Care Management and Outcomes improvement

Read the competencies/standards and identify key role functions of these two advanced nursing roles NP ( Nurse Practitioner) versus CNS(Clinical Nurse Specialist) Compare and contrast the similarities and differences between the two advanced nursing roles. Discuss how these two roles support professional practice as discussed in Koloroutis, Chapter 4? What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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Employee health and safety issues.

Research contemporary employee health and safety issues such as lack of sleep, bullying in the workplace, and other topics of personal interest. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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The most significant incident in the history of U.S.
Research the most significant incident in the history of U.S. commercial nuclear reactors. Briefly describe the incident, and highlight some of the primary types of public health emergencies the EMS leader should be aware of. Discuss thoroughly, using the course learning outcomes for this unit as a foundation to discuss the concepts. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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organizations plan for dealing with special populations

Hypothetically, you have been asked to review your EMS organizations plan for dealing with special populations, including children, during public health emergencies and make suggestions for improving the current plan. Compose a report of no less than two pages that first outlines the organizations current plan, and then give suggestions based on knowledge you have gained through this course and other outside scholarly sources, describing ways you can improve upon the current plan. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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Leadership Theory and Health Care

As Dr. Diane Mancino noted in this weeks media presentation, nurses, by their very nature, are leaders. They are leaders at the bedside, when interacting with a patients family members, in advocating for their patients, and when working on interdisciplinary teams. A nurse is responsible for many different aspects of a patients care to bring about positive change. When inefficiencies or problems are noted, the nurse must be an advocate and leader of change. Just how this is accomplished depends as much on the individual as the environment in which the change is required. This weeks media presentation and readings discussed different styles of leadership and leadership theory. Reflect on the information presented this week and on your own work environment. Then, respond to the following: Which theory of leadership do you think is most effective in todays health care environment? Why? How does ANAs Nursing: Scope & Standards of Practice influence nursing leadership? Support your response with references from the professional nursing literature. Readings (resoures) Course Text: Sullivan, E. J. (2013). Effective leadership and management in nursing. (8th ed.). Upper Saddle River: Pearson Prentice Hall. ?Chapter 4, Leading, Managing, Following This chapter explains how terms such as manager, leader, and supervisor are often used interchangeably, when, in fact, each role carries different responsibilities. This chapter explores the differences in these roles and contemporary leadership theories, and it concludes with an analysis of what makes effective leaders. Course Text: American Nurses Association. (2010). Nursing: Scope & standards of practice. Silver Spring, MD: American Nurses Association. Retrieved from the Walden Library databases. ?Introduction ?Scope of Nursing Practice ?Standard 12: Leadership The text begins by defining nursing and describing its evolution. Nursing is an ever-evolving field of study, a marriage between the hard sciences and traditional personal care. In the second section, Scope of Nursing Practice some of the new trends in nursing are discussed, including keeping up with technology and the ongoing debate on health care costs. Finally, Standard 12 outlines the measurement criteria for leadership. Course Text: Fowler, M. D., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association Silver Springs, MD: Nursesbooks.org Retrieved from the Walden Library databases. ?Introduction ?Provision 1? The Introduction section provides an overview of the history of nursings Code of Ethics, which has undergone many revisions since its informal beginnings. In this text, the author looks at these changes, analyzing why they were made and how they helped shape the current Code for nurses. Provision 1 builds off of this history, explaining how, through it all, the nurses paramount responsibility is to give care to all patients, regardless of differences. Clavelle, J. (2012). Transformational leadership: Visibility, accessibility, and communication. The Journal of Nursing Administration, 42(9), 345-346. Retrieved from the Walden Library databases. Heuston, M. & Wolf, G. (2011). Transformational leadership skills of successful nurse managers. The Journal of Nursing Administration, 41(6), 248-251. Retrieved from the Walden Library databases. Murphy, L. (2012). Authentic leadership: Becoming and remaining an authentic nurse leader. The Journal of Nursing Administration, 42(11), 507-512. Retrieved from the Walden Library databases. Wong, C., Cummings, G., & Ducharme, L.(2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. Retrieved from the Walden Library databases.

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Chaos and Complexity Theory in Health Care

Every organization must be considered the sum of its parts: the people, problems, and tools within it. Together, these parts shape the face of the institution and make it unique. When coming into a new organization, one should not presume that anything is so just because thats the way it was done at my other institution. Different organizations have varying structures and approaches to management, and newcomers may find the environment confusing at first. Consumers of health care expect predictable, safe, and quality care. Recall from the readings that organizational theory attempts to explain how organizations are structured and managed. Based on this weeks readings and what has been presented on organizational theory, respond to the following: Do chaos theory and complexity theory have any place in health care systems? Why or why not? Support your response with references from the professional nursing literature. Readings (resoures) Course Text: Effective Leadership and Management in Nursing (8th ed.) ?Chapter 2, Designing Organizations In Chapter 2, the authors discuss various forms of organizational theory and how to employ these theories in differing working environments. A leader should pay close attention to the needs of an institution, as well as to the culture of its workforce. This chapter gives several strategies for engaging the workforce so that they may feel like valued participants throughout the change process. ?Chapter 5, Initiating and Managing Change Chapter 5 examines the necessity for organizations to change to meet the needs of patients and to keep up with improvements in medicine. As the state of health care is always in rapid flux, nurses need to be leaders, bringing new ideas to their institutions. The chapter discusses change theories and connects them with the nursing process. Change strategies are also explored, as well as how to handle resistance. Course Text: Nursing: Scope & Standards of Practice Retrieved from the Walden Library databases. ?Standards of Nursing Practice This section provides an overview of the steps nurses take in patient care, from diagnoses to treatment. Emphasis is given to the nurses role as planner and strategist in devising a care program for the individual patient. Course Text: Guide to the Code of Ethics for Nurses: Interpretation and Application Retrieved from the Walden Library databases. ?Provision 2? Provision 2 states that the patient is the central figure in all nursing theories. The author explores the historical underpinnings of this provision and explains that nurses must approach each case as an ethical dilemma. They must strive to learn about their patients in order to provide care that is best for the patient, even if this care isnt a textbook solution. Diers, D., Hendrickson, K., Rimar, J., & Donovan, D. (2013). Understanding Nursing Units With Data and Theory. Nursing Economic$, 31(3), 110-117. Retrieved from the Walden Library databases.

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Pediatric Case Study

Answer a discussion board question to the following scenario. Review the facts of the case and discuss how you would find the evidence needed to address the clinical question. References must be from Nursing Journals The scenario is as follows: You are caring for an infant 4 days after cardiac surgery in the pediatric intensive care unit. Platelets and albumin were administered the night before becasue of the infants abnormal clotting profile. In consultation with the healthcare team, you remove the pulmonary artery catheter. You notice continuous ooze from the site and a marked deterioration in the patients condition. Cardiac tamponade is diagnosed, and the patient requires a reopening of the sternotomy and removal of 200 ml of blood from the pericardial sac. At the end of your shift, you wonder how rare such a complication is in the patient population and decide to look at the literature. Questions to consider: 1. to gather the evidence needed to address the clinical question how often does removing a pulmonary artery catheter contribute to cardiac temponade in infants within the first week after cardiac surgery. 2. Is there research out there and where can you find it. 3. Cochrane Collaboration data to transform practice settings, using the information/research gathered to implement projects that are based on such evidence. For example, searching the database for your practice questions will provide you with the most reliable research. Do you want your assignment written by the best essay experts? Then look no further. Our team of experienced writers are on standby to deliver to you a quality written paper as per your specified instructions. Order Now, and enjoy an amazing discount!!

Care Management and Outcomes improvement

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Care Management and Outcomes improvement

Read the competencies/standards and identify key role functions of these two advanced nursing roles NP ( Nurse Practitioner) versus CNS(Clinical Nurse Specialist) Compare and contrast the similarities and differences between the two advanced nursing roles. Discuss how these two roles support professional practice as discussed in Koloroutis, Chapter 4? What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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13.8
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13.8
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Employee health and safety issues.

Research contemporary employee health and safety issues such as lack of sleep, bullying in the workplace, and other topics of personal interest. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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The most significant incident in the history of U.S.
Research the most significant incident in the history of U.S. commercial nuclear reactors. Briefly describe the incident, and highlight some of the primary types of public health emergencies the EMS leader should be aware of. Discuss thoroughly, using the course learning outcomes for this unit as a foundation to discuss the concepts. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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organizations plan for dealing with special populations

Hypothetically, you have been asked to review your EMS organizations plan for dealing with special populations, including children, during public health emergencies and make suggestions for improving the current plan. Compose a report of no less than two pages that first outlines the organizations current plan, and then give suggestions based on knowledge you have gained through this course and other outside scholarly sources, describing ways you can improve upon the current plan. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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Leadership Theory and Health Care

As Dr. Diane Mancino noted in this weeks media presentation, nurses, by their very nature, are leaders. They are leaders at the bedside, when interacting with a patients family members, in advocating for their patients, and when working on interdisciplinary teams. A nurse is responsible for many different aspects of a patients care to bring about positive change. When inefficiencies or problems are noted, the nurse must be an advocate and leader of change. Just how this is accomplished depends as much on the individual as the environment in which the change is required. This weeks media presentation and readings discussed different styles of leadership and leadership theory. Reflect on the information presented this week and on your own work environment. Then, respond to the following: Which theory of leadership do you think is most effective in todays health care environment? Why? How does ANAs Nursing: Scope & Standards of Practice influence nursing leadership? Support your response with references from the professional nursing literature. Readings (resoures) Course Text: Sullivan, E. J. (2013). Effective leadership and management in nursing. (8th ed.). Upper Saddle River: Pearson Prentice Hall. ?Chapter 4, Leading, Managing, Following This chapter explains how terms such as manager, leader, and supervisor are often used interchangeably, when, in fact, each role carries different responsibilities. This chapter explores the differences in these roles and contemporary leadership theories, and it concludes with an analysis of what makes effective leaders. Course Text: American Nurses Association. (2010). Nursing: Scope & standards of practice. Silver Spring, MD: American Nurses Association. Retrieved from the Walden Library databases. ?Introduction ?Scope of Nursing Practice ?Standard 12: Leadership The text begins by defining nursing and describing its evolution. Nursing is an ever-evolving field of study, a marriage between the hard sciences and traditional personal care. In the second section, Scope of Nursing Practice some of the new trends in nursing are discussed, including keeping up with technology and the ongoing debate on health care costs. Finally, Standard 12 outlines the measurement criteria for leadership. Course Text: Fowler, M. D., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association Silver Springs, MD: Nursesbooks.org Retrieved from the Walden Library databases. ?Introduction ?Provision 1? The Introduction section provides an overview of the history of nursings Code of Ethics, which has undergone many revisions since its informal beginnings. In this text, the author looks at these changes, analyzing why they were made and how they helped shape the current Code for nurses. Provision 1 builds off of this history, explaining how, through it all, the nurses paramount responsibility is to give care to all patients, regardless of differences. Clavelle, J. (2012). Transformational leadership: Visibility, accessibility, and communication. The Journal of Nursing Administration, 42(9), 345-346. Retrieved from the Walden Library databases. Heuston, M. & Wolf, G. (2011). Transformational leadership skills of successful nurse managers. The Journal of Nursing Administration, 41(6), 248-251. Retrieved from the Walden Library databases. Murphy, L. (2012). Authentic leadership: Becoming and remaining an authentic nurse leader. The Journal of Nursing Administration, 42(11), 507-512. Retrieved from the Walden Library databases. Wong, C., Cummings, G., & Ducharme, L.(2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. Retrieved from the Walden Library databases.

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Chaos and Complexity Theory in Health Care

Every organization must be considered the sum of its parts: the people, problems, and tools within it. Together, these parts shape the face of the institution and make it unique. When coming into a new organization, one should not presume that anything is so just because thats the way it was done at my other institution. Different organizations have varying structures and approaches to management, and newcomers may find the environment confusing at first. Consumers of health care expect predictable, safe, and quality care. Recall from the readings that organizational theory attempts to explain how organizations are structured and managed. Based on this weeks readings and what has been presented on organizational theory, respond to the following: Do chaos theory and complexity theory have any place in health care systems? Why or why not? Support your response with references from the professional nursing literature. Readings (resoures) Course Text: Effective Leadership and Management in Nursing (8th ed.) ?Chapter 2, Designing Organizations In Chapter 2, the authors discuss various forms of organizational theory and how to employ these theories in differing working environments. A leader should pay close attention to the needs of an institution, as well as to the culture of its workforce. This chapter gives several strategies for engaging the workforce so that they may feel like valued participants throughout the change process. ?Chapter 5, Initiating and Managing Change Chapter 5 examines the necessity for organizations to change to meet the needs of patients and to keep up with improvements in medicine. As the state of health care is always in rapid flux, nurses need to be leaders, bringing new ideas to their institutions. The chapter discusses change theories and connects them with the nursing process. Change strategies are also explored, as well as how to handle resistance. Course Text: Nursing: Scope & Standards of Practice Retrieved from the Walden Library databases. ?Standards of Nursing Practice This section provides an overview of the steps nurses take in patient care, from diagnoses to treatment. Emphasis is given to the nurses role as planner and strategist in devising a care program for the individual patient. Course Text: Guide to the Code of Ethics for Nurses: Interpretation and Application Retrieved from the Walden Library databases. ?Provision 2? Provision 2 states that the patient is the central figure in all nursing theories. The author explores the historical underpinnings of this provision and explains that nurses must approach each case as an ethical dilemma. They must strive to learn about their patients in order to provide care that is best for the patient, even if this care isnt a textbook solution. Diers, D., Hendrickson, K., Rimar, J., & Donovan, D. (2013). Understanding Nursing Units With Data and Theory. Nursing Economic$, 31(3), 110-117. Retrieved from the Walden Library databases.

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Pediatric Case Study

Answer a discussion board question to the following scenario. Review the facts of the case and discuss how you would find the evidence needed to address the clinical question. References must be from Nursing Journals The scenario is as follows: You are caring for an infant 4 days after cardiac surgery in the pediatric intensive care unit. Platelets and albumin were administered the night before becasue of the infants abnormal clotting profile. In consultation with the healthcare team, you remove the pulmonary artery catheter. You notice continuous ooze from the site and a marked deterioration in the patients condition. Cardiac tamponade is diagnosed, and the patient requires a reopening of the sternotomy and removal of 200 ml of blood from the pericardial sac. At the end of your shift, you wonder how rare such a complication is in the patient population and decide to look at the literature. Questions to consider: 1. to gather the evidence needed to address the clinical question how often does removing a pulmonary artery catheter contribute to cardiac temponade in infants within the first week after cardiac surgery. 2. Is there research out there and where can you find it. 3. Cochrane Collaboration data to transform practice settings, using the information/research gathered to implement projects that are based on such evidence. For example, searching the database for your practice questions will provide you with the most reliable research. Do you want your assignment written by the best essay experts? Then look no further. Our team of experienced writers are on standby to deliver to you a quality written paper as per your specified instructions. Order Now, and enjoy an amazing discount!!

Care Management and Outcomes improvement

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. Care Management and Outcomes improvement

Care Management and Outcomes improvement

Read the competencies/standards and identify key role functions of these two advanced nursing roles NP ( Nurse Practitioner) versus CNS(Clinical Nurse Specialist) Compare and contrast the similarities and differences between the two advanced nursing roles. Discuss how these two roles support professional practice as discussed in Koloroutis, Chapter 4? What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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13.8
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13.8
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Employee health and safety issues.

Research contemporary employee health and safety issues such as lack of sleep, bullying in the workplace, and other topics of personal interest. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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The most significant incident in the history of U.S.
Research the most significant incident in the history of U.S. commercial nuclear reactors. Briefly describe the incident, and highlight some of the primary types of public health emergencies the EMS leader should be aware of. Discuss thoroughly, using the course learning outcomes for this unit as a foundation to discuss the concepts. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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organizations plan for dealing with special populations

Hypothetically, you have been asked to review your EMS organizations plan for dealing with special populations, including children, during public health emergencies and make suggestions for improving the current plan. Compose a report of no less than two pages that first outlines the organizations current plan, and then give suggestions based on knowledge you have gained through this course and other outside scholarly sources, describing ways you can improve upon the current plan. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers

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Leadership Theory and Health Care

As Dr. Diane Mancino noted in this weeks media presentation, nurses, by their very nature, are leaders. They are leaders at the bedside, when interacting with a patients family members, in advocating for their patients, and when working on interdisciplinary teams. A nurse is responsible for many different aspects of a patients care to bring about positive change. When inefficiencies or problems are noted, the nurse must be an advocate and leader of change. Just how this is accomplished depends as much on the individual as the environment in which the change is required. This weeks media presentation and readings discussed different styles of leadership and leadership theory. Reflect on the information presented this week and on your own work environment. Then, respond to the following: Which theory of leadership do you think is most effective in todays health care environment? Why? How does ANAs Nursing: Scope & Standards of Practice influence nursing leadership? Support your response with references from the professional nursing literature. Readings (resoures) Course Text: Sullivan, E. J. (2013). Effective leadership and management in nursing. (8th ed.). Upper Saddle River: Pearson Prentice Hall. ?Chapter 4, Leading, Managing, Following This chapter explains how terms such as manager, leader, and supervisor are often used interchangeably, when, in fact, each role carries different responsibilities. This chapter explores the differences in these roles and contemporary leadership theories, and it concludes with an analysis of what makes effective leaders. Course Text: American Nurses Association. (2010). Nursing: Scope & standards of practice. Silver Spring, MD: American Nurses Association. Retrieved from the Walden Library databases. ?Introduction ?Scope of Nursing Practice ?Standard 12: Leadership The text begins by defining nursing and describing its evolution. Nursing is an ever-evolving field of study, a marriage between the hard sciences and traditional personal care. In the second section, Scope of Nursing Practice some of the new trends in nursing are discussed, including keeping up with technology and the ongoing debate on health care costs. Finally, Standard 12 outlines the measurement criteria for leadership. Course Text: Fowler, M. D., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association Silver Springs, MD: Nursesbooks.org Retrieved from the Walden Library databases. ?Introduction ?Provision 1? The Introduction section provides an overview of the history of nursings Code of Ethics, which has undergone many revisions since its informal beginnings. In this text, the author looks at these changes, analyzing why they were made and how they helped shape the current Code for nurses. Provision 1 builds off of this history, explaining how, through it all, the nurses paramount responsibility is to give care to all patients, regardless of differences. Clavelle, J. (2012). Transformational leadership: Visibility, accessibility, and communication. The Journal of Nursing Administration, 42(9), 345-346. Retrieved from the Walden Library databases. Heuston, M. & Wolf, G. (2011). Transformational leadership skills of successful nurse managers. The Journal of Nursing Administration, 41(6), 248-251. Retrieved from the Walden Library databases. Murphy, L. (2012). Authentic leadership: Becoming and remaining an authentic nurse leader. The Journal of Nursing Administration, 42(11), 507-512. Retrieved from the Walden Library databases. Wong, C., Cummings, G., & Ducharme, L.(2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. Retrieved from the Walden Library databases.

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Chaos and Complexity Theory in Health Care

Every organization must be considered the sum of its parts: the people, problems, and tools within it. Together, these parts shape the face of the institution and make it unique. When coming into a new organization, one should not presume that anything is so just because thats the way it was done at my other institution. Different organizations have varying structures and approaches to management, and newcomers may find the environment confusing at first. Consumers of health care expect predictable, safe, and quality care. Recall from the readings that organizational theory attempts to explain how organizations are structured and managed. Based on this weeks readings and what has been presented on organizational theory, respond to the following: Do chaos theory and complexity theory have any place in health care systems? Why or why not? Support your response with references from the professional nursing literature. Readings (resoures) Course Text: Effective Leadership and Management in Nursing (8th ed.) ?Chapter 2, Designing Organizations In Chapter 2, the authors discuss various forms of organizational theory and how to employ these theories in differing working environments. A leader should pay close attention to the needs of an institution, as well as to the culture of its workforce. This chapter gives several strategies for engaging the workforce so that they may feel like valued participants throughout the change process. ?Chapter 5, Initiating and Managing Change Chapter 5 examines the necessity for organizations to change to meet the needs of patients and to keep up with improvements in medicine. As the state of health care is always in rapid flux, nurses need to be leaders, bringing new ideas to their institutions. The chapter discusses change theories and connects them with the nursing process. Change strategies are also explored, as well as how to handle resistance. Course Text: Nursing: Scope & Standards of Practice Retrieved from the Walden Library databases. ?Standards of Nursing Practice This section provides an overview of the steps nurses take in patient care, from diagnoses to treatment. Emphasis is given to the nurses role as planner and strategist in devising a care program for the individual patient. Course Text: Guide to the Code of Ethics for Nurses: Interpretation and Application Retrieved from the Walden Library databases. ?Provision 2? Provision 2 states that the patient is the central figure in all nursing theories. The author explores the historical underpinnings of this provision and explains that nurses must approach each case as an ethical dilemma. They must strive to learn about their patients in order to provide care that is best for the patient, even if this care isnt a textbook solution. Diers, D., Hendrickson, K., Rimar, J., & Donovan, D. (2013). Understanding Nursing Units With Data and Theory. Nursing Economic$, 31(3), 110-117. Retrieved from the Walden Library databases.

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Pediatric Case Study

Answer a discussion board question to the following scenario. Review the facts of the case and discuss how you would find the evidence needed to address the clinical question. References must be from Nursing Journals The scenario is as follows: You are caring for an infant 4 days after cardiac surgery in the pediatric intensive care unit. Platelets and albumin were administered the night before becasue of the infants abnormal clotting profile. In consultation with the healthcare team, you remove the pulmonary artery catheter. You notice continuous ooze from the site and a marked deterioration in the patients condition. Cardiac tamponade is diagnosed, and the patient requires a reopening of the sternotomy and removal of 200 ml of blood from the pericardial sac. At the end of your shift, you wonder how rare such a complication is in the patient population and decide to look at the literature. Questions to consider: 1. to gather the evidence needed to address the clinical question how often does removing a pulmonary artery catheter contribute to cardiac temponade in infants within the first week after cardiac surgery. 2. Is there research out there and where can you find it. 3. Cochrane Collaboration data to transform practice settings, using the information/research gathered to implement projects that are based on such evidence. For example, searching the database for your practice questions will provide you with the most reliable research. Do you want your assignment written by the best essay experts? Then look no further. Our team of experienced writers are on standby to deliver to you a quality written paper as per your specified instructions. Order Now, and enjoy an amazing discount!!

Care Management and Outcomes improvement

 

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