Planning and Design of Behavioral Healthcare Facilities

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants

Right-sizing

Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for Uncategorized light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need Uncategorized light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand Uncategorized light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our a
pproach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – Uncategorized light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of Uncategorized elements on patient recovery and stress reduction. Thus, it is clea
r that interior designs which integrate Uncategorized elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

Opiate Addiction and Types of Treatment Provided

Suboxone has produced the least amount of acclaim for drug addiction treatment, yet it is the one drug that is widely dispensed by physicians.

If you are taking a prescription drug right now, chances are you are taking it incorrectly. Misuse is a major health problem in the United States. The U.S. Government estimates approximately 11 Million Americans are dependent on drugs, but there are more addicts than drug centers. A large percentage of addicts seeking help face long waiting lists and thus become hesitant to start a program once their name surfaces to the top of the list. Almost 70 percent of people face a waiting list for longer than thirty days.

Those dependent on prescription drugs have a mind-set that is different from what addiction-free individuals believe. Addicts are resistant to letting go of their drugs. They typically justify their drug use because for many, they have gotten the drugs legitimately, from their doctor. Some addicts do not realize they are prone to addiction, and they can become hooked on a legal drug. Equally unfortunate is the addict who finally realizes they require help, and then seek help only to be placed on a waiting list. In the end, far too many addicts go untreated. It would seem the odds are against addiction treatment, but Suboxone relieves this problem since the guidelines to prescribe the drug is more relaxed and offer greater flexibility.

What is Suboxone?

Suboxone contains two active substances, buprenorphine and naloxone, both used to treat dependence on opioid drugs. The cost of treatment depends on the dose used and the frequency of services. This cost is higher than that of methadone treatment when the two drugs are served daily; however, there is greater flexibility in prescribing Suboxone.

How Does Suboxone Work?

Suboxone binds to opioid receptors, and thus produces welcoming effects of euphoria, and a secure comforting feeling, although at much lower levels than those addicts would of total opioid agonists such as methadone. The effects of these agonists are sufficient to allow addicts to stop the misuse of opiates, without encountering withdrawal symptoms.

The Benefits of Suboxone

· Less risk of respiratory problems
· Lower risk of overdose
· The withdrawal symptoms are less profound than when using methadone to combat addiction
· Euphoric symptoms occur less

Adverse Effects of Suboxone

The side effects of Suboxone mainly occur when too much of the drug is taken. The symptoms are similar to the side effects of opiates:

· Headache
· Sick
· Constipation (delayed bowel function)
· Poor sleep
· Sleepy
· Drowsiness
· Dizzy
· Sweaty
· Breathing difficulties (always contact a doctor)
· Dry mouth (brushing your teeth regularly and extra good care of your teeth)
· Slight pain is felt with less risk of causing more inflammation or untreated injuries
· Psychological problems (hallucinations, nightmares, depression) treatment should be coordinated with psychologist
· Itchy rash (contact your physician in connection with possible allergic reaction)
· Sleep apnea (consult a physician)
· Difficult to urinate (call a physician)

Every drug has an adverse effect, yet the result of using Suboxone is positive.

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E Cigarettes – Environmental Friendly and Stylish Alternatives to Smokers!

The mere sights of cigarette butts makes many cringe frown and roll their eyes in disgust. Insult is added to injury when the breath of one in close proximity to another is smoky and stale. It is such concerns that have led to the invention of E Cigarettes!

These are cigarettes whose utilization requires small power from battery and are also available in various flavors and varied nicotine levels. Owing to the fact that the charge from a short cable is required, carrying the electronic cigarettes and taking a puff away from the comfort of the home can be quite tasking in some case. This means that the smoking habits of individuals are in fact regulated! Also, the human body is protected from harmful smoke that is not emitted by the electrical version of these new age top notch cigarettes.

The Cigarettes Are In A Dignified Pack and They Are Durable!

For the first time ever, tobacco smokers do not have to carry matches and lighters causing burns to their finger tips and boring holes into their Sunday bests! Smoking has been taken a notch higher and the result is basic dignity for the smokers because they will not disrespect the non- smokers among them by contaminating the air that they breathe. Electronic cigarettes and the packages they come in can also be reused meaning that a lot of money isn’t spent in every interim in the purchase of pack after pack as in case of regular cigarettes. The style and durability factor surrounding the new age cigarettes is just remarkable!

They Are Environment Friendly!

For starters, this kind of cigarettes cannot be put on unless with a source of an electrical current. This means that rooms and pathways do not, under any circumstances, get filled with smoke just because a smoker passed by! The smoke usually part and parcel of the activity of smoking, is done away with meaning the air, even around a smoker, is always fresh! Disposals for the cigarettes have also been invented, meaning that they are gotten rid of responsibly so that there are no harmful smoking bits and pieces carelessly thrown away which pollute the environment!

E Cigarettes have made the world a better place, at the very least! Those who indulge in smoking on a regular or even irregular basis can therefore finally do so responsibly and while giving better consideration to their health.

Car Rental Rates – How to Get the Best Car Rental Rates

Car rental rates are obviously dependent on which dealership you opt for and how long you need the vehicle for. To get the best car rental rates you must be certain of the period in which you are going to require the vehicle for. For example, you would not want to rent a car for 3 days, to find out you need it for an additional 3 days this is where dealerships will charge for days the vehicle is required for, at their daily rate; savings are to be made when you book for a week if there is any chance of requiring the vehicle for longer. Agencies operate on weekly and daily rates; it always pays to look into the weekly rate as this is usually lower than a per day rate.

If you want to find the best car rental rates you must shop around. Car rental rates are constantly changing due to supply and demand and obviously change in line with the season. You will need to book far in advance should you want a rental car over any holiday period. Make sure you enquire about special holiday rates as some rental agents will give away a day extra for free over these periods. Make sure you are certain of you required dates over these periods as agencies cancellations over these periods will incur large fees.

To find the best car rental rates when it comes to long distance trips, it pays to book well in advance and ask your travel agent of any deals that are not publicly advertised. If you are planning a road trip to Las Vegas for tonight, you’ll have wanted to have booked at least a week ago to get the best rates and avoid disappointment. Remember that reservation only guarantees a reserved rate, you must specify if you are after a specific vehicle.

If you think the weekend car rental rates you are getting are too good to be true, then they probably are. You will want to ask for any hidden costs, such as insurance, state taxes, varying fees for drivers of different ages and refueling charges. Ask your rental agent of any compulsory insurance fees, as these hidden costs are generally what makes the advertised costs so well, read the disclaimer! Some states in America give rental car agents permission to charge extra fees on their rentals to cover the costs of licensing their cars. This is fee is generally 6% of the total rental costs. The majority of states in America do not require rental agents to inform the customer of this fee, so make sure you ask before hiring.

To get the cheapest, most value for money rental car rates you will need to shop around, be sure of the duration you require the vehicle for, make sure you ask about any hidden fees and always book well in advance.

Finding the Right Travel Nursing Placement Agency

Travel nursing is becoming one of our nation’s fastest growing professions, and it’s no surprise. If you love seeing new places and enjoy exciting new experiences that evoke the feeling of taking an extended vacation, then the career of a traveling nurse might be just what the doctor ordered! Travel nursing enables many people to stay on vacation for two to six months in free luxury accommodations while earning high hourly wages at the same time.

Yet despite all these advantages, many nurses describe to me that they’ve shied away from the traveling profession. Why? Because bad experiences with placement agencies have left them with nothing but a negative impression. They’ve been underpaid or lacked benefits, and I can’t tell you how many nurses have complained to me about inadequate housing or recruiters who were unkind, uncaring, and just plain unavailable. The sad result is that nurses end up jumping from one agency to the next, always in search of the perfect package that’s never there.

In this light, choosing the right staffing agency requires a nurse to consider everything that is offered. Some nurses emphasize pay as their top priority. Others require an excellent benefits package. Many travel RNs are location-specific and want to experience the lifestyle in the country’s hot spots. Career flexibility is often a pivotal factor, along with customer service. The bottom line is, your agency choice depends largely upon one of the four following criteria.

SALARY

No question about it, there are some agencies that offer more money than others. So the first thing to remember is that agencies may base salaries upon things like location availability, need-to-fill assignments, and cost of living.

Some agencies must offer noticeably higher rates if they expect to fill certain assignments where nurse-to-patient ratios are very low, or where a facility has extreme patient needs. If you’re a nurse who is attracted by very high dollars, be alert for a potentially desperate situation you might be entering, and the workload it could bring. You may make more money, but you’ll earn every dollar and more.

Location also factors into salary. The California bay area and many larger east coast cities definitely offer more lucrative pay rates. It’s also much more expensive to live in those places, so recognize the relationship that exists between salary dollars and cost of living. I’ve seen nurses return from Hawaii saying they had a great vacation and made a lot of friends–but their purses were lighter, not heavier from the experience. You might get less money in an exotic location and come back with more money from a not-so-exotic location. My point is, your criteria will determine your priorities.

BENEFITS

What some companies may lack in salary, they make up for with benefits. Many agencies offer benefits programs that revolve around monetary bonuses or discounted luxury housing; and I have even observed a trend with several newer companies that offer entirely free housing to all their nurses. Take note, however, that those agencies may not ante up the really high salaries. It’s a trade-off, so they compensate you with benefits to save you daily, monthly, and annual expenses. Every nurse should be aware of what benefits they need the most, and then ask their recruiters to assist in developing a package that is tailored to their individual needs.

CUSTOMER SERVICE

To many traveling nurses, customer service and aid are the most important attributes a placement agency possesses. If you called ten agencies and only talked with one live recruiter, it’s probably best to narrow it down to the agency where individual placement specialists were easily available. After all, if you’re ready to proceed with a new assignment you’ll want an agency that can make it happen fast and has recruiters available who already understand your criteria. In fact, your criteria may change from one assignment to another, so customer service is paramount. Determine what you want and then find out which agencies can make it happen.

FEATURED LOCATIONS AND HOT SPOTS

While for some nurses, salary, benefits, and career flexibility might be the number-one interest, many others just want the obvious–to travel and see the world. If you’re an adventurer who cares more about the travel experience than the money, then you’ll need an agency that can offer you the locations you want.

Not every agency can send you just anywhere. Figure out where you want to go, and then call around to discover who can send you there.

A travel nursing career is absolutely one of the best, most rewarding choices any nurse can make, but it’s important to select a company who will partner with you every step of the way. Before you jump in, do your homework and research all the best placement agencies. Finding the agency that fits your unique wants and needs will drastically increase your chances of success and happiness in your career.

Home ElectronicsCigarette (cigarrillo electronico) Automated Protection You Need To Know

Electronic cigarette(cigarette electronique) is a safe thing to consider when the(sigaretta elettronica). Electronic cigarettes(cigarros electronicos) are a new and unknown computer, that should be reviewed and understand the use of the (elektronisk cigaret) for personal use. Security (cigarrillos electronicos) to be taken seriously and understood the use of the(elektronischen zigaretten).

Safety begins with the spray electronic cigarette(cigarrillo electronico). The spray is the small part that screws into the pile of electronic cigarettes(sigaretta elettronica) and connect the spray cartridge (elektroniske cigaretter). This sprayer is heated to convert the liquid nicotine cartridge into the water vapor that is inhaled. The electronic cigarette is safe in the knowledge that this warming and can be hot. Never drag a permanent or inhaling the, because this will make(cigarros electronicos) spray to keep warm and eventually melt the toner. You must be a burden when you feel the urge to smoke. The use of the is moderately good security and cartridges will actually last longer.

Another important safety does not hinder the too hard. When you take a drag of your, you should take a slow, deep pull in about 3-5 seconds. If you pull too hard on the cartridge, you can potentially suck some of the nicotine in the mouth. If this happens, the security of(cigarro) correct too quickly, rinse your mouth with water.

Cartridges are available in a wide variety of tastes and strengths of nicotine. For regular, menthol, also the apple and strawberry flavor cartridges and nicotine strengths come in full, a medium, light, and no. While(elektroniskas cigaretes) are technically “alternative to smoking”,rather than smoking cessation device, the range of nicotine strengths offers clear opportunities to support those trying to quit smoking, and seems to be proving to be popular in these markets.

The nice thing about that you say, nicotine patches, that give the same tactile sensation and oral fixation that the desire of smokers, while satisfying the desires of snuff as well. When you take a drag n really feel your lungs fill with smoke flavored snuff warm and the waves of smoke exhaled from your lungs as the regular snuff, however, as mentioned, the smoke is actually a lot more water vapor that evaporates quickly heals and not offend anyone in the vicinity.

Ways To Stop Smoking Permanently by sigarette elettroniche

A lot of smokers want to stop and you might be looking for information on how to stop smoking having made previous unsuccessful attempts sigaretta elettronica.

It is not uncommon to be in this position as stopping smoking cigarettes electroniques is not easy and you need to really make a very firm decision to do so. It may help to write down why you to want to quit to remind you when the going gets tough.

The difficulty with stopping smoking cigarette electronique is there are both physical and mental addictions to beat and beating the physical addition is the easy part (relatively).

People smoke because:

• It is a pleasurable experience and relaxes the smoker.

• Smokers have developed an unconscious link between certain activities and environments and smoking elektronisk cigaret.

• They have an addiction to nicotine.

As an alternative to quitting smoking you might think about using electronic cigarettes(elektroniske cigaretter). People have used these to stop smoking although they are not marketed for this purpose but they do make smoking cheaper, cleaner and harmless to others. You can also choose how much, if any, nicotine they supply.

Some of the possible approaches to stopping smoking are:

Cold Turkey

This is the simplest and cheapest method but not the most successful. You pick a date and from that point you no longer smoke. The initial period is very difficult so you need to be very strong minded to be successful. The success rate is estimated to be between 5% and 10%.

Alternative Sources Of Nicotine

Products such as nicotine patches or gum are used to replace that previously received from cigarettes. They deliver a controlled dose into the body to relieve some of the withdrawal symptoms. There is a lot of variation in the claimed success rates but for nicotine replacement used on its own they vary from 7% to 35%.

Stop Smoking Medication

Medications (such as Zyban) help relieve withdrawal symptoms without the use of nicotine but are intended for short-term use only. There are also homeopathic remedies (such as Smoke Deter) which do the same thing.

Various Therapies

You can learn how to modify your behavior to break habits that lead to smoking and how to stay motivated to quit smoking. In fact it is very difficult to stop smoking without help and support and any sort of counseling or organized program will help considerably.

Quit Smoking Hypnosis

When considering how to stop smoking, hypnosis should be taken seriously as it has success rates of up to 50%. Quit smoking hypnosis is based on reprogramming the subconscious mind to stop associating smoking with pleasure and relaxation and to substitute some other behavior. It can also be used to remove conditioned responses so the smoker loses the urge to smoke when in the environments that used to trigger it.

Hypnosis will not work for everyone, but it is well worth trying.

Best Option

Trying to stop smoking on your own is very difficult and likely to fail. Support of some sort will increase your chance of success considerably and it may be that taking something to help with the nicotine withdrawal, combined with hypnosis or behavioral therapy to address the psychological addiction, is likely to give you the best chance to stop smoking for good.

Internet Marketing Training For Home Based Business Owners

How To Set Up and Start Operating a Home Based Business

I remember myself anticipating to having my first website ready when I first started, as if when I would have it ready, my business would become internationally known at a blink of an eye! Being Enthusiastic is essential… Another thing that is essential though, is to try to keep your feet on the ground. Becoming known on the internet is a Step By Step process that you have to go through very carefully and with consistency. The more focused and consistent you are from the instant you start, the sooner you will achieve your business goals, by accordingly following your business plan! Most of All: Do Not Panic!!

1) Establishing Your Target Market:

This is probably the most important thing you can do when getting your business started. You have to do your research on Who Your Customers Are before you get into any type of marketing and advertising. Especially with Pay Per Click advertising e.g., on Google AdWords you have to know what are the right keywords for your business in order to attract the right people to you, that will ask exactly for what you have to offer. Marketing to the wrong set of keywords will kill your business, produce a substandard leads. On the other hand, marketing to the right set of keywords or the right target market will explode your business.

2) Find A Good Domain Name And Hosting Company:

This is the second very important part of your business foundation. Having a good domain name that relates directly to your offering business opportunity and a hosting company that has reliable customer service daily 24/7, Live Support to make sure your website – blog is up and running effectively.

3) Decide What Method You Will Use For Your Promotion Plan:

Squeeze Pages or Branding Site? After you have established your target market, and set up a domain and a hosting account for your website, you will need to decide what type of Marketing Site you will use. Squeeze pages and branding sites are different, but both are necessary tools for the internet marketer. As with any other topic, you will get different opinions when it comes to Squeeze Pages or Branding sites. I use Branding Sites as I want people to get to know who I am and where I come from before starting any kind of partnership or business deal with them.

Difference between a Squeeze Page and a Branding Site:

A squeeze page is a mini sales page. Squeeze pages are also called opt in pages, splash pages, and landing pages. It’s the first and most important page that you will create and the place where your people will leave their name, email and number, in order to get more information about your business opportunity. Your squeeze page should have a smart eye-catching headline and invoke curiosity. The content of your squeeze page should address to solve a ‘problem’ or fill a ‘void’ of your customers.

Branding sites are designed to brand YOU. Word Press sites are great for branding. Word Press sites have a home page. The home page allows you to provide more information and detail than a squeeze page. As I mentioned earlier the branding site is meant to give your people information; lots of information about you, your product, and your services.

Lay out your branding site with a home page about your product and service. The “about me” tab should be all about you…your story, your background, and your truth.

It is a peoples’ Business and people will connect with you if they like you first and trust you later.

4) Pay Per Click Advertising:

Get Yourself Acquainted with the Forms and The Functionality of Pay per Click Advertising.

What is Pay Per Click?

Pay Per Click Marketing is the fastest way to drive traffic to your web site, that is a fact.

The three big pay per click sites that are recommend are as follows and they are in this order for a reason with Google being at the top.

The three major search engines are Google, Yahoo, and MSN, but Google is the Leader of the market.

Google is the main pay per click marketing search engine.

How Does Pay Per Click Work?

Pay Per Click works by you selecting keywords that are related to your business, product, or service.

1. You choose keywords or long key phrases

2. You bid an amount on those keywords or key phrases to get them seen

3. Google determines which ads to show

So how do you get your ads seen?

1. Write an attractive ad (great copywriting is a key factor in all marketing)

2. Bid the right amount

3. Make your ad relevant to your keywords as well as your website

Google AdWords Program has unlimited free informative tutorials on how to set up and start your PPC campaign. There you will have the choice to target your ads according to language, country, set your own preferred bids on your ads and keywords, and set specific days for your ads to run or pause them anytime you wish.

After you make your keywords research, when you will know what you are doing it won’t be that difficult to get your ads seen throughout the web. To many people rush to get their ads out on Google and do not do the proper research, or work with experienced marketers and coaches.

You can apply the strategies you use for the big search engines like Google,Yahoo and MSN. Googles’ pay per click program is called Ad Words. There is a difference between “paid” search results that appear on the top and right-hand side and “Uncategorized” searches – the search results that appear on the left-hand side of the search page which are free and can make wanders if you manage with good Search Engine Optimization to get your ads there on the first pages of these engines.

5) Article Marketing Advertising:

Article marketing is probably one of our most interesting and cost effective ways to market.

This method requires a process and time to get results and visibility. It is a way for you and your business to become known on the web and be considered as an active part of the Online Marketers Community. What happens when you do article marketing is that people pick up your articles for content on their sites, for content. It’s huge. Your content is spread around virally.

The way this works is you write an article, something of value. Be sure you check out our chapter on outsourcing on next paragraphs, because if you don’t like to write, you can outsource it to experts.

When you write and submit your articles, you are putting in your links on these articles, the articles that you originally produce. These are one-way back links to your site, so when people pick up your articles for content, the Google crawler picks up the links and your site goes up in ranking. That means more visibility for you, more traffic to your site and recognition, traffic and hopefully sales.

The articles you submit should be relevant to the topic of your business. They should pertain to what you are doing and whatever business you are in. In this case your articles should pertain valuable content for your readers to go through concerning Home Business Industry Topics. These could be Internet Marketing Techniques, the advantages of running their own business from home, freedom of time, ‘How-To’ articles which are a very ‘HOT’ plate for the search engines and many more.

Make sure that your articles are around 300-500 word long. You want to be picked up as providing good content about your industry or business. You should have a bio attached to the article. BIO is the only place that you can ‘sell’. It’s the place for you to ‘TAKE’. This is where the link to your website or splash page will be located. The bio should be about you as the author. At the body of t
he article you only ‘GIVE’: Content of Value. The links in your Bio should come back to your website.

Your Bio should include 2-3 sentences pertaining 1) Who you are and what you do, 2) A reason to visit your site after reading your article and 3) A call to action, for them to do so.

Make room in your life to submit at least two articles per week; set aside a specific time or day to make it happen. You have lots of information you can write about in whatever industry you are in. You can do it manually, or you can purchase submission services through Article Submitter Special Software. They have over 1000 places to submit your articles. It is time saving and accelerates the process of distribution and visibility.

6) Video Marketing Activity (HUGE)

Run a Google search on a topic like ‘best home based business opportunities’. Most likely, in addition to articles and websites, there will be several videos that pop up in the search results. Imagine having a dynamic and powerful video that introduces your product, service, and company live with your voice on and researchers landing on your beautiful video instead of being sent to a single and ‘one of the thousands’ splash pages. Google is very attracted to videos and pick them up quickly. It will help your ranking. Video Marketing is a very powerful selling tool as well as the fastest free way to get those ads out there. Use it in order to stay ahead of the competition.Your ultimate goal in marketing is to have your ads not only seen by as many potential customers as possible, but to be in front of as many of your targeted customers as possible.

The way you treat your Video Marketing campaign is the same with how you treat your PPC campaign and your article marketing campaign. You must focus on a specific ‘keyword-driven’ target market. At Step 1 I mentioned the importance of establishing a target market and a core group of keywords. The same keywords will be plugged into the videos when you submit them. Ultimately, everything comes up to your initial development of your target market and core keywords.

As in Article Marketing you can 1) submit your videos manually to limitless video directories for free like You Tube, Yahoo Videos, Google Videos, etc or 2) Submit to as many as possible directories through Video Submitting Software that do massive distribution of your videos with a click of a button.

7) Press Releases Marketing Method (Get Faster and Higher Ranking)

Another way of effective marketing of your website is to write and submit Press Releases. The information in your press release needs to be viable, newsworthy and high value content. Inside your press release, you should have one-way links that bring readers back to your site – your branding site or your squeeze page. The difference between the articles and the Press Releases is that in PR you can place your URL link in the ‘body’ of your content, once every 100 words. Press releases are a great SEO tool that can quickly improve your ranking. There are a lot of sites looking to gather information to build the content on their websites, so if they pick up your press release, and inside your press release you have one-way links back to your site, the search engines will know and act accordingly by rewarding you with higher ranking.

This is a method that requires some time to build a reputation. Give it some time and as long as you do this on a consistent basis, sending out once press releases per month with relevant, high value information, you’ll start seeing increased traffic to your site. Again there is a free PR submission option and a paid one. Again it will be up to your budget flexibility.

8) Social Media Marketing:

Millions of people everyday are viewing, updating, or connecting with others all over the world. These sites are very easy to get set up on, as all you have to do is sign up with your information and you are ready.

As of today the big three that I use consistently for internet marketing are Facebook, Twitter, Linked In and Ecademy.com. There are hundreds more out there and this is a great way to let people know about whom you are what you do, as well as what your product or service is all about. Social Networking Sites are considered as the Hottest Market Place and reports have shown that people search and finally trust opportunities through viral tools, such as all these today’s Hot Marketing Trends.

You must apply the ’90-10%’ Marketing Rule which means, that the 90% of your posts and interactions must be about you socializing, making connections, letting people know you first and only a 10% talking about your business. People don’t like to be sold. Be human and treat like you would like to be treated. It is a Peoples’ Business.

9) Outsourcing Resources:

Every marketing method I mentioned so far, every tool that you are given to use can be outsourced. Evaluate the time that you can give to your business, filter the activities that are most compatible to your character and nature and outsource the rest! Web design building, hosting etc. You cannot outsource everything assuming that your budget is limited; you will have to learn how to do some of them, apply at least 2 of the previous mentioned methods for your business. Article marketing, Social Media Marketing and Pay Per Click advertising is definitely skills that anyone that starts an online business should master for himself and his business’s success.

Take it Step By Step when growing your business and grow your outsourcing at a steady pace. You always have the control of all your marketing activities. You are the leader and the one that will lead you to Success!

Make sure you are on the right track and apply the knowledge you learn, every single piece of it day by day! And of course enjoy yourselves always!

Internet Marketing and SEO Information

8 Seconds Rule for Business Website

Your website has approximately eight seconds to capture the attention of a prospective customer, before they head off to another website. If a connection is not made between your prospective customers and your Singapore SEO website in a very short time frame, you will lose them.

Keyword Research

Keyword research is critical to the SEO process. The purpose of keyword research is to find out as many keywords that are relevant to your website. So, when customers search on Google and other search engines they can easily find your website.

Professional Quality Link Building

Link building must be done slowly. You must build links with a mix of good high PR and low PR links from different websites, mostly relevant to your site. If you build links too quickly, your website can be penalized by Google.

The higher your link building speed is, the more serious penalty (pagerank drop) your website may get. When Google see a large amount of links come in one month and nothing the next this can look suspicious, and you will not rank on Google, yahoo and MSN’s Bing.com

Search Engine Optimization (SEO)

SEO is a key factor of any successful website. The internet has become the primary resource for gaining advanced information, services and products. All internet users search the product information from Google. SEO and optimized social media content makes it easier for customers to find product/service information online when they’re doing the research that will help them.

Almost 85% of visitors come from Search engine result pages. Some people search for your company name and your services & products. Hire a SEO Consultant is your best option for your company if you want to increase your sales.

SEO Tips

1. First, one of the most important tips for search engine optimization is to get inbound links. It is for this reason that the more inbound links will have another popular site for your Web site, the more it becomes for you to get better ranking in search engines. For this reason, you should try to get as many of these as possible. Lends credibility to your site and help you improve your ranking in search engines.

2. Social bookmarking is another very important aspect of SEO. It is easier for visitors to bookmark your pages. Not only that, but it also allows you to submit your site to social bookmarking sites and, in turn, gives an additional benefit.

3. In addition, article directory submissions should be used for effective SEO. It also helps to build back links and is considered one of the best Internet marketing tools. By submitting articles to these directories, you can reach the wider audience that can be directed to your site after reading your article.

4. In addition to these, the presentations of the website are also very useful for link building. Since there are countless web directories, so your presence ensures your online presence the best possible way. You only need to pay a small sum although there are many free websites.

5. Site maps are also an important part of SEO. In a nutshell, is basically, you can inform search engines of different pages on your website. Consequently, it helps search engines to rank your page better and more effective.