Clinical Audits and Handwashing free essay sample

Clinical Audit is a tool used to examine the practices of health care professionals implemented in a health care environment. Clinical audit can be defined as a clinically led initiative which seeks to improve the quality and outcome of patient care through clinicians examining and modifying their practices according to the standards of what can be achieved, based on the best available evidence’ (Morrell Harvey 1999). Audit has many benefits: increasing the quality of patient care directly, professional development, promoting teamwork, and demonstrating quality to purchasers and consumers (Gannon, 2004). In this assignment, using standard audit criteria the author will undertake a clinical audit in a general nursing area. Clinical Governance was introduced by the British government in 1998 Meal et al, 2004). Taylor and Jones (2006) recognise clinical governance as the framework that ensures that NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will develop. The introduction of Clinical Governance (National Assembly Wales, (2000) cited by Donaldson and Mullally, 2004) has placed increased emphasis on the use of audit to measure the implementation of policies and procedures relating to infection control. Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness (Tait, 2004). Tait (2004) also states that clinical governance requires changes at three levels: individual health care professionals need to embrace change, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams. Before carrying out an audit, the reasons for and benefits of carrying it out should be identified. Audits are carried out to ensure that practices are safely provided and evidence-based using current research. In order to undertake an audit, staff must be informed of the process of audit. Providing staff with sufficient information about an audit, including details about what it involves and how areas of poor practice will be dealt with, may help to increase practitioners’ willingness to participate in the project (Ashmore, 2005). Staff willing to carry out an audit must be educated on the process of audit, thus they should have an understanding of the stages of clinical audit. The author will proceed to discuss the stages of audit with reference to a clinical audit that was carried out while on clinical placement in the general setting. There are five stages of clinical audit. The first stage is to choose a topic for audit. In order to select a relevant topic the auditor must consider a few questions such as: is there evidence of a serious quality problem, for example patient complaints? Is the topic a priority for the organisation? Is the problem concerned amenable to change? Is it a situation that can be improved with a responsible amount of time and effort? (NICE, 2002). The topic selected for audit must be related to patient well-being. For the purpose of this assignment the topic of effective hand washing was chosen for audit. Prior to undertaking the audit, permission from patients, medical staff, nursing staff, healthcare assistants and house-keeping staff was obtained verbally. In the case of any medical procedure including clinical audit, informed consent must always be acquired (Van Dokkum, 2005). The second stage of the audit process is agreeing or reviewing standards. By working against either local or national standards, audit can prove effective in revealing practice that is either compliant or non-compliant. Before carrying out the audit, the author researched some relevant literature that contributed to the standard that was set for the audit. The World Health Organisation recommends hand-washing at five different points in contact with a patient: before patient contact, before aseptic task, after bodily fluid exposure, after patient contact and after patient surroundings contact (WHO, 2006). A study by Golan et al (2006), illustrates that hand hygiene compliance among nurses is lower than expectations. The standard set by the National Institute of Clinical Excellence (NICE) (2003), is that hands must be decontaminated immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated, and also that hands must be decontaminated, preferably with an alcohol-based hand rub unless hands are visibly soiled, between caring for different patients, or between different care activities for the same patient. According to Girou et al (2002), an alcohol-based solution is significantly more efficient in reducing hand contamination than antiseptic soap. These standards where used by the student to devised an audit eligible to measure them efficiently. In stage three of the audit, the assigned examiner in accordance with the audit tool must collect data from current practice. This data has to be as understandable as possible to achieve the correct results. The most effective way to audit is to develop a questionnaire that can assess a situation effectively. When developing an audit tool, it is important to keep it simple. Complex questions will over-complete the audit procedure and lead to inaccurate findings. The audit tool that the author developed was a questionnaire that contained questions with an answer that was either yes/no or non-applicable. The questions chosen for the audit tool where: 1. Do nursing staff use the correct procedure for decontaminating hands? 2. Do nursing staff thoroughly dry hands after decontamination? 3. Is hand hygiene performed prior to patient contact? 4. Is hand hygiene performed following patient contact? With the audit tool completed, the student set about observing practice. The student selected a time when the ward was really busy, so as to catch people off guard. The student observed ten instances of hand washing on the ward, nine of these instances where either preceded or followed with patient contact. All participants observed were nursing staff, and each individual was fully informed that the audit was going to take place. They were not, however, told when the audit was going to take place, in order to prevent simulation. With reference to the first question, 80% of the participants used the correct procedure to decontaminate their hands. With regards the second question, 100% of participants thoroughly dried their hands after decontamination. With regards to the third question, 40% of participants performed hand hygiene prior to patient contact however 100% of participants performed hand hygiene following patient contact. After all data is collected the next stage in the audit cycle can be followed. The fourth stage is where data and findings are compared with the set standards. This is where one can find out whether results meet the set standards or not. The results of this audit did not fully meet the initial standards as only 80% of the participants used the correct procedure to decontaminate their hands successfully. The NICE guidelines (2003) stated that hands must always be contaminated before and after patient activity and in this case 60% failed to follow hand hygiene procedures before patient contact whereas all participants successfully followed hand hygiene procedures after patient contact. Overall only 80% used the correct hand hygiene procedure when decontaminating hands. In the authors’ opinion, the percentage of participants that did not adhere to hand hygiene procedures prior to patient contact is extremely low and shows definite room for improvement. The Nursing and Midwifery Council (2002) state that staff must take care to avoid any act or omission that could reasonably be foreseen as likely to cause injury or harm to themselves or another, therefore, they must follow guidelines designed to reduce the risk of infection to both themselves and their patients. However the author feels that the overall percentage of participants that demonstrated the correct procedure for hand hygiene was satisfactory in this instance. Once results are analyzed and compared with standards the fifth stage of the audit process can be commenced. Stage five is where suggestions for improvement are explored and discussed. These changes are then implemented to bring about change in a certain situation that has been audited. Changes should be implemented with recent relevant evidence-based information. Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit (Reilly et al, 2002). Once these changes are implemented they must be monitored to prove that they are effective, efficient and applied appropriately in practice. For the purposes of this assignment, a few possible changes that could raise compliance with hand hygiene where discussed but not in fact executed. Cooper and Hewison (2002) believe that the use of audit in clinical health settings can bring about improvements in quality of care which is what every health care professional strives to achieve. The author purposes that training sessions for correct hand hygiene procedures are routinely scheduled and carried out by a trained infection control nurse for this ward with attendance records of staff that receive the training. From the records one can see how often the staffs’ knowledge of accurate hand hygiene is updated. An advantage of hand hygiene training routinely available on wards is that all staff will have evidence-based information on hand hygiene which will lead to more effective patient care. The author considers that routine training on the ward will increase staff awareness of hand hygiene and will also educate healthcare professionals to the correct timing and technique of hand hygiene. If this were to be implemented a follow up audit would have to be carried out to evaluate the effectiveness of the training. While the audit process proves effective in measuring practice against procedures there can be drawbacks to clinical audit. If the audit tool is too complicated results can be misconstrued which leads to false outcomes (Rostami et al, 2009). This can then mislead the reader into thinking that practice is either effective or non-effective with the set standards. If results from a particular audit are incorrectly obtained or recorded, preventative measures implemented due to them may be time consuming, expensive and can also cause a reduction in the quality of care patients receive as opposed to increasing the quality of care. When partaking in this audit the author found no huge restrictions during the collection or analysis of data however, the author felt that some of the participants where aware that the author was observing them thus influencing them to perform correct hand hygiene procedures. The author felt that there were no additive measures that could have been implemented to prevent this from occurring in this case. In conclusion, this assignment has discussed what is meant by clinical audit and what the functions of performing an audit are. Audits are carried out to measure the effectiveness of certain clinical procedures and to measure how well healthcare professionals adhere to policies and standards set specifically for any given area. The author also discussed using relevant literature the term of clinical governance. It basically means an approach to maintaining and improving the quality of patient care by observation of current practice within a health care environment that was brought about by the British government. In this assignment the author also discussed a clinical audit take was put into effect while on placement in a general setting. The author also discussed the five stages of audit while also referring to the audit that was carried out. Findings of the audit were reviewed and compared with standards and possible solutions for change were talked about. From the audit, the author can see that more emphasis should be placed on hand hygiene prior to and after patient contact. The author also believes that in order to carry out an audit the individual must be educated in the process of audit and willing to make the necessary changes for improving practice for patient care. The author would advise all health care professionals to update their knowledge of clinical audit by attending workshops and seminars on the topic of audit (Kinn et al, 1994).

All About Modernism Essay Topics

All About Modernism Essay Topics For instance, in college, you might be requested to compose a paper from the opposing viewpoint. In that instance, the topic will appeal to the majority of women since it's relatable. The first thing which you've got to understand about this kind of essay is the simple fact a very good topic will certainly go a very long way in aiding you to get as much marks from the paper as possible. Your persuasive essay needs to have a very clear plan, which will provide you an opportunity to focus on the most important elements of the work and put aside all of the minor arguments. The Tried and True Method for Modernism Essay Topics in Step by Step Detail The purpose of such essays isn't to demonstrate your knowledge, yet to exhibit the crucial thinking and analytical skills. Expository essay is a sort of assignment that demands demonstration of your research and reasoning skills on a specific topic. When it is all about figuring out how to compose an A P English synthesis essay, it's important to open the official AP website with the present requirements and study the grading rubric to comprehend what things to concentrate on. Actually, understanding how to compose a persuasive essay is a significant skill for students of various specialties. The 5-Minute Rule for Modernism Essay Topics Next, you are going to want to take into consideration how many categories there are. It's possible to go for an intriguing topic from any area of science. Such essay is based on a superior research and knowledge of all of the advantages and disadvantages of the chosen topic. At times, during your nursing program you are going to be asked to compose several essays and research papers. The New Angle On Modernism Essay Topics Just Released Persuasive essays are a fantastic method to encourage the reader to check at a particular topic in a different light. Essay about politics have become the most obvious option if you require a sure-fire sub ject. If you cannot come up with two or three, then you might need a new subject. Your subject will represent a wide whole. The Basic Facts of Modernism Essay Topics Professionals of the customized writing are here in order to help you! It can be easier than you think. If don't have any single idea about what to write about, look through the topics you've already passed in your textbooks. Besides persuasive topics, it is possible to also think about argumentative essay topics since they supply the exact same effect. List down all of the intriguing topics that you run into. These topics will be able to help you attain that. Most Noticeable Modernism Essay Topics The cost of an essay rides on the quantity of effort the writer has to exert. In summary, to learn to compose a great synthesis essay, a student should discover more regarding the area of research. Expository essay is a kind of paper that's super common for all degrees of education. If you would like to create a descriptive essay about your own personal experience, it could possibly be unusual and specific. If You Read Nothing Else Today, Read This Report on Modernism Essay Topics Therefore, before writing a GED essay your task is going to be to choose the subject of your research paper. Somehow, this issue of your upcoming essay is dependent on what you would like to do by your paper and the sources you rely on. Though, there are particular patterns that you are supposed to follow when you compose a descriptive essay. If you would like your persuasive essay to acquire the greatest possible scores, you should not merely focus on its key elements but also to the format and outline. How to Get Started with Modernism Essay Topics? The classical comprehension of logic dictates that two ideas can't contradict with each other, A and A can not exist at the identical moment. Once you choose the topic which suits you most, remember the reason you write your essay, concentrate on the main details to tell about in your text and don't neglect the value of senses and feelings in your essay. Any sort of violence entails negative consequences which are hard to prevent. Violence in a wide sense is using force on another which causes some sort of harm. The Modernism Essay Topics Stories There are obvious differences in the varieties of vacation destinations people chooseand in how folks view vacation generally speaking. Non-written sources are wise for inspiration. Among the useful strategies to keep in mind is that your sources ought to be somehow linked to one another. It's important to understand that essay topics are just basic ideas that leave you pondering a notion that might be a huge deal to another person. Actually, sources utilized for writing the synthesis essay ought to be perceived as building blocks using which you construct your distinctive idea. When looking for sources, you need to pay attention to the most relevant and exciting ones that fashion in which you will be in a position to develop a tentative collection of synthesis topics to write about, from which you'll have the ability to pick the best one. One of the most fascinating pieces of a classification essay is exploring the many ways which you can categorize the pieces of your subject. You may use several examples that can be found on the web free of charge.

Culture Of Vietnam And Pakistan Essays - Divorce, Women In Pakistan

Culture of Vietnam And Pakistan What is culture? Culture is set of learned behaviors, beliefs, attitudes, values, and ideas that are characteristic of a particular society or population. In this paper, I will compare and contrast Pakistani and Vietnamese culture. Furthermore, I will discuss what I have learned from this exercise. In Vietnam traditional role of the woman in society has been that of nurturer: to stay within the confines of the home for the purpose of caring for the family. In Pakistan and Vietnam women are raised and taught how to become good daughters, wives, and mothers. They are told that they must obey their husbands, respect their parents and their parents-in-law, and work hard to support the family. In Vietnam parents does not prefer their daughters to go to school or work in a position that is normally occupied by a man. Most of the women do not work. They stay home and look after their family. In Pakistan most of waves and daughters stay out of sight of other men because of the religion strictness. Pakistani women stay in the house, behind the veil, in special sections of buses, and in the "family" area of the restaurants. For Pakistani Muslims this is the way to show respect and devotion towards women. Pakistani does believe in education for their daughters and sons. However, sons get the first priority and higher education. Also girls must go to separate school from boys until she will reach University, which is 4 year in college. In other words, until she is engaged and mature enough not to fall in love with someone her parents restrict. In Vietnamese and in Pakistani culture, their older siblings arrange marriages. Marriage is more like compromise, which is made between two families. But as the time has changed girls are not forced to marry however when girl is the one to choose she will pick her companion base on love and family agreement. When parents choose a guy for their daughter it's usually the best offer which means that guy is educated, have stable future, and wealthy. But when girl is being picked parents want to have healthy, hard working daughter-in-law, who would take care of their family's welfare. A likely scenario under these circumstances is a marriage between a 17 years old girl and a 7-year-old boy. When that husband reaches adulthood, he would realize that his wife might be too old for him; and he would be entitled to take a younger girl as his second wife. Polygamy was accepted in Vietnam but remarriage for the wife is not allowed since, faithfulness to her first husband is required. Thus the first wife, being restricted by the old custom, must remain a lonely slave with her husband's family until her death. In Pakistani culture woman has no saying in any aspect of her life, including her own marriage, and when betrothed, belongs excessively to her husband's family. When guy's parents look for a mate for their son not that she has to be beautiful and well-mannered girl but also who will bring great amount of dowry. To all extents and purposes she is an alienable property, and once the bride price has been paid, she cannot be returned, whether in a state of divorce, separation or widowed. In both cultures girls must obey her in laws in order to gain respect in her husband's house. In Vietnam and in Pakistan family is very important. They have joint family system. After the marriage daughters move out of the house however sons stay with their parents atlongest they can. Family size in Vietnam is fairly large. Back in the days 12-16 was normal family size. However, as poverty and population has increased so the family size has decreased to 3-4. On other hand side, in Pakistan typical family size is about 3-5. In Pakistan and in Vietnam parents prefer to have sons than daughters. In both cultures Parents expect their children to be perfect and obedience. Therefore, strict physical punishment is used for discipline. Parents are usually very hard and strict on girls however they are flexible when it comes to boys. Parents are more protective about daughters and they expect girls to know and does everything for instance: cook, clean, sew, and in other words perfect in house chores. Guys are very spoiled, they get everything they want but they are expected to find perfect "angel" wives so she will obey her in laws. Also son is somewhat head of the family after the

Topic For Opinion Essay Writing

Topic For Opinion Essay WritingTopics for opinion essay writing. As an essay writer, you will often be asked to write a topic for an essay. In fact, this is one of the most common questions asked by both school and college teachers and examiners alike. The importance of creating a suitable topic is important because it will give the essay its style and 'voice'.A careful consideration of all the factors to consider in creating an appropriate topic is vital. First of all, you should decide on what kind of topic you want to write. Is it a research topic? If so, the important question to ask yourself is whether the topic is going to deal with data, research, findings, or even some other kind of data?Research topics are generally more interesting and detailed than opinion topics. If you want to write a research essay, the best strategy is to outline and choose the types of facts that you will explore. This way, you will be able to avoid going overboard in writing your topic and will get a chance to concentrate on what is more important - the research aspect.Writing an opinion essay will be different from a research essay. You will need to think about what you are writing about. It may well be that you find an interesting idea and have difficulty deciding what the best way to express that idea is. In this case, you might wish to consider using dialogue as a writing tool.Opinion essays will be likely to contain some statements about a specific subject or series of ideas. These should be presented in a brief, concise manner. An opinion essay will rarely be long enough to provide a full discussion of any subject or theory. If you feel the need to expound on an idea, you will need to write something that is shorter and more concise than your opinion essay will require.Some people enjoy writing essays about personalities or observations they have made about certain events. Such a topic can be difficult to write about, but it can be much easier to write about when you begi n by thinking about the person who might be writing it. Perhaps there are some personal beliefs that you feel strongly about, and they would help to shape the story. All these things can be reflected in the opinions of the author of the essay.For topics for opinion essay writing, you will want to consider that people are extremely varied in their opinions. It is therefore likely that the topic of the essay will change dramatically from one person to the next. So, while the idea may initially be for one person to write about their opinion about a particular issue, if the opinions of the people in the essay change and make their viewpoint more clear, the conclusion might be more suited to an opinion column. In either case, you should try to reflect the original idea in the form of an opinion essay.When you are asked to write a topic for an opinion essay, take some time to think about what you think is most appropriate to discuss. Remember that the topic should reflect the opinions of the people in the essay, so make sure that the essay reflects the author's opinions or points of view, rather than those of the reader.

Tips on How to Teach 4th Grade Essay Writing

Tips on How to Teach 4th Grade Essay WritingIf you want to know how to teach 4th grade essay writing, you have already come to the right place. First of all, you have to make sure that your students understand what is to be written on the paper. Then, the assignment should be discussed to them in a manner that it would be understood and they should be able to complete the project.The greatest challenge that most school children face when trying to write a paper comes from the fact that they feel awkward when it comes to writing because they don't know how to write properly. As such, they need to practice so that they would be able to figure out how to write something that they really want to write. In addition, there are certain things that they should remember while teaching 4th grade essay writing.The first thing that you should consider when it comes to writing a good essay for fourth grade is the basic writing skills. That is one of the basic things that you can start doing immed iately because you can train your students with this by doing some exercises with them. The techniques that you could use are those that will help your students achieve their writing goals. The basis of these exercises is the creativity and imagination of your students.As such, the fifth grade is the year that is considered as a turning point for the future of your students. This means that you need to do something to ensure that they are well equipped to take on challenges that they will face in the years to come. For example, you could ask them to write about a particular subject that you choose to study and then ask them to choose which facts they are going to include in their papers. Afterward, you should instruct them on what to write in their papers.This way, you would be able to make your students realize that you are the teacher who is the most knowledgeable in the subject and that you are theone who can actually make them become experts in the subject matter. Your students are not going to learn anything if they don't have any experience in studying a particular subject. Hence, you have to make sure that they are taught properly about the topic.You should be careful with the topic that you teach your students on the 4th grade because it can be very challenging for them. One of the things that you need to remember is that this is the age when they would get into subjects that are more complicated than what they have studied before. As such, you have to be sure that they have experienced the challenges that they will face once they go into subjects like chemistry, biology, biology or physics.Another important part of teaching your students is to make sure that they understand why they should write in the way that they do. For this, you can ask them to write in groups of two. You then ask them to listen to their classmates' paper and then give a response to it. Based on the responses that they give, you would be able to determine the best solution that t hey can do.These techniques are some of the ones that you can use in teaching fourth grade essay writing. The basic strategies are simply those that you could implement in order to make sure that your students could grasp the importance of making things understandable. As such, you should always make sure that your students will be able to put things down when they are finished.

Topic Of The Essay Topics Of The Tempest

Topic Of The Essay Topics Of The TempestThe topic of the essay you write should be one that you can write from your heart. If you can make a fresh topic for a final and it reflects you as an individual, you'll achieve success in writing a powerful essay topic of the tempest.First, it is a fact that essay topics for the tempest are done. But many students who did not get the top grades in the test often give up. This is because they don't feel they were able to show something new.Second, if you want to get a good topic for a final or essay topic of the tempest, you need to prepare your essay with careful selection of the topic of the tempest. One should take into consideration not only what he has learned but also what he knows about that subject. You can also learn by reading other essays of the tempest. These essays can help you determine which topic you can write about.Third, you need to make sure you can compose your topic in such a way that it can match the theme of the essay. If you take into account these three factors, you will have much better chances of achieving a good topic of the tempest. If you want to write a topic of the tempest that is going to be well received, you should keep in mind these three facts.Fourth, if you want to have an excellent topic of the tempest, you should set aside some time every day to work on it. While this will be your first priority, there are other things that you need to do first such as writing the research.Fifth, the topic of the essay topics of the tempest should reflect your professional skills. There is nothing wrong with being self-motivated if you have the ability to speak out your mind well. But if you have difficulty expressing yourself as well as others, it is better that you see a professional.Sixth, if you want to write an essay topic of the tempest, be honest. Be sure you explain everything with clarity so that others can know the truth about you.

The Costs Versus the Benefits of Illegal Immigration Essays

The Costs Versus the Benefits of Illegal Immigration Essays The Costs Versus the Benefits of Illegal Immigration Paper The Costs Versus the Benefits of Illegal Immigration Paper The Cost versus the Benefits of Illegal Immigration Every year thousands of people choose to leave their home country and come to the United States to start a new life. They dream of freedom and endless possibilities that they would never have in their home countries. Unfortunately, there are those who chose to disregard the law and come to this country illegally. It is estimated that there are 20 million illegal immigrants in the U. S. today. Illegal immigration affects our country in many ways. The cost of illegal immigration effects many aspects of our economy. One way in which our economy is affected is when an illegal immigrant is injured or sick and must go to the hospital. They often do not have the money to pay the bill, and the hospitals do not have a way to bill the patient as they are here illegally and either move often or give false information. The hospitals cannot refuse treatment, so this means that we, the taxpayers, must take on the burden of paying for those costs. Another affect illegal immigration has on our economy is the fact that migrant workers will work for less than minimum wage. This makes fewer jobs available for legal entry level citizens, which puts a huge strain on our economy. There is also the issue of securing our borders to keep illegal immigrants out. One of the newest resolutions to this issue is building a fence, which will cost a lot of money to build, maintain and defend. Another cost of illegal immigration is the cost of innocent American lives taken by illegal immigrants who drive without insurance or a license, and those affected by the gangs that have come out of Mexico, such as the Mexican Mafia and MS-13. One might ask, â€Å"Are there any benefits to illegal immigration? † Well, it depends on who you talk to. According to some groups, there are some pros to illegal immigration. Some think that it helps to keep the economy moving by filling low-wage jobs that many Americans do not want; it creates a bigger pool of customers for a variety of goods and services; farmers are able to plant and harvest their crops less expensively; millions of illegal’s rent properties in depressed areas where renters are hard to find. There are also those who say that illegal’s contribute to social security funds, which often go unclaimed; contribute to mortgage loan profits, open bank accounts that yield interest and dividends to bankers and purchase real estate and generate commissions for agents and brokers. (Garibaldi) In general, illegal immigrants coming from Mexico, South and Central America are trying to make money and help support their families here and abroad. Many of them are fleeing oppression, unemployment and poverty. Again, it truly depends on who you talk to in order to find any benefits to illegal immigration. From what I have been able to find, there are very few sources that include benefits of illegal immigration to the United States. There are, however, many benefits of illegal immigration for Mexico. Unfortunately, that does not do the U. S. any good. It seems to me that the negative effects far outweigh the positive effects. Many studies have been done which document the fact that illegal immigrants are a major burden on local communities. FAIR estimates that current local annual costs of illegal immigration for educating the children in public schools and providing medical services in emergency rooms and prisons amounts to approximately $36 billion. It is estimated that the yearly fiscal costs in 2010 will increase by nearly 70% to $61. 5 billion for those same program areas, and by an additional 73% by 2020. Studies done in 2004 and 2005 examining the fiscal costs of illegal immigration in California, Arizona, Texas and Florida show that the annual net costs were $8. 8 billion ($1,183 per household), $1. 3 billion ($717 per household), $3. 73 billion ($725 per household), and $. 91 billion ($315 per household) respectively. (Fairus. org) FAIR claims that illegal immigration is a key factor influencing the number of people without healthcare in the U. S. and the reason for the fiscal crisis burdening public healthcare systems. (Immigration issues) A recent study claims that one in every four people in the United State s is an immigrant. Nearly half of the immigrants living in the U. S. either have no insurance or it is provided to them at the taxpayers’ expense. As much as two-thirds of operating costs for some hospitals are for uncompensated care for sick or injured illegal aliens. This increase in uncompensated care has forces some hospitals to reduce staff, increase rates, eliminate services and shut down certain areas such as maternity wards and trauma centers. In the last ten years, legal and illegal immigrants and their children who arrived in the U. S. between 1994 and 1998 account for 59% of the growth of the uninsured population. In California, legislators are debating a government fix for the California health care market. Largely because of government policies, regulations and mandates, the cost of hiring a legal employee in California far exceeds the cost of hiring the same employees in Oregon, Nevada, Arizona and Washington. The tax burden on California businesses far exceeds the burdens on businesses in those same states, and despite its abundant energy resources, California pays more for energy than any other state except Hawaii. So how can businesses survive in this kind of environment? Some move out of state, while others choose a different route. Some pay employees under the table, some hire illegal aliens and participate in an underground economy. Theses underground economies, or black markets, exist in response to avoid government costs and regulations. These underground economies are not fair to legitimate business people and can have many bad side effects, such as the cost illegal immigration inflicts on the public education system, hospital emergency rooms and prisons. (Healthcare Reform and Illegal Immigration) The net annual cost of immigration has been estimated at between $67 and $87 billion a year. The National Academy of Sciences found that the net fiscal drain on American taxpayers is between $166 and $226 a year per native household. Economic Costs) Many issues arise when a company, large or small chooses to hire an illegal immigrant over an American citizen. In the end, nobody truly benefits. For awhile, the company may benefit because their operating costs will be lower. However, when they are eventually caught, the resulting fines and the loss of business due to being shut down will quickly overturn the amount s aved by hiring the illegal. This also has a negative effect on the American citizen who now must rely on welfare because the illegal immigrant took the only job available. More and more people have to rely on welfare which puts even more of a burden on all taxpayers. Between 40 and 50 percent of wage-loss among low-skilled Americans is due to the in-migration of low-skilled workers. Many American workers lose their jobs through unfair competition. An estimated 1,880,000 American workers are displaced from their jobs every year by immigration and the cost for providing welfare and assistance to these Americans is over $15 billion a year FAIR research. (Economic Costs) Many wonder if a border fence is a good solution to keeping illegal immigrants out of the U. S. It has been the topic of many debates around the country. There are many people on both sides of the issue. According to many north and south of the fence, it is working. Since about only one fifth of the fence is complete, those who planned to cross where the fence is now can simply go elsewhere. U. S. officials have vowed to complete nearly 400 of the 700 miles of the fence by the end of 2008. The big question is how much this the fence going to cost? The House Appropriations Committee estimates that the fence will cost around $9 million per mile, for a total cost of approximately $6. billion. However, the House Homeland Security committee estimates that the fence will cost about $2 to $4 billion. Some say the fence could cost upwards of $50 billion to build. There is also the issue of maintaining the fence. It is estimated that maintaining the fence could cost nearly $70 million per mile over its 25 year life span. Will the benefits of the fence outweigh the costs associated wi th building the fence? It all depends on who you ask. Some say the fence is pointless if it does not cut deep enough into the ground since the discovery of more and more tunnels linking the U. S. and Mexico. Some critics joke that if the fence is 10 feet tall, illegal immigrants would find shovels that are 11 feet tall. Others feel that we have to do whatever it takes to protect our borders and keep illegal immigrants out. It is not a violation of the law to leave the scene of an accident in Mexico as it is in the United States. It should not be surprising that Mexicans driving in the U. S. , especially those here illegally and driving without a license or insurance are more likely to flee from the scene of a car accident than a U. S. driver. (Fairus. rg) There are ten states that do not require ‘lawful proof of presence’ for an applicant to obtain a drivers license. In these ten states, Hawaii, Maryland, Michigan, Montana, New Mexico, North Carolina, Oregon, Utah, Washington and Wisconsin, 14. 4% of traffic fatalities are caused be non licensed drivers, compared to the national average of 13. 6%. The top ten states containing the highest population of illegal immigrants are California, Texas, New York, Arizona, Florida, Illinois, Georgia, North Carolina, New Jersey and Colorado. In these states, 14. 6% of fatalities from car accidents are caused by unlicensed drivers. The percentage of hit-and-run drivers is higher in these states as well. Some say that illegal immigration is a ‘victimless crime’. Consider this: Over 25% of today’s prison population consists of illegal aliens. Violent crime and drug possession and distribution are prevalent among illegal immigrants. In Los Angeles, 95% of about 1500 outstanding warrants for homicides are for illegal aliens. About 67% of the 17,000 outstanding fugitive felony warrants are for illegal aliens. There are currently over 400,000 unaccounted for illegal alien criminals with outstanding deportation orders, of which at least 25% are hard core criminals. There are 80,000 to 100,000 illegal’s who have been convicted of serious crimes that are walking the streets. Some studies say they will commit on average 13 serious crimes per offender. At least 4. 5 million pounds of cocaine is smuggled across the southern border every year. Illegal immigrants commit anywhere from 700,000 to 1,289,000 or more crimes in a given year. Approximately 2,158 murders are committed by illegal immigrants each year. Illegal sexual predators commit an estimated 130,900 sex crimes every year. There are approximately 240,000 illegal sex offenders throughout the United States, who will commit an average of 8 sex crimes before being caught. Nearly 63% of these sex offenders have been deported on another offense prior to committing the sex crime. Only 2% of illegal sex offenders had no history of criminal behavior. Though nobody knows just how big, the sex slave problem is enormous. The horribly brutal gang MS-13 has over 15,000 members and is in at least 33 states. Given these facts, how could illegal immigration possibly be considered a ‘victimless crime’? (usillegalaliens. om) It would take a much longer than this paper allows to cover all of the possible costs of illegal immigration. From what I could find, the costs far outweigh the benefits of this issue. Illegal immigration cannot be ignored- something must be done. It is not fair to the immigrants who chose to follow the law and come to this country legally so that they may become true American citizens a nd live â€Å"The American Dream. † Without immigrants, the United States of America would not be what it is today. We are all from somewhere else, and while the laws were different when many of our ancestors came here, the law is the law and must be followed. Today’s lawmakers are on their way to funding a solution. The fence is a good place to start. That cannot work without extensive immigration reform. There cannot be sanctuary cities. If someone wants to come to this country to make a better life for themselves and their families, they must follow the law, become legal citizens, learn about our country and learn to speak English. Illegal immigration is a crime and is not acceptable. The United States and it’s citizens simply cannot afford it. Economic Costs. The American Resistance. 6 April 2008 theamericanresistance. om/issues/economic_costs. html. Editorials. 12 July 2007. MySanAntonio. com. 6 April 2008 mysanantonio. com/opinion/editorials/stories/MYSA071307. 01O. tunnel1ed. 27514e8. html. Fairus. org. 6 April 2008 fairus. org/. Garibaldi, Mario. 8 MAY 2006. Searchwarp. com. 6 April 2008 http://searchwarp. com/swa61485. htm. Healthcare Reform and Illegal Immigration. 14 June 2007. Ventura County Republican Part y. 6 April 2008 vcrcc. org/press/index. cfm/ID/131. htm. Immigration issues. 2008. About. com. 6 April 2008 http://immigration. about. om/cs/economicslabor/i/ImmHealthCCosts_2. htm. Priestap, Kim. Dont Tell the Pro-Illegal Immigration Crowd: The Border Fence is Working. 5 November 2007. Wizbangblog. com. 6 April 2008 http://wizbangblog. com/content/2007/11/05/dont-tell-the-proillegal-immigration-crowd-the-border-fence-is-working. php. usillegalaliens. com. 6 April 2008 usillegalaliens. com/impacts_of_illegal_immigration_crime_summary. html. Viqueira, Mike. First Read- The cost of that border dence. 26 October 2006. MSNBC. MSN. COM. 6 April 2008 http://firstread. msnbc. msn. com/archive/2006/10/26/8879. aspx.