Free Essay

Tcp1 - Research Paper

In: English and Literature

Submitted By pepperdr11
Words 3720
Pages 15
Utilization of Continuous Electroencephalography in the Intensive Care Unit

TCP1 – Task 2 – Research Paper
Patients are admitted to the intensive care unit (ICU) of a hospital for a myriad of disease and injury conditions. Critically ill patients often present with a specific serious health issue that needs to be addressed, however, can often evolve to include secondary problems. Secondary cardiac issues develop from a long list of unrelated heart conditions, and as such, all ICU patients today are placed on bedside electrocardiogram (EKG) monitoring. Years of research, advancements in technology, and international implementation of the service has led to bedside EKG being the standard of care for all ICU patients, regardless of the primary diagnosis. The heart is not the only organ that can often have secondary issues. For decades physicians have tracked and noted secondary neurologic changes in their critically ill patients, but lacked research-based evidence on what caused the neurologic change onset, and how best to monitor and watch for those changes. Over the past two decades, a lot of research has been conducted looking into this specific issue. Research now suggests that the use of continuous electroencephalography (cEEG) for patient populations in the ICU is an effective, affordable, valuable, and prognostic diagnostic tool to evaluate cerebral function, detection of epileptic activity, and to monitor neurologic changes. Electroencephalography (EEG) is a diagnostic tool used to monitor activity of the brain, and has been in common practice since the 1960s (Koenig, Kaplan, & Thakor, 2006). The early use of EEG was solely evaluation of spontaneous electrical discharge from neurons on the brain, in order to detect for seizures and guide antiepileptic drug (AED) medication for management of seizures. EEG machines were once analog instruments, large and bulky in size. The electrical activity of the neurons were transmitted to the instrument, where finely calibrated ink pens would map out the speed and voltage of the activity, in a trace or pattern on a roll of paper. Advancements in computer technology has transformed the modern day EEG machine into a digital computer, where the patterns are now displaced and recorded on monitors small enough to sit at the bedside of a patient.
Just as the technology advanced, application of the service and utilization for additional monitoring reasons expanded as well. EEG testing began to be utilized to detect cerebral ischemia, assess level of consciousness, monitor sedation levels of patients in induced comas, and localize onset of epileptic activity for surgical resection of diseased cortical tissue (Harris, 2014). However, the utilization of the EEG was in a routine or intermittent length of time, capturing anywhere from thirty minutes to an hour of cortical activity, leaving roughly twenty-three hours of cortical activity unmonitored.
In the mid to late 1990s, neurologists from the University of California Los Angeles (UCLA) began to question the clinical efficacy of utilizing EEG monitoring on a continuous bases versus routine or intermittent length. Patients admitted to the ICU, who showed no clinical signs of seizure, failed to improve neurologically. Additionally, patients placed into medication induced comas following cardiac arrest, or those in unexplained comas, failed to wean successfully from ventilators and properly awaken. The neurologists began to order EEGs lasting longer than one hour, and were surprised to find that patients were suffering from nonconvulsive seizures (NCS) and of nonconvulsive status epilepticus (NCSE) (Vespa, Nenov, & Nuwer, 1999). In both of these situations, the brain is abnormally discharging electrically inducing a seizure, but showing no outward clinical manifestation. Undetected and untreated with AEDs, both situations are extremely dangerous and mortal.
The Vespa, Nenov, and Nuwer (1999) study stated the following:
Never before in the practice of neurology and neurosurgery has an emphasis on timely diagnosis and intervention been as poignant as in the past 2 years. At the same time, development of specialized intensive care units (ICUs) and stroke units has continued to burgeon, and framework of how to deliver care and when to deliver this care is evolving. It is in this context that continuous electroencephalographic monitoring (cEEG) and other forms of neurophysiologic monitoring have begun to develop at a time when timely information may be able to make a significant difference in outcome. (p.2). cEEG would now monitor the electrical activity of the brain for extended periods of time, typically twenty-four to seventy-two hours, providing physicians with a more complete picture of the cortical function of a patient, and the ability to track and manage neurologic care.
EEG testing is labor intensive, and the technical testing has to be carried out by a highly skilled technologist with expertise in the field of neurodiagnostics. The American Board of Registration of Electroencephalographic and Evoked Potential Technologists is the governing body that conducts the examination and testing for registration of an EEG Technologist (R. EEG T.). In the fifty years of credentialing technologists, there are fewer than 5500 R. EEG T. in the country (ABRET, 2015). This labor shortage creates limitations on hospitals to recruit and employ skilled technologists to provide the cEEG studies. In addition, the professional testing is conducted by a neurologist, usually fellowship-trained in epilepsy monitoring, who makes the final read and dictation of the EEG study. In order for a patient to receive a cEEG exam, the technologist applies twenty one specialized electrodes, in predetermined locations according to the international 10/20 system of measuring, performs a calibration of the machine and recording, and then monitors the continued real-time activity of the electrical output of the brain (ACNS, 2006). The neurologists is then responsible for review of the entirety of the study, and provides a professional interpretation of the patterns that are recorded, looking specifically for any abnormalities that may be present. This makes performing a cEEG test not only labor intensive, but time intensive as well.
Sensitive to the labor and time intensive aspects of providing cEEG, neurologists across the World began discussing which patient populations within the ICU would benefit the most from cEEG and have improved outcomes, narrowing the focus onto those patient populations. Dr. Lawrence J. Hirsch authored an article in late 2004 that listed six indications for cEEG monitoring. According to Hirsch (2004), “detection of NCS and NCSE, characterization of spells, assessment level of sedation following trends, management of burst-suppression in anesthetic coma, detection of ischemia, and prognostication” (p. 333), are the most common indications for cEEG monitoring. Expounding upon those six indications, the European Society of Intensive Care Medicine (ESICM), sought out to recommend specific critically ill patients in the ICU that should receive cEEG. The group decided to evaluate every article from the PubMed database that provided quality evidence-based indications where cEEG monitoring in the ICU would or would have increased the positive outcome for a patient. They focused on the underlying etiology that patients first presented to the ICU with, in an attempt to prevent secondary evolution of neurologic changes, and categorized them as to the objective cEEG would supply. The group first focused on Hirsch’s primary indication for utilizing a cEEG, detection of NCS and NCSE, and then systematically worked their way through each category. The result was that they recommended cEEG in the following patient etiology populations: traumatic brain injury, intracerebral hemorrhage, cardiac arrest, encephalitis, comatose patients without primary brain injury, post convulsive status epilepticus, and acute ischemic stroke. For the indication of detecting ischemia, the group recommended cEEG only for patients with a subarachnoid hemorrhage when a clinical examination is unreliable. For indication as a prognostic tool, the recommendation was for all cardiac arrest patients, unexplained comatose patients, and those with toxic and metabolic encephalitis (Claasen, et al, 2013).
The combination of Hirsch’s indications for cEEG and the ESICM group’s recommendation for specific patient populations allowed clinicians to now narrow the scope and utilization of cEEG testing and to prioritize which patients receive the limited personnel resources. Now that patient populations were identified, the next question became how long should the patients be hooked up and monitored to detect the primary indication for NCSs? A study conducted in 2004 retrospectively looked at 110 critically ill patients who had undergone cEEG for the detection of seizures. Of those, approximately 51% were successfully detected in the first hour of recording, 87% within the first 24 hours of recording, and 7% were not detected until more than 48 hours of monitoring. The primary contributing factor to the delay in detection was for patients who were in coma upon initial clinical exam. This study concluded that for patients in a non-coma status, 24 hours of cEEG would be adequate; however, in comatose patients, cEEG would need to be recorded for a minimum of 48 hours, and possibly longer (Kull & Hirsch, 2004). When cEEG it utilized for Hirsch’s other indications, such as assessment of level of sedation and prognostication, those durations are dictated by the management of care. When being used to assess the level of sedation induced by anesthetic drugs, the cEEG monitoring will be utilized for the duration that medication is continued, as directed by anesthesia, pharmacy, nursing, or physician management.
Although the cost of healthcare is an ever changing number, the overall cost of cEEG monitoring is approximately 1% of a patient’s total hospital cost. However, utilization of cEEG is more effectively measured as a cost-avoidance test. When cEEG is utilized, and physicians are able to more timely manage the secondary neurological insult of their patients, length of stay is dramatically decreased. In one study the median length of stay for traumatic brain injury patients with cEEG monitoring declined from 24.3 days to 13.6 days. Decreased patient stays helps to decrease overall hospital cost. The same study showed the average hospital cost declined from $88,690 to $49,578 (Vespa, Nenov, & Nuwer, 1999). Those are declines that are tangible and immediately have an impact on the financial state of a hospital institution. Non-tangible financial impacts though, are that once discharged and sent home, patients are able to rehabilitate and become active members of society again, working, producing, and consuming, all of which add financial gains downstream versus patients who were not monitored with cEEG and either remain in the hospital for longer periods of time, accruing more charges, or those that pass away and never leave.
With the efficacy of cEEG proven in terms of outcomes and finances, recommendations are needed to maximize the labor shortage while providing safe and effective technical monitoring. A staffing model was presented by staff members of Indiana University Health, the nation’s first hospital to provide real-time 24-7-365 coverage of cEEG monitoring. Their neurophysiology department is staffed by a team of technologists that operates on two 12-hour shifts, from 7:00 am to 7:00 pm and 7:00 pm to 7:00 am. The team supplies monitoring support to five facilities that make up their Academic Health Center, which includes an adult level 1 trauma center, the states only pediatric level 1 trauma center, the states only specialized epilepsy center, the nation’s largest adult Neurocritical care unit, and a combined seventeen ICUs. Administration established a protocol for monitoring, in order to maintain high patient safety, in a 4:1 patient to technologist ratio (Thomas, Curtis, Adams, Brown, & Lau, 2014). One technologist is able to real-time monitor the cEEG of up to four patients at any given time.
The American Neurodiagnostic Society (ASET) states “. . . in order to promote and maintain a safe patient environment and best practice in the Epilepsy Monitoring Unit, the patient should never be left unattended” (ASET, 2013). That means there needs to be personnel resources to provide the monitoring in the 4:1 ratio, with separate personnel able to provide the technical hookup and application of the EEG electrodes. A group from Duke University conducted research on determining the quality of electrode lead placement, when done by a nontechnologist compared to a technologist-applied hookup. The nontechnologists who lack the necessary education and skill training to provide a standard measured international 10/20 electrode hookup, instead utilized a special template system in the form of an electrode cap. The electrode cap was available in different sizes depending on patient head circumference, and the overlaying template showed nontechnologists precisely where and which electrodes to place. The nontechnologists were still given a brief period of training on identification of the particular electrodes, techniques for applying and securing the electrodes, and model heads to practice the application process prior to placing on live patients. The technologists applied their hookups according to standards set forth by the American Clinical Neurophysiological Society (ACNS) through a series of technical guidelines (ACNS, 2006). The EEG application was blind to the neurologists providing the professional reads. Analysis of the impedance for both forms of EEG hookup were tracked. Subjective quality assessments from the neurologists were also tracked. The results showed no significant difference in quality between those applied using the template versus the technologist-applied hookup (Kolls, et al, 2012). Skull deformities, ventriculoperitoneal shunts, open wounds, recent craniotomies, and several other scenarios would prevent a patient from being eligible for the template electrode cap application. However, there are many patients who have no cranial anomalies and utilizing ICU staff in the form of nurses or nurse aids, would free up the burden on the R. EEG T. to focus on continued patient monitoring. By allowing nontechnologists to provide the cEEG hookup, delay in initiating cEEG monitoring is also decreased.
There are additional technological challenges to providing cEEG monitoring, many of which are specific to the ICU setting. The ICU is an environment filled with advanced computer instrumentation, medical devices, equipment, and electrical machines. All of these combined make the ICU a high source for electrical artifact. All equipment that is powered through electrical means, leaks electrical current into the surrounding atmosphere. The EEG electrodes placed on the scalp are designed to pick up the electrical activity produced by the neurons of the brain, amplify the signal so it can be read, and transmit the signal back to the digital computer. When ICUs have large sources of electrical leakage, they can be picked up by the sensitive EEG electrodes and become a source of artifact on the EEG recording. There are precautions taken to minimize this electrical interference, such as grounding the recording machine, using specialized coated electrode wires, and applying filters on the digital equipment that cancel out and block electromagnetic artifact that is usually transmitted in 60 Hz noise (Kaplan, 2006). Electrical artifact is only one of many forms of artifact that can be transmitted and recorded on the EEG. Common sources of known artifact include: intravenous (IV) drip artifact, respirator artifact caused by artificial mechanical ventilation, sweat artifact caused by excessive patient perspiration of the scalp, muscle artifact caused by increased temporal tension and activity, ballistocardiographic artifact caused by pulsation of an artery near a recording electrode, movement artifact caused by nurses adjusting and cleaning the patient, and physiological artifact caused by chewing, talking and blinking. Identification and correlation of these artifacts, along with troubleshooting skills to eliminate them are essential to the quality and integrity of cEEG monitoring.
Due to the many volatile artifacts that can obscure or compromise the recording of cEEG, many neurologists advocate for, and support the use of, simultaneous time-locked video recording. Because the patient population in the ICU is often unable to provide an adequate oral clinical neurologic exam, and many of their seizures are from the nonconvulsive category, video cEEG allows the professional reader to correlate EEG activity with patient and environment activity. Some patterns observed while a patient is asleep or has their eyes closed can be considered normal, however, if the same pattern is seen during the waking state, the pattern would be deemed abnormal. Video cEEG allows the professional reader to visualize the patient and in this scenario determine if the patient’s eyes are in fact open or closed, awake or asleep. Many medications, including all barbiturates, cause a dramatic effect on the frequency and activity of the EEG. Video cEEG allows the professional reader to observe when medication was administered to the patient, and correlate with the exact time period that the EEG was altered or affected. When monitoring specifically for epilepsy, not all seizures manifest themselves into complete body jerking and thrusting. Some seizures are very subtle and consist of only small rhythmic movements, such as an index finger moving or the corner of the mouth twitching. It is for these reasons and more that Hirsch recommends video recording be mandatory in all cEEG at his facility, for every recording unless a technical reason makes it unavailable (Kull & Hirsch, 2004).
When patients are admitted to the ICU, one of the primary goals for all treating clinicians is to determine the prognosis in a timely manner. Prognostic data forecasts the likely outcome for the patient and their chance of either recovery or death. For many individuals and families, knowing the prognosis will help direct the course of action for determining lifesaving efforts. For clinicians, it helps determine what hospital resources, effort, and time to apply to patients to promote the best chance for recovery. A patient with a very poor prognosis receives less hospital resources and lifesaving effort compared to a patient with a very high or positive prognosis. Many variables combine together to help determine a patient’s prognosis. They include age, gender, diagnosis, imaging studies, lab results, and EEG. The EEG is a very valuable diagnostic tool that can help clinicians determine the prognosis, by associating certain patterns and grading them as to their influence on prognosis, similarly to how a Glasgow Coma Scale is used (Kramer, Jette, Pillay, Federico, & Zygun, 2012). One of the most highly sought patient populations to determine prognosis, is for patients who are comatose following cardiac arrest. Physicians will utilize the cEEG to look for specific patterns that are associated with poor outcomes. The EEG is classified according to pattern findings and given a grade between I and V, with I being high-grade outcome and V being low-grade outcome. Grade I would resemble a normal adult pattern activity dominant for alpha rhythm and reactive to stimulation. Grade V would be isoelectric, resembling a very flat EEG with no rhythm (Koenig, Kaplan, & Thakor, 2006). Between the spectrum I-V there are many additional patterns that aid in determining a patient’s prognosis and setting the time frame for recovery. Periodic lateralized epileptiform discharges, burst-suppression, triphasic waves, electro cerebral silence, and alpha and theta coma all support poor outcome for prognosis. Furthermore, the EEG can be noted to change dramatically during the course of monitoring and intervention by the clinical team. Burst suppression carries a poor prognosis when seen in a patient who is comatose following cardiac arrest, however, it is the desired pattern when a patient is strategically placed into a drug induced hypothermic state. It is not the single pattern during a lone time frame window, but the overall progression and evolution of the EEG as a whole that is best looked at when determining prognostic value.
The utilization of cEEG in the setting of the ICU is still a relatively new testing procedure, and not widely implemented across the nation. Research over the past two decades has transformed the test from merely a routine hour exam to detect for seizures, to a highly valuable diagnostic tool providing a real-time assessment and look into the function, ischemic, and electric activity of the brain, on a continuous basis. Advancements in computer technology, innovation in delivery and application of electrodes, declines in patient length of stay and total hospital costs, and the prognostic ability of the test, have all catapulted cEEG into becoming a growing standard of care for patients admitted in the ICU. There continues to be a personnel shortage of trained and registered EEG technologists, but staffing models have improved the maximization of technologist numbers while maintaining safe monitoring protocols. With the amount of research that continues to be conducted, the utilization of cEEG and its many valuable applications to clinical management of care will continue to expand.

References
ABRET – American Board of Registration of Electroencephalographic and Evoked Potential Technologists, (2015). Newly Certified Technologists. Retrieved 22 January 2015, from http://abret.org/employers/newly_certified/
ACNS – American Clinical Neurophysiology Society, (2006). Guideline One: Minimum Technical Requirements for Performing Clinical Electroencephalography. Retrieved 22 January 2015, from http://www.acns.org/practice/guidelines
ASET – The Neurodiagnostic Soceity, (2013). LTM Position Statement: long-term monitoring (LTM) for epilepsy. Retrieved 23 January 2015, from http://www.aset.org/i4a/pages/index.cfm?pageid=3992
Claassen, J., Taccone, F. S., Horn, P., Holtkamp, M., Stocchetti, N., Oddo, M., (2013). Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Medicine, 39, 1337-1351.
Harris, C., (2014). Neuromonitoring Indications and Utility in the Intensive Care Unit. Critical Care Nurse, 34[3], 30-40.
Hirsch, J. L., (2004). Continuous EEG Monitoring in the Intensive Care Unit: An Overview. Journal of Clinical Neurophysiology, 21[5], 332-340.
Kaplan, P. W., (2006). EEG MONITORING IN THE INTENSIVE CARE UNIT. American Journal of Electroneurodiagnostic Technology, 46, 81-97.
Koenig, M. A., Kaplan, P. W., & Thakor, N. V., (2006). Clinical Neurophysiologic Monitoring and Brain Injury from Cardiac Arrest. Neurologic Clinics, 24, 89-106.
Kolls, B. J., Olson, D. M., Gallentine, W. B., Skeen, M. B., Skidmore, C. T., & Sinha, S. R., (2012). Electroencephalography Leads Placed by Nontechnologists Using a Template System Produce Signals Equal in Quality to Technologist-Applied, Collodion Disk Leads. Journal of Clinical Neurophysiology, 29, 42-49.
Kramer, A. H., Jette, N., Pillay, N., Federico, P., & Zygun, D. A., (2012). Epileptiform Activity in Neurocritical Care Patients. Canadian Journal of Neurological Sciences, 39, 328-337.
Kull, L. L., & Hirsch, L. J., (2004). Continuous EEG Monitoring in the Intensive Care Unit. American Journal of Electroneurodiagnostic Technologists, 44, 137-158.
Thomas, J. A., Curtis, C. M., Adams, L. C., Brown, S. L, Lau, R. R., (2014). Indiana University Health Staffing Model for Neurotelemetry and Epilepsy Monitoring Unit Patient Populations: Part 1. Neurodiagnostic Journal, 54, 68-74.
Vespa, P. M., Nenov, V., & Nuwer, M. R., (1999). Continuous EEG Monitoring in the Intensive Care Unit: Early Findings and Clinical Efficacy. Journal of Clinical Neurophysiology, 16, 1-13

Similar Documents

Premium Essay

Research Paper

...Lesson Guide The Research Process In writing a research paper, you will use the skills you have already learned, such as summary, analysis, and synthesis. You will go beyond the readings in the text, however, to add breadth and depth to your paper. Depending on your topic, you might use library research for traditional sources, online research for Internet sources, field research, or a combination of the three. Each topic chapter provides a list of Research Activities at the end. These suggestions will guide you to source material outside the textbook and provide ideas for research papers. Additionally, make use of the topic chapter links provided on this Companion Website to find more readings on each subject. What follows is a list of the steps you will take in planning and writing a paper. Remember that writing is a recursive process; you will not necessarily follow these steps in this order, and you may find yourself backtracking and looping. Find a Subject. If a subject is not assigned to you, decide what subject you are going to research and write about. Your text provides you with a wealth of ideas to start with. Use it as a springboard for discovering ideas. Develop a Research Question. Formulate an important question that you would like to answer through your research. This helps you narrow and focus your topic. The answer to the research question will become your thesis statement. Conduct Preliminary Research. To help you narrow your topic further and to find......

Words: 917 - Pages: 4

Premium Essay

Research Paper

...ReaseachA SAMPLE RESEARCH PAPER/THESIS/DISSERTATION ON ASPECTS OF ELEMENTARY LINEARY ALGEBRA by James Smith B.S., Southern Illinois University, 2010 A Research Paper/Thesis/Dissertation Submitted in Partial Fulfillment of the Requirements for the Master of Science Degree Department of Mathematics in the Graduate School Southern Illinois University Carbondale July, 2006 (Please replace Name and Year with your information and delete all instructions) Copyright by NAME, YEAR All Rights Reserved **(This page is optional)** RESEARCH PAPER/THESIS/DISSERTATION APPROVAL TITLE (in all caps) By (Author) A Thesis/Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of (Degree) in the field of (Major) Approved by: (Name of thesis/dissertation chair), Chair (Name of committee member 1) (Name of committee member 2) (Name of committee member 3) (Name of committee member 4) Graduate School Southern Illinois University Carbondale (Date of Approval) AN ABSTRACT OF THE DISSERTATION OF NAME OF STUDENT, for the Doctor of Philosophy degree in MAJOR FIELD, presented on DATE OF DEFENSE, at Southern Illinois University Carbondale. (Do not use abbreviations.) TITLE: A SAMPLE RESEARCH PAPER ON ASPECTS OF ELEMENTARY LINEAR ALGEBRA MAJOR PROFESSOR: Dr. J. Jones (Begin the abstract here, typewritten and double-spaced. A thesis abstract should consist of 350 words or less including the heading. A page and one-half is approximately 350 words.) ...

Words: 3580 - Pages: 15

Premium Essay

Research Paper

...Research Article: IMPACT OF INTEREST RATE ON INVESTMENT Farhan Nawaz UNIVERSITY OF GUJRAT, PAKISTAN E-mail: 10050920-086@uog.edu.pk Waqas Akram UNIVERSITY OF GUJRAT, PAKISTAN E-mail: 10050920-084@uog.edu.pk Abstract: The main aim of this study is to investigate “the impact of interest rate on investment” in an economy. For this purpose three main variables are selected which are Interest rate, Income level and Investment. Two variables are independent (Interest rate and Income level) and One variable is dependent (Investment). The hypothesis of this study is that the Investment has a negative association with interest rate and Investment has positive relationship with income. Interest rate has negative effect on investment and investment has a positive relation with the income level. We use questionnaire for finding our results and questionnaire are filled by different students of business studies. We find that there is a Negative relation between the interest rate and investment. If our finding matches with economic theory and others researchers finding than policy makers can make better policies for the economy. Impact of interest rate on Investment Introduction: An interest rate is the rate at which interest is paid by borrowers for the use of money that they borrow from a lender. Interest rate is the cost of borrowing money. When interest rate increases the overall investment is reduces. Most of the businesses invest partially or wholly is......

Words: 1679 - Pages: 7

Premium Essay

Research Paper

...Rockwood School District Research Paper Guide Revised 2008 Table of Contents What is a Research Paper?................................................................................................................2 How to Efficiently, Effectively Conduct Research and Evaluate Sources .......................................3 What Types of Information to Collect ..............................................................................................6 How to Write Source Cards for a Research Paper ............................................................................7 How to Write Note Cards for a Research Paper .............................................................................11 How to Write a Thesis ....................................................................................................................14 How to Write an Outline ................................................................................................................15 How to Structure Writing in a Research Paper ...............................................................................16 How to Integrate Quotes .................................................................................................................17 Internal Documentation ..................................................................................................................18 Works Cited Page ..............................................................................

Words: 3304 - Pages: 14

Free Essay

Research Paper

...Research paper may refer to: * Academic paper (also called scholarly paper), which is published in academic journals and contains original research results or reviews existing results * Term paper, written by high school or college students * Thesis or dissertation, a document submitted in support of a candidature for a degree or professional qualification, presenting the author's research and findings A thesis or dissertation[1] is a document submitted in support of candidature for anacademic degree or professional qualification presenting the author's research and findings.[2] In some contexts, the word "thesis" or a cognate is used for part of abachelor's or master's course, while "dissertation" is normally applied to a doctorate, while in others, the reverse is true.[3] Dissertations and theses may be considered asgrey literature. The word dissertation can at times be used to describe a treatise without relation to obtaining an academic degree. The term thesis is also used to refer to the general claim of an essay or similar work. ------------------------------------------------- Etymology[edit] The term "thesis" comes from the Greek θέσις, meaning "something put forth", and refers to an intellectual proposition. "Dissertation" comes from the Latin dissertātiō, meaning "path". ------------------------------------------------- Structure and presentation style[edit] Structure[edit] A thesis (or dissertation) may be arranged as a thesis by publication or...

Words: 1243 - Pages: 5

Premium Essay

Research Paper

...Care Procedures This paper will critique a qualitative research study about how nurses manage patients who refuse nursing care procedures. These articles also explains how nurses view informed consent as not being essential to nursing care procedures. PROBLEM STATEMENT The clinical problem being examined in the research study is the way in which nurses obtain consent prior to administering nursing care procedures, and the way nurses manage patients who refuse any nursing care procedures. By stating that nurses “do not regard obtaining consent as an absolute requirement” also stating that “consent is preferred but no considered essential” the significance is established and a clinical problem identified (Aveyard, 2004). The author identifies the need for further education of nurses on the need to obtain informed consent for nursing care procedures, and the need for more research of this topic. The role of persuasion in situations of informed consent has been widely commented on. Many commentators argue that the health care provider has a duty not only to give information but also to persuade the recipient of care to accept the course of action considered most appropriate for the patients’ safety. PURPOSE and RESEARCH QUESTIONS The study clearly identifies the aim of the study as “to examine the way in which nurses manage patients who refuse nursing care procedures (Aveyard, 2004).” The study identifies two main purposes for the research study as: To examine......

Words: 902 - Pages: 4

Premium Essay

Research Paper

...Business Research Ethics Lilia Tenorio RES/351 University of Phoenix May 15, 2014 Albert Smothers Business Research Paper: Synopsis of the Enterprise Resource Planning (ERP) System Enterprise Resource Planning (ERP) System is a software system that supports and automates the business processes by providing timely and accurate enterprise-wide information for decision making (Vemuri & Palvia, 2006). This paper is based on the research article, "Improvement in Operational Efficiency Due to ERP Systems Implementation: Truth or Myth?" by the authors Vijay K. Vemuri and Shailendra C. Palvia, which will discuss the purpose of the ERP system along with explaining some of the problems under investigation, and by identifying the parties involved that conducted the investigation, and describing the methods and variables used in researching the ERP system. Although, a system such as, the ERP system is very much needed within a business, however, is the system efficient enough to be cost effective. By researching the ERP system, the idea will be whether the investment towards the system is worth having. "Good research generates dependable data that are derived by professionally conducted practices and that can be used reliably for decision making" (Cooper & Schindler, 2006, p.22). Define the Business Research and Purpose of ERP Vemuri and Palvia (2006) state, the purpose of researching the ERP system is to evaluate the improvement of operational efficiency due to......

Words: 953 - Pages: 4

Free Essay

Paper Research

...most students' careers when they are assigned a research paper. Such an assignment often creates a great deal of unneeded anxiety in the student, which may result in procrastination and a feeling of confusion and inadequacy. This anxiety frequently stems from the fact that many students are unfamiliar and inexperienced with this genre of writing. Never fear—inexperience and unfamiliarity are situations you can change through practice! Writing a research paper is an essential aspect of academics and should not be avoided on account of one's anxiety. In fact, the process of writing a research paper can be one of the more rewarding experiences one may encounter in academics. What is more, many students will continue to do research throughout their careers, which is one of the reasons this topic is so important. Becoming an experienced researcher and writer in any field or discipline takes a great deal of practice. There are few individuals for whom this process comes naturally. Remember, even the most seasoned academic veterans have had to learn how to write a research paper at some point in their career. Therefore, with diligence, organization, practice, a willingness to learn (and to make mistakes!), and, perhaps most important of all, patience, a student will find that she can achieve great things through her research and writing. This handout will include the following sections related to the process of writing a research paper: Genre- This section will provide an......

Words: 345 - Pages: 2

Premium Essay

Research Paper

...English 102— Research Paper Requirements and General Guidelines Dr. B. Bryant Office phone—671-6358 Office—Bldg. 1, room 119 E/ office 19 Research Paper due—May 2nd (Fri) 3:00 pm in my office It must contain copies of your research. 1. Your final paper needs to be 5-8 pages (not including “Works Consulted page”) in MLA format. NO PAPER UNDER 5 PAGES WILL BE ACCEPTED!!! 2. In your research folder—a folder that does not allow your research materials to fall out—you must have the following items: • Research Paper—11/25 • Rough Draft • Research proposal/outline due 4/24 for class time • COPIES OF YOUR RESEARCH! • Your paper must be sent to on safe assignment PLEASE NOTE: NO PAPER WILL BE ACCEPTED WITHOUT COPIES OF YOUR RESEACH! The paper will receive an F. 3. Research Materials—Included on your “Works Consulted” page, you must have at least 5 professional journal articles or books. You can have more; the research really depends on your topic. Also the research papers I gave you count as a source and Loot. 4. The journal articles can come from the internet, but make sure the article is a professional article with a thesis/research, not a general informational page. All internet articles must be cited as an internet source. You can use the museum websites and YouTube. 5. For books and articles in books, you must copy the title page, copyright page, table of contents and the......

Words: 628 - Pages: 3

Premium Essay

Research Paper About a Research Paper

...Research Paper about a Research Paper Name place Professor 05/22/11 Research Paper about a Research Paper Research is a way to formulate questions and ideas used to solve a give problem using of all sorts of sources to collect information that would generate a solution. Research in the simplest form could be presented as; my computer keeps rebooting. The research focus could involve looking threw the internet to find web help that addresses the same issue or finding a business that specialize in computer repair by doing a query for computer repair from online in your area or looking threw the phone book. In this instance, someone has prepared both sources with the intention to help find the answer from documented information (Booth, Colomb & Williams, 2008). Over centuries information and been collected in libraries all the information desired. The information age yielding the internet that contains information collected by others for others to answer questions and develop new questions, and find answers. Research papers are also used as a primary form of learning that begins in elementary school and used all threw college and beyond. Carriers have been built for the purpose of conducting research and writing research papers by teachers, scientists, writers, historians, lawyers, engineers – list is goes on. Educators have established the fact that formal research can be a tool used for learning, thinking and understanding......

Words: 1673 - Pages: 7

Premium Essay

Research Paper

...Organizing a Research Paper Introduction A research paper is a combination and ultimate result of an involved procedure that entails source evaluation, critical thinking, planning and composition. No matter its objectives, any research paper must attain some common goals. As such, organizing a research paper requires a systematic approach that will enable the researcher to accomplish the intended objectives of the research. Apart from addressing the needs of the assignment, a research paper should have a clear purpose, thesis and discussing the quantity as well as quality of sources. In order to gain experience in research writing, an individual must be familiar with the whole process involved in organizing a research paper. There are two types of research paper namely; * Argumentative research * Analytical research Although each type has its own specified format, they bear seven similarities when it comes to their organization; a. Collect printed sources and evaluate them Assemble materials such as scholarly articles, state documents and other useful sources with regard to the research question. Skim through them to get hint on their importance. One can also evaluate online materials since most of them have useful although random information. b. Choose a method for keeping notes You should keep notes on different index cards and ensure to indicate the title or author as this will enable you to recheck the information obtained from the source material. c. Use...

Words: 378 - Pages: 2

Free Essay

Research Paper

...Writing a Research Paper in Literary Studies1 The most important aspect to bear in mind is that you are writing a research paper and not an essay! This means that you are arguing a thesis with reference to secondary literature – it is essential that you conduct relevant research and that you integrate your findings into your paper. Things to keep in mind: • Your paper should have a well-defined topic and a precisely formulated argument. • Your approach should be recognizably systematic. • Your argument should remain relevant and clear-cut, consistent and coherent throughout. • Your secondary material should be discussed critically and documented accurately. • Writing is a process; you should constantly revisit and revise. DON’T FORGET TO PRINT, SIGN AND ATTACH THE “PLAGIATSHINWEIS”! First steps Many students neglect the preliminary work of the writing process, but if you give it sufficient attention the actual writing of your paper will be faster and more organized than if you just start writing. The most important thing is to be systematic in your approach. 1. Finding a topic Perhaps the most difficult part of any research paper is finding an adequate topic, formulating a title and making a coherent argument. Once you have decided on a topic or a title, which in literary studies will most likely involve a certain text, rephrase it as a question to guide your research. You should also think about the methodology you intend to apply to your analysis. • ...

Words: 3119 - Pages: 13

Premium Essay

Research Paper

...are required to apply IFRS. Ten years have passed, what is the effect of mandatory IFRS adoption on these countries, and how IFRS affect on earning management. In the paper, I will discuss this question based on some previous finding. Next, I will use IFRS 9 as a specific case for my conclusion. Finally, I will give my opinion on the effect of mandatory IFRS adoption on earning management. Key Words: Accounting Standard, earning management, IFRS, Financial Instrument, bank, impairment of asset, IAS39, IFRS 9 I. The effect of mandatory IFRS adoption on earning management 1.1 In 2012, Yi Lin Chua, Chee Seng Cheong. And Graeme Gould publish a article named “The Impact of Mandatory IFRS Adoption on Accounting Quality: Evidence form Australis. This article examines the impact of IFRS on accounting quality by focusing on threes perspectives: (1) earning management, (2) timely loss recognition, and (3) value relevance. In my paper, I will focus on earning management. First, the author talk about the reason he choose Australia. Because Australia is one of the first countries located outside of the EU that has mandated IFRS and is also the first non-EU adopting country that had fully prohibited an early adopting of IFRS prior to the 2005 mandate. After that, the article propose the three research hypotheses: HI: Earnings management has changed following the mandatory adoption of IFRS in Australia. H2: Timely loss recognition has changed following the......

Words: 2776 - Pages: 12

Free Essay

Research Paper

...Catalfano Writing Mode: Persuasive Research Due: Please upload your essay to turnitin.com by the assigned due date. Late papers will incur the typical 10% per day late grade deduction. Length: Between 700 and 850 words for College Prep students; between 850 and 1000 words for Honors students. Format: Typed, double-spaced, 10-point Times New Roman font. Grading: 60 points, graded according to the standard rubric. (Note: this paper will also require two or three “checkpoints,” each of which is worth 10 points.) Topic Selection: What do you care about? This is a persuasive research paper, which means you are taking a position on a contemporary issue that you care about and setting out to prove that your position is correct with strong, convincing sources. How many sources? * at least four sources for College Prep students * at least six sources for Honors students Of course, you need to set out to support an idea that is capable and worthy of being supported—not something completely obvious. Because one of the major course objectives is to write about what you believe in (as you find your writing voice), you will be allowed to choose your own topic for this persuasive research paper, so long as it is not a topic you have written about already for another class (remember: your intellectual and personal integrity should be important to you, so research something new to you, which is most of the “fun” of research). I must also approve your......

Words: 1960 - Pages: 8

Premium Essay

Research & Terminology Research Paper

... Research is defined as "studious inquiry or examination; especially : investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws" ("Research," 2012). It's said that research is one of the most important processes in the field of criminal justice. There are many ways to complete research which can cause the process of research to take the most time. This paper will discuss the different methods and the different terminology that is used in the criminal justice system. There are two common methods that are used in the criminal justice system and they are the qualitative and quantitative methods. As part of the readings, it was determined that there are so many different methods for researching. However, some of these research methods have never been heard of or people don't know anything about them. There are several steps that would need to be taken in order to complete the entire research cycle. The first term that will be discussed is Scientific Research, which means it's the "research into questions posed by scientific theories and hypothesis" ("Scientific Research," 2011). The most common research method that is used today is the scientific research method, which is used highly in the criminal justice system. Just about every aspect of the criminal justice system revolves around science. Doing......

Words: 599 - Pages: 3