc.#600642: Reference List Personal Bihar, which over the last couple of decades has become a sort of national symbol for corruption, venality and incompetence in Indian governance, at Hr Strategy 2015 | Voice | Ceridian, least amongst the Weekly 20-26) urban Anglophone classes. (This phenomenon has, of course, accelerated since the ascent of Hr Strategy | March 2015 Newsletter, unprincipled rusticity to Analysis To Identify | Rick Wilkinson, high office in Hr Strategy Workbook | Voice Newsletter that State, as embodied in the person of Printable Umbrella Template - Apigram.com, Shri Laloo Prasad Yadav.) Worse still, the Workbook | March | Voice Newsletter e-mail claims the Doc.#600642: List Template howler-laden essay actually got its author into the IAS. This is startling, because it suggests that the Hr Strategy | March 2015 Newsletter stock of that institution, once considered the Template - Apigram.com home of the best and the brightest in our society, has fallen lower than any of | Voice | Ceridian, us could have imagined, at Of Authenticity Art | Proposal Templates, least in | March 2015 Newsletter the eyes of Template Word | Teknoswitch, our nouveau-riche computer-owning yuppies and their NRI friends.

In the Workbook Newsletter old days, the IAS officer was the paragon of authority and power, the prospective bridegroom who commanded the highest price on the marriage market. Today, as multinationals and dot-coms (and better still, multinational dot-coms) reward their executives with riches and perks a mere sarkari babu can only dream of, the once-august IAS man can even be portrayed as a semi-illiterate dehati who can't write a sensible English paragraph but still gets sent off to rule over Certificate Of Authenticity Art | Proposal Forms Templates, the masses, at least in Bihar. Of course I may be making far too much of a silly Internet joke, but I wonder what its wide circulation (I have received it from at least three different people) does reveal about the Hr Strategy 2015 | Ceridian way our society is changing. I once wrote elsewhere about the insidious divisions being promoted between India and Bharat #151; between a slice of our country that is seen as cosmopolitan, liberal, Anglophone, technologically-savvy and secular, and Reference – Doc600642, the undifferentiated rest that is Workbook | March | Ceridian thought of as traditional, casteist, superstition-ridden, backward and vernacular. Workouts 20-26)! It worries me that, in this era of Workbook | March | Voice | Ceridian, greater communication, complete interdependence and the levelling influence of mass television, the gulf of 20-26) – Operation, empathy between the Indians and the Bharatvasis seems to be widening rather than shrinking. There is probably room here for more serious sociological enquiry than I am capable of. I hope it is undertaken by someone in Bihar. Workbook | March 2015 Newsletter! But I don't want to leave the subject of classroom howlers before making the defensively feeble observation that Biharis, or for that matter Indians, are not their only perpetrators. Prof. Anders Henriksson, an American professor of history (at the not particularly well-known Shepherd College in West Virginia) has compiled a volume he has titled Non Campus Mentis , a collection of egregious errors taken word for Umbrella - Apigram.com word from term papers and Hr Strategy | March 2015 | Voice, exams conducted at American and Personal Reference List, Canadian colleges. His chronicle runs from such prehistorical periods as the Stoned Age to the more contemporary dramas of the | Voice | Ceridian Berlin Mall.

In his account, Julius Caesar is assassinated on Report Template the Yikes of | March | Ceridian, March and bursts out 6+ Newspaper Template Word while dying, Me too, Brutus! In the student essays the Hr Strategy | March 2015 good professor has trawled, there are knowing references to Weekly Workouts – Operation Nutrition, Judyism as a monolithic religion (whose adherents, in Workbook | March | Voice Newsletter a contemporary computer-age error, worship the Printable - Apigram.com god Yahoo). Columbus' benefactors, Ferdinand and Isbaella, conquer not Grenada but Granola #151; the name of an Workbook | March | Voice Newsletter American breakfast cereal. Martin Luther King Jr. (the student even left out the surname King, confusing the Black American Nobel winner with the 15th Century German Protestant reformer) makes a historic If I Had a Hammer speech (the title of Use Root Cause To Identify, a pop song #151; King had, in reality, famously declared, I Have a Dream). Hitler is depicted as terrorising his enemies with his feared Gespacho, a conflation of the Spanish soup, or gazpacho, with the | March 2015 | Ceridian dreaded Gestapo. Kennedy resolves the Canadian Missile Crisis, not the Cuban. And so on. | Apa! Ignorance, in other words, knows no boundaries. Not even national ones. Workbook | March 2015 Newsletter! I don't know how much they might know about the Resume | Apa cow, but I have no doubt that none of the American children in Prof. Hendriksson's book would have got into the IAS.

Shashi Tharoor is the Workbook | Voice author of the Analysis Wilkinson new novel Riot. Hr Strategy 2015 | Voice | Ceridian! Visit him at Certificate Art |, www.shashitharoor.com. Send this article to Workbook | March | Voice Newsletter, Friends by E-Mail. Comments to Use Root Cause Analysis Lessons, : [email protected] Copyright ? 2002, The Hindu. Republication or redissemination of the contents of Hr Strategy Workbook 2015 | Voice Newsletter | Ceridian, this screen are expressly prohibited without the Word | Teknoswitch written consent of The Hindu.

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An Interprofessional Quality Improvement Project to Implement Maternal/Infant Skin-to-Skin Contact During Cesarean Delivery. Karen Brady, MAHSM, BSN, RNC-OB, C-EFM. Family Birthing Center. St. Workbook | March Newsletter | Ceridian? Vincent's Medical Center. 2800 Main Street. Bridgeport, CT 06606. First published: 30 June 2014 Full publication history DOI: 10.1111/1552-6909.12469 View/save citation Cited by (CrossRef): 2 articles Check for updates. The authors report no conflict of interest or relevant financial relationships. Immediate skin-to-skin contact between a mother and her newborn has been associated with successful breastfeeding outcomes. One of the challenges nurses face in promoting skin-to-skin occurs in Personal Template Personal the operating room during a cesarean delivery.

Utilizing an interprofessional approach for this quality improvement project, we successfully implemented skin-to-skin contact for all eligible mother/infant couplets after cesarean birth. Exclusive breastfeeding rates for these women increased as a result. The benefits of breastfeeding are recognized throughout the world. Breastfeeding benefits not only the mother and her infant, but also society as a whole when taking into Hr Strategy 2015 | Ceridian, account the decrease in illness and associated costs (Bartick Reinhold, 2010). List? The World Health Organization (WHO; 2013) and Baby-Friendly USA (2011) encourage all hospitals and birthing centers to institute the Ten Steps to Successful Breastfeeding (Table 1) as a means to promote and support breastfeeding for all mothers. As of April 2013, 154 hospitals and birthing centers in the United States had achieved the Baby-Friendly designation (Baby Friendly USA, 2014), identifying them as centers that support and Hr Strategy | March 2015 | Voice | Ceridian promote breastfeeding as the – Doc600642, gold standard for infant nutrition. Hr Strategy | March 2015 | Voice Newsletter? From Baby-Friendly USA, Inc. Used with permission from Use Root To Identify United Nations International Children's Emergency Fund (UNICEF). Baby-Friendly USA provides a 10-step model of practice that supports specific opportunities for continuous improvement. Workbook | March | Voice? Hospitals designated as Baby-Friendly regularly evaluate evidence-based practice (EBP) regarding breastfeeding to provide women and their infants with the best opportunities for breastfeeding success. Step Four of the Baby-Friendly Ten Steps addresses the importance of skin-to-skin contact (SSC) immediately after birth, with the goal of initiation of breastfeeding within an hour of birth (Baby-Friendly USA, 2011).

For hospitals attempting to receive the Cause Analysis Lessons, Baby-Friendly designation, this particular step can present many challenges, as it involves a change in the model of care and routine nursing practices. Although every member of the patient care team can receive education and speak to the benefits of early SSC for mother and infant, implementing this practice takes a coordinated effort. There are numerous barriers to overcome, particularly for women undergoing cesarean births. With the cesarean birth rate at Hr Strategy 2015 Newsletter | Ceridian, in the United States approximating 33% (Hamilton, Martin, Ventura, 2012), it is imperative that all women and their infants be provided with the best opportunity for breastfeeding success. This best opportunity for success includes early initiation of SSC after birth. Report Letter? The purpose of this article is to outline the interprofessional process necessary to implement SSC in the operating room (OR) as a quality improvement project. Breastfeeding exclusivity rates may be lower among women who experience cesarean delivery. Implementing skin-to-skin contact in the operating room can affect exclusive breastfeeding. This quality improvement project was conducted at a 473-bed community teaching and Hr Strategy Workbook | Voice referral hospital located in Bridgeport, Connecticut.

The Family Birthing Center (FBC), consisting of labor and delivery, postpartum couplet care, and a Level IIb nursery, provides care for 6+ Newspaper Word, approximately 1,200 women and their infants each year. There are currently 57 RNs, 8 clinical care associates/certified surgical technicians, 2 lactation consultants, 1 clinical nurse leader, 1 clinical nurse educator, and a nurse manager working in the FBC. The entire FBC staff, including physicians, participated in Workbook | Voice Newsletter | Ceridian the process to achieve the Baby-Friendly designation. As part of the initial training, all nursing staff was required to attend a 2-day workshop titled “Ten Steps to Successful Breastfeeding Support Specialist Program” and to spend supervised hours with a lactation consultant (Baby-Friendly USA, 2011). Use Root Analysis To Identify | Rick? Education for physicians included grand rounds presentations, an online learning module titled Breastfeeding Exercises, and some individual sessions with a lactation consultant. The Joint Commission (TJC) defines exclusive breastfeeding as “a newborn receiving only breast milk and Hr Strategy Workbook | March 2015 | Voice no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines” (The Joint Commission [TJC], 2013, p. Workouts (january Nutrition? 67). Workbook 2015 | Voice Newsletter? Exclusive breastfeeding while in the hospital has been associated with an Resume For Hostess | Apa Proposal increase in the overall duration of breastfeeding (Murray, Ricketts, Dellaport, 2007). Increased duration of breastfeeding is one of the objectives of Healthy People 2020, which are defined by Workbook, the U.S.

Department of Health and Human Services (2010, November). Our FBC data indicated that for infants born via cesarean in the year 2011, 9% were discharged home exclusively breastfeeding. The implementation of Step Four, which is to 6+ Newspaper, help mothers initiate breastfeeding within one hour of birth (Baby-Friendly USA, 2011), presented an operational challenge that the 2015 Newsletter | Ceridian, staff was able to overcome with vaginal births but not cesareans. The initial challenge with this step involved the practice of initiating SSC immediately after birth. According to the guidelines of Step Four, infants should be placed in continuous SSC with their mothers from immediately after birth for at least one hour until completion of the first breastfeed. Weekly (january? For infants born via cesarean, the additional qualifier in Step Four is that the infant is placed with the mother once the mother is responsive and Hr Strategy Newsletter | Ceridian alert (Baby-Friendly USA, 2011). Routine nursing practices and newborn admission assessments were reasons cited for the initial resistance to SSC by members of the nursing staff. Through staff education, peer coaching, and role modeling, SSC became the standard of care for vaginal births. Upon acceptance of SSC for vaginal births, the next step was to incorporate this model of care into cesarean deliveries.

At the Weekly Workouts 20-26) – Operation Nutrition, time of the Baby-Friendly designation, the practice of Workbook | March | Voice Newsletter | Ceridian SSC for women and their infants experiencing cesarean deliveries occurred in the postanesthesia care unit. Upon acceptance of the practice change with SSC in the postanesthesia care unit, placing the infant in SSC with the For Hostess, mother in the operating room (OR) during a cesarean delivery was the final step to Workbook | Voice Newsletter | Ceridian, full implementation of Step Four. Some members of the medical and nursing staffs expressed concerns about the safety of placing an infant SSC in the OR. Specific concerns included temperature stability, need for increased surveillance of the Certificate Of Authenticity Art |, mother and infant during a cesarean delivery, and the ability to Hr Strategy | March | Voice Newsletter | Ceridian, follow recommended staffing guidelines to provide a nurse to care for the infant while facilitating SSC in the OR. An important piece of the implementation plan for Doc.#600642: Personal List Template Personal, SSC during a cesarean delivery was the utilization of a transition nurse.

The transition nurse role was established during the process to become Baby-Friendly. Hr Strategy 2015 Newsletter | Ceridian? Based on the recommended staffing guidelines of one nurse to one patient for circulating during a cesarean delivery, an additional nurse was needed to Certificate Art | Forms Templates, care for 2015, the newborn (American Academy of Pediatrics American College of Obstetricians, 2012). Additionally, the Association of Report Letter Template Women's Health, Obstetric and Neonatal Nurses (AWHONN; 2010) staffing guidelines recommend a nurse to patient ratio of two to one at birth, one nurse for Hr Strategy Workbook | March | Voice | Ceridian, the mother and one nurse for the newborn. The role and responsibilities of the transition nurse were discussed and Use Root Cause Lessons Wilkinson defined with input from | Voice nurses and physicians, as this change in the model of care affected the entire team. The transition nurse's primary responsibility is to 6+ Newspaper | Teknoswitch, attend all births and provide care for the newborn infant at the bedside, rather than removing the newborn to the nursery. | March | Voice Newsletter | Ceridian? The transition nurse assists new mothers with immediate SSC. The initial assessment and routine tasks are delayed until completion of the first breastfeed. Resume For Hostess | Apa? There are two key committees that were integral to the successful achievement of SSC in the OR. Being interprofessional in Newsletter | Ceridian nature, these committees were able to monitor progress and obstacles in processes and acceptance of change by team members. These two committees, with distinct purposes, are the Perinatal Safety and Patient Satisfaction (PSP) committee and Workouts – Operation the Baby-Friendly Committee.

Each of these committees played an Hr Strategy | Voice | Ceridian active role in the implementation of SSC in Doc.#600642: Personal List Template – Doc600642 Personal the OR and is detailed in Table 2. The Perinatal Safety and Patient Satisfaction (PSP) committee originated as part of an Institute for | Voice | Ceridian, Healthcare Improvement (IHI) safety initiative, in early 2006, and is recognized as a change agent for practice improvements in the FBC. Responsibilities of this committee include bundle compliance, crisis simulation drills, patient satisfaction monitoring, and Personal Personal oversight of all aspects of patient safety on the unit. An additional function of this committee is to review the | March 2015 | Voice | Ceridian, perinatal score card and compliance with TJC's (2013) Perinatal Core Measures. Exclusive breastfeeding is one of the core measures, therefore collaborating with this committee was essential to the success of the quality improvement project. Committee membership includes nurses, obstetricians, neonatologists, pediatricians, anesthesia providers, quality improvement and Word | Teknoswitch risk management staff, and security. This team approach provided the opportunity to evaluate SSC in the OR, with each discipline offering a unique perspective on patient safety as well as practical solutions to overcoming perceived barriers. The Baby-Friendly Committee was created in the fall of 2006, with the | Voice, goal of bringing the Cause To Identify Lessons | Rick Wilkinson, Baby-Friendly designation to our institution.

Committee members include the Hr Strategy Workbook 2015 | Voice Newsletter | Ceridian, medical directors of obstetrics and pediatrics, the nurse manager, clinical nurse leader, clinical nurse educator, lactation consultants, staff nurses, and a hospital quality improvement specialist. Weekly Workouts (january – Operation? Upon being designated Baby-Friendly, the committee continued to meet monthly to Hr Strategy Newsletter, ensure compliance with the Ten Steps and work on Use Root Cause To Identify | Rick maintenance of the Hr Strategy 2015 Newsletter, designation. Additionally, the committee reviews Baby-Friendly statistics, including TJC (2013) Exclusive Breast Milk Feeding PC-05. Statistics on SSC and infants breastfed in the first hour of life are also evaluated monthly, to monitor trends and discuss opportunities to improve clinical practice and breastfeeding outcomes. The plan, do, study, act (PDSA) method was used to implement small tests of For Hostess Proposal change in a disciplined fashion and to assess the feasibility of initiating SSC contact in the OR (Nelson, Batalden, Godfrey, 2007). Hr Strategy | Voice Newsletter? The Transforming Care at the Bedside workgroup from IHI suggests that when planning a test of change three conditions should exist: staff should be willing to Doc.#600642: Personal – Doc600642 Personal, try it, they should believe it's a good idea, and Hr Strategy Workbook | March | Voice there should be a low cost of failure should the test fail (Rutherford et al., 2008). The PDSA method provided ongoing tests of change and revisions to the process on a small scale, while incorporating the interprofessional collaboration needed for the overall success of the project. The Baby-Friendly Committee analyzed current practices on Cover Letter the unit to identify opportunities that could positively affect breastfeeding exclusivity rates at discharge. Hr Strategy Workbook 2015 | Voice | Ceridian? The initial step was to build support of the initiative through evidence. Members undertook literature searches and information was dispersed among the Resume | Apa, staff about evidence that was found. In particular, team members researched and discussed articles regarding increasing trends in cesarean section rates, lower exclusive breastfeeding rates among women who had a cesarean delivery, and SSC in the OR.

Publications of special interest were brought to a formal journal club for discussion. One article in particular, by Hung and Berg in 2011, was reviewed as it discussed one California hospital's quality improvement project to implement SSC in the OR from a nursing perspective. Hr Strategy 2015 | Voice Newsletter | Ceridian? Collectively the time spent on exploring the evidence and discussing it in an interprofessional format supported the “ownership” of Workouts 20-26) team members and established excitement about the project. As plans were formulated to begin this performance improvement project, it became evident that implementing SSC in the OR would require an interprofessional team approach. Key members of the interprofessional team included nurses and scrub technicians, obstetricians, anesthesiologists and certified registered nurse anesthetists, neonatologists and pediatricians, lactation consultants, and last, patients themselves. Each of these disciplines brought a unique perspective and set of challenges to the practice change. A few of obstetricians were concerned that aseptic technique in the OR would be jeopardized if the infant's feet should slip beneath the drapes and into Hr Strategy Newsletter | Ceridian, the surgical field. Various anesthesia personnel thought they might be responsible for monitoring an infant while in Resume | Apa Proposal SSC with its mother. Many nurses worried the infant might get cold stressed in the cool OR environment, or that the Workbook 2015 Newsletter | Ceridian, mother wouldn't be able to sufficiently hold her infant in SSC in the OR. Last, a few pediatricians shared their thoughts on Of Authenticity Proposal Templates the newborn transition period and Hr Strategy Workbook the nurse's ability to 6+ Newspaper, monitor the infant while in SSC with the mother.

These concerns were discussed with each discipline at individual department meetings and collectively at the PSP and Baby-Friendly Committee meetings. A solid educational plan was another component of the implementation design. Education across all disciplines is necessary for facilitating change in any setting. Baby-Friendly USA (2011) details a prescribed 15 hour curriculum for nursing staff working with new mothers. Currently, education of nursing staff regarding SSC in the OR begins in orientation with new staff. As part of Hr Strategy Workbook 2015 breastfeeding orientation, education is provided on what SSC means, the benefits of Use Root Analysis To Identify Wilkinson SSC, and | March 2015 | Voice Newsletter how to facilitate SSC for vaginal births and Cause To Identify Lessons cesarean deliveries. Placing infants in SSC regardless of feeding choice or delivery method is a cornerstone of this education curriculum (Baby-Friendly USA, 2011). Breastfeeding and Hr Strategy | March 2015 | Ceridian SSC immediately after birth are the standard of care. Newly hired physicians complete an online learning module on breastfeeding, which includes information on Baby-Friendly USA and the Ten Steps. Lactation updates are a standing agenda item for the monthly FBC staff meeting, as well as the Wilkinson, monthly meetings of the | March | Ceridian, department of obstetrics and pediatrics, to provide ongoing education as needed.

Nursing education also includes dissemination of the practice change and List Personal the support of EBP through the Baby-Friendly Committee, Unit Practice Council, and journal club. Patient education plays a vital role in partnering with patients to implement an individualized plan of care. Mothers and Workbook 2015 Newsletter their significant others can be seen as a barrier to this model of care. Prenatal education should include the practice of SSC, to Doc.#600642: Reference List Template – Doc600642, avoid risking a delay in 2015 Newsletter | Ceridian the initiation of SSC after birth (Rowe-Murray Fisher, 2002). This education will allow the mother to understand the benefits of SSC after birth regardless of her feeding preference. Although the majority of women are able to participate in SSC in the OR, a mother must also understand the possibility of Template her inability to hold her infant due to Workbook, instability on her part, or on Report Letter Template the part of her infant.

Instances of general anesthesia, intraoperative pain or nausea and vomiting, or infants in need of resuscitation or a higher level of care will result in delaying SSC for the mother/infant couplet. Workbook | March 2015 | Voice | Ceridian? Finally, a mother might feel modest about Doc.#600642: Reference List Template Personal exposing her breasts, due to cultural or personal reasons, and Hr Strategy Workbook | Ceridian this barrier needs to be approached with sensitivity and care. Prenatal education on Workouts (january 20-26) SSC is offered in a variety of | March Newsletter ways. At this institution, it has been incorporated into Weekly (january Nutrition, childbirth education class, prenatal breastfeeding class, baby care class, sibling class, and prenatal tours. The process of placing the infant on the mother in SSC as soon as possible after birth is 2015 | Voice not only Use Root Cause | Rick Wilkinson, described, but also demonstrated in patient education videos and printed information. It is promoted as the standard of practice. Benefits, including health benefits for mother and infant, as well as patient satisfaction are reviewed. Additionally, SSC can be incorporated into prenatal visits, especially if a surgical delivery is anticipated. Discussing SSC in the OR as a means of normalizing the birth experience can have a positive effect on a patient's anxiety level.

The local Women, Infants and Hr Strategy Workbook | Voice Children (WIC) office have breastfeeding coordinators discuss SSC with their clients during prenatal visits. For Hostess? Referrals are made to Hr Strategy | Voice, the hospital lactation consultants for follow-up if further education is needed. Use Root To Identify Lessons Wilkinson? The final piece of the Workbook | March 2015 | Voice, patient education process takes place upon admission to the FBC. At this time, prenatal education of SSC is reinforced with patients who have attended classes, or introduced to patients who are new to the concept. This education is provided by the nursing staff and is documented in Report the electronic medical record (EMR). A key element in Workbook | March | Voice | Ceridian the planning was enhancements made to Art | Proposal Forms, the EMR to allow for ease of Hr Strategy Workbook 2015 Newsletter | Ceridian documentation and data collection. When admission education is complete, nurses document the education provided, as well as the Workouts (january 20-26), patient's agreement to SSC, in the EMR.

With the ground work laid for implementing SSC in the OR, it was time to begin a test of | March change. Two nurse champions volunteered to pilot SSC in the OR. For the first test of change, the transition nurse spoke with members of the OR team prior to the start of the case to discuss the possibility of initiating SSC in the OR. With the team in agreement, the nurse then spoke with the patient preoperatively, provided education on SSC, and obtained verbal consent from the Use Root Cause | Rick Wilkinson, patient to proceed. Following birth, the infant was placed under the radiant warmer for a brief period of observation by the pediatrician, as per the usual OR routine at that time. Hr Strategy 2015 | Ceridian? After 5 minutes of Personal List Template – Doc600642 observation, the transition nurse prepared the Workbook 2015 | Voice Newsletter, mother for SSC and placed the infant on her chest, where the Personal Reference Template – Doc600642, infant remained for the duration of the operation. | March | Voice? Following AWHONN staffing guidelines (2010), the transition nurse remained with the infant the 20-26), entire time, while the circulating nurse attended to the needs of the surgical team and the mother.

The following day, the second nurse champion, using the same procedure, initiated SSC in the OR. Nurse champions, collaborating interprofessionally with the operating room team, were successful in implementing skin-to-skin contact in the operating room. Workbook 2015? An informal discussion followed each of these two tests of change. The patients and the transition nurses reported a high degree of satisfaction with this change in practice. Positive comments included patient satisfaction at being able to hold her infant earlier, increased breastfeeding within the first hour, and surprise from the 6+ Newspaper Template, nurses at the ease of placing a newborn SSC in the OR. Based on the success of the first two tests of change and the feedback received from the team, the Workbook | Voice Newsletter, plan was to continue with a core group of engaged team members to further identify potential barriers and Doc.#600642: Personal Template build on successes. Multiple tests of change occurred until implementation of the Newsletter, process was complete. Of Authenticity? As part of the learning process, staff was encouraged to talk about their experiences with initiating SSC, and practice SSC in 2015 the OR with every cesarean delivery. Nurse champions, who have been shown to successfully affect workplace practices, acted as peer coaches and engaged additional staff members in the initiation of SSC in the OR (White, 2011). With the help of these champions, acceptance of SSC in the OR increased.

Members of the team were empowered to implement any changes to the process that were easy to do and resulted in Of Authenticity Art | Proposal Forms improvements. Simultaneously with the tests of change, preparations were under way to disseminate information on the practice of Workbook | March 2015 | Voice SSC in the OR to the other members of the interprofessional team. A list of Workouts – Operation hospital committees was compiled that included members of the interprofessional team needed for success. The list included departmental meetings for | Voice | Ceridian, the obstetricians, pediatricians, anesthesia personnel, FBC staff meetings, Unit Practice Council meetings, and For Hostess the PSP committee. Each of the key team members provided their own insight into Workbook | March 2015 | Ceridian, the process and their feedback was instrumental in overcoming the barriers identified.

Evidence in the literature was used to support the practice change and reassure members of the OR team that their concerns were being acknowledged and addressed. Proposal? At one department meeting, various positions for SSC were demonstrated to team members, to assure them that aseptic technique could be maintained throughout the surgery. Thermoregulation was a concern for many members of the team, but a study by Gouchon and colleagues (2010) provided information to overcome this barrier. Workbook 2015 | Voice Newsletter? The results of their study showed that infants born via cesarean section who received SSC were not at risk for Resume For Hostess, developing hypothermia compared to infants who did not receive SSC. Additionally, current neonatal resuscitation guidelines allow for SSC to provide thermoregulation for infants who are term, breathing or crying, and Hr Strategy | March | Voice | Ceridian exhibit good muscle tone (American Academy of Pediatrics and American Heart Association, 2011). Providing a safe environment through adequate resources was vital to the success of the project. The role of the transition nurse, as the Resume, primary care provider for the infant based on staffing guidelines (American Academy of 2015 | Voice Newsletter Pediatrics and American College of Obstetricians, 2012; AWHONN, 2010), was reinforced with all disciplines and key to the acceptance of the practice.

The lactation consultant and the clinical nurse leader attended a department of anesthesia meeting to discuss the concept of SSC in the OR and the anesthesia provider's role in the process. Once concerned members of the group had a clear understanding of the role the transition nurse and Use Root Cause To Identify | Rick Wilkinson her sole responsibility of monitoring the infant, and that the function of the circulating nurse would remain unchanged, they were more accepting of the practice change. The pediatricians were also reassured, knowing that the infant would receive constant surveillance while in Workbook | March 2015 Newsletter | Ceridian SSC with its mother. Evaluation of the project was the shared responsibility of established committees and project specific designees. Initial monitoring of the change in practice took place via chart review and feedback between select members of the Baby-Friendly Committee and members of the OR team. Use Root Cause Analysis To Identify? It was through the work of the PSP and Baby-Friendly Committee that many of the details of the | March 2015, process were finalized utilizing EBP. Both committees continued to meet monthly and tracked the data that were being collected on initiation of SSC in the OR and breastfeeding exclusivity rates.

These monthly meetings provided the opportunity for all disciplines involved to share feedback and troubleshoot any problems encountered, such as equipment that created barriers and staff bias in regards to the change in practice. It was also a time to share positive case reports and acknowledge the efforts of the team. As more nurses began to Proposal, incorporate this practice into the OR routine, feedback from the team was used to make improvements to the process. The logistics of positioning the baby with the mother to Hr Strategy Workbook Newsletter, ensure sterility during the case, the role of the transition nurse continually at the family's side for safety, placing the electrocardiogram leads off to the side to Cause Analysis To Identify Lessons, accommodate the infant SSC on Hr Strategy Workbook the mother, and the timing of the initiation of SSC are examples of some of the innovations based on input from the team. As time went on, the feedback became increasingly positive as acceptance of the process change became part of the normal OR routine. After 6 months of preparation, the FBC staff fully implemented SSC for patients undergoing a cesarean delivery. All members of the team cooperated with the practice change.

Policies, and procedures had been revised, enhancements were made to the EMR, and patient safety needs addressed. SSC in the operating room was to be initiated for all medically stable mothers and infants. A key aspect of Use Root Analysis To Identify | Rick evaluation is data analysis. Initially, anecdotal data identified barriers previously unknown to the committees, as well as spread success stories. Once a few tests of change had been completed, it became important to obtain more concrete data.

The Baby-Friendly Committee selected the items that were needed for data collection and changes were made to the EMR to capture these data. An item was created to capture instances of SSC in the OR, as well as the time of initiation of SSC. For ease of Hr Strategy Workbook Newsletter documentation by the transition nurse, each of these items was added to the newborn assessment screen on Of Authenticity Art | the delivery summary. With the completion of these changes, SSC in the OR was added to the lactation statistics report, making the data available for monthly review. A second key component of the data analysis was to create a report to monitor trends.

Through the use of the EMR, a breastfeeding statistics report was generated that tracked the patient-specific details of instances of SSC in the OR. The lactation consultants, along with the clinical nurse educator, tracked the data from this report and audited charts to monitor the progress of this quality improvement project. This detailed report contained specific information extracted from each delivery including method of delivery, delivery date/time, anesthesia type, gestational age, feeding preference, SSC in OR, breastfed in first hour, delivery nurse, as well as the | Voice, disposition of the infant (i.e., mother/baby care, nursery for observation or special care nursery). This allowed the team to drill down for more information than the lactation statistics report offered, and provided the opportunity to identify trends should a decline in SSC in the OR occur. In addition to tracking individual patient data on initiating SSC in the OR, the report identified patients that did not initiate SSC.

Each individual case was analyzed to determine why SSC was not initiated. Reasons for noninitiation of SSC included: patient refusal, condition of mother and/or infant, bottle feeding, and resistance among team members. Staff members who initiated SSC for their patients were praised for their efforts and | Teknoswitch had their success stories shared with the staff. Discussions were held with team members who did not initiate SSC to determine any barriers they encountered, and provided on-the-spot trouble shooting or reeducation as needed. The final piece of the data collection was anecdotal experiences shared by the patients with the lactation consultants during their postpartum rounding. Patients have remarked on how SSC in the OR normalized their birth experience.

In addition, several mothers indicated that they really enjoyed having the Workbook | March 2015 | Voice, baby with them SSC in the OR, and Workouts (january – Operation it was much better than when they had their last baby. When patients praised the efforts of the staff in Hr Strategy Workbook | March | Voice the OR for Resume For Hostess | Apa Proposal, placing the babies SSC, this feedback was shared with the staff. Data analyses and Hr Strategy Workbook 2015 Newsletter | Ceridian educational support among disciplines were key factors in the successful implementation of skin-to-skin contact in the OR. The major goals of this performance improvement project were to implement SSC in the OR and increase exclusive breastfeeding rates at discharge. A small test of change began with two women and their infants participating in SSC in Template Word | Teknoswitch the OR. At the Hr Strategy 2015 | Voice, completion of the first month of full implementation, 43% of women undergoing a cesarean delivery experienced SSC in the OR. The FBC goal for 2013 is 80% and will be reevaluated upon achievement and Doc.#600642: Reference List sustainment of that goal. Figure 1 represents the first 10 months of data for Workbook | March | Voice, SSC in the OR, exclusive breastfeeding rates, and exclusive breastfeeding rates among patients experiencing a cesarean delivery. As cases of SSC in the OR increased, there was an increase in exclusive breastfeeding rates as well, from 30% in December 2012 to 63% in April 2013. Exclusive breastfeeding rates for women undergoing a cesarean delivery increased from 8% in December 2012 to – Operation, 19% in April 2013. Skin-to-skin in the operating room compared with exclusive breastfeeding rates July 2012 - April 2013.

SSC = skin to skin contact; OR = operating room; Exc BF all pts = exclusive breastfeeding for all patients; Exc BF CS = exclusive breastfeeding for patients with cesarean birth. As with all new process changes, continued surveillance is required to ensure that the change has been fully embraced and incorporated into practice. Hr Strategy | March 2015 | Voice Newsletter? The Baby-Friendly Committee and the PSP Committee will continue to monitor the data to identify trends and provide reeducation as needed. Further monitoring through team observation and chart audits will be utilized to sustain the practice change. Weekly 20-26) – Operation? Through collaboration of the interprofessional team, this project was successfully implemented. It will require their continued efforts to | Voice | Ceridian, maintain its success. Hospitals across the Resume, country have been challenged to improve breastfeeding initiation rates and sustained breastfeeding at Workbook Newsletter, discharge. It has become a national health care priority. To meet these challenges, more and Doc.#600642: more hospitals are attempting to achieve the Baby-Friendly designation. Hr Strategy Workbook | March 2015 | Voice | Ceridian? Implementing Step Four of the Ten Steps, particularly in the OR, requires a well-coordinated interprofessional collaborative effort to achieve success.

The barriers to the implementation of Step Four in the OR were overcome with the support of the interprofessional team. 20-26) – Operation? Continuous monitoring of Workbook | March 2015 | Voice Newsletter staff compliance and data collection will ensure sustainability of the practice change. Through communication and collaboration, the healthcare team in the FBC was able to Weekly Workouts 20-26) – Operation Nutrition, overcome the Hr Strategy | March 2015 | Voice Newsletter | Ceridian, barriers of SSC in the OR and Report Cover Template have succeeded in fully implementing Step Four of the Baby-Friendly Ten Steps. Karen Brady, MAHSM, BSN, RNC-OB, C-EFM, is the Newsletter | Ceridian, clinical nurse educator in the Family Birthing Center at St. Vincent's Medical Center, Bridgeport, CT. Denise Bulpitt, RN, BSN, IBCLC, is a lactation consultant at University of Texas Southwestern Medical Center, Dallas, TX. Caren Chiarelli, RN, BSN, is the clinical nurse leader in the Family Birthing Center at Of Authenticity Proposal, St.

Vincent's Medical Center, Bridgeport, CT. 2014 The Authors. Journal of Obstetric, Gynecologic, Neonatal Nursing published by Wiley Periodicals, Inc., on behalf of AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. This is an open access article under the Hr Strategy Workbook | March 2015 | Voice | Ceridian, terms of the Creative Commons Attribution License, which permits use, distribution and Certificate Of Authenticity reproduction in any medium, provided the original work is properly cited. Baby-Friendly; interprofessional; skin-to-skin contact; cesarean delivery; perinatal core measures; exclusive breastfeeding. Issue online: 17 July 2014 Version of Hr Strategy Workbook 2015 | Voice | Ceridian record online: 30 June 2014 Manuscript Accepted: April 2014. Use Root Analysis | Rick Wilkinson? American Academy of Pediatrics American College of Obstetricians and Gynecologists . ( 2012 ). Guidelines for perinatal care ( 7 th ed. ). Elk Grove Village, IL : Author. American Academy of Pediatrics, American Heart Association . ( 2011 ). 2015 | Voice Newsletter? Neonatal resuscitation textbook ( 6 th ed. ). Elk Grove Village, IL : Author. Association of Women's Health, Obstetric and Neonatal Nurses . ( 2010 ). Guidelines for professional registered nurse staffing for perinatal units . Washington, DC : Author. Baby-Friendly USA . ( 2011 ). The guidelines evaluation criteria for facilities . List – Doc600642? Retrieved from Hr Strategy Workbook | March 2015 | Voice | Ceridian https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria Baby-Friendly USA . ( 2014 ). Get started . Retrieved from http://www.babyfriendlyusa.org/get-started Bartick, M. Personal Reference List? , Reinhold, A. ( 2010 ). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis . Pediatrics , 125 ( 5 ), e1048 e1056 . CrossRef | PubMed | Web of Science® Times Cited: 152 Gouchon, S. , Gregori, D. , Picotto, A. , Patrucco, G. , Nangeroni, M. , Di Guilio, P. ( 2010 ). Skin-to-skin contact after cesarean delivery . Workbook | March 2015 | Voice | Ceridian? Nursing Research , 39 ( 2 ), 78 84 . Doc.#600642: Reference List? CrossRef | Web of Science® Times Cited: 9 Hamilton, B. E. , Martin, J. A. , Ventura, S. J. ( 2012 ). | March 2015 Newsletter? Births: Preliminary data for 2011 . Certificate Art | Forms Templates? National Vital Statistics Reports , 61 ( 5 ). Web of Science® Times Cited: 4 Hung, K. J. , Berg, O. ( 2011 ). Early skin-to-skin after cesarean to improve breastfeeding . MCN The American Journal of Maternal Child Nursing , 36 ( 5 ), 318 342 . CrossRef | PubMed | Web of Science® Times Cited: 16 Joint Commission . ( 2013 ). Specifications manual for Joint Commission national quality core measures, Version 2013A1 . Retrieved from https://manual.jointcommission.org/releases/TJC2013A/ Mangan, S. , Mosher, S. ( 2012 ). Challenges to skin-to-skin kangaroo care: Cesarean delivery and critically ill NICU patients . Neonatal Network, The Journal of Neonatal Nursing , 31 ( 4 ), 258 261 . Murray, E. Workbook Newsletter | Ceridian? K. , Ricketts, S. , Dellaport, J. ( 2007 ). Hospital practices that increase breastfeeding duration: Results from a population-based study.

Birth , 34 , 202 211 . doi: 10.1111/j.1523-536X.2007.00172.x Wiley Online Library | PubMed | Web of Science® Times Cited: 68 Nelson, E. , Batalden, P. , Godfrey, M. ( 2007 ). The model for improvement PDSA . In E. Nelson , P. Batalden , M. Godfrey (Eds.), Quality by design a clinical microsystems approach (pp. 271 283 ). San Francisco, CA : Jossey-Bass. Rowe-Murray, H. J. , Fisher, J. Doc.#600642: Reference List Personal? R. W. ( 2002 ). Baby-Friendly hospital practices: Cesarean section is a persistent barrier to early initiation of breastfeeding . | Voice? Birth , 29 ( 2 ), 124 131 . Wiley Online Library | PubMed | Web of Science® Times Cited: 96 Rutherford, P. , Phillips, J. , Coughlan, P. , Lee, B. , Moen, R. Art | Forms? , Peck, C. , Taylor, J. ( 2008 ). Transforming care at the bedside how-to guide: Engaging front-line staff in innovation and 2015 | Voice Newsletter quality improvement . Proposal? Cambridge, MA : Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/resources/Pages/Tools/TCABHowToGuideEngagingStaff.aspx U.S. Department of Health and Human Services . ( 2010, November ). Healthy people 2020 (ODPHP Publication No. B0132). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26 White, C. L. ( 2011 ). Nurse champions: A key role in bridging the gap between research and practice . Journal of Emergency Nursing , 37 ( 4 ), 386 387 . CrossRef | PubMed | Web of Science® Times Cited: 1 World Health Organization . ( 2013 ). Implementation of the baby-friendly hospital initiative . Retrieved from Hr Strategy Workbook | March Newsletter http://www.who.int/elena/bbc/implementation_bfhi/en/ Articles related to the one you are viewing. 1 Jackie Tillett , Gentle Cesarean Delivery, The Journal of Perinatal Neonatal Nursing , 2015 , 29 , 4, 267 CrossRef 2 Mavis N. Schorn , Elizabeth Moore , Bennett M. Spetalnick , Anna Morad , Implementing Family-Centered Cesarean Birth, Journal of Midwifery Women's Health , 2015 , n/a Wiley Online Library. Report Letter? Copyright 1999 - 2017 John Wiley Sons, Inc.

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coursework banks In earlier sections of this course we looked at 2015 | Voice Newsletter | Ceridian the critical role that business investment plays in facilitating economic growth. For Hostess Proposal? The conclusion was made that additions to Hr Strategy Workbook 2015 Newsletter the capital stock (investment), in Use Root To Identify | Rick, the form of machinery and Hr Strategy Workbook | Voice | Ceridian equipment that assist workers in the production process are the key catalyst for future economic growth. As worker productivity rises, so do output and national income. The essence of economic systems that rely on capital as the engine of economic growth is the monetary and financial system. Well-operating financial systems facilitate the investment process by making savings readily available for businesses to borrow and invest in new capital. What constitutes money?

Today we consider elaborately printed paper with specific numbers to be money. In the past precious metals such as gold and silver commonly served as a monetary unit. 6+ Newspaper Template Word | Teknoswitch? In order to be considered money, a commodity (such as gold) or paper ( fiat money ) that represents some tangible value must be accepted by the public. Whatever is considered money must serve several purposes: A medium of exchange. Without money, people would resort to barter to make transactions. Money is a great time-saver in facilitating transactions without a person having to seek another for trade of goods or skills. By serving as a medium of exchange, money is used to Hr Strategy 2015 Newsletter purchase goods and Resume services. Today we commonly use paper or fiat money. Gold has lost its value as money as it does not serve as a medium of Workbook exchange.

The next time you wish to buy a major appliance (e.g., a toaster oven), try opening a bag of gold coins at Certificate Proposal Forms Templates the register. A store of value. We are willing to hold money as long as we know it will retain its purchasing power. Money loses its property as a store of value in times of Workbook | March 2015 high inflation, which rapidly erodes the real (purchasing power) value of money. By holding money, we place our trust that the government issuing the currency will not inflate away its value. A unit of account. Money also gives us a way of comparing the relative prices (values) of different goods. We will soon discuss the role of the Central Bank in dealing with the economy. Central Banks impact the economy through the Report Template, money supply.

In the United States there are several measures of the 2015 Newsletter | Ceridian, money supply that the Federal Reserve Board can adjust when using active monetary policy. 6+ Newspaper | Teknoswitch? The two most important definitions of money are known as M1 and M2 . M1 is the narrowest definition of money and includes currency and coins, traveler's checks, and checking accounts (demand deposits). M2 gives a broader definition of money and Hr Strategy | March 2015 Newsletter comprises all components of Of Authenticity Proposal M1, savings and time deposits of less than $100,000, money market mutual funds held by individuals, and Eurodollars (U.S. dollars that are deposited in European banks). M1 and M2, to a lesser extent, share the Hr Strategy, characteristic of being highly liquid , where liquidity is the term that describes the ease of converting an Workouts (january 20-26) asset into money. With cash being perfectly liquid, a checking account is nearly so.

When the Federal Reserve changes the money supply, it targets M2. Although there are even broader definitions of money known as M3 and L, we need only concern ourselves with M1 and M2. The basic functions of Hr Strategy | March 2015 banks are to collect savings and loan to businesses and consumers. Banks were found in early civilizations, especially in Rome, where banks made loans and exchanged foreign currencies. The penalty for failing to repay a loan in Rome was severe -people who defaulted on loans became the slaves of their creditor. And if they made poor slaves, they might have been sold off as scrap to the Coliseum as food for the lions. Modern banking originated in Renaissance Italy where bankers traded currencies and took in demand (checking) and time (savings) deposits. Workouts (january 20-26) – Operation? The most common check of Hr Strategy 2015 | Voice Newsletter | Ceridian this era was an oral transaction.

Depositors would visit the banker who would sit behind his bench or table. The expression bankruptcy comes from the Italian custom of breaking the bench of a banker who could not return the deposits of his creditors. In England, goldsmiths took in their customers' gold and silver for safekeeping. The goldsmiths used a fractional reserve system , lending some out, retaining the rest for the portion of customers who came calling for their deposits. As a record, depositors were given receipts that were transferable to other people (an early checking system), who could collect the corresponding amount of gold or silver. In colonial America, the first bank was founded in 1782 and was known as the Bank of North America. 6+ Newspaper Template Word? At this time all banks were state chartered and the banking system grew rapidly, although many new banks were unsound and two out of five failed. The founding fathers of the United States were a suspicious lot when it came to banking matters. Thomas Jefferson considered a standing army and Hr Strategy Workbook 2015 | Voice a strong banking system to be the two major threats to a democracy.

As a result, the early U.S. banking system allowed for 6+ Newspaper Template each state to control the | March Newsletter | Ceridian, banks chartered within its border. And state banks were allowed to print their own currency. By ensuring a multicurrency banking system, problems resulted in currency convertibility, especially for Use Root Cause Analysis Lessons Wilkinson transactions that took place across states. In 1791, Alexander Hamilton encouraged Congress to charter the Hr Strategy | March Newsletter | Ceridian, First Bank of the United States, which was the first nationally chartered bank. | Teknoswitch? Part of the goal of the First Bank was to control the excessive issuing of money by state banks. Offending banks would find that the First Bank would refuse to honor their script or be required to Hr Strategy 2015 | Voice Newsletter redeem their script issues in gold. The early United States had no national currency, which would require some concentration of For Hostess Proposal strength in the bank(s) that issued the Workbook 2015 Newsletter, nation's currency.

After the First Bank's charter expired in 1811, the Second Bank of the United States was chartered in 1816. Never a supporter of concentrated banking and with a dislike for the Second Bank's president, President Andrew Jackson did not renew the bank's charter, allowing it to expire in 1836. After a period of extremely lax banking regulation, which would not be seen again until the 1980s, the U.S. Civil War necessitated further reform of Use Root Cause Analysis Lessons | Rick Wilkinson banking. Wars necessitate significant increases in government expenditures to finance war activities.

To raise money, governments can use some combination of taxes and Hr Strategy | Voice | Ceridian obtaining loans from its citizens. A sound banking system encourages citizens to save with the banks, money which the Resume | Apa Proposal, government can easily borrow. In order to raise money and encourage its citizens to save with banks, the northern Congress passed the National Currency Act of 1863. This law set up a system of nationally chartered banks that issued the Workbook | March | Voice, first national currency, the greenback, which became the standard currency for the remainder of the century. At the same time, a significant tax on state bank-issued notes drove other currencies from circulation. A major problem facing the rapidly expanding U.S. economy during the later part of the nineteenth and early part of the twentieth centuries was severe economic business cycles.

The economy went through frequent boom-depression cycles. Weekly (january 20-26) – Operation? Many of the economic downturns were caused by a rapid escalation of the interest rate at Workbook | March 2015 | Voice Newsletter which people and businesses borrowed. The cycle was often caused during harvest season when grain buyers would take out loans from banks to buy grain from farmers. Template? The sudden acceleration in the demand for money and lending activity would quickly drive up the price of money (the interest rate) as the supply of loanable funds (savings) remained relatively constant. 2015 Newsletter? Surging interest rates would crowd out borrowing by the commercial and consumer sectors, leading to a reduction in spending, sometimes causing a recession or depression. A lack of central control of the money supply also caused problems during the financial panics that swept though the financial sector every decade or so.

These panics would cause a wave of bank failures and a severe economic downturn was the consequence. In response to the business cycles caused by scorching interest rates and 6+ Newspaper Template | Teknoswitch financial panics, the government decided it needed to be able to increase the money available for banks to loan during periods of high demand, which would help to Hr Strategy Workbook 2015 | Voice | Ceridian maintain stable interest rates, and Use Root Analysis Lessons | Rick increase bank liquidity during times of Workbook 2015 | Ceridian panic withdrawals. Despite strong opposition and Of Authenticity Art | Forms fears that a central bank would lead to a banking cartel run by bankers, the Workbook | March | Voice Newsletter, Federal Reserve Act of 1913 created the Federal Reserve Board. The Federal Reserve was given the responsibility of controlling the Certificate Art | Proposal Templates, money supply and stabilizing the financial system. The Structure of the Federal Reserve Board (Fed) The headquarters of the Federal Reserve System is located in Washington, D.C. and is known as the Board of Governors. Placed geographically throughout the United States are 12 Federal Reserve banks. Fed policy is made by the politically appointed Fed chairman (currently Alan Greenspan) and the Federal Open Market Committee (FOMC), comprising the political appointees on Hr Strategy | March 2015 Newsletter | Ceridian the Board of For Hostess Proposal Governors plus 5 of the 12 regional Fed bank presidents.

The FOMC meets eight times a year to discuss and decide the direction of Fed monetary policy. Despite the political nature of important decision-making appointments at the Fed, once in place Fed members are expected to Hr Strategy | March 2015 make decisions without significant political pressure. The Fed makes policy choices independent of the executive and legislative branches of government. Although the president and Congress will often voice their displeasure when the Fed is carrying out economic policies with which they disagree, the Fed is free to Lessons | Rick (and often does) disregard these potential influences. This is part of the checks and balances found in government. Although there is occasional discussion by lawmakers of reeling in the Fed and making it more accountable, Fed independence also provides a convenient outlet for political/economic ineptitude. When the economy goes into the tank, the Fed offers a convenient scapegoat for the president and Congress on which to focus the unhappy public's attention (1) . (1) The Fed chairman and six members of the Federal Reserve Board of Governors in Washington D.C. are appointed by the President and approved by the Senate. To insulate these FOMC members from short-term political pressures the Hr Strategy Workbook Newsletter, chairman is appointed for four-year terms and other Board of Governors members are given 14-year memberships (with no limit on renewals). 6+ Newspaper Template | Teknoswitch? The other members of the FOMC are comprised of the presidents of the 12 regional Federal Reserve banks. Hr Strategy Workbook 2015 | Voice? Each is chosen by Resume For Hostess | Apa their respective boards of directors and approved by the Board of Governors.

Although most of the regional banks presidents are present at FOMC meetings, only five have a vote on Fed policy at any given time. In many ways, it the Fed staff and Chairman that dictate Fed policy by controlling how the Hr Strategy Workbook | March 2015 Newsletter | Ceridian, economy is modeled and analyzed. Template? The conclusions of the forecast of future economic condition are prepared by the Fed staff and Hr Strategy Workbook | March 2015 Newsletter presented to the FOMC in the Green Book. The potential consequences of Fed policy on financial and other are outlined to List FOMC members in the Blue Book. Arguments in defense of Fed procedures include the need for the Fed staff to create forecasts independent of the policy views and possible biases of the influential FOMC members. Furthermore, each of the twelve regional Fed bank presidents has a sizeable research staff of his or her own which prepare their own independent forecasts that may be introduced into FOMC meetings. In addition it can set a bias of monetary policy towards inflation, recession or a neutral (or no) bias.

The bias is Hr Strategy Workbook Newsletter | Ceridian important because it allows the Chair of the Fed to Workouts – Operation Nutrition act unilaterally in changing the Hr Strategy | March Newsletter | Ceridian, fed funds rate between FOMC meetings. For example, in late 2000, the FOMC changed its viewpoint to Personal List – Doc600642 Personal a bias against an economic slowdown or a recession. This was a result of the weakening economy and the concern that the US might be heading for Hr Strategy | March 2015 Newsletter a recession. Doc.#600642: Reference List – Doc600642 Personal? By setting the Hr Strategy Workbook 2015 | Ceridian, bias against a recession, Fed Chair Alan Greenspan was able to reduce the fed funds rate several times on his own initiative in 2001. In 2002, the 6+ Newspaper Template | Teknoswitch, FOMC changed the bias to 2015 | Voice | Ceridian neutral. When the bias is neutral, the Federal Reserve Chair can no longer act on his own to change the fed funds rate. With a neutral bias, Greenspan must wait for the FOMC to met and to vote to change the Doc.#600642: Template – Doc600642 Personal, fed funds rate. It is only when there is a bias against recession or inflation that the Fed Chair can act on his own without the FOMC vote of approval. In this Topic we study monetary policy, which is used by Hr Strategy Workbook | Voice Newsletter | Ceridian the Fed to influence economic growth and For Hostess | Apa Proposal thus unemployment and inflation rates. When the Fed conducts monetary policy, it measures the current and Hr Strategy | March | Ceridian projected future condition of the economy.

It can follow one of three options: Restrictive , which involves: decreasing the money supply to: raise interest rates, and to slow economic growth. Neutral , the Fed may be happy with the current and projected outlook or may require more evidence before deciding to act. Expansionary , which involves: increasing the money supply to: lower interest rates, and to increase economic growth. The Fed carries out Cover its policies through what is known as open market operations , which involves the Workbook | March 2015 | Ceridian, buying and selling of bonds. The major source of money the Fed has at its disposal is from banks in the form of required reserves . The Fed requires all banks and similar financial institutions that operate in the United States to keep 10% (a dime) of Resume For Hostess | Apa every dollar deposited on reserve with the Fed.

Although, this money is a liability from the Fed to a bank, the Fed can use this money to Hr Strategy Workbook | March 2015 conduct open market operations. Resume For Hostess? We will see how this works in the next section. Note that the figure given, 10%, is known as the reserve requirement. During the 1920s, banks were part of the roaring growth in financial markets taking place in the United States. Workbook | March | Voice Newsletter | Ceridian? Looking for | Apa ways to Workbook 2015 make greater profits, banks actively participated in the stock market. Banks would take in Report Template, deposits and not only make loans to businesses and individuals, but would buy stocks of companies. Furthermore, banks would make loans that used stocks as collateral. With extensive involvement by the banking sector, the stock market soared during the 1920s. Another factor driving the stock market during the 1920s was margin buying by investors.

Buying on the margin required stock purchasers to put down only 10% to 20% of a stock's value, greatly exceeding the number of shares that could be obtained if full cash payment was required. Hr Strategy Workbook 2015? Given the volatility of stock prices, this practice significantly increased the risk exposure of investors. Given the frenzy of stock market activity caused by the reckless investing of individuals, businesses, and banks, the Certificate Of Authenticity, stage was set for the devastating crash of Hr Strategy Workbook 2015 | Ceridian 1929. After a decade of tremendous growth, stock prices plummeted in the fall of 1929. The effects were immediate. Individual investors were required to meet their margin requirements and Report Cover needed to raise cash immediately. They flooded the banks, withdrawing every cent that they could from their accounts. Since the majority of depositors' money had been lent out by the banks, much of it to purchase what was almost equally worthless stocks, the money available in bank vaults was rapidly depleted.

Their funds vaporized, many banks became insolvent overnight and declared bankruptcy. The overall situation in the fall and winter of 1929 was chaos and Hr Strategy | March Newsletter | Ceridian panic. News of bank failures caused depositors to withdraw their money from Personal, even well run banks. The run on banks caused the financial system to collapse and the economy soon followed. The United States economy went into 2015, the Great Depression, which would last until World War II. One of the major causes of bank failure during the Certificate Art | Forms, panics of 1929 and the early 1930s was caused by the rapid withdrawal of deposits by nervous savers. At the time, if a bank failed, depositors who had accounts with the bank risked losing a major portion or even all of their money. Hr Strategy Workbook | March 2015 | Voice Newsletter? By trying to preempt a bank failure, a sudden rush of withdrawals would seal the fate of a bank, leaving most account holders with large losses. To stop the panic, the Roosevelt administration created the Federal Deposit Insurance Agency (FDIC) in 1933, followed by the FSLIC (for Savings and Weekly (january 20-26) – Operation Nutrition Loans) in 1934. The FDIC established a federally guaranteed insurance fund for bank deposits. People were assured that even if a bank failed their deposits would be covered in 2015 | Voice, full up to a mandated limit (although the limit is seldom enforced).

The FDIC required banks to pay a small insurance premium based on the value of deposits into a fund. With this government program in place, the panic runs on banks ended and the banking system would remain very stable until the wildcat frenzy of banking deregulation in the 1980s. Please note that the discussion also applies to other depository institutions such as savings and loans, and credit unions, as well as banks. When a customer makes a deposit into his account at Template Word a bank, this creates a liability for Workbook Newsletter | Ceridian the bank. A liability describes the bank's obligations, or what it owes to others.

In other words, the bank is liable for the amount of the deposit. On the other side of the coin, the deposit creates an asset for the bank. The bank now owns the value of the 20-26) – Operation, deposit and Workbook | March Newsletter will put the money to work, looking for a rate of return that exceeds the interest it pays on the liability. This is the Report Template, business of banking. By offering savers a return (and/or other services), banks take in deposits (liabilities), which creates assets that a bank can lend out. As long as the Hr Strategy Workbook | March 2015 | Voice Newsletter | Ceridian, total return on Weekly (january 20-26) – Operation assets exceeds the payment on liabilities (and other costs of doing business) the bank is profitable. When a bank receives a deposit, it must keep a portion on reserve with the Federal Reserve (Fed) and pay a deposit insurance premium to the FDIC. At the present time, the Fed's reserve requirement is 10%.

With this in mind, let us use a few balance sheets to demonstrate how banks create money from deposits. 2015 | Ceridian? We will see that for every dollar deposited, the money supply increases by a multiple of the amount deposited. Let us first examine the balance sheet of Glen Echo Bank. We see in Table 10-1 that the value of total liabilities to Doc.#600642: Personal Reference List Template – Doc600642 Glen Echo equals $100 million. In addition, the bank is required to have its own net worth as a buffer against bad loans and insolvency. Net worth is considered the value of the owners (share holders) stake in the bank. In this case, net worth is 3% of total liabilities and Hr Strategy Workbook | March 2015 equals $3 million, which the bank raised by selling shares of Proposal Forms stock to the public.

The bank is obligated to | Voice Newsletter | Ceridian hold reserves of 10% of total deposits with the Report Cover Letter, Fed, in Workbook | March | Voice Newsletter, this case the amount of Doc.#600642: Template Personal required reserves is $10.0 million ($100.0 million in deposits x 0.10). Table 10-1: Glen Echo Bank Balance Sheet (1) Consider a hard-working, thrifty (and rich) person like yourself. Let us assume that you deposit $1 million in your account at Workbook | Voice Newsletter | Ceridian Glen Echo Bank. On the Report Template, balance sheet that follows, Glen Echo now has an additional $1 million liability. Let us assume that the deposit insurance premium has no affect on our analysis, since it is so small. Your deposit also creates an Hr Strategy | March | Voice Newsletter | Ceridian additional $1 million in assets. Of your $1 million deposit, $100,000 (10%) is legally required to be kept as reserves with the Workouts 20-26) – Operation, Fed.

Table 10-2: Glen Echo Bank Balance Sheet (2) (Add $1.0 million deposit from you) Notice in Table 10-2 what the bank did with your $1 million deposit. $100,000 went to the reserve requirement with the Fed, and the bank lent out the other $900,000 (loans outstanding increased from Hr Strategy Newsletter, $80 million to $80.9 million). For simplicity, let us assume that the entire $900,000 made available by your deposit was borrowed by one business: Joe-Bob's Rooter. Joe-Bob doesn't borrow the money for fun, he wants to invest in new capital equipment, which will increase the productivity of his workers. Joe-Bob wants to invest in a new laser rooter, for which he pays $900,000 to Sapphire Slick's Laser Emporium. Let us also assume that Sapphire has an account with Glen Echo Bank, where she deposits the $900,000 received from Joe-Bob's purchase. Cause Lessons | Rick? Table 10-3 shows the new balance sheet for Glen Echo Bank after Sapphire's deposit.

Table 10-3: Glen Echo Bank Balance Sheet (3) (Add $0.9 million deposit from Sapphire Slick) Several things have occurred due to Sapphire's deposit of $900,000 in the Glen Echo Bank. | March | Voice | Ceridian? Total deposits increased from $101 million to $101.9 million. Required reserves increased by $90,000 (= $900,000 x .10). Total required reserves increased from Resume, $10.1 million to $10.19 million. The bank was able to lend out the difference between the Hr Strategy, deposit ($900,000) and required reserves ($90,000), an amount equal to Art | Proposal Forms Templates $810,000. Outstanding loans increased from $80.9 million to $81.71 million ($80.9 + 0.810) As we have shown, after meeting the reserve requirement, Glen Echo Bank loans out all the Hr Strategy | March | Voice Newsletter | Ceridian, additional money available. | Apa Proposal? You should be getting the Hr Strategy | March | Voice | Ceridian, basic idea: your initial deposit has triggered multiple rounds of lending and deposit activity. Things are happening well beyond your initial deposit.

We can complete another round like the previous round, where someone borrows the money, spends it, and the recipient deposits the money in Glen Echo. However, rather than continue the tedious math, we can invoke the simple money multiplier to summarize our situation. For the purposes of this course, we can define the Use Root Analysis To Identify Lessons | Rick, money multiplier as equal to. which equals to one divided by the reserve requirement. While we will work with the simple multiplier, in reality there are a number of 2015 Newsletter leakages from the above scenario that will reduce the value of the multiplier: People may not deposit all of their cash into the banking system. Besides the money we keep in our wallets, we may save some of our money outside the depository banking system. Banks may not loan out all potential reserves, choosing to keep excess reserves . Note that in | Teknoswitch, our example we assumed that all deposits end up in Hr Strategy 2015 | Voice | Ceridian, the same bank. As long as deposits end up in the domestic banking system the result is the | Teknoswitch, same. The money multiplier will attain the same value as shown in | March, this example, and the overall increase in the money supply will be the same. The Monetary Base and Money Supply.

We leave this section with a look at the determination of the money supply . We begin with the monetary base, which equals: all reserves held by banks and all currency in circulation. The next part of the Analysis | Rick Wilkinson, determination of the money supply is the process of transforming the 2015 | Voice | Ceridian, monetary base into Cause | Rick, the money supply. Through the multiple deposit expansion described above, where money is deposited, loaned, and redeposited into the banking system, the money supply is determined. By definition, the money supply equals: