Reflexivity in relation to anthropologicalethnographic filmmaking Essay

Reflexivity in relation to anthropologicalethnographic filmmaking - Essay Example The Ax Fight was originally created to show students the difficulty in placing a single point-of-view out of a certain field experience. The footages actualize the teaching process and problematize the translation from one cultural experience to another cultural idiom, within which the anthropologist often condenses, analyzes and-makes intellectual models (Ennis, Asch, 1). In the first unedited section of the film all the events are presented and the sound continues even after the film goes dark and the comments of Chagnon, Asch and Johnson are just heard. In the second part, Napoleon Chagnon explains the socio-political significance of the fighter's behavior. The third part, delves more into the socio-cultural complications of the village people. The final section is an edited version. Timothy wanted his students to understand the shortcoming of a film that is has smooth editing and fibula structure like the Nanook of the North. Films like The Ax Fight show how an intellectual inter vention influences an onlooker. The film is also a direct criticism of the inconsistencies of spectatorship and how the desired effect in understanding is achieved by a good filmmaker. Contrary to pre-disposed notions in science and filmmaking, anthropological faithfulness to observation of another culture cannot ever be beyond bias, unless reflexivity is used to both question that objectivity and nurture mental exercise within the spectators. Anthropological filmmaking combines two processes together. One is the filming process and the other is social science. The balance is crucial since science and art clash headlong. The frame within the camera may help to communicate cultural conditions and also further Western knowledge of the "Other", but a culture cannot be completely understood just by introducing a non-fictional narrative as Flaherty does. The limitations are numerous. First, a narrative forces the plot of the actual observation towards a composition of a fiction. Flaherty wanted to manipulate viewers understanding of the biography of Nanook and not further any racist understanding of the Eskimo culture. But with Timothy Asch reflexivity is the first sta nce to question the all-understanding nature of the anthropologist. He wanted to keep certain signs and their nature open to critical interpretation and never risk a comfortable lapse leading to an acceptance from his audience. The conscious effort to keep the audience visually uncomfortable while watching the fight makes the confrontation of inter-cultural experience more critical. Accumulation of data, the process of accumulating it, narration, and little editing of the film may help the nature of critical viewership and gives minimum control to the maker. Timothy and Chagnon relinquish all control of their point-of-view and plunges their own spectatorship with that of the audience in such a way so that it becomes impossible to neglect the cultural and ideological subjectivity of the anthropologists. The students are left to situate the filmed observations within the sphere of public and uniform scientific study. The anthropologists become a part of the study themselves since their psychological perspectives are of profound value in regard to the choice of the subject itself. Human recording of another human behavior is the proper subject of postmodern dialogism. The indefinite and inadequate interplay of

Management of information Systems Essay Example | Topics and Well Written Essays - 1250 words

Management of information Systems - Essay Example and Google have been able to reduce their costs of production, carry out market segmentation, and produced differentiated products. The need to introduce modern technology in regular business operations have been necessitated by the stiff competition created through globalization. One of these latest technologies is the electronic commerce. With the competition intensifying, companies such as Google Inc. have gone an extra mile to make their operations electronic. Qin broadly defines electronic commerce (e-commerce) as the widespread applications of computer networks and internet to communicate, carry out commercial transactions, and make online payments (34). It draws on a number of technologies including mobile commerce, supply chain management, electronic data interchange (EDI), automated data collection technologies, inventory management systems, on-line marketing, and electronic fund transfers. In this twenty first century, e-commerce heavily reply on the World Wide Web (www) in nearly every life cycle of a transaction, though it also rely on other internet-enabled technologies such as e-mail. It is an e-business aspect that aids is data exchange and facilitation of financial payments (Laudon and Guercio 37). E-businesses take the form of virtual storefronts (E-tail), on-line marketplaces, e-mails, or fax. Since 2000, the numbers of business transactions conducted by Google Inc. via online platforms have more than tripled. Kurihara established that e-commerce accounts for over 60% of retails transactions globally. Information technology has directly impacted on the business sector by expanding customer bases, increasing product information symmetry, and improving product/service quality (72). Internet serves as an interactive medium where the business community congregates and transacts. Besides, this medium helps in eliminating geographic barriers to trade and commerce. E-commerce is critical in the strengthening of customer

Political Application of Liberty and Rights

Political Application of Liberty and Rights The concept of freedom A general definition of liberty or freedom defines it as immunity from subjective exercise of authority. However, philosophers of the seventeenth and eighteenth century seem to explore deeper aspects of this concept. Among these philosophers are Thomas Hobbes and Rousseau, who held strong philosophies of liberty but somewhere along the line, their views differed. To begin with, Hobbes presents two categories of freedom in a persuasive manner where he argues that the first category of freedom is granting individual’s liberty to choose from alternatives, while the second category of freedom is freedom to approve individual’s choice in an instance (Tuckness, 2002, p,105). Analysts claim that Hobbes concept of liberty or freedom is persuasive in nature because the philosopher argues that only the exercise of a power has the ability to reduce people’s freedom. In this case, Hobbes is a determinist because he perceives that any happenings including human action is trig gered by the effect of ancestral or unpreventable causes. Therefore, man exists in a state of withdrawn liberty because the law of nature determines it; hence, freedom is of little use because it benefits no one and that whoever desires to live in freedom end up contradicting oneself (Tuckness, 2002, p, 105). Rousseau on his part brings forth two types of liberties namely, civil or moral liberty and natural liberty. He further explains that natural liberty is the freedom to influence personal desires, while civil liberty is the freedom to convince the general will (Tuckness, 2002, p, 105). Rousseau seems to dig deeper into freedom analysis where he explains that man is extremely free because the cruel state or fellow man does not dominate him nor does the spirituality of artificial needs that exist in the current society enslaves him. However, the scholar claims that man is enslaving himself with needs, which result to the ills experienced in the society today. The concepts outlined by the two scholars present the fact that both of them have similar perception on liberty but they differ in the sense that Hobbes supports negative liberty, while Locke supports the negative side of it. Locke’s positivity exhibits in the sense that he focuses on the positive aspects of what result the law can accomplish because it is only the law that do not restrict freedom (Tuckness, 2002, p, 105). However, this is the point through which differences chip in because Hobbes claims that law restricts peoples many choices; hence, restricting them from freedom (Tuckness, 2002, p, 105). However, he advocates for this kind of freedom by asserting that people should learn how to part with much liberty in order to acquire security and peace. Political application of the theory The two authors seem to disagree on political application of liberty theory. Hobbes believes that liberties must comply and surrender to a sovereign in order to flee the state of nature (Tuckness, 2002, p, 106). He further argues that the government should solely pass rules that govern the society in order to curb human conflicts and that no one should interfere with the government’s business. Hobbes meant that as long as people had basic freedom, acquired after letting go of the much-needed freedom, adhering to the government laws was not a hard task. This is the reason why the philosopher argued that equality is established in covenant form between people and not between people and sovereignty; hence, denying the many the decision making process. Conclusively, Hobbes meant to simplify that people should embrace a little liberty as long as their existed security and peace and grant the sovereign liberty to rule them. Rousseau on his part claims that the most fundamental objective of any government is to allow its citizens exercise freedom. Therefore, the endorsement and existence of certain government codes can grant a certain level of freedom to the society. In this regard, the philosopher meant that the government should not be extremely rigid towards its people in terms of passing laws that could lead to enslavement but rather should advocate for the society’s views and opinions in order to foster the needed freedom (Tuckness, 2002, p, 106). Unlike Hobbes who advocates for sovereign powers to restrict peoples’ freedom, Rousseau seems to advocate for equity and coordination between the sovereign and its people as a form of liberty. The concept of rights According to Hobbes, rights are liberty to do things without facing any sort of restriction and that Man is equal to the other. The philosopher outlines two types of rights namely basic and civil rights, where basic right is the right to cloth, shelter, food and other basic needs, while civil right is the right to freedom of expression, life and other fundamental rights (Edmundson, 2012, p, 23). However, a deeper perspective reflects that Hobbes generalizes the concept of rights on a social platform because he differs with the manner in which rights apply between society and the government. John Locke’s philosophy concerning rights is reviewed in a wider dimension because he believes that human beings are entitled to every necessary right that include the right to live, the right to freedom among other rights (Edmundson, 2012, p, 24). Unlike Hobbes who believes in social rights, Locke differs greatly because he believes that man should posses the right to dominate the society in every means possible. The difference between the two scholars is that Locke involves rights with larger moral complexity compared to Hobbes who views rights as doing whatever one pleased for their own survival. Political application of the rights concept Hobbes clarify that sovereign should safeguards people’s rights but in a shallow dimension because he advocates for government control over its citizens (Edmundson, 2012, p, 24). The reason why the philosopher argues that government should safeguard its people is because people undergo different aspects of conflicts that in one way or another will need superior intervention. The purpose of government at this point is to advocate for equality in the social context because it will ensure that people’s enacted rights are safeguarded (Edmundson, 2012, p, 24). However, sovereign safeguarding of rights occurs due to people’s inferiority and lack of adequate liberty to safeguard their own rights. Hobbes advocates for this type of liberty and the right to protection where the sovereign is the overall determiner of what rights befits the society. This concept drives to the fact that ordinary citizens will suffer because what the sovereign decides is final because no invol vement or negotiations between the two parties exist. Therefore, Hobbes political theory of rights is problematic because it enhances absolute obedience of sovereignty above the rights of millions of people in the society (Edmundson, 2012, p, 24). The philosopher further asserts that once the government is in place, people have no right to criticize or change its form; hence, defying peoples’ right to freedom of expression. Locke seems to challenge Hobbes view on sovereignty and rights because he believed that people had numerous rights that they could safeguard without the dictatorship of the sovereign. Among these rights is the right to challenge the government, which further grants people the right to overthrow an oppressive government (Edmundson, 2012, p, 24). This clarifies the fact that people’s rights should not face any sovereign dictatorship but rather the sovereign should grant its people the right to criticize injustices from any horizon including their rulers because they possess the liberty to do so. The two philosophers differ greatly because Hobbes advocates for the sovereign safeguarding people’s rights while Locke believes in peoples’ empowerment to the extent that they can fight for their own rights. The concept of private property Lock held strong views on property institution due to its importance to humankind and sacredness. Locke begins by reminding everyone that God the creator gave the world to man to dominate it and no one has an elite claim to anything. However, different versions of laws and policies have modified God’s will by allowing man to share the properties of the world according to sovereign constitutions and codes. These institutions grant human beings the right to property because it is the fruit of their labor. In this regard, Locke advocates for the right to own private property through labor and hard work. More so, the scholar advocates for heredity form of property ownership where an individual should not only acquire property through labor but also acquire it through inheritance (Bhargava, 2008, p, 216). This clarifies the point that man has fundamental objectives in the society that include ownership of property because it is beneficial to both the society and the sovereign. Lock ’s theory of property resulted from the reason that man mixes his labor with then earth in order to acquire as much as he needs. On the other hand, Karl Marx held a different view on property ownership because he advocated for its abolishment in all possible means. On his argument, Marx believed that a community should exercise equality in the sense that the community should not undergo any form of separation in form of classes. Resources that include private property ownership bring about these class variations within the society (Bhargava, 2008, p, 216). Marx argued that private property ownership oppressed the poor and should not be encouraged. The communist further differs with Locke’s view on property ownership as man’s own labor because he argues that man did not acquire property through labor, but rather became a victim of this property because it ended up exploiting them (Bhargava, 2008, p, 216). Marx wished to see equity especially on the amount of labor applied as well as its rewarding system because as much as he faced critics concerning man’s labor to acquire property, he saw a vacuum through which workers would face exploitation (Bhargava, 2008, p, 216). This leads to the conclusion that the two philosophers greatly differed on property ownership concept because Locke perceived property ownership as the main fundamental aspect to both the government and the society. This is the reason why he advocated for property ownership right and looked forward to a period when all citizens would acquire their own property. Marx on his perspective argues that property ownership does not necessarily imply to home or land ownership as perceived by many, but rather as a means of production, that ended up contributing to unequal distribution of wealth and exploitation of many. Therefore, as much as Locke campaigned for property ownership, Marx called upon its abolition. Political application of the private property concept Concerning legislative, Locke argues that the government should not interfere with an individual’s property without his consent irrespective of the existing constitution (Bhargava, 2008, p, 216). Such government involvement arises in form of taxes, where the philosopher argues that sovereign should not inflict tax payments on property owners if possible. Locke further argues that government should adhere to the will of the people by meeting their vast needs that include empowerment to acquire property rather than oppressing them through taxation. Marx on the other hand did not contribute much on issues concerning the government but he still depicted his mistrust in it. This came up because Marx claimed that most of the ruling class in the society supported the government and vice versa. This leads to the notion that the government will not foster the much-needed change in the society in terms of class equity but rather the solution lies on the society itself. Therefore, property ownership has led to social class emergence that even the government cannot help equate; hence, abolition of private property seemed to be Marx’s final option (Bhargava, 2008, p, 216). Conclusively, the two scholars seem to agree on government’s inefficiency in handling property ownership issues and the impact it inflicts towards the society. References Bhargava, R. (2008). Political Theory. Pearson Longman. Edmundson, W. A. (2012). An introduction to rights. Cambridge: Cambridge University Press. Tuckness, A. S. (2002). Locke and the legislative point of view: Toleration, contested principles, and law. Princeton, N.J: Princeton University Press.

Faraday Essay -- Science, Inventions

According to the author of this obituary, what aspects of Faraday’s life and work contributed to his reputation? How does the picture presented in the obituary compare to the picture presented in Book 1, Chapter 4? There are two questions to answer for this TMA. To answer the first question one needs to know the definition of Reputation: the estimation in which a person or thing is generally held; opinion,(E. Dictionary, 2006). It is also necessary to know what in life and work contributed to his reputation. The second question, one needs to understand what it means to Compare: to regard or represent as analogues or similar; liken, (E.Dictionary, 2006). It is also necessary to examine and compare the two pictures. The picture created of the life and work from the obituary, in The Times, 28 August 1867, p.7,'(Assignment Book, 2008), is a very obscure one. An individual reading this extract would find it difficult to know exactly what Michael Faraday had invented, or discovered. There is no exact knowledge, no mention of creation, nothing to indicate unique developments ...

Energy Technology Data Center Migration Case Study Solution

Advantage Energy Technology Data Center Migration* Brian Smith, electronic network administrator at Advanced Energy Technology (AET),has been given the responsibility of implementing the migration of a large data center to a new office location. Careful planning is needed beca aim AET operates in the highly competitive petroleum industry. AET is one of five field computer software companies that provide an accounting and business management box for oil jobbers and gasoline distributors.A few years ago, AET jumped into the practical application service provider world. Their large data center provides clients with outback(a) access to AETs complete suite of application software systems. Traditionally, one of AETs primary competitive advantages has been the companys trademark IT reliability. Due to the compositeity of this regard, Brian will have to use a parallel method of implementation. Although this will increase intention costs, a parallel approach is essential if reliability is no t to be compromised.Currently, AETs data center is located on the second floor of a renovated old bank mental synthesis in downtown Corvallis, Oregon. The company is moving to a new, one-level construction located in the recently developed industrial complex at the Corvallis International Airport. On February 1, Brian is formally assigned the line by the Vice-President of Operations, Dan Whitmore, with the following guidelines: From start to finish, it is anticipated the entire determine will take three to four months to complete. It is essential that AETs 235 clients suffer no downtime.Whitmore advises Brian to come back to the Executive delegacy on February 15, with a presentation on the background signal of the project that includes costs, firstcut timeline, and proposed project team members. Brian had some preliminary discussions with some of AETs managers and directors from each of the functional departments and then arranged for a full-day scope meeting on February 4 with a fe w of the managers and technical†¦ If you expect to get a full essay, order it on our website Outline / Highlights: Case Advantage Energy Technology Data Center Migration Brian smith network administratorAdvanced Energy Technology (AET) Implementing migration of large data center to a new office location Petroleum industry 1 of 5 national software companies that provide accounting and business management package for oil jabbers and gasoline distributors Provide remote access to AET’s complete suite of software Due to complexity use parallel method of implementation – This will lead to high project costs / but provide reliability Continue to provide IT reliability Currently AET’s data center is located on 2nd floor of old renovated bank building in downtown Corvallis, Oregon Company is moving to new 1-story bldg. ndustrial complex at Corvallis International Airport on February 1st. Assigned task by Vice-President of Operations, Dan Whitmore Completion date is 3 – 4 months.Complete no later than June 1st 235 clients suffer no downtime Come back on Feb 15th with presentation of Project Scope INCLUDING cost, ‘first cut† timeline and proposed project team members Full Scope Meeting Feb 4th with Managers, technical representatives from Operations, Systems, facilities, and applications SCOPE IS: 3 – 4 months is a feasible project timeline and 1st cut estimate is $80,000. 00 – $90,000. 0 (includes infrastructure upgrade to new site) Critical no downtime – Need to rely on remote disaster recovery â€Å"hot† site for full functionality Personnel Brian is Project Manager 1 person each from: facilities Operations Systems Operations Telecommunications Systems Applications Customer Service First meeting with team is March 1st. This is the initial task After meeting hire contractors to renovate new data center Also need to figure out how to design the network Screening and hiring contractor will take 1 w eek. Network Design 2 weeks Needs new ventilation system has lead time of 3 weeksNeeds Ambient temperature of 67 degrees for equipment Order racks for switches, servers, and other network devices Racks have two-week delivery time Replace all power supplies and data cables NEED TO ORDER (1 week time frame to order lead time) Ventilation and racks need to be done first Time frame for ventilation system is 1 week Time frame for racks installation is 3 weeks Construction will take 20 days Once construction begins and before Brian installs the ventilation system, and racks, the city inspector must approve the construction of the raised floor.City Inspector will take two days to inspect Infrastructure Once construction begins it will take 20 days After city inspection and after new power supplies and cables have arrived Brian can install power supplies and run the cables Estimation of completion is 5 days to install the power supplies and 1 week to install data cables NEED SWITCHOVER APPR OVAL from all functional units before taking network offline, and switching to hot site Meetings with all functional units will take 1 week. During this time check voltage and make sure it is sufficient Requires 1 day.After completion of power check it will take one week to install test servers, batteries need to be charged, ventilation installed, test servers up and running before Management can sign off that new infrastructure is safe. THIS WILL TAKE 2 days Then sign off systems check, taking one day of intense meetings and then set official date of network move. Move will take place on weekend in 2 days. Assignment is:1. Generate a priority matrix for AET’s system move2. Develop a WBS for Brian’s project. Include duration (days) and predecessors3. Using a project planning tool, generate a network diagram for this entire project. ote: Base your plan on the following guidelines: 8 hour days, 7 day weeks, no holiday breaks, March 1st, 2010 is the project start date. As signment requirements This Portfolio Project will consist of a scholarly paper (in APA format) and a PowerPoint presentation. You may select any case study (other than those used in other class assignments) or a case study from another source (must be approved in advance by the instructor). You should write your paper and make your presentation from the standpoint of a hired business consultant. The project will address the following elements: (1) What is the current situation? 2) What needed to happen? (3) What are the constraints? (4) What resources are required? (5) Who is responsible for the resources? (6) What is the timeframe of the project (including sequencing of sub tasks)? (7) What are the costs associated with the project (or not doing the project, or even failing)? (8) What is the return on investment for the project? (9) What is the risk assessment for the project? (10) What is the method for tracking the progress of the project? For the project, you are required to pre sent a summary of the case study.This summary should contain enough information so the reader understands the situation presented in the case study. You will then complete all the questions presented with the case study (as applicable). While all the questions, including the 10 elements listed above, need to be answered within your paper; please do not just list the questions and then the answers. You are expected to incorporate the questions presented in your discussion. The PowerPoint presentation will be based on your paper. This is where you will present the findings of your research.You PowerPoint will need to present the current situation and then present your findings and solutions. There should be no new information in your PowerPoint presentations as you are presenting your paper. Your presentation should last 10 – 15 minutes (based on the content of the â€Å"script†). The main body of your paper is expected to be at least 10 pages. (You will have several cha rts and diagrams in your paper to address the elements above. ) In addition, you will need to use at least five (5) external resources to support your recommendations and findings. At least three (3) of these resources need to come from the school online library.

Intramuscular Injection Techniques Essay

The synthesis of art and science is lived by the nurse in the nursing act JQSEPHINE e PATERSON If you would like to contribiito to the art and science section contact: Gwcn Clarke, art and science editor, Nursing Standard, The Heights, 59-65 Lowlands Road, Harrow-on-the-Hill, Middlesex H A l 3AW. email: gwen.clarkeva rcnpublishing.co.uk Intramuscular injection techniques Hunter J (2008) Intramuscular injection techniques. Nursing Standard. 22, 24,35-40. Date of acceptance: October 29 2007 Summary The administration of intrairiLiscLitar (IM) injections is an important part of medication management and a common nursing intervention in clinical practice, A skilled injection technique can make the patient’s experience less painful and avoid unnecessary complications. Intramuscular injections AnIM injection is chosen when a reasonably rapid systemic uptake of the drug (usually within 15-20 minutes} is needed by the body and when a relatively prolonged action is required. The amounts of solution that can he given will depend on the muscle bed and range from 1 -5ml for adults. Much smaller volumes are acceptable in children (Rodger and King 2000, Corben 2005). The medication is injected into the denser part ofthe muscle fascia below the subcutaneous tissues. This is ideal because skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue and can absorb larger volumes of solution because ofthe rapid uptake ofthe drug into the bloodstream via the muscle fibres. This means that IM injections are less painful when administered correctly and can be used to inject concentrated and irritant drugs that could damage subcutaneous tissue (Rodger and King 2000, Greenway 2004). Examples of drugs administered via this route are analgesics, anti-emetics, sedatives, immunisations and hormonal treatments. It is important to recognise and understand potential complications associated with IM injections and that rapid absorption of the drugs may increase these risks (Foster and Hilton 2004). The administration of any medication can present a risk and, therefore, the nurse must be able to recognise the signs of an anaphylactic (allergic) reaction, with signs of, for example, urticaria, pruritus, respiratory distress, shock or even cardiac arrest. Inappropriate selection of site and poor technique can increase the risk of patient injury and lead to pain, nerve injury, bleeding, accidental intravenous administration and sterile abscesses caused through repeated injections at one site with poor blood flow (Rodger and King2000). Author Janet Hunter is lecturer in adult nursing, City Community and Health Sciences, incorporating St Bartholomew School of Nursing and Midwifery, City University, London. Email: j.a.hunter@city.ac.uk Keywords Clinical procedures; Drug administration; Injection technique Tliese keywords are based on the subject headings from the British Nursing Index. Tliis article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.cD.uk. For related articles visit our online archive and search using the keywords. THE NURSING and Midwifery Council’s (NMC’s) (2007) Standards for Medicines Management state that administration of medicines ‘is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner (now independent/supplementary prescriber). It requires thought and the exercise of professional judgement.’ Therefore, the administration of intramuscular (IM) injections requires the healthcare practitioner to possess the knowledge and rationale of the guiding principles that underpin these clinical skills. It is essential that all aspects of these techniques -anatomy, physiology, patient assessment, preparation and nursing interventions – are evidence based so that the nurse can perform safe and accountable practice (Shepherd 2002, NMC 2007). The aim of this article is to update the nurse’s knowledge and skills on injection techniques. This article describes the practical, step-by-step approach for administering IM injections, which will assist nurses to perform this skill safely and competently. NURSING STANDARD Intramuscular injection sites There are five sites that can be considered for IM february 20 :: vol 22 no 24 :: 2008 35 art & science clinical skills: 37 injections (Figure 1). The two recommended sites for IM injections are the vastus lateralis and the ventrogluteal sites (Donaldson and Green 2005, Nisbet 2006). However, when the patient is obese, rhe vastus laterahs is a better option (Nisbet 2006). When choosing an appropriate site for administration, the nurse needs to ensure that the medication will be absorbed. The nurse needs to consider whether the patient is receiving regular ]M injections because the site will need to be rotated to avoid irritation, pain and sterile abscesses. Choice will also be influenced by the patient’s physical condition and age. Active patients are more likely to have a greater muscle FIGURE 1 Sites for intramuscular injections (IM) Mid-deltoid site The mid-deltoid site is easily accessible but due to the size of the muscle the area should not be used repetitively and only small volumes shouid be injected. Tlie maximum volume should be 1ml (Rodger and King 2000). Tlie denser part of the deitoid must be used. It is Lisef j l to visualise a triangle whereby the horizontal line is located 2.5-5cm below the acromial process and the midpoint of the lateral aspect of the arm in line with the axilla forms the apex. The injection is given about 2.5cm down from the acromiai process, avoiding the radial and brachial nerves (Workman 1999, Rodger and King 2000). Dorsogluteal site Tliis a’&3. is used for deep IM and Z-track injections. Up to 4mi can be injected into this muscle (Workman 1999, Rodger and King 2000). Commonly referred to as the outer upper quadrant, it is located by using imaginary lines to divide the buttocks into four quarters. To identify the gluteus maximtis, picture a line that extends from the iiiac spine to the greater trochanter of the femur. Draw a vertical line from the midpoint of the first line to identify the upper aspect of the upper outer quadrant This location avoids the superior gluteal artery and sciatic nerve (Workman 1999, Small 2004). Rectus femoris site This site is used for deep I M and Z-track injections. Between mass than older or emaciated patients, so individuals will need to be assessed to see if they have sufficient muscle mass. If not, the muscles may need to be ‘pinched’ up before the injection (Workman 1999, Rodger and King 2000). Any area or presence of inflammation, swelling or infection should be avoided (Workman 1999). Patient preparation It is important to explain the procedure so that the patient fully understands and is able to give his or her informed consent and co-operation. The discussion should include the choice of site for the injection and information about the medication, action and side effects. The patient can then express any concerns or anxieties relating to the procedure and the patient’s knowledge can be l-5ml can be injected, although for infants this would be 1-3 mi. The rectus femoris is a large and well-defined muscle and is the anterior muscle of the quadriceps. I t is located halfway between the superior iliac crest and the patella (Workman 1999), Vastus lateralis site The vastus lateralis site; used for deep IM and Z-track injections. Up to 5ml can be administered (Rodger and King 2000). The muscle forms part of the quadriceps femoris group of muscles and is located on the outer side of the femur. If is foLind by measuring a hand’s breafh from the greater trochanter and the knee joint, which identifies the middle third ofthe quadriceps muscle (Workman 1999). There are no major blood vessels or structures which could cause an injury in this area (Rodger and King 2000). Ventrogluteal site This site is used for deep IM and Z-track injections. This site is located by placing the palm ofthe nurse’s hand on the patient’s opposite greater trochanter (for example, the nurse’s right palm on the patient’s left hip), then extending the index finger to the anterior superior iliac spine to make a ‘V. The injection is then given into the gluteus medius muscle, which is the centre of fhe V (Workman 1999, Rodger and King 2000). Evaluated. It is important to check whether the patient has any known allergies to identify potential reactions to the medication. FVeparation ofthe equipment All the necessary equipment shouid be prepared before commencing the procedure to avoid any delays or interruptions during rhe procedure. The equipment required for administering IM injections is listed in Box I and preparation of rhe equipment is described in Box 2. The techniques used for administering IM injections are outlined in Box 3. Skin cleansing There are inconsistencies regarding skin preparation for IM injections. It is known rhar cleansing the injection site with an impregnated alcohol swab before an IM injection reduces rhe number of bacteria on the skin (Workman 1999, Lister and Sarpal 2004). However, if rhe injection is given before rhe skin is dry this procedure is ineffective and rhe patienr may experience pain and a sdnging sensation from rhe antiseptic. This may allow entry of bacteria inro rhe injection site and cause local irritation (Workman 1999, Lister and Sarpal 2004). Therefore, when using an alcohol swab ro prepare the skin it should be used for 30 seconds and then allowed to dry (Lister and Sarpal 2004). Some local policies no longer recommend skin cleansing ifthe patient’s skin is physically clean (Little 2000, Wynaden et al2005) and the nurse maintains rhe required standard of hand washing and asepsis during rhe procedure (Workman 1999). Equipment for intramuscular injections I 2. 3. 4. 5. 6. 7. 8. 9. Prescription chart. Prescribed drug to be administered. If required, diluent for reconstitution. Clean tray or receiver for equipment, Syringe of appropriate size (2-5ml), Sterile 21G (green) needle for adult patients. Alcohol-impregnated swab with isopropyi alcohol 70%. Gloves. Tissue or clinical wipe. 10. Clinical sharps container. Preparation for intramuscular (IM) Injection administration The following steps describe the procedure when preparing the equipment for an I M injection. †¢ Wash and dry hands thoroughly with bactericidal soap and wafer or use bactericidal handrub to prevent any contamination of the equipment or medication. Put on gloves. Gloves are required for all invasive procedures including IM injection (Pratt etal2Q07). Check the patient’s prescription chart and determine the: – Drug that is to be administered. – Required dose. – Route for administration. – Date and time of administration. – Prescription is legible and signed by an authorised prescriber. These actions ensure that any risk to the patient is minimised and that the patient is given the right dose of medication at the correct time by the prescribed route (Jamieson et al 2002, Lister and Sarpal 2004). If any errors are noticed withhold the medication and inform the medical team. Check the drug against the prescription chart. As all medications deteriorate over time, check the expiry date – this shows when a drug will no longer be guaranteed to be effective. To prepare the syringe for medication: (a) Check all packaging is intact to retain sterility. Check the expiry date. If any packaging is damaged or has expired, discard. (b) Open the packaging of the syringe at the plunger end and remove the syringe. Make sure that the plunger moves freely inside the barrel. Take care not to touch the nozzle end to prevent contamination. (c) Open the needle packaging at the hilt (coloured) end. Hold the syringe in one hand and then attach the needle firmly onto the nozzle of the syringe. Loosen the sheath but do not remove it. Place the syringe on the tray. This prevents contamination or any potential injuries. †¢ Examine the solution in the ampoule for cloudiness or sedimentation. This may show that the medication is contaminated or unstable. Make sure that all the contents are in the bottom o f t h e ampoule by tapping the neck gently. To prevent injury, splashing or contact with the medication use a clinical wipe or tissue to cover the neck of the ampoule and break it open. Observe the solution for any glass fragments because these pose a risk to the patient if injected. Discard the ampoule and contents if any foreign matter is visible. !f you are using a plastic ampoule, break the top off, making sure not to touch the top. †¢ Pick up the syringe and allow the sheath to fall off the needle onto the tray and insert the needle into the solution of the ampoule. Avoid scraping the needle on the bottom of the ampoule, because this wilt blunt the needle. †¢ Pull back the top of the plunger with one finger on the flange and draw up the required dose. I t may be necessary to tilt or hold the ampoule upside down to make sure the needle remains in the solution to prevent drawing in air (Figure 2). Take care not to contaminate the needle. †¢ Re-sheathe the needle carefully using the aseptic non-touch technique to to maintain sterility (Figure 3). †¢ Expel the air. Hold the syringe upright, at eye level and let any air rise to the top of the syringe To encourage air bubbles fo rise, lightly tap the barrel ofthe syringe. Slowiy, push the piunger to expel the air until the solution is seen at the top of the needle. Needles Re-sheathing a needle betore the medication is administered to a patient is safe. This method is achieved hy using the aseptic non-touch technique (Figure 3) and prevents droplets of the medication from heing sprayed onto the skin or inhaled when air is heing expelled from the syringe (Nicol etal 2004). When giving an !M injection a ‘green’ or size 21 gauge needle is used for all adult patients to ensure that rhe medication is injected into the muscle. This also applies to patients who are cachectic or thin, except that the needle is not inserted as deeply. If a smaller gauge needle is used the nurse needs to apply more pressure to inject the solution, which will increase the patient’s discomfort (King 2003). Single and multi-dose powder vials Some medications come in single or multi-dose vials and need to he reconstituted before heing drawn up and mjected. The following steps should be undertaken when administering I M injections to patients: †¢ Take the tray with the syringe, ampoule, impregnated alcohol swab, tissue, prescription and sharps container to the patient’s bedside. Re-check the prescription and medication with the patient’s name band according to local policy. Draw the curtains for privacy and assist the patient into a comfortable position to allow access to the injection siteandto make sure that the identified muscle group is flexed and relaxed. †¢ Clean the skin with an impregnated alcohol swab for 30 seconds and then allow to dry to minimise the risk of infection (Lister and Sarpal 2004), or alternatively it should be cleansed in accordance with local policy, †¢ With the non-dominant hand stretch the skin slightly over the chosen injection site to displace the underlying subcutaneous tissues and to aid the insertion of the needle. †¢ With the dominant hand hold the syringe like a dart Having informed the patient, quickly and firmly in a ‘dart-like’ motion insert the needle into the patient’s skin at a 90 ° angle until approximately 1cm of the needle is left showing (Nicol et al 2004, Corben 2005) (Figure 4). †¢ Hold the skin with the ulnar edge of the hand and with the thumb and index finger hold the coloured part of the needle to maintain stability and prevent movement. †¢ Withdraw the plunger slightly to confirm that the needle is in the correct position and has not entered a blood vessel. If blood is not present, depress the plunger and carefully inject the solution at a rate of 1ml per 10 seconds until the syringe is empty to allow the tissues to expand and absorb the solution (Workman 1999, Lister and Sarpal 2004). This rate also reduces patient discomfort. If blood is present stop the procedure and withdraw the needle and syringe. Start again with new equipment and drug and explain to the patient what has happened to reduce patient anxiety. †¢ Wait ten seconds to allow the drug to diffuse into the tissues then quickly and smoothly withdraw the needle. Use a tissue to apply pressure to the injection site or until any bleeding ceases. It is not necessary to massage the area because this may cause the drug to leak from the injection site and cause local irritation (Rodger and King 2000). †¢ Discard the needle and syringe immediately into the sharps container to prevent any injury. Do not re-sheathe the needle. Remove gloves and wash hands, †¢ Record the administration of the medication on the prescription chart to show that the drug has been given. Report any abnormalities or complications. †¢ Replace any clothing and make sure that the patient is comfortable. Return to the patient after 15-20 minutes to observe and check the effectiveness ofthe medication, especially anti-emetics and analgesics. Observe the injection site within two to four hours for signs of local irritation {Rodger and King 2000), involves some key principles to ensure safe practice. †¢ Before reconstiruting any medication, the nurse should first read rhe manufacturer’s information sheet. †¢ It is important that the powder is at the bottom of the vial so thnt all the medication is dissolved. †¢ The cap must be cleaned with an alcoholimpregnated swah and allowed to dry to prevent bacterial contamination. * It is vital that the correct volume of diluent is used according to the manufacturer’s recommendations to provide the most therapeutic concentration. †¢ The diluent should be injected slowly into the vial so that the powder Is wet before mixing. †¢ When mixing, ensure the needle remains inside the vial to maintain sterility. If there is pressure In the vial hold the plunger down while doing this to avoid the separation ofthe needle and syringe from the vial {Nicol etal 1004}. To mix the medication, agitate or roll the vial until the powder has dissolved. For some powder multi-dose vials, a needle is inserted into the cap before adding the diluent because this allows air to escape and releases the vacuum in the vial. Then with a second needle and syringe, inject the diluent into the vial. Remove the needle and syringe and place a sterile swab over the venti ng need le to prevent contamination ofthe drug and the atmosphere. Agitate or roll the ampoule until the powder has dissolved (Jamieson etal2002., Lister and Sarpal 2004). All solutions need to be inspected for precipitation and cloudiness. Continue to agitate until the powder and diluent have fully mixed to form a solution. †¢ Todrawuprhedrug, hold the ampoule upside down to avoid drawing in air, insert the needle so that it is below the level ofthe solution and pull back the plunger to withdraw the correct amount of solution. For multi-dose vials, clean the cap with an impregnated alcohol swab and allow to dry before inserting the needle and syringe to prevent bacterial contamination.