Development And Implementation Of Business Strategy Marketing Essay

Development And Implementation Of Business Strategy Marketing Essay The purpose of this paper is to critically discuss the strategic methods Bavarian Motor Works (BMW Group) applied to become one of the major leading automobile brand today. With reference of BMW automobiles Case Study by Mr. Valeriano Lencioni, I will further examine what happened with the company, what are the different business strategy approaches the company could use to overpower the high competition in the automobile industry, and what is in the future for the company. Like any other business companies, BMW went through rough time when they continuously keep on losing their market share and with the presence of tight competition, everything would have been unsuccessful. With the use of business strategies, BMW was able to determine what went wrong and what they could do to survive the pressure in the industry. Organisations in a similar environment are not identical but have different capabilities. BMW has strategic advantages that sets them apart from its competitors. BMWs resources and competences developed over years for the company to survive and grow. Every company needs a foundation to continuously keep up with its changing environment and with competition. Presently, BMW is a multi-billion company that manufactures several of the best-known cars in the market. BMW has gone way far ahead from its competitors even with the pressure from competition and still manage to survive and even growing and expanding globally. What are these business strategies BMW applied all these years to get there on top? How did the company even manage to be one of the biggest car manufacturers in the present time knowing the company went bankrupt in the year 1961? What is happening in the automobile industry and what is the position of BMW in the competition? Will it still manage to survive in the future? What are the challenges in store for the company for the next 10 years? BUSINESS ENVIRONMENT AND MAIN TRENDS IN 2004 The global car market started decline in 2003, led by the drop in the market in North America and Western Europe. Other regions of the world led by East Asia are seeing further car market expansion in 2003. In 2004, projections for livelier economic growth strengthen the continuation of car market growth in Western Europe and North America. Although how laws can get stricter and how badly it can affect the companies earnings, it also develop new technologies and markets. Another major external factor affecting the current situation of BMW is that industry structure is becoming more intense. BMW is a business which could face problems in the future if it doesnt take into consideration strategic alliances. Although, the problem was that the economy in North America and Western Europe has been affected by the overcapacity in the automobile industry. It became a global economic instability as consumers from the said part of the world decided to reduce spending on non essential goods. There was lower car demand and so, sales was automatically affected. The automobile industry is becoming more and more competitive, with 6 major groups which have recently formed. Car manufacturing presently is largely affected by external social and environmental pressures, which influence both current production practices and the development of future products and technologies. Environmental standards are mostly set by government regulation and even associations within the automobile industry. These acts aim to as anti-emission laws get stricter every year, and companies look to double or triple their fuel efficiency, alternative technologies are being developed to replace the traditional gasoline engines, and have started to hit the market. Increased fuel-economy and decreasing vehicle weight are gradual changes that slowly improve automobile performance; disruptive technologies include new fuel sources such as electricity, solar energy, and fuel cells. Please refer to Appendix III: UK car production in Year 2003. Within the automobile industry, it had too many difficulties and the players in this field have experienced the troubles of surviving. The change is needed as equity prices drops and geopolitical tensions arised, including the related threat to oil prices, all having a negative impact on the economy. Increasing the safety standards for automobiles also mean that nowadays cars take longer time to be developed and manufacturers should now focus on pre-marketing activities, making cars look more desirable to consumers due to their safety. Competitive forces determine the market power of competitors, the kind of competition they engage in, the factors that give some of them a competitive advantage, and the attractiveness of that market compared to others. BMW GROUP Bayerische Motoren Werke Aktiengesellschaft (BMW) or Bavarian Motor Works is a German automobile, motorcycle and engine manufacturing company founded in 1917. The BMW Group is now one of the ten largest car manufacturers in the world and, with its BMW, MINI and Rolls-Royce brands, possesses three of the strongest premium brands in the car industry. The group also has a strong market position in the motorcycle sector and operates a successful financial services business. The company aims to generate profitable growth and above-average returns by focusing on the premium segments of the international automobile markets. With this in mind, a wide-ranging product and market offensive was initiated in 2001, which has resulted in the BMW Group expanding its product range considerably and strengthening its worldwide market position. The companys brand is extremely strong and is associated with high performance, engineering excellence and innovation. Indeed, the BMW brand is often cited as on e of the best in the world, and the company continues to launch a stream of innovative products as part of its battle with German peer Mercedes to be the worlds largest luxury car maker. II. PESTEL Analysis for BMW; its impact and how these influenced its strategy Organisations, such as BMW, need to look into the macro environment in which they exist, as these factors will have an impact and influence upon their industry. The macro environment is broken up into six main categories forming the PESTEL analysis. Automobile manufacturers must identify and select the issues which are most important to their industry in order to conduct a valid external analysis. Political/ Legal Factors Trade barriers and restrictions, import tariffs and tax policies are critical factors to consider especially for global manufacturers as they can influence the pricing levels of their products in each market and affect the profitability of a company. Also, Environmental protection laws regarding the CO2 emissions; In 2007 the European Commission proposed binding rules to cut CO2 emissions on new cars to 130 gms/km and it shows Porsche whose cars have highest CO2 output fell 2% as a result and average BMW emissions drop to 170g/km. With the threat of legislation looming BMW has shown that even premium car makers can seriously reduce CO2, stated by Jos Dings, Transport and Environment Director. Please refer to Appendix IV: CO2 Emissions by Car Brand Economic Factors The overall economic health of the car industry will have a great effect on each of the industry players. Interest rates, exchange rates and the level of unemployment can also depress demand. Most importantly the level of consumers disposable income is a critical issue particularly for manufacturers such as BMW and Jaguar, who compete in the luxury car market, as an economic downturn can seriously damage sales and revenues. Socio-cultural Factors This is an important factor to consider especially with regard to the luxury car market such as BMW. The particular lifestyles of consumers determine which strategy the organisation should pursue in order to capture the needs of its market effectively. Levels of education also affect the industry, as a highly skilled labour force is required in order to produce high performance and excellently engineered cars. Other factors are the Population demographics, Income distribution, Social mobility, Attitudes to work and leisure and Environmental concern of the market. Technological With many organisations competing with one another innovation and technological developments can help differentiate the companys product. Years ago the level of technology that was available, limited and restricted the models and designs car manufacturers could produce. Nowadays, technology has significantly moved on and companies can deliver more and more to their customers resulting in fierce competition amongst industry players to stay ahead of the market and be the best. By incorporating the latest technology advancements, car producers can lead the market in this field and achieve a competitive advantage. Environmental Although not a major driving force, manufacturers must be aware of the advantages in producing cleaner cars as there is now greater emphasis on protecting the environment. BMW have taken this into consideration and launched their Hybrid model. The result is a reduction in fuel consumption by up to 20 per cent compared with a comparable BMW running on a combustion engine alone or it could be driven by electric power only, on the combustion engine alone, or with a combination of both power units. III. BMWs competitive advantage According to Mr Lencioni, the car market was already full of good quality cars and consumers found very few ways to distinguish between many of the available brands and models. Quality was no longer an issue in the industry since most models were well built and reliable. Design and Brand Appeal became the distinguishing elements and customers choice factors. Companies that had given attention to the look of their automobiles, even this strategy can only make small gains, rather than losing market share. With this realisation, Design became the biggest factor in the fight for market share, as this feature grabbed customers attention. And with this action, automobile companies had to hire the most talented car designers which leads to massive costs for the company as well as the car prices. Pursuing quality and appeal in design was putting pressure on companies resources, so was brand building and management. It had become clear that a brand identity was one of the most effective ways to be more competitive in an industry where more and more products came to the market. BMW brand which is the circular blue and white logo represents an aircraft propeller. As company grew, the emblem evolved as the white and blue colours of the flag of Bavaria. The logo has made it easier for people to remember and has given the company more recognition. The BMW logo represents power, stylish and elegance, thus making BMW much more competitive in the market. Please refer to Appendix V: BMW logo. Apart from brand and design, BMW has able to survive through developing strong customer knowledge, special levels of service and access to distribution channels. Another method we could clearly understand the competitive advantage of BMW is through its strength of five forces. Please refer to Appendix VI: The Five Forces that Shape Industry Competition. Threat of new entrants Analyse shows that threat for new entrants is low mainly due to huge capital and cutting-edge technology. Car industry is highly depended on their suppliers, because of advancement of technology and materials needed to build car. Even though all firms produce cars, no two firms are totally different and no two firms are exactly the same. Strategic group maps display different competitive positions that rival firms occupy. Based on Information contained in perceptual map it is easy to notice that more and more firms are going into all sort of alliances which help to offer more and more cheap cars. Additionally, there are many substitutes, but these decrease if the special features of material increase. Bargaining power of suppliers and buyers Overall suppliers are weak because they are spread all over the world and cannot easily integrate forward, however more and more companies move into close partnerships with suppliers, even by acquiring them in order to reduce costs and exclusivity. The buyer concentration ratio and information availability is high as well as ratio of firms producing cars, on the other hand the power of buyers is weak due to low demand for non-consumer goods- automobile, high switching costs and low ability to backward integrate. The threats of substitutes are moderately strong because there are many different and less expensive transportation facilities. On the other hand, intense rivalry is strong because the major players are dominant in the market by nearly same technology and manufacturing processes, suppliers relationship and distribution systems. The ease of differentiating cars and price based competition. BMW is looking at entering into alliances, joint ventures, partnerships as it is the safest way of securing a market share, product attractiveness and competitive prices. In a decision to purchase a BMW product or that of the competitor, an individual will be influenced by a group of people that he or she wants to join; people in a certain social class or in a certain income level. There are also three factors that affect the buyer behaviour that a marketer must consider; they are social, personal and psychological. It will therefore be highlighted how these factors affect the consumer behaviour and in turn how the consumer behaviour affects the buying decisions. Competitive rivalry within industry BMWs attractive product variations were a very good source of strength. BMW is having a repetition of building a driving machine that respond really good and enjoyably to their drivers commands whilst also providing the safety, style, quality, reliability, and durability that help make long term ownership. On the other hand BMWs factories are measured very supple and most dynamic in Germany utilising the latest technology in each phase of its value chain. All the above strengths and many others has places BMW in a good position with respect to the main strong competitors in terms of performance, features, dealer networks , foreign markets, for example Lexus, Mercedes-Benz or Cadillac where rivalry among these competitors increases when they compete globally in US car market, Europe and Eastern Europe and South-east Asia, but BMW strong brand is more costly to be switched especially for quality conscious customers which makes strong competitors. Please refer to Appendix VII: Global ve hicle production and financial performance 2005-2006. Threat of substitute products The global marketplace is in jeopardy by lower car demand in North America and Western Europe, both comparatively established car markets that have been badly impacted by high-energy prices and very less consumer response. The global automotive market is extremely competitive. Many large businesses operate on a worldwide scale. Competitors are constantly trying to find new technologies and markets to increase global market share. Recent years have seen globalisation and consolidation strategies increase by competitors resulting in competition intensifying. BMW faces strong competition worldwide in the luxury saloon market. Traditional competition, which has always been strong from Mercedes and Audi, has intensified with the emergence of Lexus as a major player, along came Fords new model, Lincoln. IV. The future challenges for BMW BMW has modernised model almost after every few months that might shift emphasis on getting a new model to market rather than focusing on issues that may develop with existing models, issues such as software, and mechanical problems. Reflecting this possibility, BMW stock shares have dropped 41% in year 2002 as it was relying too heavily on one model, the 1 Series to uphold its high edge. BMW also earning profits due to the strong sales of the loaded models of the Mini but need to diversify, or in other words not keep all their eggs in one basket. Although this can also be identified as strength it can also be a true weakness. Strong competition with the major players that BMW needs to look out for, Lexus, Mercedes-Benz, Audi, and even Cadillac. As an example, the Lexus RX300 SUV rivals the BMW X5; the Mercedes E-Class still outsells the BMW 5 Series worldwide; Audi 3, 6 and 8 Series compete directly with BMWs 3, 5 and 7 Series; Cadillac which has a whole new generation of models, leaving buyers with strong power in building preferences. The 1 series may weaken the BMW trademark with comparison to 7 Series buyers, the 1 Series models may be viewed as cheaper cars with less quality. It could also be viewed as a tactic for BMW to obtain higher sales volumes. V. The Global Business Environment A combination of strategic models and frameworks will be used to critically evaluate the competitive landscape of the car industry in order to identify the prevailing conditions in the wider environment and the dynamics of the industry that can ultimately impact and influence HONDA and BMW car manufacturers. Car industry represents oligopolistic type of market with differentiated product features, unrestricted but hard to force entry barriers, strong competition and few dominant firms that hold most of market share. Governments rely on the car sector as well as related suppliers and services in terms of employment, taxation, GDP and balance of payments. Demand fluctuations are appearing between country markets. Increase in taxations of production which represents significant government revenue. In 1980 there were thirty car manufactures, by 2000 this had fallen to thirteen where smaller manufactures (Saab, Rolls Royce, Jaguar, and Volvo) were bought by larger companies (General Motors, BMW, Ford) Changing the upstream supply chain as component suppliers split into layers and become total solution providers. Full cell technology will replace safety as the number one technology issue. The volume of traffic in many cities around the world is forcing governments to consider a range of road pricing, congestion charging, and car and petrol taxation measures to encourage more use of public transport, potentially reducing demand for cars. High competition encourages manufacturers to locate plants in low-wage countries (Hungary, Brazil, Romania) generating job loss and resentment in traditional car manufacturing countries (Britain, America) Global demand has also emerged extensively. Please refer to Appendix VIII: Development in global demand in from the year 2004 to 2012. VI. Development and implementation of Business Strategy The automotive industry is always seeing new legislation appearing on matters such as safety and the environment. For example legislation on end of life of vehicles changed practices of many car manufacturers in 2002 and 2003 regarding materials used in car manufacture and other factors. BMW successful competitive strategies are grounded on the brand representation of BMW as a constructive and powerful; BMW reflects typically style, high value, up-to-date manufacturing and good performance to an object audience. Customer Feelings BMW is perceived as Quality Company and therefore seen as producing quality products. As a result, it is accepted among customers that BMW might charge higher prices. The BMW Group stays in fifth place amongst the worlds car manufacturers. Based on the external challenges, opportunities and potential future trends in the industry BMW should consider technological innovations looking at government policies concerning environmental issues. BMW should consider product innovation to reduce toxic emissions and to develop more efficient engines such as full cell technology which will replace standard car engines. BMW should consider all opportunities and take advantage of its strengths. Looking at the macro environment BMW should carefully examine world sales of cars, customers behaviour and shift in economy such as interest rates. For BMW to stay ahead in terms of competition and remain gaining market share, the company should understand the increasing weight in the global automotive market in developing countries and emerging markets. Collaboration between companies should be maximised in order for BMW to remain competitive and create strong links with suppliers due to soaring prices for steel, aluminium, precious metals and plastic. Cross boarder alliances and mergers should be considered by BMW in order to draw near to the Asian car manufacturers. BMW has noted that sales of its 7-Series model are up in the US, the product has been met with less enthusiasm in Europe. As Germany remains the companys most important market, this may be classed as a risk. A commonly held view is the radical restyling of the 7-Series has failed to excite the traditional BMW driver. This may be especially worrying given the releases of the new 5- and 6-Series models, as they are believed to have undergone restyling as well. If the designs prove to be too innovative or radical, the companys short-term growth could be seriously impacted. The risks associated with the introduction of a number of new models into an underperforming segment are only likely to increase the threat of failure within the segment. Competitive Strategy fitting with the Maturing Automotive industry Looking on the Automotive Industry in general we can see that it is in a maturing life cycle, where nearly all potential buyers are already users of the industry products, demand consists mainly of replacement, with growth totally depends on the competing firms abilities to attract new buyers and convince existing buyers to upgrade their usage, also the critical success factor (CSF) is mainly the cost efficiency. Throughout the firms Industry Life Cycles (ILC) many challenges faces the BMW corporate managers that needs to tailor BMW strategy , these changes on the strategy called the Strategy Fit , essentially managers will depend on certain input factors which are weighted when choosing the best strategy to fit the current ILC, these factors that affects managers decisions in choosing the company strategy depends on the industry life cycle phase introduction, growth, mature, decline, focusing on maturing and growth ILC phases as they are related to the selected companies. Maturing i ndustries challenges are mainly the slow growth in demand which generates more head to head competition, buyer become more sophisticated more familiar with competing brands with hard bargaining due to repeated purchases, for BMW more focus is on service and price combination competition, challenge of innovating new product feature of find further use of the product current features to keep attracting buyers attention. VII. BMW Strategic Effectiveness in the Market BMW took good steps in driving the costs down by focusing on the design and production, it activates Operation activity in the value chain, although the shared component is a good idea for cost reduction, but also BMW high different in the prices of its product series could be an important factor in customer perception to the concept of the product features and design, perhaps focusing more on other cost reduction areas and avoid disturbance to customer perception can be a recommended option . Based on the research it is possible to distinguish customers who follow standard patterns; buying affordable but comfortable medium size cars, are those aged between 20 and 40 years old, regardless of the sex but dependant on income and household status. These clients tend to have more urbanised and settled lifestyle. On the other hand those at middle age, male with high income and preferences tend to pay fortunes regardless comfort, fuel usage or environment issues. With regards to a variety of car models it is impossible to aim at mass market just with standard type of car. More applicable is a differentiated marketing strategy like those developed by GM, Ford and Daimler Chrysler which target clients at high and low income and offers cars with separate marketing and mixed variables. This strategy favours merger and acquisitions to overcome mobility barriers and gain presence also in luxury car segment. Strategic success for BMW in maturing industries by introducing a wide selection of features in the products, enhancing the industry value chain for example increase use of advanced technology, integrate the suppliers by internet to streamline various value chain activities, drive down unit cost, developing more economical product design, increasing sales to present customers using promotions or more services, acquiring rival firms at bargain price, expanding internationally, adapting core competency according to customer requirements and expectations and pushing it towards distinctive competency where the firm better then rivals . As part of BMW strategy tailoring by developing more economical product design, and focusing more on the technology innovation that reduces the cost in the overall value chain, for example BMW has been using new technology called RoDip-3, it is a new method for pre-treatment of the electro coating vehicle bodies that provides many enhancements and reduce cost to this process as explained by Christoph Klocke from BMW group. The first of these new pre-treatment and electro coating plants to be installed anywhere in the world is now operating in BMW group. Being one of the market leaders, BMW was very successful in adapting its Sales strategy with customer new needs and new preferences, BMW offered the BMW financial service to facilitate the customer financial payments utilising the Internet technology and many payments facilities. VIII. Conclusion In order for BMW to compete effectively within their industry, they must first identify which issues are critical in achieving successful competitive strategies. Decisions concerning the direction and development of the company must take into consideration the whole range of external issues, which have been covered throughout this report. The significant factors affecting BMW have been raised and are summarised below. These issues are critical to BMWs success. Size of organisation There are many acquisitions and mergers between industry players and so a small sized companies such as BMW must understand their vulnerability have merged with other companies to fight off industry giants. Mass market organisations also need to achieve economies of scale to remain profitable, whereas for manufacturers in the luxury niche markets this is not as vital as they charge premium prices and achieve very high profit margins. Quality of resources High quality of resources can help companies achieve a competitive advantage over others. Quality is seen as a key success factors to becoming successful within the market. Technology and Innovation Customers are demanding newer products and developments in technology and innovation can achieve this. Using the latest technology will once again strengthen the companys competitive position in the marketplace. Strong Brand image BMW has and can continue to build up a strong brand image through high quality resources. This is essential in the automobile industry as it creates a unique position in the marketplace and builds up customer loyalty making it difficult for other competitors to steal market share. Differentiation This is the key to survival. Companies can either differentiate themselves on price or through their unique characteristics of their products. 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The Soyuz 11 Space Disaster: a Case Study in Engineering Disasters

The Soyuz 11 Space Disaster: A Case Study in Engineering Disasters ENGG 123 November 20, 2011 ABSTRACT In 1971, Soyuz 11 was the first manned spaceship to contact the first space station. As the astronauts were preparing to re-enter the earth's atmosphere the crew cab depressurized and the astronauts were killed within seconds. This paper will discuss the events that happened and how they were investigated. It will also discuss how the disaster affected future engineering decisions regarding the Soyuz missions as well as other future space adventures. i Table of ContentsAbstract†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. i Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. ii List of Figures†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ iii 1. 0 Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 2. 1 What Happened†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3. 1 What Went Wrong†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 3. 2 What Was Learned†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 4. 0 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 8 Works Cited†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 9 List of Figures Figure 2. 1: a) a view of Soyuz 11 docked b) a view of Soyuz 11 taking off (Space Facts, n. . )†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 Figure 2. 2: a) seating chart for the astronauts b) the three astronauts inside Soyuz 11 c) astronauts preparing for takeoff (Space Facts, . n. d)†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 Figure 3. 1: a) map of the landing route for Soyuz 11 (Svens Space Page, n. d. )†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Figure 3. 2: a) Soyuz 11 after landing b) workers covering up the astronauts.. 7 ii Figure 3. : a) Funeral held for the three Soyuz 11 astronauts†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 1. 0 Introduction The purpose of this paper is to provide background and information on the Soyuz 11 space disaster. This disaster occurred in 1971 and took the lives of three astronau ts who took part in the first successful visit to the world's first space station. This paper will provide insight on how the disaster actually happened, what the causes were of this disastrous event. It will provide insight on how the events that occurred were investigated and also what was learned from these events and what changed. 2. 1 What HappenedUnless otherwise stated the information in this section is provided from About. com(n. d. ) 1 Salyut 1, a space station made by the Soviets was the first space station to ever be made. It was launched on April 19, 1971. It was a large cylinder with three compartments, could be used with or without people inside of it and it could only dock one spacecraft at a time. The primary use of this space station was to study the effects of long term space travel on a human body, as well as studying effects on growing plants.On April 19, 1971 Soyuz 10 was the first spacecraft to attempt a mission out to the space station however this mission wa s unsuccessful. As the space craft attempted to dock it failed so the astronauts had to return to earth. On the return the ships air supply turned toxic but only one man passed out, all three astronauts recovered fully. On 2 June 6, 1971 Soyuz 11 embarked on a journey to the space station. This ship was originally supposed to be manned by Valery Kubasov, Alexei Leonov, and Pyotr Kolodin. Just before the launch, Valery Kubasov was suspected to have tuberculosis so this crew was replaced by three other men.They were: Georgi Dobrovolski, Vladislav Volkov, and Viktor Patsayev. Soyuz 11 successfully reached the space station and managed to hand dock the ship once they were within 100 metres. Once docked, problems began to take over the mission. Instruments and telescopes were not working, cramped space made it hard to work, and personalities were clashing. A small fire had even broke out at one point. This is when the crew decided to cut the mission six days short and go home. Right afte r Soyuz 11 undocked and made its way back to earth, all communication with the crew was lost.This happened much earlier than was to be expected. The ship made its way to earth and was discovered on June 29, 1971. When it was opened, all three members of the crew were found dead. The following images are from Space Facts(n. d. ) Figure 2. 1: a) a view of Soyuz 11 docked b) a view of Soyuz 11 taking off (Space Facts, n. d. ) a b Figure 2. 2: a) seating chart for the astronauts b) the three astronauts inside Soyuz 11 c) astronauts preparing for takeoff (Space Facts, n. d) abc 3 3. 1 What Went Wrong Unless otherwise stated the facts provided in this section come from Engineering Failures(n. . ) All the people on earth at the time thought this was a normal re-entry of a space craft. However upon opening the capsule the discovered differently. It was obvious to the people there that the crew had suffocated. Located between the orbital module and the descent module was a ventilation valve. As the two modules had been separated this valve was forced open. The two modules were connected via explosive bolts, these bolts were intended to fire sequentially or one after the other, but they actually fired simultaneously or at the same time.Because of this there was extra force put onto internal parts of the space craft. The ventilation valve had been jerked open by all this extra force. This valve was intended to automatically adjust cabin pressure but because it was actually opened in outer space the cabin pressure of the space craft very quickly reached zero, a fatal pressure for the cabin to be at. This valve was located underneath of the astronauts chairs making it impossible for them solve the problem. One of the astronauts was wearing a suit with biomedical sensors that showed he died within 40 seconds of the pressure loss.It only took 935 seconds for the cabin to reach a pressure of zero. 4 The facts in the next paragraph are from abyss. uoregon. edu(n. d. ) What cau sed all this to go wrong was a poor design. It should have been placed in a more accessible place. When thoughts were going into its design it was thought that it would only need to be used in an emergency, however no one thought what would be happening that it would need to be closed. The valve was intended for emergency but proved no use in the emergency because it was inaccessible.This problem could have been solved if the design team performed more tests, however it is impossible for a design team of a safety device to know every single situation that could happen. The following is a quote from Geoff Perry, Senior Science Master at Kettering Grammar School. 5 â€Å"I picked up my first signals for over 7 days on 28 June around 2110 UT   – Salyut on 20. 008 MHz and assumed that recovery would take place on 29 June around 2000 UT. Consequently I set the alarm clock for 3. a. m. BST hoping to see two objects indicating that Soyuz-11 had separated from Salyut   but that was not to be.We had no signals during 29 June and when 2000 UT came and went I went off watch, but, fortunately, left the time switch to do the pass at 2230 and 0300 UT. I did not believe that the Russians would worry about a recovery in darkness at this time of the year, considering their usual precision landings. However, they did worry and Soyuz-11 went two extra revs to give a daylight recovery. The time switch recorded signals 45 s after it had operated with LOS at 2247:15 +/- 15 s (allowing for possible variations in mains frequency affecting the clockwork).Peter Bentley had banked on a daylight recovery and was listening at Menai Bridge and gives LOS at 2247:27 +/- 1 s (or, as he says, +/- 5 s for 99% accuracy). I have therefore adopted 2247:25 +/- 5 s as LOS and the time of separation of the descent module and instrument module. The tragedy must have occurred minutes, or even only seconds, later. Telemetry at LOS was normal for a Soyuz recovery†. (Svens Space Page, n. d. ) The following is a map taken from Svens Space Page (n. d. ) showing what information the Kettering group had received from Soyuz 11. Figure 3. : a) map of the landing route for Soyuz 11 (Svens Space Page, n. d. ) a 6 The following are images from after Soyuz 11 landed. Figure 3. 2: a) Soyuz 11 after landing b) workers covering up the astronauts a b Figure 3. 3: a) Funeral held for the three Soyuz 11 astronauts a 3. 2 What Was Learned 7 After this terrible and fatal accident much thought and consideration went into the next missions. First off the USSR never again attempted to send astronauts to the Salyut 1 space station. Eventually Salyut 1 was deorbited and burnt up. It took more than two years for another man mission to be attempted About. om(n. d. ) The Soyuz spacecraft went through a lot of modifications. The first main difference was that it was redesigned to only carry two astronauts instead of three. This allowed more room inside which allowed for the astronauts to wea r space suits during the launch and the landing. The Soyuz capsule remained this way until a new design in 1980 which allowed three astronauts. 4. 0 Summary The Soyuz 11 space disaster was an extremely unfortunate event. Three astronauts died from a malfunction that should have been fixable. This is a

Prone Positioning On Critically Ill Health And Social Care Essay

In my nursing experience, I have worked in both the neonatal intensive attention unit ( NICU ) and the paediatric intensive attention unit ( PICU ) . When I worked in the NICU, our babies were positioned prone ( face down ) for comfort grounds for the bulk of a 24 hr period. Our neonatologists seldom used sedation or trouble direction resources for our automatically ventilated patients. In the PICU I presently work in, all of our automatically ventilated patients are given uninterrupted medicines for both sedation and hurting, nevertheless prone placement is about ne'er used. When I have positioned patients prone in the past, most nurses look cross-eyed at me as though I have done something incorrect. Past research has suggested that prone placement is a curative manoeuvre that improves oxygenation in both paediatric and big patient populations ( Curley et al. , 2006 ) . However, some clinical tests in both paediatric and big populations have demonstrated that there is no betterment in clinical results for the patient ( Curley et al. , 2006 ) . In other surveies, when a patient is placed in the prone place, it has been shown that there is an increased in terminal expiratory lung volume and improved ventilator-perfusion fiting taking to better oxygenation ( Gattinoni et al. , 2001 ) . As you can see, there is assorted informations from many surveies proposing prone positioning leads to break clinical results for patients. Besides, as I was researching, I truly could n't happen a survey or literature that was new within the last 5 old ages. There is a current demand for updated research surveies and information. Hopefully I can carry through and add to the research with my proposed survey.Purpose, Aims, and HypothesissThe intent of this research survey would be to bring forth informations to assist infirmaries develop a policy, process and protocol for prone placement in critically sick, paediatric patients. The informations collected from this survey can add to the literature and hopefully convey current evidence-based pattern to PICUs across the state. Harmonizing to Polit & A ; Beck ( 2008 ) , purposes can be defined as the particular accomplishments a research worker would trust to accomplish by carry oning a research survey. My proposed survey has two specific research purposes.Aim 1To prove the effectivity of prone placement in automatically ventilated, critically sick paediatric patients, related to betterments in oxygenation.Aim 2To analyze techniques in airway direction of a automatically ventilated, critically sick paediatric patient, to find the safest nursing pattern in prone placement.HypothesissFor Aim 1, the hypothesis is that paediatric patients, who are critically sick and automatically ventilated, will hold better positive clinical results related to betterment in oxygenation in prone placement than in supine placement. The void hypothesis is that there is no difference in prone or supine placement in patient clinical results. For Aim 2, the hypothesis is that there will be safe techniques in airway direction in prone placement for the automatically ventilated, critically sick paediatric patient. The void hypothesis is that there is no safe technique in airway direction in the prone place based on continued, critical inauspicious events.BackgroundThe reappraisal of literature on the effects of prone placement in automatically ventilated patients has mixed ideas. Surveies conducted by Dr. Martha Curley and her research squad from Boston Children ‘s Hospital have refuted and so accepted the usage of prone placement in automatically ventilated, critically sick paediatric patients. Curley et Al. ( 2000 ) researched the physiologic alterations of automatically ventilated paediatric patients and evaluated the safety of prone placement who experienced acute lung hurt. The information was collected from a single-center prospective instance series from October 1997 to March 1999. The sample was 25 paediatric patients with bilateral paranchymal disease necessitating mechanical airing with a partial force per unit area of arterial oxygenation ( PaO2 ) to the fraction of divine O ( FiO2 ) ratio of less than or equal to 300 millimetres of quicksilver ( mm Hg ) ( Curley et al. , 2000 ) . The patient ‘s ages ranged from 2 months to 17 old ages. The participants were placed prone for 20 hours a twenty-four hours â€Å" until clinical betterment or decease occurred † ( Curely et al. , 2000, p. 156 ) . After run intoing eligible standards, informations collected consisted of arterial blood gases, critical marks ( temperature, bosom rate and arterial blood force per unit area, and cardinal venous force per unit area. Ventilator scenes and the figure of staff utilized and the clip it took to turn a patient were besides collected. The research workers besides collected informations on the medicine profile, particularly comfort medicines such as morphia and diazepam, and assessed force per unit area ulcers and presenting. â€Å" Features of the survey population are expressed as frequences, mean ( +/- SEM ) , or average with interquartile scopes ( IRQs ; 25th and 75th percentile ) † ( Curley et al. , 2000, p. 158 ) . The survey revealed that when prone place informations measurings were compared to the patient ‘s supine measurings, there were immediate and cumulative betterments in oxygenation ( Curley et al. , 2000, p. 161 ) . The research workers conclude that their survey suggests informations that prone placement is both safe and effectual in paediatric patients with ALI. Dr. Curley and her co-workers believe that this survey provides a foundation for a hereafter randomized survey to look into early and repeated prone placement for this paediatric population. Dr. Curley and her co-workers took on a prospective, multi-center randomized survey from August 2001 to April 2004. The hypothesis of this survey was that kids with ague lung hurt treated with prone positioning would hold more ventilator-free yearss than those treated with supine placement. Patients were included if they were age 2 hebdomads to 18 old ages old, intubated and automatically ventilated with a ratio of a PaO2 to FiO2 of 300 or less, bilateral pneumonic infiltrates, and no clinical grounds of left atrial high blood pressure ( Curley et al. , 2005 ) . Exclusion standards included patients less than 2 hebdomads of age, less than 42 hebdomads post conceptual age, had relentless hypotension or intellectual high blood pressure, cardiac related respiratory failure, and a figure of other medical conditions listed by the writers in their article. Of 8017 patients screened, merely a sum of 102 participants were included in the survey. A information and safety supervising board stopped the test at the interim analysis based on the futility fillet regulation. Ninety-four patients had completes the 28-day survey period. Of these 94, 47 were in each of the groups. After statistical analysis had been done, it was determined that if the survey had reached the planned registration of 180 patients, the chance of showing a difference in ventilator-free yearss between intervention groups was less than one per centum ( Curley et al. , 2005, p. 232 ) . The survey found that there was no statistically important difference of ventilator-free yearss between supine and prone placement in paediatric patients with acute lung hurt. Dr. Curley and her co-workers do non back up the continued usage of prone placement of paediatric patients as a curative intercession to better results in acute lung hurt ( Curley et al. , 2005, p. 236 ) . This province counters the research decisions drawn from Curley et Al. ( 2000 ) . Interestingly, Dr. Curley continued her research by executing a secondary analysis on this information collected in 2006. The intent of this secondary analysis was to depict the effects of prone positioning on airway direction, mechanical airing, enteric nutrition, hurting and sedation direction and staff use in paediatric patients with acute lung hurt ( Curley et al. , 2006 ) . The research workers suggest that their informations really shows that prone placement can be accomplished safely in critically sick paediatric patients. The research workers besides province that they believe patients can be safely assess and managed piece maintained in the prone place for drawn-out periods of clip, every bit long as 20 back-to-back hours ( Curley et al. , 2006, p. 417 ) . In this article on secondary analysis performed by Dr. Curley and her co-workers ( 2006 ) , they province that prone placement should go on to be used in critically sick kids as a enlisting manoeuvre in acute lung hurt to better oxygenation, lessening force per unit area wounds, and decreased bronchopulmonary compaction. These research workers besides province that this is the first survey to clearly show that prone placement can be accomplished safely. After researching prone placement in critically sick, automatically ventilated paediatric patients, I wholeheartedly agree. I believe that this is why these surveies could be replicated to assist formalize the protocols developed by Dr. Curley and her co-workers.SignificanceThe significance of a research survey on prone placement in paediatric patients is overpowering. In my ain personal experience, there has ne'er been grounds presented to my nursing co-workers or myself on whether prone placement is really safe and effectual. As ant ecedently stated, in reexamining the literature, there are really few clinical surveies that would be considered good mentions as true province of the art, evidence-based nursing pattern. In fact, I can non believe that merely Dr. Martha Curley has taken this undertaking on for the paediatric population. This proposed survey will be able to place the effectivity of prone positioning on improved oxygenation in a automatically ventilated paediatric patient. From survey informations aggregation, techniques in safe air passage direction could assist ease the usage of prone placement in paediatric patients of all ages and sizes and possibly advance more positive clinical results. In my survey, I hope to retroflex Dr. Curley ‘s methods utilizing her protocols, with some minor tweaking. This proposed survey should add to the organic structure of literature. The significance of this survey could assist formalize Dr. Curley ‘s protocols from her past surveies and besides assist make a criterion of pattern for prone placement.Research MethodsSample, Setting and RecruitmentThe mark population to be studied would be critically sick, paediatric patients runing from ages 2 hebdomads to 18 old ages of age. Inclusion standards will besides include patients with acute respiratory hurt necessitating cannulation and mechanical airing. Exclusion standards will be patients with respiratory hurt or failure of cardiac nature. Patients will besides be excluded if they have spinal instability or hold had abdominal surgery, as it would non be safe for these patients to be prone positioned. Patients with tracheotomies will be excluded. I would trust to include patients on conventional airing and high frequence hovering airing. Patients will be excluded if they weigh over 200 lbs, as the protocol will merely utilize three staff members to turn the patient, and this may be insecure in a patient of this size. The survey participants will be recruited from paediatric intensive attention units from infirmary centres willing to take part. In day-to-day unit of ammunitions, we would allow the paediatric critical attention doctors determine if the patient ‘s medical position was stable plenty to be eligible for survey standard. Randomization of patients will be done between prone placement and supine placement by utilizing a consecutive figure system. Centers will be provided envelopes with cards denominating between prone and supine placement and assign as each new participant is eligible. A sample size that would mirror Dr. Curley ‘s would be ideal. I hope to obtain at least 100 participants, but purpose for 200 participants. With 200 participants, the hope is to duplicate the original sample size, duplicate the figure of prone-to-supine and supine-to-prone bends, and increase the cogency of the research.Data Collection and InstrumentationFor my research survey, I hope to develop a systematic extension reproduction of the old surveies done by Dr. Curley and her research squad ( Curley et al. , 2000 ; Curley et al. , 2005 ; Curley et al. , 2006 ) . Dr. Curley and her co-workers ( 2006 ) developed a prone placement protocol for bedside nurses to follow in respects to analyze participants. The protocol is attached in Appendix1, nevertheless a brief drumhead is provided to assist assistance in the shaping of informations aggregation and instrumentality. When a patient has been met standards and is designated as eligible for the survey, informations will be collected based on the Pediatric Risk for Mortality III ( PRISM III ) ( Pollack et al. , 1997 ) . Demographics such as age, race, and ethnicity will be categorized. An anteroposterior thorax radiogram, in the supine place, should be obtained to document and guarantee that the endotracheal tubing ( ETT ) is positioned decently in the deep windpipe. The security of the ETT shall be assessed every bit good, based on the establishments current protocols. The size of the ETT, whether it is cuffed or uncuffed, and arrangement shall be paperss as Ten centimetres ( centimeter ) at the gum, as in â€Å" the patient has a 4.5 cuffed ETT, taped firmly at 12 centimeter at the gum † . The turnup of an ETT should be inflated with the minimum leak technique: inflate turnup until an air leak is ascultated at end-inspiration while maintain turnup force per unit area & gt ; 25 millimeter Hg ( Curley et al. , 2006, p. 420 ) . Security of the ETT and arrangement at the gum will be documented after each bend from the supine-to-prone and prone-to-supine placement every bit good as every 4 hours while in the prone place. The nurse or respiratory healer will doc ument whether or non the patient had a nonelective extubation during the bend. In respects to soothe and clamber unity, the patient ‘s should hold separately sized caput, thorax, pelvic, and leg shock absorbers to place the patients while prone ( Curley et al. , 2006, p. 419 ) . The end is to hold the patient positioned prone, with their shoulders, hips and lower limbs supported while their venters has room to stick out ( towards the bed ) and custodies can be tucked under the venters. The existent shock absorber will be difficult to set up, as every infirmary uses different positioning devices, nevertheless, I will offer the thoughts of slackly rolled covers or the Eggcrate stuff cut to the appropriate size. It will be documented if the patient has developed a force per unit area ulcer, and the ulcer will be staged harmonizing to National Pressure Ulcer Advisory Panel ‘s ( NPUAP ) description. The NPUAP ( 2007 ) established four phases of force per unit area ulcers. The first phase includes force per unit area sores that include non-blanchable inflammation, with integral tegument, normally over a cadaverous prominence. Phase two includes shoal, unfastened ulcers with a ruddy or pink pigmentation, without sheding of the tegument. Stage three ulcers include a full thickness tissue loss. Hypodermic fat is normally seeable at this phase and shedding may be present. In a phase four ulcer, the ulcer is stage three with seeable bone, musculus or sinew. A patient will stay positioned prone for 20 hours of the twenty-four hours and supine for 4 hours a twenty-four hours. The length of clip a patient is prone and supine will be recorded. Ongoing measurement will be done on all organic structure systems, including pneumonic and circulatory. Arterial blood gases will be obtained 1 hr prior to a patient being positioned prone and 1 hr after the patient has been prone. To maximise safety, staff will use bedside nurses and respiratory healers during chances for turning. The respiratory healer should be responsible for the unity of the tubing and turning the patients head, bedside nurse 1 shall be responsible for the turning of the shoulders, thorax and weaponries, and beside nurse 3 shall be responsible for the turning of the hips and legs. The prone positioning protocol that is attached as Appendix 1 which will be at the bedside of every patient for the nurses and respiratory healers to follow consequently.Datas AnalysisHarmonizing to Polit & A ; Beck ( 2008 ) , there are two wide categories of statistical trials, parametric and nonparametric. Parametric trials normally involve the appraisal of parametric quantities, require measurings on an interval graduated table, and presume that the variables for distributed usually for a population. These trials are frequently considered the most power and are normally preferred by research workers ( Polit & A ; Beck, 2008, p. 591 ) . Nonparametric trials do non gauge parametric quantities, normally used when the sample size is little or the information is considered non-normal. Figure 22.5 in Polit & A ; Beck ( 2008, p. 592 ) is a speedy mention for choosing bivariate statistical trials. Harmonizing to Polit & A ; Beck ( 2008 ) , the Fisher ‘s exact trial will be used to prove the significance of the differences in the two interventions ( Polit & A ; Beck, 2008, p. 601 ) . Fisher ‘s exact trial or x2 trial will be used to compare prone and supine groups in their baseline features and results that will be calculated on an single patient footing. Based on the categorical informations, such as the oxygenation of the patient, related to the arterial blood gases, I think a Fisher ‘s exact trial will be the best trial. The accidental extubation rate during bends will be calculated utilizing an exact binomial trial for comparing the rates of two Poisson procedures. For prone patients, Wald ‘s statistic, distributed as a qi square, will be calculated based on results evaluated after alterations in placement. The figure of staff utilized and the length of clip involved in the place turns will be analyzed utilizing signed rank trials such as a Wilcoxon rank trial. Once all information has been collected, synthesized and analyzed, the research will be drafted into a manuscript and submitted to the Pediatric Critical Care diary. Before the survey begins, it will be reviewed, and hopefully approved, by the IRB. Before a patient becomes a participant of the survey, written informed consent will be obtained from a parent or legal defender. Both female and male patients will be utilized, and the exclusion standard is entirely based on patient safety. The participants will be allocated to the prone and supine placement groups reasonably by utilizing random assignment. Complete decrease of prejudice can non be established because it will be impossible for the clinicians to non cognize whether or non their patient is positioned prone or supine. With the assorted placement protocols and adjustments with pressure-reducing stuffs, I hope to diminish the incidence of compromised tegument unity and uncomfortableness. This survey does non object, and encourages the usage of sedation and hurting medicines while the participants are automatically ventilated.

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