Wound care essentials summative assignment The WritePass Journal

Wound care essentials summative assignment Reference List Wound care essentials summative assignment IntroductionSection 1. Search strategySection 2. Wound aetiologySection 3. Wound AssessmentSection 4. Wound ManagementSection 5.Reference ListRelated Introduction Section 1. Search strategy Describe the strategy you used to retrieve the right resources to help you write your assignment. You must include the key words you used, the databases used and other sources of your literature such as websites, the years searched and the type of literature you were looking for. Approximate word count: 150-200 Your answer here: Keywords used in the search engine are: diabetic, foot, ulceration, risk, prospective, aetiology, prevalence, cost, infection, dressing, treatment, amputation, wound, management, policy, guidelines, UK, Philippines, South Asia, Europe, which were consecutively joined together, using the Boolean Operation of adding AND and an asterisk to each terms. The main databases used were CINAHL plus and PubMed.   Another source of evidence that the researcher used is the official website of the National Institute for Health and Clinical Excellence in which a clinical guideline was used deemed necessary for the said topic. The World Health Organization and the National Health Services websites were also used in collecting data for statistics as well as the Department of Health website in the Philippines. Peer reviewed articles have been searched using the said databases and have been sources of information. Limitations in this search have been identified. These are as follows: The search has been limited for ten years only to make the search more manageable and clinically up to date while capturing key information. The search is only applicable for humans aged 65 and up, regardless of gender.   This bracket has been chosen because according to the World Health Organization (2006) diabetic foot ulceration is rampant in this age group. The search is limited for peer reviewed journals only. The search is not confined to the United Kingdom only; hence, statistics from Asia were also gathered. Section 2. Wound aetiology Select a common wound type (e.g. diabetic foot ulceration, pressure ulcer, leg ulcer, fungating wound, dehisced surgical wound. Now explain and discuss: What your chosen wound type is How this type of wound develops (including contributory factors) How this type of wound is recognised (common characteristics) Who it affects Prevalence in UK and home country (if known) Approximate word count:   800-1000 Your answer here: The type of wound that the author chose is diabetic foot ulceration. This was chosen because this type of wound is prevalent in the nursing home that the author is currently working at and Diabetes itself is a serious health issue worldwide.   Consequently, diabetic foot ulceration is considered to be one of the most significant complications of diabetes, representing a worldwide issue of medical, social, and economic problem greatly affecting the patient’s quality of life. (World Health Organization, 2004)   Earlier definitions of diabetic foot ulceration dated back to 1985 by the World Health Organization stating that it is an infection, ulceration, and/or destruction of deep tissue related with neurological abnormalities and various degrees of peripheral vascular disease in the lower extremities. This has been argued by Brownlee (2005) that the term ‘diabetic’ foot signifies that there are specific qualities about the feet of the individual with diabetes th at sets this disease apart from other conditions that affect the lower extremities. However they added that anything which affects the foot in those with diabetes can also affect the foot in those without the disease. Thus the definition by De Heus-van Putten (1994) best neutralise those views, stating that diabetic foot ulcers is the many different lesions of the skin, nails, bone, and connective tissue in the foot which occur more often in diabetic patients than non-diabetic patients, such conditions like ulcers, neuropathic fractures, infections, gangrene, and amputation. This is supported by the contemporary study of Vileikyte (2001), presenting that the diabetic patients are statistically more likely to develop foot ulcer that usually leads to disablement and leg amputation. The aetiology of diabetic foot ulceration comprises many components. A multicentre study by Rathur and Boulton (2007) attributed 63% of diabetic foot ulcers to diabetic neuropathy and peripheral vascular di sease to be the main causative factors of diabetic foot ulceration. Peripheral neuropathy is a complication of diabetes that is the result of overtime damage of the nerve due to high blood sugar levels (Jerosch-Herold, 2005). This complication consequently contribute to the cause of diabetic foot ulcer for the nerves that relay messages of pain and sensation to the lower limb are generally affected, leading to numbness or even complete loss of sensation in the legs and feet. Losing sensation would also mean not knowing if the feet are hurt or damage. This explains why diabetic patients are usually prone to problems like minor cuts, bruises and blisters without them feeling it.   Ã‚  Furthermore, another risk factor is the peripheral vascular disease wherein there is narrowing of the arteries caused by fatty deposits that accumulate in the lining of the arteries resulting to poor blood circulation to the feet (Medina, Scott-Paul, Ghahary Tredget-Edward, 2005). Inadequate blood sup ply to the wound means decrease healing and is likely to be damaged. This explains why even a mild injury like stepping in small object or a small scratch in bare foot can eventually become ulcer for a diabetic patient. Moreover, according to Veves, Giurini, and LoGerfo (2006), predisposing factors that may act in combination to the two main risk factors are the unrecognised trauma, the biomechanical abnormalities or deformity, the limited joint mobility, and the increased susceptibility to infection. Demographic factors also play an effect on diabetic foot ulceration, such as age, gender, ethnicity and lifestyle (Medina, Scott-Paul, Ghahary Tredget-Edward, 2003).   According to the World Health Organization (2004) Diabetic foot ulcerations are common on individuals who have Type 1 and Type 2 Diabetes and who are in the age bracket of 65 years old and above. This statistics is not only relevant here in the UK but also worldwide. People who have diabetes for a longer period or man age their diabetes less effectively are more likely to develop foot ulcers.  Smoking, not taking  exercise, being  overweight and having  high cholesterol  or blood pressure can all increase diabetes foot ulcer risk (Diabetes UK, 2004). Previous foot ulcers and diabetes complications can increase foot ulcer likelihood, as can ill-fitting shoes or previous foot problems such as bunions, etc. Diabetic foot ulceration usually located in increased pressure points on the bottom of the feet. However, ulcers related to trauma can occur anywhere on the foot (Diabetes UK, 2004)   Anatomical distribution of diabetic foot ulceration comprises 50% of ulcers are on the toes; 30-40% are on the plantar metatarsal head; 10-15% are on the dorsum (sole) of the foot; 5-10% are on the ankle; and up to 10% are multiple ulcers (Department of Health, 2002). According to the National Diabetes Support Team (2006), the appearance of a diabetic foot ulcer generally has a base with pink/red or brown/black, depending on the patient’s blood circulations, and with a border of ‘punched-out’ like appearance while surrounded by callous skin. It has a bed with necrotic cap or ulcer (underlying tissues are exposed). Ulcers  with a mainly neuropathic aetiology will have a healthy granulating bed whilst those with a significant arterial component will have a necrotic bed (Reiber, 200 1). The International Diabetes Federation (2005) accounts that there are 170 million cases of diabetics reported worldwide. By 2025, this figure is expected to rise to 300 million. These diabetics patient have a 12-25% risk of suffering a foot ulcer at some time in their life. According to Reed (2004), elderly people with diabetics have twice the risk of developing foot ulcer, three times the risk of developing foot abscess and four times the risk of developing osteomyelitis. Similarly, diabetics were at greater risk of either local amputations or higher amputations (Hall DeFrances, 2003). Since different regions of the world have populations that at variance in body builds, footwear, habits and lifestyles, the differences in the prevalence of diabetic foot ulceration is expected. Such differences are likely to be found in Asia, Africa and America for developing countries will experience the greatest rise in the prevalence of Type 2 diabetes in the next twenty years (Stanley Colli er, 2009). Thus, people living in these countries will be expected to have greater risks of ulceration in the later years. However, Abbott et al (2005) focused on Type 2 diabetics among migrant populations of South Asia and African-Carribean populations, compared with data from Europeans living in the UK, and revealed a three to four times higher incidence of ulceration in the Europeans. The lower risk of South Asians was attributed to the lower rates of foot deformity, peripheral vascular disease and neuropathy. In the Philippines on the other hand, the author was not able to find statistics regarding the prevalence of diabetic foot ulcerations on individuals with either Type 1 or Type 2 Diabetes. Apparently, the Department of Health Philippines website does not have relevant statistics regarding the above matter however, according to the World Health Organization (2004), the prevalence of people having diabetes in Asia is fast rising and it may comprise to 75% of all diabetics in 2025 worldwide. Section 3. Wound Assessment Identify one feature of your chosen wound type that is commonly identified during the assessment process and critically discuss different ways of assessing this problem. Your discussion must make clear which aspect of wound assessment you have chosen e.g. exudate, odour, infection, and include an exploration of the different options available for measuring, describing and documenting it. You must link your discussion to the contemporary wound care literature. Approximate word count: 800-1000 Your answer here: When a diabetic patient develops an ulcer, it is very essential to know that the ulcer presents in the perspective of the diabetic. However, in the case of a diabetic patient, the skin usually in the feet does not heal efficiently and is prone to develop an ulcer as discussed on the previous section. This is what the writer believes to be the foremost feature of the diabetic foot ulceration that needs major consideration for it can eventually result to infection. Assessing the delay wound healing of a diabetic foot and its relation to the aspect of infection involves thorough evaluation, thus, a general assessment by the multidisciplinary care approach of the patient with diabetic foot ulcer is fundamental. This includes evaluating for evidence of retinal and cerebro-vascular pathology that could relate to foot and ankle problem (Pham et al, 2000). The said evidence can play a part to falls, traumatic injury and poor foot hygiene of the patient and can aid in appropriate treatment of the wound. The renal and cardiac disease evaluation is another pathological assessment that can contribute to the evaluation of poor healing potential (Stanley Collier, 2009). The standard observations of blood pressure, heart rate and temperature are also requisite assessment for these can reveal overriding features of sepsis such as pyrexia, tachycardia and general malaise (Costigan, Thordarson Debnath, 2007).   Stanley and Collier (2009) also added that in spection of the diabetic foot such as the characteristics of the skin, nails, and web spaces, is important for it can reveal pathology of the nails (Paronychia) or the cause of the spread of infection. Generally, limb-threatening infections can be defined by cellulitis extending 2cm from the ulcer perimeter, as well as deep abscess, osteomyelitis   or critical ischemia (Frykberg et al, 2002). The existence of odor and exudates, and extent of cellulitis should be properly noted for these are indicative of osteomylitis which could indicate infection (Frykberg et al, 2002). In the case of neurological assessment, Jerosch-Herold ‘s (2005) assessment review stated that Semmes-Weinstein monofilament is considered to be the most reliable test for evaluating any loss of protective sensation done in the sole of the feet. The test is not only relevant in assessing loss of sensation; it also evaluates foot deformity, risk for ulceration and signs of infection. Moreover, a vital part in this assessment is the classification of diabetic foot ulcer itself. This is supported by Frykberg et al (2002) stating that classifying ulcer is important in order to facilitate a logical approach to treatment and aid in the prediction of outcome. In line with that, there are several wound classification guidelines used universally to assess the diabetic foot ulcer. One of this is the Wagner ulcer classification system (1987) is the most widely accepted descriptive classification of diabetic foot ulcerations. It categorises wound depth according to 6 wound grades. These include: grade 0 (intact skin), grade 1 (superficial ulcer), grade 2 (deep ulcer that includes tendon, bone, or joint), grade 3 (deep ulcer with abscess or osteomyelitis), grade 4 (forefoot gangrene) and lastly grade 5 (whole foot gangrene). However, the downside of the Wagner classification system is that it does not specifically address the aspect of infection and circulation problem, which are actually the important parameters of diabetic foot ulceration.   However, this method is not really very reliable in assessing ischemia and infection because only useful guidance in the management of each class of ulcer is provided. Nonetheless, a more comprehensive scale has been developed at the University of Texas, which includes risk stratification and expresses tissue breakdown, infection and gangrene separately. According to Abbott et al (2005),   this system is generally predictive of the outcome for it uses four grades of ulcer depth (0 to 3) and then stages them into four stages (A to D) basing on the presence or absence of ischemia and   infection. The classification system assesses the depth of ulcer penetration, the presence of wound infection, and the presence of clinical signs of lower-extremity ischemia. Similarly, the International Working Group on the Diabetic Foot (2004) has proposed the PEDIS classification which grades the wound on a 5-feature basis: Perfusion (arterial supply), Extent (area), Depth, Infection, and Sensation. Finally, according to the Infectious Diseases Society of America guidelines (2004), the infected diabetic foot is sub-classified into the categories of mild (restricted involvement of only skin and subcutaneous tissues), moderate (more extensive or affecting deeper tissues), and severe (accompanied by systemic signs of infection or metabolic instability). In addition to that, another form of assessment for infection is the surface swab. But according to Bowker and Pfiefer (2001), it is inadequate for identifying the type of bacteria causing limb-threatening deep infection. The most accurate and reliable technique involves removing exudates from the ulcer, getting a little tissue biopsy from the base of the ulcer and sending the sample to the laboratory in appropriate aerobic and anaerobic culture material. Plain film radiographs should also be obtained to look for tissue, gas and foreign bodies and to evaluate the infected ulcer for bone involvement. (Sutter Shelton, 2006) Probing to bone using aseptic technique is also done to find out if osteomyelitis is present. Section 4. Wound Management Using the same wound feature that you identified in Section 3; critically discuss the different ways there are of managing this problem. Your discussion must include: The different types of wound care dressings, products and treatments that could be used to manage this problem Other appropriate/related aspects of patient care such as nutrition and positioning How the patient experience can be improved Approximate word count: 800-1000 Your answer here: After a comprehensive assessment, an ulcer management plan must be developed to direct treatment goals. In the treatment of diabetic foot ulceration, the primary goal is to attain wound closure and to control infection (Frykberg et al, 2002). In order to achieve this goal good wound care techniques are required. Part of this wound technique are dressings. Wound dressings represent a part of the management of diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide protection for the wound and promote healing. (Hilton, Williams, Beuker, Miller Harding, 2002) In line with that, the NHS (2002) released a guide for useful dressings which included dressings for infected diabetic wound. Dressings that are low or non-adhering must be used on infected diabetic wounds with daily dressing changes. According to Foster, Greenhill, and Edmonds (2007), the ideal dressing for infected diabetic foot ulcers are those that fit in the shoes and does not take up too much room, it could withstand shear forces and carry out properly in an enclosed environment, does not increase the risk of infection, absorbs exudates suitably as well as allow drainage and it can be changed frequently and can be removed easily. Hydrocolloids are the best example of such dressings. They contain gel-forming agents, such as gelatin, so when the dressing comes into contact with wound exudate it absorbs ï ¬â€šuid and forms a gel which creates a moist healing environment (Heenan, 2008).   According to Pudner (2001), it is advisable to use hydrocolloids in a diabetic foot ulcer as they absorb exudates and can give a visual indication of the need to change dressing. This kind of dressing can be easily removed by gently lifting an edge of the dressing and pulling carefully upwards to reduce the seal of the dressing on the skin and thus minimise trauma to the wound bed and surrounding skin. (Pudner, 2001) Regular dressing changes are done to monitor deterioration of the ulcer. Dressi ngs with Inadine, Iodoflex or Iodosorb are also used to reduce bacterial inhabitation in the ulceration. Daily Flamazine dressings are also recommended for the treatment of Pseudomonas infection. (Sibbald et al, 2003) When the infected diabetic wound become heavily exudated, foams and alginate may be used because they are highly absorbent.   Hydrogels facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing Inadine and Silver may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds. All dressings require frequent change for wound inspection. (Armstrong, Lavery Harkless, 2003) Another management is debridement. The purpose of this is to remove dead or devitalised tissue. (Bowker Pfeifer, 2004) It is also recognised as one of the most important methods of wound bed preparation because it promotes the release of growth factors which contribute to progressive wound healing. (Leaper, 2002) Ulcer debridement is performed to remove unhealthy tissues such as necrotic, callus and fibrous tissue and recondition them back to bleeding tissues in order to facilitate full image of the extent of the ulcer and its underlying problems like abscesses or osteomyelitis (National Diabetes Support Team, 2006).   Offloading must also be part of the management plan for the infected diabetic foot ulcers to relieve pressure from the wound to allow healing to take place. (Doupis Vevies, 2008) However, offloading devices might be impractical for diabetic individuals who are frail or susceptible to falls, and a disadvantage of devices that cannot be removed is interference with b athing and showering. (Caravaggi, Faglia, De Giglio, 2000) In addition to the management stated above, antibiotic treatment is also necessary. The antibiotic regimen should be based on the anticipated spectrum of infecting organisms. (Chantelau, Tanudjaja Altenhofer, 2006) The combination of an aminopenicillin and a penicillinase inhibitor has the required activity but other options include a quinolone plus either metronidazole or clindamycin. (Tentolouris, Jude Smirnoff, 2003)   In addition to antibiotic therapy, It may also be necessary to promote non weight bearing strategies such as bed rest and or use of wheelchair, crutches, walker, or cane. Diabetic individuals may also be advised to replace or modify their footwear. The lack of sensation associated with neuropathy can result in the tendency to buy shoes that are too small or too tight. It is necessary to accommodate any foot changes or deformities. Orthoses or custom-made shoe inserts may be required for pressure reduction. (Armstrong, Lavery, Harkless, 2003) In selecting devices , the ability of a device to remove or redistribute pressure, the ease of application, cost-effectiveness, and ability to gain compliance must be taken into consideration. Proper footcare and general skincare must also be implemented. Feet should be checked daily for further cuts, sores, blisters, bruises or dry skin to prevent further ulcer formation. Bringing blood glucose levels within normal range is essential. (International Diabetes Federation, 2009) Strictly managing diabetes is the first stage in treating all the other complications and even the condition itself. Diet and exercise will almost certainly play a role in preventing as well as treating diabetes. (Embil, 2003) Section 5. Identify a contemporary source of evidence based guidance (i.e. a clinical guideline) which could be used as a basis for providing a high standard of care to patients with this type of wound. Critically discuss how the guidance given in this document might influence your nursing practice including whether you believe there are any omissions or recommendations made that would be difficult to manage in your own placement. Please also comment on whether the Guideline recommendations could be implemented in your home country e.g. Philippines, Sri Lanka, Malaysia, China. You must clearly state the title your chosen guideline document and link your work to other healthcare literature where appropriate. Approximate word count: 400-500 Please start this section by stating the name of your chosen Clinical Guideline. Name of Guideline: Clinical Guidelines for Type 2 Diabetes Prevention and management of foot problems A very crucial statement in the guideline states that diabetic individuals should have their feet and legs examined for specific problems at least once a year. This is highly recommended and should be implemented. Diabetic individuals need help to detect problems when they develop neuropathy and lack of protective pain sensation. If this is carried out, prevalence of infection and other diabetic complications will surely go down. With regards to the whole healthcare setting, the NICE guideline recommends that health care professionals who carry out examinations must be properly trained but specific details of the training are not given. Nurses as well as other members of the healthcare team would need specific trainings most especially on handling equipments as well as imparting management to the affected individuals. It was also mentioned that diabetic individuals with active problems will be seen by the multidisciplinary foot care team that consists of highly trained podiatrists and orthotists, nurses with training in dressing diabetic foot wounds and diabetes specialists with expertise in lower limb complications. However, there is currently a shortage of podiatrists, nurses and other specialised members of the healthcare team. Lack of clarity about the membership of the multidisciplinary team may affect in the implementation of the guideline. Regarding ulcer management, there is a further problem with the section in the NICE guidelines on how ulcers should be managed. One or more interventions are suggested, including dressings, antibiotics to treat infection, and pressure relief by the use of special shoes or total contact casts. However, there is little guidance as to which intervention should be chosen and in which circumstance. Unfortunately, this could lead to a reinforcement of current practice where many patients with diabetic foot ulcers have dressings applied to their ulcers with no further interventions until the ulcer deteriorates. (Rathur Boulton, 2007) Nurses caring for patients with diabetic foot ulcers should understand that, in addition to dressings, patients need effective pressure relief and management of infection. As with regards to the author’s workplace which is a nursing home, although the guideline is flawed, as all guidelines are, the author believes that it will be really helpful in the management of diabetic foot problems since almost all of the residents who have diabetes are experiencing foot problems already. However, it will be better if the guideline made recommendations regarding services exclusive to nursing homes to address to the specific needs of the diabetic residents. The author believes that this guideline is not achievable to the Philippines. In view of the current health care setting of the country, it will be very had to implement the guideline due mainly to lack of funding and a huge shortage of specialist health care professionals. The Philippines is one of the countries in South East Asia that prevalence rate of diabetic foot ulcerations and infections are fast rising (WHO,2004) but unfortunately, the country is also understaffed and underfunded. The author believes that for the NICE guidelines to be implemented whether in the placement or for the whole healthcare setting, it will be necessary to recruit and train a lot of diabetic foot professionals or better yet, educate existing health care professionals. Careful monitoring of the diabetic individuals will be essential as well as imparting proper lifestyle change and management. Reference List Abbot, C.A, Carrington, A.L., Ash, H., Bath, S., Every, L.C., Griffiths, J., et al. (2002). The Northwest diabetes foot care study: incidence of and risk factors for new diabetic foot ulceration in a community based cohort. Wiley.19(5). 377-384. Abbott, C.A., Garrow, A.P., Carrington, A.L., Morris, J., Van Ross, E.R. Boulton, A.J. (2005). Foot ulcer risk is lower in South-Asian and African-Caribbean compared with European diabetic patients in the UK. The North-West Diabetes Foot Care Study,  Diabetes Care, 28(8), 1869–1875. Armstrong, P.G., Lavery, L.A., Harkless, L.B. (2003). Validation of a wound classification system. Diabetes Care. 21 (5). 855-859. Brownlee, M. (2005). The pathology of diabetic complications. Diabetes. 54. 1615-1625. Bowker, J.H., Pfeifer, M.A. (2001). The Diabetic Foot. 6th edition. St. Louis: Mosby Caravaggi, C., Faglia, E., De Giglio, R., Mantero, M., Quarantello, A., Sommaria, E., et al. (2000). Effectiveness and safety of non removable fibreglass off-bearing cast versus a thereapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care. (12). 1746-1751. Chantelau, E., Tanudjaja, T. Altenhofer, F. (2006). Antibiotic treatment for uncomplicated neuropathic foot ulcers in diabetes: a controlled trial. Diabetic Medicine. 13. 156-159. Costigan, W., Thordarson, D.B., Debnath, U.K. (2007). Operative management of  ankle fractures  in patients with  diabetes mellitus,  Foot  and Ankle  International, 28(1), 32–37. De Heus-van Putten,  M.A. (1994). The role of the Dutch podiatrist m the treatment of diabetic feet. Journal of British Podiatric Medicine,49(42), 161-164. Department of Health. (2002). National service framework for  diabetes. London: HSMO. Diabetes UK. (2004). Epedimiology and Statistics. London: HSMO Doupies, J., Vevis, A. (2008). Classification, diagnosis, and treatment of diabetic foot ulcers. Retrieved March 30, 2009, from woundresearch.com/article/8706. Embil, J. (2003). Getting to the bottom of the diabetic foot. The Canadian Journal of CME. 3:76-86. Foster, A.V.M., Greenhill, M.T., Edmonds, M.E. (2004). Comparing two dressings in the treatment of diabetic foot ulcers. J Wound Care. 3: 224-228. Frykberg, R.G., Armstrong, D.G., Gurini, J., Edwards, H., Kraviette, M., Kavitz, S., et al. (2002). Diabetic foot disorders: a clinical practice guideline. The Journal of Foot and Ankle Surgery. 39(5). Hall, M.J. DeFrances, C.J. (2001).  National Hospital Discharge Survey. Advance data from vital and health statistics; No: 332, National Center for Health Statistics:Hyattsville. Heenan, A. (2008). Frequently asked questions: hydrocolloid dressings.   Retrieved February 2007 from www.worldwidewounds.com/1998/april/Hydrocolloid-FAQ/hydrocolloid-questions.html Hilton, J.R., Williams, B.T., Beuker, B.M., Harding, K.G. (2004). Wound dressings in diabetic foot disease. Medline. 1:39, 100-103. International Diabetes Federation. Diabetes. (2009). atlas 2nd edition. Brussels. Leaper, D. (2002). Sharp technique for wound debridement. Retrieved December 15, 2005 from www.worldwidewounds.com/2002/december/leaper/sharp-debridement.html Medina, A,, Scott Paul, G., Ghahary, A. Tredget Edward, E. (2005).   Pathophysiology of chronic nonhealing wounds,  Burn Care Rehabilitation,  26(4), 306–319. .National Diabetes Support Team. (2006). Diabetic foot  guide, NHS Clinical Governance Support Team. London: NHS. National Health Service . (2002). Diabetic Foot Ulcer Dressings Guidance and Referral Advice. Leicester. National Institute for Clinical Excellence. (2004). Prevention and Management of foot problems in people with type 2 diabetes. Retrived January 2002 from nice.org.uk/nicemedia/live/10934/29246/29246.pdf Pham, H., Armstrong, D.G, Harvey,   C., Harkless, L.B., Giurini, J.M. Veves, A. (2000). Screening techniques to identify people at high risk for  diabetic foot  ulceration: a prospective multicenter trial,  Diabetes  Care, 23(5), 606–611. Pudner, R. (2001). Hydrocolloid dressings in wound management. Retrieved February 2007 from www.jcn.co.uk/journal.asp?MonthNum=048 Rathur, H.M Boulton, A.J. (2007). The diabetic foot. Clinics in Dermatology, 25(1),109-201. Reed, J.F. (2004). An audit of lower extremity complications in octogenarian patients with diabetes mellitus,  International Journal of Lower Extremity Wounds, 3  (3), 161–164. Reiber, G.E., Smith, D.G.,    Wallace., C.,(2002). Effect of therapeutic footwear on ulceration in patients with diabetes. Journal of the American Medicine Association. 287: 2552-2558. Sibbald, R.G., Williams, D., Orstead, H.R., Campbell, K., Keart, D., Krasner, D. et al. (2003). Preparing the wound bed: Focus on infection and inflammation. Ostomy/Wound Management. 49 (11). 24-51. Sutter, J.H., Shelton, D.K. (2006). Three phase bone scan in osteomyelitis and other musculoskeletal disorders. Diabetes Medicine. 24 (12). 93-98. Tentolouris, N., Jude, E.B., Smirnoff, I. (2003). Methicillin resistant Staphylococcus Aureus, an increasing problem in the diabetic foot clinic: a worsening problem. Diabetic Medicine. 20 (2). 159-161. Veves, A., Giurini, J. LoGerfo, F. (2006).  The Diabetic Foot: Medical and Surgical Management.  Totowa, NJ: Humana Press. Vileikyte, L. (2001).   Diabetic foot ulcers: a quality of life issue.  Diabetes Metabolism Research and   Review,17(4), 46–249. Wagner, F.W. (1987). 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Organisational dialouge Essay Question 2: A range of authors (e.g. Gerard and Ellinor 2001; Isaacs 1993, 1999; Schein 1993; Senge 1995) suggest that dialogue can positively transform organizational cultures. Do you agree with this assessment? Why? Why not? Engage with relevant academic literature in developing your argument. Student Name: Nguyen Vu Hoang Dung Student Number: 11477445 In organization people spend 80 percent of their time to communicate (The British Psychological Society 2012). Communication is a key tool to share information, foster different opinions and build alignment and trust. According to Gerard Teurfs (1995), the process of dialogue is an invitation to create organization cultures through conversations. It acts as a learning environment that shifting individuals to â€Å"a deeper understanding of collaboration in groups, and a new way of sensing their connections to others throughout the organization† (Querubin 2011, p.19). It brings all the ideas together and suspends judgment so people will have a greater chance to understand each other (Brayman, Grey Stearns 2010). This essay will analyze the role of dialogue in transforming organizational cultures positively and all the benefits it brings. However, it will also examine the challenges of implementing dialogue. Organizational culture includes shared values and beliefs that guide behaviors of all members and determine the way things should be done in the organization (Sergiovanni 1984). Company has its own culture usually indicates higher performance. The role of dialogue is not only to spread the common values and meanings that company wants its employees to follow but also allow everyone to express their own interest. According to Gerard and  Ellinor (2001), the main purpose of dialogue is to produce collective understanding. Firstly, they compared the differences between dialogue and discussion. In discussion, people tend to protect their own thoughts and do not truly concern about other’s opinions and needs. They play as a speaker’s role rather than as a listener. It might leave the remainder out of discussion with frustration, isolation and disrespect. Decisions could be made by the person who has the most power and influence in the group (Gerard and Ellinor 2001). Hence it weakens the aim of enhancing organizational cultures. In contrast, when employees participate in a dialogue, their role as a listener is more important than as a speaker. They desire to hear what others want to say. They try to fit all different perspectives into a common value. Therefore, if issues occur, they listen to deeply understand other’s thoughts and opinions (Gerard and Ellinor 2001). By doing that, employees are getting closer to each other and conflicts are minimized. They help their team or their department to build shared culture. Secondly, Gerard and Ellinor (2001) stated five skills of dialogue including suspension of judgment, listening, reflection, assumption identification and inquiry. They defined the meaning of suspension in dialogue is not to stop one’s judgment about a problem. Instead, they have to aware what their judgments are and â€Å"then holding them lightly so they can still hear what others are saying† (Gerard and Ellinor 2001, p. 7). After listening carefully to other’s ideas, they need to reflect their own assumptions. Therefore, to revising whether those assumptions are linked to the organization or not. If they cannot understand the differences, they must inquire for more information. Hence, this process of dialogue enables each employee to foster different views and converge them together to become one unique aim. Organizational culture is enhanced. In agreement with Gerard and Ellinor, Isaacs (1999) analyzed four principles of dialogue based on Bohm’s research in 1996. They are listening, respecting, suspending and voicing. Firstly, Isaacs had compared listening skill in dialogue to listening to music. He stated a single note of music could not deliver the meaning of the whole song. It is similar to one’s role in a conversation. A single idea is not sufficient to set purposes and  cultures for the whole organization. Hence, dialogue is an excellent practice to give people a chance to listen deeply and get into the nature of the conversation. Secondly, he defined respecting as getting to know more about one person and figure out what sources or circumstances has created their particular thinking. Based on this understanding, people in an organization will pay more respect to each other. The main goal of respecting in dialogue is not to seek decision but to tolerate difference, gap and conflict (Isaacs 1999). The third principle of dialogue, suspending, is determined similar to Gerard and Ellinor (2001). And the last principle Isaacs mentioned is voicing. He suggested people should listen internally so as to select what should say and what should not say in a circumstance. Sometimes keeping silence and listen can achieve the best result. Therefore, the purpose of voicing means people contribute their speech, not only for themselves, but to the whole idea. Overall, these principles are considered having positive effects on organizational learning. They emphasize group and organization achievements rather than an individual accomplishment. In Schein’s study (1993), he described dialogue as â€Å"talking around the campfire† (p. 391). He used â€Å"campfire† as a metaphor to explain how decision is made through dialogue. In the past, people sat around campfire during meeting and shared their own opinions. Arguments would never come up as people just simply expressed their thoughts without any discussion or debate. Through that, they were aware themselves which idea was acceptable and were unacceptable (Schein 1993). This process allowed enough time for each person to listen to a deeper layer of other’s opinions then reflect on their own assumptions. Moreover, Schein introduced the check-in concept. At the beginning of the meeting, each person will respectively contribute his or her ideas, views and feelings to the group as a whole, and therefore, â€Å"has helped to create the group† (Schein 1993, p. 392). Lastly, Schein stressed the limitation of eye contact. This makes people feel ea sier to suspend disagreements and concentrate on listening. Senge (1995) determined dialogue as a facilitator for team learning. Based on his research, team is the key unit to build culture in an organization. By applying dialogue into team learning process, it develops shared vision and  brings result every member truly desires. It also creates teamwork and shares equal leadership to each member in the group. Through sharing a common pool of meaning, culture is positively transforming from individual to group values and beliefs. Although dialogue is proved to have a great effect on organizational culture, there are challenges in implementing it into organization learning system. The first challenge is due to hierarchy level in an organization (Raelin 2012). Dialogue requires equal say and sharing from each member of the organization. However, employees tend to afraid of expressing their true views in front of their managers. They leave decision making to people at higher position. In top-down companies, upper levels of management have full knowledge of desired targets, goals and norms. They have the right and ability to create and change organizational culture. They enforce rules and duties on their employee. They usually do not spend time to listen to individual’s opinion and feeling. Hence, it is very challenging to apply dialogue into this type of business. Furthermore, if the organization involves a cross-culture, that employee come from different culture backgrounds, there is a need for a more lengthy and complicated process of dialogue (Schein 1993). In this type of organization, people use different languages and operate from different mental models. Organization needs to design a dialogue that enables all these people to communicate effectively. Thornhill, Lewis Saunders (2000) also emphasized there is may be a need to â€Å"re-designing of performance appraisal systems and reward systems† and â€Å"the re-definition of job roles to induce employees into accept the new behavior expected from them† (p. 27). Hence it is costly and time consuming. Finally, dialogue may not be suitable to apply to all organizations cultures in the world. For example, Western culture is different from Eastern culture. As dialogue encourage the limitation of eye contact (Schein 1993), people from the West will consider this as impolite or even disrespectful (Spindler 1990). In addition, in Western countries people prefer confrontation whereas Eastern people prefer to say what they feel most  appropriate in this circumstance or least hurtful to the others (Schein 1993). Therefore, dialogue must be selective so it is suitable for each particular organization. In conclusion, dialogue has played a key role in positively transforming organizational culture. It acts as a learning environment that shifts individual to group thinking. It leads each employee to recognize the essential of collaborating in a group. Querubin (2011) demonstrated that dialogue enables members to â€Å"become open to diversity and lose an â€Å"us vs. them† paradigm so prevalent in task-oriented cultures† (p. 19). Hence, group achievement is more important than individual accomplishment. Moreover, dialogue includes suspending of judgment, listening, respect, reflection, assumption and voicing. Through all these principles, dialogue creates collective understanding and leads all members of the organization to higher commitment. However, the implementation of dialogue still faces several challenges, including hierarchy levels, time consuming and different cultural backgrounds. Therefore, selective approach of dialogue must be considered to apply to specifi c organization. REFERENCES Bohm, D. 1996, On Dialogue. Ed. Lee Nichol, Routledge, London New York. Brayman, J., Grey, M. Stearns, M. 2010, Taking Flight to Literacy and Leadership, Rowman Littlefield, viewed 16 December 2010, Ellinor, L. Gerard, G. 2001, Dialogue at Work: Skills at Leveraging Collective Understanding, Pegasus Communications, Waltham, MA. Ellinor, L. Gerard, G. 2001, Dialogue at Work: Skills at Leveraging Collective Understanding, Pegasus Communications, Waltham, MA, pp. 7. Gerard, G. Teurfs, L. 1995, Dialogue and Organizational Transformation, 1st edn, Sterling Stone, Inc., San Francisco. Isaacs, W. 1999, Dialogue and the Art of Thinking Together: A Pioneering Approach to Communicating in Business and in Live, Currency, New York. Querubin, C. 2011, ‘The effect on the organization’, Dialogue: Creating Shared Meaning and Other Benefits for Business, pp. 19, Raelin, J. 2012, ‘Dialogue and deliberation as expressions of democratic leadership in participatory organizational change’, Journal of Organizational Change Management, Vol. 25. Schein , E. H. 1993, On dialogue, culture, and organizational learning . Organizational Dynamics, pp 391-392. Senge, P. M. 1995, The spirit of personal mastery, MN: Charthouse International Learning Corporation, Burnsville. Sergiovanni, T. 1984, ‘Leadership and excellence in schooling’, Educational Leadership Journal, vol. 4. Spindler, G. 1993, The American Cultural Dialogue and Its Transmission, Psychology Press, The British Psychological Society 2012, Dialogue: How to create change in organizations through conversation, viewed 14 May 2012, http://www.bps.org.uk/events/dialogue-how-create-change-organisations-through-conversation-1 Thornhill, A., Lewis, M. Saunders, M. 2000, Managing Change: A Human Resource Strategy Approach, Prentice Hall, London.

An Organizational Study of The United States Air Force :: Business Organization Research

The United States Air Force faced a leadership vacuum with the resignation of Air Force secretary James Roche and his Undersecretary Peter Teets. The Pentagon decided to take over of the buying decisions for the Air Force since they believed that there was no one who was in the position to take on the responsibility. The Department of Defense is now taking in charge to support and to assist the Air Force Command by overseeing and providing advice on important Air Force programs during a time of transition. It was clarified however that within the next six months, a new Air Force Secretary will be appointed. At present though, the Air Force is under the temporary command of Lt. Col. Michael Rodriguez (http://money.cnn.com/2005/03/28/news/fortune500/pentagon/). All organizations whether it be in the business industry, socio-civic, private or government-regulated face the challenge of running the whole system according to the principles as well as the goals and objectives of the system. The organization normally is confronted with how it will operate accordingly to meet the expectations and put up with the responsibilities and duties of the members as well as the departments that make up the whole system. The changes in the surroundings of the workplace in the internal as well as in the external environment and affairs make influence the overall operations of the structure. The military is not an exemption in this regard even for the fact that the defense team of a country undergo regulations that are very systemic and defined. There are internal as well as external affairs, issues and problems that should be attended to in order for the whole organization to function fully and provide the necessary outputs being demanded. That i s why it is interesting to look at a certain military arm experience a challenge of change in the system to be able to fit in the constantly changing global and wide social context on which it operates. Air Force Organizational Structure Just like other organizations, the United States Air Force is composed of complicated and systematic divisions. The people in this particular service are classified not just according to ranks. Since the recruits in this defense arm came from different state with varying cultural orientation, it is but expected that the people in this service are also diverse.

Managing & Enhancing Care in Rapidly Changing & Complex Situations Leadership Essay

Introduction to the folder of Evidence This assignment is an analysis of my leadership development though my training, and to assist me to adapt from a student nurse to a staff nurse confidently. This, along with an action plan (appendix 1) is completed though out my module 8 placement in accident and emergency. My leadership skills are developed by shadowing my mentor whilst she is in charge of shifts for 3 weeks, as well as accurately and confidently handing over patients to other members of the multi-disciplinary team. In this setting, skills such as communication, decision making, prioritising care and time management are necessary, therefore this placement has assisted me in developing those skills. This assignment relates to learning outcome 2-Utilise a range of therapeutic approaches and problem solving skills when planning, implementing and evaluating care to enhance quality of life for patients and carers, 3- Utilise effective coaching skills in the support of patients, carers and less experienced colleagues, and 4- Analyse and develop professional care, management and leadership roles within the context of multidisciplinary and collaborative care delivery in meeting health and social care needs for patients with increasing levels of dependency. (MSG, 2011) I will develop my leadership skills by shadowing her whilst she is triaging patients, in charge of shifts, and when she is handing over, along with accurate communication skills. Though out the placement, I will gain feedback from my mentor on my progress in order to help me to achieve sufficient leadership skills. Introduction The aim of this reflective account is to analyse leadership skills that have been developed throughout my module 8 placement in Accident and Emergency. I will debate the motives for my choice of actions, and evaluate the extent which it has enabled me to improve my leadership skills. I will discuss what I have discovered about my leadership skills, how I’ve developed as a leader, and what effect this has on the care given to my patients. This assignment, in collaboration with the practise assessment document, will assist me in identifying skills developed, with significance to learning outcomes 2, 3, and 4. The identified skills along with leadership literature will be evaluated using the Gibbs Reflective Cycle (1988) which comprises of description, feelings, evaluation, analysis, conclusion, and action plan. There are many definitions of leadership, such as being a ‘’function of knowing yourself, having a vision that is well communicated, building trust among colleagues, and taking effective action to realize your own leadership potential ‘’. (Bennis, 1959), ‘Leadership involves the use of interpersonal skills to influence others to accomplish a specific goal.’ (Sullivan and Garland, 2010). All of these definitions gave me a great idea of leadership, and allowed me to choose an aspect of leadership skills within my placement. This allowed me to focus on my leadership skills whilst making decisions in the clinical setting. Clinical decision-making is a process that nurses undertake on a daily basis when they make judgements about the care that they provide to patients and management issues. (Banning, 2007). NMC 2008 states that you must ‘‘Provide a high standard of practice and care at all times’’. This reflective account is also based on my leadership skills whilst leading handover. Clinical handover refers to the transfer of information from one health care provider to another when a patient has a change of location or venue of care, and/or when the care of/responsibility for that patient shifts from one provider to another (ACSQHC, 2005). The NMC (2008) states that ‘’you should be aware of, and develop, your ability to communicate effectively within teams. The way you record information and communicate is crucial. Other people will rely on your records at key communication points, especially during handover, referral and in shared care.’’ Stage 1: Description of the event Decision making plays an important role in the A&E department. This determines the care each patient receives. My mentor asked me to triage a patient in the minors department. No names are mentioned in this piece in order to respect dignity and privacy as stated by the NMC (2008). I began to triage a 29 year old female who presented with abdominal pain and vaginal bleeding. This patient was 7 weeks pregnant. As I was assessing the patient I noticed that she was hypotensive at a blood pressure of 95/65. Following this, I informed my mentor of my patient and my findings. Following a discussion with my mentor, we decided that this patient was high priority. Whilst my mentor inserted a cannula and took bloods, I was given the responsibility of allocating the patient to a bed. Following the discussion with my mentor, I felt that it was necessary to place the patient in majors, and on a monitor bed. As this was being put into action, my mentor and I noticed that all monitored beds were tak en up. I then had to liaise with the nurse in charge to decide if all patients on the monitored beds were required to stay on monitors. After organising a monitor bed for the patient, I then bleeped the gynecologist on call for further advice. After the patient was assessed by other members of the multi-disciplinary team, it was decided that the patient was to be admitted for further tests, as the gynecologist was querying an ectopic pregnancy. My mentor then allowed me to liaise with the bed manager to organise a bed on a suitable ward for the patient. After a bed was arranged, I then escorted the patient to the ward and gave a full handover to the nurses under my mentors supervision. Handover is another very important aspect of communication in the clinical setting, as it ensures the correct information is given to the nurse, and therefore, care for the patient will be organized accurately. Stage 2: Feelings When my mentor allocated me to triage patients, I felt that I was given a lot of responsibility. Porterfield (1999) states that empowering employees is an important part of employee development and can in turn produce a higher level of employee satisfaction. I questioned my ability to assess to as I was not used to this level of responsibility. I mentioned this to my mentor and she reassured me by discussing what assessment tools to use, and  mentioning that she and the rest of the nursing team were there for any guidance throughout the assessment. Once the patient was assessed and allocated to majors, I felt quite confident in my decision making skills. My mentor mentioned that I had triaged the patient successfully and competently and this was very reassuring. As I continued care for the patient, I became to feel more confident in the care I was providing. After a clinical decision was made and the patient was to be handed over to the nursing staff on the ward, I felt slightly nervous in regards to ensuring the correct and accurate information is being given to the staff, as well as the essential information in regards to the patient. As I proceeded to begin handover, I became more confident as I had been with this patient since the beginning, and had a good insight to the care that was given and the care that was to be given. I gave the nurses a full handover in regards to the patient, including what examinations were carried out and the results of the examinations, and what the patient is required in order to keep comfortable. I also mentioned that this was the patient’s first pregnancy and reassurance is vital. Following handover, my mentor gave me feedback on how I handed over the patient. We discussed my communication skills, and my mentor mentioned that I gave an accurate and well-spoken handover, and mentioned all relevan t information in regards to the patient. After receiving that feedback, I felt that my style of leadership tailed was transformational. Stage 3: Evaluation Leaders are often described as being visionary, equipped with strategies, a plan and desire to direct their teams and services to a future goal (Mahoney, 2001). Decision making is a fundamental element of nursing, and is essential to understand. (Reilly, 2003). By my mentor allowing me to make clinical decisions on patient care, leadership skills whilst making decisions were put into practice. With the support of my mentor and all the staff, I was able to analyze clinical situations and make a decision based on best practice, as well as evidence based practice. By gaining feedback from peers, it allowed me to evaluate how effective my decision making and communication skills were. Communication can be identified as a vast field with the nursing setting. (Donnelly and Neville, 2008). Throughout handover, my delivery of information was accurate and precise, and the level  of communication between the nursing staff receiving handover from I was approached to in a professional manner. I feel that, throughout the experience, my confidence levels were low and adverse. Dao (2008) states that self-confidence is the fundamental basis from which leadership grows. Although, I received positive feedback from peers, being given such important tasks made me doubt my competency as a nurse. Stage 4: Analysis The Gibbs et al (1988) reflective model encourages the analysis stage to break down the event into its components so they can be explored separately. In order to analyze, becoming aware of the variety of learning theories and styles will assist in evaluating. Timmins (2006) states that critical analysis should analyse current practice along with examining the research base of practice and exploring theories that update nursing. I feel by exploring various leadership styles, I achieved this throughout my placement. An effective leader should be able to adopt, either consciously or unconsciously, various leadership styles in various situations (Bennett et al. 2010). By approaching the range of leadership theories, I feel that I have obtained the transformational leadership technique. Transformational leadership style is made up of 4 elements, Idealized influence, Inspirational motivation, Intellectual stimulation, and Individual consideration. In comparison, Transactional leadership style is made up of 2 elements, Contingent Reward and management by exception. Aarons (2006) states transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. I feel that I built a professional relationship with not only my mentor, but with other colleagues in the department, and had the support necessary to assist me in making decisions and handing over. In terms of patient’s safety, accurate decision making and hand over is an essential. The NMC (2008) states that you must ‘’provide a high standard of practice and care at all times’’. By obtaining a transformational leadership style, this ensures that whilst decision making, that all decisions are made with rationale and in the best interest of the patient. When handing information of care of patients over to colleagues, effective co-ordination and communication is essential. Clinical decision-making is a complex activity that requires practitioners to be knowledgeable in relevant aspects of  nursing, To have access to reliable sources of information and appropriate patient care networks and to work in a supportive environment. (O’Neill, Dluhy & Chin, 2005). However, although being supervised whilst making decisions and handing over, I was expected to do these tasks independently and professionally, and based on the best interest of the patient. This allowed me to gain further insight to the transition of student nurse to staff nurse. Stage 5: Conclusion In conclusion I feel the time I spent working within the Accident and Emergency team facilitated greatly in assisting me to develop my leadership skills. The stated event reflected best shows how I incorporated two aspects of my new leadership skills. I feel by studying the styles and skills involved in leadership I gained a good knowledge of leadership styles which I presented during my time here. I received feedback from my mentors and colleagues in regards to the skills, which have given me confidence to practice these skills in the future as a staff nurse. I have come to realise that a variety of leadership styles of leading best work in a hospital setting. In the future I will strive to further develop my leadership skills. Stage 6- Action Plan I plan to continue developing my leadership skills by observing and taking part in handover throughout the rest of my placements. I also hope to continue developing my decision making skills by shadowing my mentor and other colleagues throughout triaging and deciding patient care. As a self-regulated learner, I plan to gain feedback from both mentors and colleagues and focus on areas of further development. REFERENCES Aarons, G. (2006). Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice. . 57 (8), 1162-1169. ACSQHC- Passing the baton of care – a patient relay – May 2005. Available. http://www.sswahs.nsw.gov.au/pdf/policy/gl2007002.pdf. Last accessed 17 May 2012. Banning, M. (2007). A review of clinical decision making: models and current research. J. Clinical Nursing. Available at http://bura.brunel.ac.uk/bitstream/2438/1395/1/2005-0319%20R2.pdf. Accessed 26 May 2012. Bennett, C., Perry, J., Lapworth, T. (2010) Leadership skills for nurses working in the criminal justice system. Nursing Standard. 24 (40), p.35-40. Bennis WG (1959) Leadership Theory and Administrative Behavior: The Problem of Authority. Admin Sci Q 4(2): 259–301 Bennis W. (1999). The Leadership Advantage. Available: http://www.hr-newcorp.com/articles/bennis_Leaders.pdf. Last accessed 26th May 2012 Dao, F. (2008). Without Confidence, There is No Leadership. Available: http://www.inc.com/resources/leadership/articles/20080301/dao.html. Last accessed 29 May 2012. Donnelly, E, Neville, L. (2008) Communication and Interpersonal Skills, p4 Reflect Press Ltd Publishing. Gibbs, G. (1998) Learning by doing: a guide to teaching and learning methods. Oxford centre for staff and learning development. London Further Education Unit. Polytechnic, Oxford Mahoney, J. (2001) Leadership skills for the 21st century. Journal of Nursing Management; 9: 5, 269-271. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. www.nmc-uk.org O’Neill, E.S., Dluhy, N.C. & Chun, E. (2005). Modelling novice clinical reasoning for a computerised decision support system. J. Advanced Nursing, 49, 1: 68-77 Potterfield, Thomas A. (1999) The Business of Employee Empowerment: Democracy and Ideology in the Workplace. Westport, CT: Greenwood Publishing Group. Riley, M. E. (2003), Removing chest drains – a critical reflection of a complex clinical decision. Nursing in Critical Care, 8: 212–221. Sullivan EJ, Garland G (2010), Practical Leadership and Management in Nursing. Pearson Education Limited,Harlow T immins, F. (2006) Critical practice in nursing care: analysis, action and reflexivity. Nursing Standard, 20 (39), p.49-54.

Chemical Equibrium in Solution #3 Essay - 2020 Words

Table of Contents Abstract 1 Introduction 1 Experimental Method 2 Results 5 Discussion 8 References 8 Appendix 9 Chemical Equilibrium in Solution Ginger Rimestad 10 December 2005 Abstract The experiment, Chemical Equilibrium in Solution, makes use of a titration of a heterogeneous solution. This is done in order to find the distribution of molecular Iodine, I2, as the solute between two immiscible liquid phases, water and a hexane solution. The average values obtained for (I2) = 6.11E-06 M, (I-) = 0.1097, (I3-) = 2.82E-04. The results that were found in this experiment show an inaccuracy. This may have been due to the third run in†¦show more content†¦Distribution constant is not a true thermodynamic equilibrium constant. This is determined by titration of both phases with the standard thiosulfate solution when I2 is distributed between hexanes and pure water. II. Experimental Method The experimental method was similar to the experiment that is described in the textbook (Experiments in Physical Chemistry, 7th ed., Exp. 12[1]). The experiment was modified as follows: Instead of using carbon tetrachloride, hexanes were used instead. This is due to hexanes not being as harmful to use and similar results can be obtained. The first thing that was accomplished was to measure the distribution constant, k, defined by k = (I2)w (2) (I2)h The iodine is represented in two phases. The hexanes is represented by , h, and the aqueous phase is represented by, w, in Eq. 2. The quantities for each run is given in Table 1 (runs 1 to 3). The values used for this calculation is found in the results section in Table 6. Each run is a different Molarity of I2 to check the variation of the distribution constant with the concentration. The Erlenmeyer flasks that contained the solutions were equilibrated at 25ËšC, after shaken for 5 minutes. The flasks were yet again shaken for 5 more minutes, after being in the thermostat bath for 10 minutes, and yet placed again in the bath for another 10 minutes. This is to allow the liquids to separate out completely. The flasks,