Write a clear, concise, well organized analysis of a business case using correct grammar, composition and spelling. Please use theory, concepts, models, and research findings that you have been studying in our MGT 489 class to enrich your view of the case and help you to identify problems and support your analysis. In addition to the above criteria, you will be assessed on your ability to think creatively.
The assignment should include a maximum of three pages text double spaced 12 point Times-Roman font with one inch margins all around. You can also include an additional three pages of tables and or figures. Please completed assignment by December 15, 2014 with the subject heading MGT 489 (your section #) Individual Business Case Analysis
The elements of your business case analysis should include:
I. A Problem (or Opportunity) Statement
1. Please describe the most important strategic issue facing Coca-Cola’s ongoing expansion in China in 2014.
II. Elements of Analysis
2. Please describe the key economic and policy issues and trends in the China where the firm is operating.
3. Please describe the industry in which Coca-Cola is operating perhaps including information such as competitors, new entrants, substitute products, suppliers, the buyers and the intensity of industry rivalry.
4. Please identify the relevant stakeholders.
III. List Strategic Recommendations
5. Please list three strategic recommendations you would want top management to consider.
IV. Make a Final Recommendation
6. Please choose your most important recommendation and defend why it is the most important.
V. Learning Reflection
7. Please write one or two paragraphs that reflect on your own learning processes as you worked to complete this assignment.
Please use Case 20 in the text book (pages 666 – 674) as background information and be sure to research more current information online or at the library.
SAMPLE ANSWER
Coca Cola Analysis
A Problem Statement
Coca Cola similar to other firms operates with the objective of increasing its profit value over a specified period. To attain this objective, the company creates a value for very constraint it serves, such as, its customers, stakeholders, creditors and so forth. China is undeniably the best investment environment for Coca Cola Company. Therefore, re-investing in China in 2014 has eventually become the strongest brand. However, besides expanding its operations in China, Coca Cola is facing the strategic issue of advancing its product diversification plan so as to engross a wider customer base. Currently, Coca Cola has exhausted the key sectors in the soft drink industry, including the carbonated dinks, bottled water and juice products. All these products are available in the China Markets. Although Coca Cola Company may ha the potential to diversify its product lines, the escalating health awareness of customers is a major threat towards the expansion (Rudarakanchana, 2013).
Elements of Analysis
Key economic and policy issues and trends in the China
Coca-Cola’s market distinguishes its market using location and age factors. Location relates to determining where the consumers come from. Although, most of the viable customers come from rural regions, Coca Cola customer’s base is within the urban regions. China’s economic diversity supports such segmentation. Economy analysis investigates the local and the international economy in addition to the inflation and recession crisis. Essentially, economic factors take into account factors that influence the production process as well as the output. As much as Coca Cola Company has already developed a marketing plan to expand its operations in China in 2014, the economic condition is uncertain. Therefore, the company would encounter great hostility from the already existing firms when setting up the price. Besides this, income inequality is another economic issue that is affecting the success of Coca Cola Company in China. The inequality in terms of economic growth in different locations impacts the purchasing ability of the consumers. Another key issue is the policy issue. Currently, Chinese customers are very conscious about their health based on the global campaign against sugary products. Therefore, industries in China have implemented a policy to avoid sugary products. Therefore, fast food restaurants which sell most of Coca Cola products are not avoiding Coca Cola products for fear of loosing their customers (Rudarakanchana, 2013).
3. Industrial Analysis in which Coca-Cola operates
to determine the likelihood of success of Coca Cola Company in China, it is important to conduct an industrial analysis to have an insight of the Porter’s 5 forces affecting the company.
Threat of New Entrants/Potential Competitors
Entry barriers for Coca Cola Company in China are comparatively low. The consumer switching expenditure is insignificant and no capital is required. However, there are relatively new brands entering into the market with even lower prices than Coca Cola products. Coca Cola Company, nevertheless, offers its products as beverages and brand in order to embrace a larger market share. Therefore, the loyal customers are unlikely to try any substitute brand.
Threat of Substitute Products:
Energy drinks and beverages are diverse and numerous in the market. In this regard, Coca Cola Company is yet to produce an entirely incomparable flavor. Therefore, customers rarely note the difference between the flavors produced by Pepsi and Coca Cola.
The Bargaining Power of Buyers:
The bargaining power of Coca Cola Company has no influence on the company, whether in terms of production or setting up of prices.
The Bargaining Power of Suppliers:
Coca Cola Company has always used the same ingredients since its started operating. The major ingredients include carbonated water, phosphoric acid, sweetener, and caffeine. The company does not change its suppliers, and is probably the largest customer to its suppliers.
Rivalry among Existing Firms:
The key competitor is the Pepsi Company, which as well offers a variety of soft drink products using its brand. Other brands in the market that are yet to gain momentum are such as Dr. Pepper.
4. The relevant stakeholders.
In China, the objective of the Coca-Cola Company is to engage in direct distribution of its products by establishing a sales centre in a strategic location with a population density of about one million people. These distribution centres also operate as storage houses. The owners of these centers become stakeholders to the company and, therefore, controls them distribution process within a confined location. Other important stakeholders include the large wholesalers with vast experience in retailing process as well as private wholesalers that distribute the products to the local customers. Besides, Coca Cola company as well partners with the government. Furthermore, Coca Cola Company forms an association with fast food restaurant which helps in selling and promoting the products to their customers (Rudarakanchana, 2013).
III. List Strategic Recommendations
For Coca Cola Company to thrive in Chinese soft drink market should implement a reward system technique that serves as a motivation to its employees that promotes the product locally and internationally.
Coca Cola Company should improve its consumer relationship initiatives, especially in markets where government intervention is intense.
Coca Cola Company needs to market segment its products in order to understand the insight of consumer tastes and preferences.
Demographic issues are as well a major factor that the top management should explore. Each market environment has diverse culture and traditions which are significant in determining the strategic measure to include.
Make a Final Recommendation
Coca Cola Company should diversify and target growth segments in major markets.
This is a key recommendation over the rest. As illustrated, Coca Cola Company faces stiff competition from other large companies like Pepsi. Therefore, unless the company diversifies its product, that is, launching a new product in the market
V. Learning Reflection
Coca Cola is constantly increasing its reputation globally as it continuous expanding its operations in China in spite of the economic recession. It is apparent that its operations in China are almost a success since the company has already adopted the economic and policy issues required. Furthermore, their contributions to economic development in China, in terms of employment opportunities have compelled the Chinese government and other partners to collaborate for the well being and prosperity of China (Rudarakanchana, 2013).
ANALYSIS OF RESEARCH DATA
Analyzing Quantitative Data
Previously you discussed how data is collected. Now you will consider how the information gathered with data collected is analyzed.
How does the researcher go about organizing and looking at the data in order to understand what it means? In quantitative research this is accomplished through the use of statistics.
The methods for data analysis depend on the purpose and data collection methods. Most all studies will have descriptive statistics. These statistics describe the sample that was studied. They include data like the percent of men and women, the mean age of the sample, and any other demographic data collected.
The two other most common methods of data analysis are the paired t-test, which measures the differences in means between two groups, or the same group with a pretest and posttest; and the Pearson’s r which measures the relationships between two variables. Pearson’s r can also be used to identify relationships between demographic data and other variables.
Activities
REQUIRED ACTIVITIES
From your textbooks, read:
Introduction to Nursing Research Incorporating Evidence-Based Practice
• Chapter 12
• Chapter 13
Please look up and read the following articles before completing the critique of this paper
• Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal Of Nursin, (BJN), 16(11), 658–663.
• Giuliano, K., & Polanowicz, M. (2008). Interpretation and use of statistics in nursing research. AACN Advanced Critical Care, 19(2),211–222
• Ingham-Broomfield, R. (2008). A nurses’ guide to the critical reading of research. Australian Journal Of Advanced Nursing, 26(1), 102-109.
Please review the following websites.
Please visit the following sites to understand statistics and nursing research:
KuKanich, K. S., Kaur, R., Freeman, L., & Powell, D. A. (2013). Evaluation of a Hand Hygiene Campaign in Outpatient Health Care Clinics. AJNonline; 113(3).
Problem:
What is the problem the study was conducted to research?
Many research studies conducted earlier have tested the interventions for improving hand hygiene within teaching hospitals and clinics and the interventions were found to be successful. Nonetheless, moderately few research studies have actually tested such interventions within outpatient hospitals and clinics.
Why is the problem an important one for nursing to research?
The problem is an important for nursing to research primarily because it will help to improve adherence to hand hygiene practices of health care workers in outpatient settings.
Study Purpose
What is the purpose of the study?
The purpose of the research study is essentially to improve hand hygiene in 2 outpatient healthcare clinics by introducing an informational posters as well as a gel sanitizer (Kukanich et al., 2013).
Research Question
What is the main research question?
The researchers formulated 5 main/primary questions that were to be addressed in the study. These include the following:
Could an intervention campaign carried out in 2 outpatient healthcare clinics result in improved hand hygiene?
Are there any dissimilarities in the observed frequency of hand hygiene at baseline compared with that at 1 week and 1 month after introducing the intervention?
Are there any dissimilarities in the observed frequency of hand hygiene basing on the gender, profession, and timing (post-patient and pre-patient contact) of the worker?
Which tools of hand hygiene do healthcare staffs in these settings – outpatient settings – prefer?
Would the observed healthcare staffs later on report that both or either intervention tools were actually motivating and indeed influenced habits of hand hygiene?
Hypothesis/hypotheses
What is the study hypothesis? If it is not stated, what would you say the hypothesis is?
Interventional campaigns in the 2 outpatient health care clinics will lead to improved hand hygiene. The use of a multifaceted implementation approach that consists of a gel sanitizer and giving informational posters helps in achieving significant improvement in adherence to HH practices and practices within outpatient clinics.
Study Variables
INDEPENDENT
Define the meaning of the term “independent variable.”
Independent variables (IV) are those variables which are manipulated or varied by the researcher during the investigation. In essence, the IV is the presumed cause, it is the antecedent. In experiments, the IV is the one which is manipulated and controlled by the person doing the experiment. In non-experiment research in which there is no experimental manipulation, the IV is basically the variable that logically has some effect on the Dependent Variable (Hoe & Hoare, 2012).
Identify the independent variables in this study and provide a definition of the variable.
It is notable that 2 outpatient health care clinics were used in this research study. The 1st clinic was an outpatient oncology clinic, and the 2nd clinic was an outpatient gastrointestinal (GI) clinic. The IV in this study basically comprised the introduction of an informational poster and a gel sanitizer as an intervention.
How is the independent variable carried out in this study?
Gel sanitizer was included in this study in order to provide HCWs with an alternative to foam sanitizer and water and soap. The researcher’s created an informational poster in order to increase HCW’s awareness of HH, offer information regarding when HH has to be done, and encourage HCWs to take personal responsibility for decreasing the spread of infections which are associated with health care (Kukanich et al., 2013).
DEPENDENT
Define the meaning of the term “dependent variable.”
A Dependent Variable (DV) is understood as the response which is measured in an experiment. The DV is the presumed effect, it is the consequent. The Dependent Variable is not manipulated by the investigator, rather, it is the Dependent Variable which is measured or observed for variation as a presumed, supposed outcome of the variation in the Independent Variable (Venkatesh, Brown & Bala, 2013). The Dependent Variable is essentially the status of the outcome or the effect in which the investigator is interested. In essence, the DV is the variable that the researcher observes and is likely to change in response to the IV.
Identify the dependent variables in this study and provide a definition of the variable.
In this study, the DV is the adherence of health care workers – doctors, nurses, and other workers in the hospital setting – to hand hygiene practices and guidelines.
How is the dependent variable measured in this study?
The DV variable was measured by directly observing HCWs to measure HH opportunities as well as attempts at baseline, after the intervention, and in the course of the follow-up period. Direct observation by trained observers is essential in providing more precise, exact information as regards the preferences of a health care worker for hand hygiene tools. The investigators measured the number of HH attempts against the number of HH opportunities. The opportunities were monitored by direct observers who recorded the attempts. HH opportunities were defined as the opportunities which occurred instantaneously prior to, and after a HCW directly contacts a patient. HH attempts are efforts to do HH in each opportunity (Kukanich et al., 2013).
Conceptual Model/Theoretical FRAMEWORK –
Is the framework explicitly expressed or must the reviewer extract the framework from implicit statements in the literature review? JUSTIFY your response!
In this research study, the conceptual model/theoretical framework is not explicitly expressed. The reviewer has to extract the framework from implicit statements in the literature review. This is because it is not overtly or clearly stated by the authors anywhere in the article and to know it; the reviewer must read through the statements contained in the literature review.
Is the framework based on scientific, substantive, or tentative theory?
The theoretical framework in the article is based on tentative theory; the researchers built tentative theory basing on certain propositions.
Does the framework identify, define, and describe relationships among the concepts of interest? Provide examples and rationale for your response.
Yes, the framework identifies, defines and describes relationships amongst the concepts of interest. For instance, the researchers have pointed out that an earlier hospital-wide study included the promotion of alcohol-based sanitizers, which led to increased usage of these hand sanitizers that resulted in improved adherence to HH guidelines. Simply put, there was a relationship between the promotion of alcohol-based sanitizers and improved adherence to HH guidelines; the more it was promoted, the more the HCWs in that hospital used it. Another example is the relationship between alcohol-based sanitizers, soap and water, and bacteria. When properly used, studied have demonstrated that alcohol-based sanitizers are more effective in removing some bacteria relative to water and soap (Kukanich et al., 2013).
How is the framework related to the body of knowledge in nursing?
The framework is related to the body of knowledge of nursing in that it helps in understanding how exposure of HCWs in busy outpatient healthcare settings to interventional tools could result in improvement of adherence to HH guidelines. It also helps to understand how gel sanitizers or informational posters help to improve adherence.
Review of the Related Literature
Are the articles relevant with previous studies and theories described?
Yes, the articles are relevant with previous studies and theories described. This because the articles are largely about adherence of HCWs to HH guidelines, which are in line with the previous theories and studies described which are also about the same thing – adherence of HCWs to guidelines of hand hygiene.
Are the references current? Identify the number of sources within past 10 years and the number of sources within past five years.
A total of 28 references were used by the researchers in this study. Most of them are relevant since out of the 28, 18 of them are from past the 10 years – dated 2004 up to present year –, and 5 are from the last 5 years – 2009 up to present year.
Describe the current knowledge about the research problem.
The practice of hand hygiene (HH) by healthcare workers (HCWs) including nurses and physicians using either water and soap or an alcohol-based hand sanitizer, is regarded as the most effective and significant method utilized to prevent healthcare-associated infections. Earlier studies have clearly shown that hand hygiene helps to reduce the rates of healthcare-related infections, adhering to the guidelines of hand hygiene is low amongst HCWs. In order to improve the adherence to HH guidelines and sustain such improvement in the long-term, it is important to recognize and address barriers. The main barriers basically include: a perception that HH interferes with patient-worker relationships; skin irritation; poor habits that were learned early in life; time constraints; poor access to HH materials; time constraints; forgetfulness; as well as lack of knowledge of HH guidelines (Huis et al., 2013).
Cleaning hands using an alcohol-based sanitizer usually takes less amount of time compared with washing with the use of water and soap. In addition, when utilized properly, it has been demonstrated that alcohol-based sanitizers are more effective compared to water and soap in eliminating some bacteria. It is on account of this that the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) actually recommend the utilization of alcohol-based sanitizers or hand rubs for clinical healthcare contexts. Nonetheless, washing hands using water and soap is still the favored way when hands are noticeably dirty. It is also the preferred method whenever one suspects contact with some infectious agents, for instance norovirus and Clostridium agents, considering that these organisms are very much resistant to killing with the use of alcohol (Boudjema et al., 2014).
Individual HCWs generally have dissimilar preferences of HH products and they can be affected to some extent by dissimilar barriers and motivators to HH. Santos (2013) noted that it has been shown by earlier studies that the use of more than one method is necessary in order to attain improved HH practices and sustain them over the long-term. In essence, such campaigns typically comprise the promotion of alcohol-based hand sanitizers. Even though evidence is lacking showing that educational materials alone for instance posters are actually effective at altering behavior of HCWs to adhere to HH guidelines, those which employ messages framed in terms of possible gains instead of losses and which entreat the HCW’s sense of responsibility for the health of the patient might be of benefit in combination with other vital strategies.
Specify the gap in the literature that justifies the need for the research.
There is little or very limited knowledge about the adherence of HCWs in busy outpatient settings to hand hygiene guidelines. There is also gap in knowledge regarding the effectiveness of using gel sanitizers and informational posters in the overall HH performance of HCWs within outpatient clinics. This study was aimed at addressing this gap in existing knowledge.
Many research studies have tested interventions that can be applied to improve HH in teaching hospitals and it was found that they were actually successful. Nonetheless, fairly few studies have tested these sorts of intervention within outpatient clinics. Mensah (2005) in their study which they carried out in outpatient clinics in Britain observed that baseline HH adherence was 18 percent. In a different research study carried out in an outpatient clinic in Israel, Cohen (2002) observed the behavior of doctors and sampled their hands for bacteria, although there was no intervention that was introduced. Observance to HH was low at just 31 percent. It was also observed that 69 percent of the doctors had Stapholococcus aureus in their hands. Some of the reasons that doctors cite for not adhering to HH guidelines include the absence of hygiene facilities, lack of awareness, too much workloads, as well as negative reactions to disinfectants (KuKanich et al., 2013).
Study METHODOLOGY
NAME the specific quantitative methodology of the study.
Observation is the specific quantitative methodology that was applied by the researchers. At times one cannot control a situation, and conducting an experiment is typically not feasible. Nonetheless, it might be probable to observe what goes on.
Provide a clear description/definition of this methodology (in your own words); use an article or your text to support the definition and provide a citation.
Quantitative observation is basically an observation that could be measured in numbers for instance length, volume, and acceleration. In essence, quantitative observations are usually made using instruments (Lubbe & Roets, 2014). They are observations observed of data in numbers; objects are counted or measured and are commonly with numbers.
Why was the choice of this methodology appropriate for this study? JUSTIFY your response.
The choice of observation quantitative methodology is appropriate for this study since the researchers has to collect data through observations. They needed to observe the subjects/participants in order to monitor the HH opportunities and to record the HH attempts of the HCWs in the 2 clinics.
Sample and Setting
Identify inclusion and exclusion sample criteria.
The inclusion criteria included the following: (i) the participant had to be a health care worker; (ii) the participant had to be working at either GI clinic or at the oncology clinic; (iii) the subject had to be a nurse or a physician; and (iv) the subject has to be aware of hand hygiene practices. The exclusion criteria: (i) the individual not being a health worker; (ii) the participant not working at either GI clinic or at the oncology clinic; (iii) the individual not being either a nurse or a physician.
Indicate the method used to obtain the sample. Provide a definition of the method and discuss why it was an appropriate choice for this study
The sampling method utilized by the researchers in this study is purposive sampling. Purposive sampling is essentially a sampling method in which the researcher samples with a purpose in mind. The researcher would typically have 1 or more precise groups that he/she is seeking. Purposive sampling is essentially a kind of non-probability sampling wherein some elements of population do not have any chance of selection, or in which the probability of selection cannot be established accurately (Yarcheski & Mahon, 2013).
Purposive sampling method was appropriate in this research study since the researchers started with a purpose in mind; they wanted a certain predefined group – health care workers in busy outpatient clinics. As such, they only had to sample individuals who are health care workers working in outpatient clinics.
State the sample size. Indicate if a power analysis was conducted to determine the sample size.
This study included a sample size of 88 participants: 41 HCWs at the GI clinic and 47 HCWs at the oncology clinic. Power analysis was not performed to determine the size of the sample.
Identify the SPECIFIC characteristics (demographics) of the sample.
The demographic in this study is defined in terms of gender. Survey was conducted in which 56 HCWs were sent questionnaire survey: 15 from the GI clinic and 41 from the oncology clinic. Of the 56 respondents, 30 were females while 26 were male.
Identify the sample mortality (or attrition) number and percentage.
Sample attrition or mortality is understood as the number of individuals who drop out of the research study in the course of the study. Initially, 88 health care workers were mailed questionnaire survey and only 56 of them returned the survey. As such, the attrition is 32. This is equal to 36.36%.
Indicate the type of consent obtained and institutional review board approval.
Getting consent for the participation of participants in any research study is of major importance. The main types of consent include proxy, post-hoc, implied/implicit, and explicit/express/informed. Implied/implicit consent was obtained from the participants of this research study given that the consent was not obtained through formal ways, for instance verbal or written approval (Schneider, Nicholas & Kurrus, 2013). The participants completed questionnaire forms and this implied their consent to take part. Approval was obtained from the administration of the two clinics.
Identify the study setting and indicate if it is appropriate for the study purpose. JUSTIFY your response!
The research study was conducted in 2 outpatient clinics. This setting is appropriate for the purpose of the study since the researchers wanted to improve HH in the 2 outpatient health care clinics by way of introducing an informational poster and a gel sanitizer.
Identification and Control of Extraneous Variables
Define extraneous variables
Extraneous variables are basically understood as undesirable and unwanted variables which influence the relationship between the variables being examined by the investigator. Extraneous variables influence an experiment’s results, although they are not the variables of interest (Hoe & Hoare, 2012).
What are the extraneous variables in this study? In what way(s) were appropriate measures used to control for the influence of the extraneous variables? Describe fully. If not addressed, explain how you know this and identify the extraneous variables you would note.
In this research study, the extraneous variables include gender, age, background and mood of the participant. It is notable that during the research study, female HCWs were more consistent in HH compared to male HCWs. The influence of extraneous variables was controlled by using almost the same number of male and female participants in the study, and ensuring that they all have the almost the same background regarding knowledge of hand hygiene practices.
Study Instruments/Tools
Identify the instruments used in the research
Survey was the instrument used.
FOR EACH INSTRUMENT: Instrument #1; Name of Instrument: Discuss how the instrument was developed or purpose of use. Cite the source for the background information about the instrument.
Survey was the instrument utilized by the researchers. A survey was mailed by the researchers to the nurse managers at the 2 clinics, and was circulated to 41 HCWs at the GI clinic and to 47 HCWs at the oncology clinic, 3 months following the final day of the follow-up observations. The researchers carried out the survey in order to evaluate the HCWs’ opinions of HH at their respective clinics, as well as their preferred tools of HH – gel sanitizer, foam sanitizer, or water and soap (Kukanich et al., 2013). Surveys are a descriptive, non-experimental method of research and they are particularly valuable whenever the investigator wants to gather data on phenomenon which cannot be observed directly, for instance opinions and perspectives of participants (Hoe & Hoare, 2012).
Identify the type of measurement strategy (e.g., Likert scale, visual analog scale, physiological Measure, questionnaire, observation, or interview).
Questionnaire, observation and Likert scale were used. Observation was measurement strategy applied. Interventional observation was used as the participants were directly observed to monitor HH opportunities and record HH attempts. Questionnaire was used after the observation. A 5-item Likert scale that ranged from strongly agree to strongly disagree was utilized for questions about the motivational effectiveness of each of the intervention tools.
Identify the level of measurement (nominal, ordinal, interval/ratio) achieved by the measurement strategy. Provide a definition of the level of measurement(s) you identified and justify WHY you believe the instruments represent this level of measurement.
The measurement strategy achieved ratio. In ratio measurement, a meaningful absolute zero is always there. This implies that the researcher can construct a meaningful ratio using a ratio variable (Yarcheski & Mahon, 2013). The instruments represent ratio level of measurement because in the survey conducted in this study, there could be zero HCWs who believe that HH campaign has improved their HH practices.
Report the reliability of the instrument from previous studies and the current study.
He instrument is consistent. The information collected by the survey is consistent.
Report the validity of the instrument from previous studies and the current study.
The instrument is accurate and it serves the function that it was intended to serve, and always gives information that is correct.
Data Collection Methods
Detail how the data were collected.
Data were collected through observation and the use of survey. Through observation, the investigators observed the subjects/participants in order to monitor the HH opportunities and to record the HH attempts of the HCWs in the 2 clinics. One month following the final day of interventional observations, the researchers conducted follow-up direct observations of HH on 3 non-consecutive days. Survey was carried out to evaluate the HCWs’ opinions of HH at their respective clinics, as well as their preferred tools of HH – gel sanitizer, foam sanitizer, or water and soap
In what way(s) is the data collection procedures appropriate for this study?
Observation is appropriate since they needed to observe the subjects/participants in order to monitor the HH opportunities and to record the HH attempts of the HCWs in the 2 clinics. Survey is appropriate since it was useful in assessing the HCWs’ sentiments of HH at their respective clinics, as well as their preferred tools of HH.
In what way were appropriate steps taken to protect the rights of the subjects?
The subjects were respected and treated as autonomous agents and those who wanted to drop out were allowed to do so. In essence, there right to end participation in the research study at any time was respected. They were also given access to information as regards the research study.
Statistical Analysis Procedures
Identify the statistical procedures used in the study: Statistical Procedure #1 (Name and definition):
Chi-square: Pearson’s x2 was used. Pearson’s chi-squared is essentially a statistical test which is used in sets of categorical data in evaluating how probable it is that any observed dissimilarity between the sets came about by chance (Yarcheski & Mahon, 2013). In essence, it is utilized in determining whether there is any sort of relationship between 2 categorical variables.
Pearson’s Chi-square is the only statistical procedure that was used.
How was it used in the study?
Pearson’s x2 analyses were utilized in comparing the frequency of HH attempts throughout the 3 observation periods and in comparing the post-contact and pre-contact frequency of such attempts. It is notable that every calculation had 1 degree of freedom, and a P value equal to or less than 0.05, that is, <= 0.05, was seen as significant (Kukanich et al., 2013). Only descriptive statistics were utilized in assessing the frequency of HH by HCW’s profession and gender considering that there were considerably less observations of male HCW’s to allow comparative analyses. In addition, descriptive statistics were utilized to compare the HH tools utilized, given that product availability did vary in the course of the study.
Complete the table below with the analysis techniques conducted in the study:
Statistical Procedure
Statistical Findings
Significance (provide a narrative description of the significance as well as the actual statistical values
Chi-square
Before intervention: Rate of attempt at GI clinic = 21%
Rate of attempt at oncology clinic = 11%
After intervention:
Rate of attempt at GI clinic = 54%
Rate of attempt at oncology clinic = 36%
In both the GI and oncology clinics, the overall rates of HH attempts to HH opportunities were 21% and 11% respectively.
This improved greatly after the intervention was introduced to 54% and 36% respectively, and remained improved at the 1-month follow-up period 51% and 32% respectively.
What are the specific results of the study? Provide DEPTH and write IN YOUR OWN WORDS.
In the GI clinic, at baseline, the overall rate of HH attempt to opportunities was 21%, it was 11% for the oncology clinic, and after the intervention, these improved substantially to 54% for the GI clinic and 36% for the oncology clinic. Half of those who were surveyed agreed or strongly agreed that the HH campaign had actually increased the awareness of HH. On the whole, 34 percent of the subjects agreed that HH campaign had improved their HH practices. Moreover, half of the participants agreed or strongly agreed that introducing gel hand sanitizer served as an effectual motivator and resulted in improved frequency of HH. HH performance was consistently better after contact with patient compared to before contact with patient.
Strengths\Limitations
What are two major strengths of the scientific merit of this study? (This does not refer to findings of the study)
It was easier to answer the research questions using a small sample size than a large one
The study was carried out on a new area which has not been examined previously thus it greatly contributes to the body of existing knowledge.
What are two major limitations of the scientific merit of this study?
The possibility of the Hawthorne effect – some HCWs may have noticed that they are being observed, and hence they cleaned their hands more regularly.
Only 56 subjects actually took part in this study which is a very small figure hence the findings cannot be generalized to the entire population of outpatient HCWs. It is difficult to generalize findings from a small size (Hackshaw, 2010).
How did the researcher generalize the findings?
The researchers generalized the findings by stating that the HH campaign demonstrated that providing informational posters and introducing a gel sanitizer could bring about short-term improvements in HH performance within outpatient clinics.
What did the researchers say the relevance of the data was? Describe the researchers’ interpretation of the findings.
They stated that the results of the research show that the HH frequency by HCWs in busy outpatient healthcare settings is low. They added that short-term exposure to interventional tools could result in modest improvement still seen at 1-month follow-up. Moreover, pre-testing interventions within a particular healthcare setting and utilizing a multi-faceted implementation approach may help in achieving the highest improvements. Reinforcing and/or establishing a clinic-wide expectation that HCWs would follow HH recommendations is also an important measure which might further encourage HH adherence.
Where in nursing can the results of the data be applied?
In busy outpatient settings
What suggestions for further study were identified?
The researchers recommend that in future, after the collection of baseline data, researchers should seek the ongoing involvement and support of influential HCWs who may also act as role models for other HCWs.
Is the description of the study sufficiently clear for replication? Explain and Justify your response
Yes, the description of the data is adequately clear for replication. This is because the instruments used were valid and reliable. They were accurate and measured what they were designed to measure.
REFLECTION
Reflect upon your newly developed understanding of quantitative research. What has this experience critiquing a quantitative research study meant to you and how will this make a difference in your overall practice of nursing? Please provide depth and be sure you respond to the question. This is a subjective response and must be at least 2 full paragraphs. Please respond in reference to understanding quantitative methodology and not the specific focus of the research study.
What has the experience of reading and critiquing a quantitative study meant to you?
It has meant much to me as it has helped to gain essential knowledge and skill that I can effectively utilize to conduct a useful quantitative research. It has helped me to identify the weaknesses such as small sample size that I need to avoid in order to ensure that the findings which I obtain can be generalized. It has also offered me a better, clear understanding of Chi-square/Pearson’s X2 and how I can use this statistical procedure in quantitative data analysis.
How will understanding and using quantitative research findings make a difference in your practice of nursing?
The understanding of using these quantitative research findings will make a difference in my practice of nursing in several ways. It will allow me to effectively apply the findings in my workplace, for instance by adhering to HH guidelines. Moreover, it will help me to focusing on doing what is right in order to improve outcomes.
References
Boudjema, S. S., Dufour, J. C., Aladro, A. S., Desquerres, I. I., & Brouqui, P. P. (2014). MediHandTrace®: a tool for measuring and understanding hand hygiene adherence. Clinical Microbiology & Infection, 20(1), 22-28. doi:10.1111/1469-0691.12471
Cohen, H. A .(2002). Handwashing patterns in two dermatology clinics. Dermatology;205(4):358-61.
Hackshaw, A. (2010). Small Studies: Strengths and Weaknesses. European Respiratory Journal; 32(5):1141-1143.
Hoe, J., & Hoare, Z. (2012). Understanding quantitative research: part 1. Nursing Standard, 27(15-17), 52-57.
Huis, A., Hulscher, M., Adang, E., Grol, R., van Achterberg, T., & Schoonhoven, L. (2013). Cost-effectiveness of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International Journal Of Nursing Studies, 50(4), 518-526. doi:10.1016/j.ijnurstu.2012.11.016
KuKanich, K. S., Kaur, R., Freeman, L., & Powell, D. A. (2013). Evaluation of a Hand Hygiene Campaign in Outpatient Health Care Clinics. AJNonline; 113(3).
Lubbe, J., & Roets, L. (2014). Nurses’ Scope of Practice and the Implication for Quality Nursing Care. Journal Of Nursing Scholarship, 46(1), 58-64. doi:10.1111/jnu.12058
Mensah E. (2005). Hand hygiene in routine glaucoma clinics. Br J Ophthalmol;89(11):1541-2.
Santos, L., Souza Dias, M., Borrasca, V., Cavassin, L., Deso di Lobo, R., Bozza Schwenck, R., & … Bierrenbach, A. (2013). Improving hand hygiene adherence in an endoscopy unit. Endoscopy, 45(6), 421-425. doi:10.1055/s-0032-1326284
Schneider, B., Nicholas, J., & Kurrus, J. E. (2013). Comparison of Methodologie Quality and Study/Report Characteristics Between Quantitative Clinical Nursing and Nursing Education Research Articles. Nursing Education Perspectives, 34(5), 292-297.
Yarcheski, A., & Mahon, N. E. (2013). Characteristics of Quantitative Nursing Research from 1990 to 2010. Journal Of Nursing Scholarship, 45(4), 405-411. doi:10.1111/jnu.12038
We can write this or a similar paper for you! Simply fill the order form!
Guidelines: There will be 5 – 6 questions for you to answer. These will be a combination of personal and analytical questions so you may use first person. There is a minimum requirement of five sources (including the textbooks) and I ask that you try and use more journals and print related sources rather than just pure online sources. Please use Microsoft Word with standard margins, double-spaced with a works cited page at the end. Although you do not need a formal cover sheet, please place your name, class and date at the top of the first page. Also, please designate if you are in the MGT 3303 or SCM 3303 course. Finally, the paper should be 4 – 6 pages in length in terms of text excluding works cited.
Questions:
1) Discuss a time when you found yourself in a position where you negotiated in real life.
a) Tell me about the circumstances and how did things turn out for you and the other party. b) Looking at the materials from class, which set of principles do you think you utilized in the negotiation (tactics, techniques etc.). Also, what did the other party utilize (again, tactics, techniques etc.) in their aspect of the negotiation?
2) Reflect upon these three definitions of negotiations:
Lewicki et al – Negotiations is a process by which two or more parties attempt to resolve their opposing interests
Jim Camp – Negotiation is the human effort to bring about agreements between two or more parties with all parties having the right to veto
a) Compare and contrast both of these two definitions to each other. Demonstrate where they are both similar and also quite different. While I know you don’t have the work from Jim Camp, his definition should give you plenty to work with for this paper.
b) In all honesty, which definition seems to work best for you? In other words, when you think of how you approach negotiations, which definition applies more towards how you view and act in a negotiation situation and tell me why.
3) Think about a time when you had to negotiate with someone who was at greater level of power than you.
a) What was the situation exactly and what was at stake for you or the people that you were negotiating for?
b) Which approach did you use in order to be effective? If you weren’t effective, what do you think happened that caused you to not get the desired results? Knowing what you now know, what would you have done differently?
4) Tell me about a situation where you had alternatives or BATNA’s in mind. What was the situation, and did the other side have BATNA’s?
a) In your experience (whether it relates to the above question or in any other instance) do (or did) BATNA’s actually work for you in negotiation situations?
b) Does the concept of win-win also something that agree with or do you find yourself more inclined to follow the win-lose ideology?
5) Inevitably, negotiations can result in conflict. Reflect upon the time when conflict arose as a result of a negotiation in your life.
a) What happened during the negotiation situation that caused conflict to occur? Was the problem related to you or the other party?
b) Looking at the elements of effective conflict management, which elements did you use during the conflict? Also currently, which style do you prefer to use now when conflicts arise?
*Extra Credit Bonus Question worth 5 points towards your lowest grade*
Discuss how relationships are valued and viewed in negotiations.
a) How important is it to you to establish and or maintain a relationship when you are negotiating?
b) In terms of meeting new business partners, how are relationships valued in different cultures? Contrast how Western and non-Western cultures view and value the importance of relationships in negotiation situations. Provide some examples and are there points that can be taken from various cultures in terms of how to work with relationships during negotiations?
SAMPLE ANSWER
Analysis and Reflection paper
#1 a).
I happened to have been involved in a negotiation with my cousin Erick in 2012. It was summer and I wanted us to spend our holidays in at the coast so that we could enjoy the breeze from the beach, and dine in the flashy restaurants at the coast. On the other side, Erick wanted us to visit some of our relations upcountry and visit some of the flashy hotels in the region. We had budgeted for a period of one week for our holidays, and both of us wanted to have enough time to cool our minds from the busy academic year that we had experienced that year. In relation to this, both of us had the same interest, which was to relieve ourselves from the stress of learning. Moreover, both of us wanted us wanted to have enough time to enjoy a variety meals, which could be found in either the hotels or restaurants. However, we had differing opinions in terms of where we wanted to spend our holidays. As such, we agreed to send three days at the coast and the other four days upcountry. This agreement benefited both of us in that we had enough time to cool our minds, enjoy various meals and coastal breeze, and visit our relations.
b)
In the negotiation, I applied the principle of focusing on interest and not positions. As such, I focused on the interest that both of us had as opposed to our positions on where to spend the holidays. Consequently, the two of us had to apply the principle of looking for alternatives that could satisfy our interests (Kazakevicue 158). As such, we agreed to spend art of the time at the coast and the other part upcountry. Here, we managed to achieve mutual gain. Furthermore, both us applied the concept of insisting on objective criteria in that we ensured that we relived ourselves from the stress of learning, and enjoyed a variety of meals.
#2
In the definition of negotiation provided by Lewicki et al., it is considered as collaborative process in which two or many individuals try to resolve their opposing views or interest. In relation to this, my cousin Erick and I wanted to resolve our opposing interests in that Erick wanted us to spend our holidays upcountry, while I wanted us to spend the holidays at the coast. On the other hand, Jim Camp defines negotiation as the effort of human to establish agreements between two or many parties I which all parties have the right to veto. In relation to this, Erick and I were decided to look for a common consensus in which both of us offered opinions.
a)
The definitions of negotiation provided by Jim Camp and Lewicki et al. are similar in that they both refer to it in terms of looking for solution for two or more parties’ opposing views. On the other hand, the definition offered by Lewiki et al. focuses on the resolution of opposing interest from one party’s point of view, while Camp’s definition focus on the resolution of opposing views from the point of view of all parties involved (Collisson 198). As such, Camp’s definition emphasizes on mutual gain as opposed to the definition of Lewicki et al.
b)
In my opinion, the definition provided by Lewicki et al. offers the best approach to negotiation. One of the aims of negotiation is ensuring that a party’ interests are fulfilled. Anytime I am involved in a negotiation, I often try to ensure that most my interests are satisfied. As such, this definition works best for me as opposed to Camp’s definition, which is based on the agreement formed on the opinions of the opposing parties.
#3
a)
I remember being involved in a negation with my dad about where I was to attend my high school learning. I wanted to learn in one of the high schools in the city, whereas my dad wanted me to attend a high school that was located in a remote area. I preferred the city to the remote place as it could give me chance to get exposed to new ideas and friends whom I considered civilized and trendy. On the contrary, my dad argued that the city life could hinder my education as it could expose me to bad company. Thus, my getting exposed to new ideas and fashionable friends what at stake.
b)
I was forced to employ the win-lose approach or the distributive negation. This approach is founded on the idea that one individual can manage to win only at the expense of the other person. One of the characteristics of this approach is that the dominant strategies include withholding of information and manipulation (Tastan 1343). I knew that my dad loved me so much that he did not like to see me get hurt or sad. As a result, used emotional blackmail to get my plea had. I decided to be sad and emotional when my dad insisted on me learning at the school located in the remote region. I refused to eat or talk to anyone and this strategy managed to be effective I that my dad allowed me to study in the city.
#4
BATNA refers to the course of action or step that will be adopted by a party in case the current negotiations fail thereby making it difficult for an agreement to be achieved. BATNA acts as the principle focus and the driving mechanism behind successful negotiators (Dana 87). While in high school, my dad did not want me to have a girlfriend or be involved in any issue of boyfriend-girlfriend affair. However, I was attracted strongly to a girl called Liza who was also attracted to me. In contrast, Liza’s parents had no problems with her having a boyfriend. Our problem came when Liza insisted that we had to make our relationship known to our parents. I knew that this issue could bring problems in our relationship since my dad could not consent to our affair. Therefore, I had to find a BATNA, which was to take her to my uncle who had no issues with boyfriend-girlfriend affair. Liza only wanted our relationship to be known to our relations and this action could make her satisfied in case she insisted on me taking her to my parents. In like manner, she embraced this idea and we continued dating throughout our high school learning.
b)
In my experience, I believe that BATNA’s often work effectively in situations of negotiations. BATNA’s often provide appropriate solution in cases where two or more parties cannot agree at each other’s’ view by providing a neutral ground. Thus, BATNAs are effective in negation situations where the parties involved have robust stands or positions.
b)
In my view, I believe that the concept of win-win is ineffective and unrealistic. In a negation, the interest of one party often ends up prevailing over the interest of the other. Moreover, it is difficult to find a situation in which all parties in a negation end up being satisfied fully. As such, one party often feels more satisfied than the other (Collisson 195). Therefore, the concept of win-lose happens to be more realistic to me than that of win-win.
#5
a)
Indeed, negotiations can lead to conflicts. Conflict can be defined as a process that commences when a party perceives or feels that other party has affected negatively something the other party cares about. In negotiation situations in which the parties involved believe that their needs cannot be met, conflicts often arise (Sierau 227). I happened to have this experience with my friend, Edward. We had been saving money together and wanted to open a small business that could deal with groceries. As such, we had to negotiate on how we could share our profits. Edward had enough of free time, which meant that he could spend more time in the grocery than I could, which made him to demand for a bigger share of the profits. On the other hand, my financial contributions to the business were slightly more than Edward’s, and I wanted to earn a bigger share than him. Thus, the problem was related to both of us. As a result, we could not reach a common agreement since each of us felt that our needs could not be met even on a fifty-fifty basis. Thus, a conflict emerged and we were forced to abandon our plan and split our capital in terms of our contributions.
b)
Effective conflict management elements include listening, understanding the conflict, empathy, and agreement. Unfortunately, I did not apply any of these elements in my negotiation with Edward (Dana 76). As such, we did not manage to agree with each other. We needed to have taken adequate time to understand the conflict, listen at each other, and empathize with each other. These steps could have helped us reach a common agreement. Currently, any time I am involved in a conflict, I always apply these three elements to arrive at a satisfying agreement.
#6
a)
In my view, maintaining a relationship during negotiation is vital as it helps in ensuring that the parties involved in the negation do not cross each other’s boundary. Moreover, it provides a platform on which the parties involved in the negotiation can view and understand each other’s views.
b)
Various cultures have different approaches of handling negotiation from the viewpoint of relations. In western cultures, the aspect of relationship is not emphasized during negotiations. On the contrary, non-western cultures such as African prioritize the aspect of relationship during negotiations. As such, they tend to arrive at agreements that are based on maintaining the relationships of parties involved in negotiations (Dana 192). For instance, negotiations that involve members of the same kin are often conducted in a manner that preserves the kinship involved between the parties involved.
Works Cited
Collisson, Brian. “Failing to See Eye to Eye: The Role of the Self in Conflict Misperception.” American Journal of Psychology 16(2014): 193-200
Dana, Daniel, Conflict Resolution. New York: McGraw-Hill, 2000.
Kazakevicue, Aiste. “Adlerian Lifestyle and Conflict Resolution Strategies in a Lithuanian Organization.” Journal of Individual Psychology 2(2013): 156-167
Sierau, Susan; Herzberg, York. “Conflict Resolution as Dyadic Mediator: Considering the Partner Perspective on Conflict Resolution.” European Journal of Personality 26(2012): 221-232.
Management and Business, and this is a business research essay based on the business research of the company of JP Morgan. Please read the
Requirement and the research proposal first, than write a 3500 words essay. Please mind the following issue:
1. Please also read the ZIP file “Example”, it was high mark paper from previous students, take it as the standard for the structure and word-count for each
part. But please must not copy anything from it.
2. Please do not directly copy anything from the example and the rest reading material, the similarity ration must low than 15% including the reference and
appendixes.
3. The slides of all lectures are also uploaded, please check.
We can write this or a similar paper for you! Simply fill the order form!
Be sure to read the information under the Course Home Financial Analysis link, go through the tutorial videos listed on the page, and download the
transcripts for each video to use as references when completing the financial analysis assignment. These tutorials and transcripts will give you most, if not
all, of the instructions you need to make your analysis. One tip – total assets and current assets are different figures.
To give you a brief recap of this task:
You are using your financial expertise to analyze CanGo’s financial situation. Looking at the first line of the spreadsheet, the first line is “Efficiency
Ratio: Receivables Turnover.” The tutorial videos will explain what the Receivables Turnover Efficiency Ratio is and why it is important. This detail is what
you will put in the column “Explanation of why ratio is important.”
The tutorial videos will also give you the formula for “Receivables Turnover,” and this is what you will put in the column “Formula (express the ratio in
words).”
I recommend that you review the video tutorials and complete the two columns described above first so that you will understand what needs to be done next,
which is that you will review the CanGo financial information and calculate the “Receivables Turnover” using CanGo financial information and the formula that you already identified. This information will be placed in the column “Detailed calculation (actual numbers from financial statements used for the calculation).”
The results of your calculation for CanGo will be placed in the column “Final number (final result of the detailed calculation).”
You do not need to put the CanGo financials as a reference, but you do need to list any sources that you used to understand and describe the ratios.
This assignment is worth 96 points, with each box that needs to be completed on the form worth 3 points.
The CanGo financial information can be found on the CanGo Intranet; the link is available at the bottom of the Course Home Report Guide page.
I would like to give you a few tips to hopefully help you avoid mistakes that many students make with this assignment. As I recommended in a previous
announcement, your first step should be to complete the formula column for the specific ratio. You can find the formulas in the videos or transcripts under
Financial Analysis link. I recommend looking there first. If it still seems confusing, I am listing some websites below that some students have found
helpful.
After you have the formula, look for the matching figure on the CanGo financial statement. Don’t make this harder than it has to be! Some of the formula
components are line items on the financial statement and some of the exact figures you need are on the financial statement, without requiring that you
perform calculations. You will need to calculate some of the amounts, but not all of them. For example, the Cost of Goods Sold is a line on the Income
Statement. Cost of Goods Sold is not any type of income, however, this figure is used in an area of the Income Statement for calculating Gross Profit. Net
Income is also a line on the Income Statement, and the figure is there for you. My recommendation is that after entering your formula in words in the Formula column, look for the matching line item in the financial statement to get the figure that you need to use in the Detailed Calculation column. If you do not find a matching line item, then you will need to determine which figures you need to make the appropriate calculation.Another tip, “Current” assets and “Current” liabilities are different from “Total” assets and “total” liabilities or total debt. Keep in mind that “current” is not the same as “total.” Total
Assets is not the same as Total Equity.
I hope this information helps. The following websites might help in addition to the tutorial videos and transcripts available in the course under the
Financial Analysis link information. http://accountingexplained.com/financial/ratios/ http://www.netmba.com/finance/financial/ratios/ http://beginnersinvest.about.com/od/financialratio/Financial_Ratios.htm http://www.accountingcoach.com/online-accounting-course/03Xpg01.html
We can write this or a similar paper for you! Simply fill the order form!
The following things should be done: Service Area Competitor Analysis? Using the Emanuel Medical Center case, complete the following requirements (in addition to the same analyses applied in the Cooper Green Hospital case – SOSI, stakeholder analysis, trends analysis).
You will critically analyse your chosen protocol, in the form of a 2500 word academic essay. You should focus on evaluating the relative strengths and
weaknesses of the research and evidence described in the protocol, using the guiding questions (BELOW) as the basis for your appraisal. Please note that you
should not just present a question and answer format – you must write this in an academic essay style so that your analysis based on the guiding questions
flows as an integrated piece of work.
You are expected to justify comments and analysis with reference to literature.
You are trying to determine the strengths and limitations of the protocol, including the evidence which underpins the protocol and in so doing its relevance to your practice, in the same way, that you would review research or opinion based article to determine its strengths or limitations in supporting your discussion.
Protocol to be analysed
GUIDELINE: Initiation of Patient Controlled Epidural Analgesia (PCEA) and Assessment of Motor and Sensory Response in Hip and Knee Surgery Patients Post Combined Spinal Epidural Anesthesia
Department of Nursing
Population/Specialty-Based Clinical Guideline
PTU/PACU
PURPOSE
To provide a guideline for the timely initiation of Patient Controlled Epidural Analgesia (PCEA) based on the assessment of motor function and sensory
response in hip and knee surgery patients post combined spinal-epidural anesthesia.
DEFINITIONS
Combined Spinal-Epidural Anesthesia (CSE): A type of regional anesthesia that combines the benefit of both spinal and epidural anesthesia. The spinal
component gives a rapid onset of a predictable block. The epidural indwelling catheter component provides access for the administration and titration of anesthesia and analgesia (Mulroy, 2002)
CSE allows for a minimal dose of spinal anesthetic of a short duration and allows of the addition of epidural reinforcement of anesthesia and /or
administration of analgesia (Bali, Sharma & Gupta, 2007)
Patient Controlled Epidural Analgesia (PCEA): A method for patient self administration of narcotic-analgesia and a low dose of local anesthetic agent through an epidural catheter via a dedicated programmable infusion pump (Standl et al, 2003; Block et al, 2003).
Sensory Response Level (Dermatome): The dermatome is the area of the skin supplied by the sensory nerve and approximately corresponds to the myotome (Waxman, online).
It may also be assessed to evaluate the extent of spinal blockade and its resolution (Mulroy, 2002).
Motor Function (Myotome): The muscle and its nerve comprise a myotome. Each muscle in the body is supplied by a particular level of the spinal cord and its corresponding spinal nerve. The initiation and resolution of the spinal blockade of anesthesia is determined by evaluating the motor function of the lower extremities (Smet, Vlaminck & Vercauteren, 2017).
PROCEDURE:
Upon Arrival
1. Positioning Patient;
a. If patient is hypotensive, keep HOB flat.
b. If blood pressure in normotensive range (or other BP parameters defined by anesthesiologist) and other vital signs are stable, place patient in semi
fowlers (HOB @ 30 degrees) unless contraindicated by surgeon or anesthesiologist.
c. Initiate comfort measures and orient patient to Recovery area.
GUIDLINE: Initiation of Patient Controlled Epidural Analgesia (PCEA) and Assessment of Motor and Sensory Response in Hip and Knee Surgery Patients Post Combined Spinal Epidural Anesthesia
2. Assess and document patient’s level of consciousness to determine the level of sedation and anesthesia, vital signs (blood pressure, heart rate, and respirations), oxygen saturation via pulse oximetry, body temperature.
Monitor and document every 15 minutes per protocol.
3. Assess pain level
a. Using the Pain Management Guideline for patients who respond verbally and follow commands.
b. Refer to Pain Assessment Tool for Non-Cognizant Adults.
4. If pain present and no motor movement has occurred, follow physician orders.
5. Access of the epidural catheter and document condition of dressing;
a. Transparent dressing intact, notify anesthesia immediately if not intact.
b. If displaced, bloody, or leakage present, notify physician.
6. Motor Function:
a. Assess and document both lower extremity movements.
b. Motor function is assessed by asking patient to move lower limbs especially the unaffected side, since movement of the unaffected limb usually occurs sooner than the affected limb.
c. Assess every 15 minutes per xxx until meets xxx discharge criteria.
d. Document dermatome level before transferring patient to the floor.
7. The assessment indicator for the resolution of CSE anesthesia and initiation for PCEA is any movement of either lower extremity. This is due to the
relatively low dose of local anesthetic in the PCEA that is routinely used in post hip and knee surgery patients. Thus, the low dose of medication is
unlikely to cause motor and sensory blockade and interfere with the resolution of CSEA (Patel, Sadoughi & Zadeh 2010).
8. Sensory Response
a. For assessment of dermatome level, use alcohol prep to assess “cold” and “wet” sensation (Bourne, Campbell, Mushambi & May, 1997).
b. Assess the non affected area first (for example chest or upper arm) then the affected area.
c. Assess every 15 minutes per xxx until meets xxx discharge criteria.
With the return of any movement of either lower extremity: Prepare to initiate PCEA
1. Two RNs verify medication with physician order
a. Confirm settings on infusion pump are entered correctly per order
b. Co-signatures of RNs are entered on the paper record
c. Label tubing “PCEA”
2. Assess and document vital signs (blood pressure, heart rate, and respirations), oxygen saturation via pulse oximetry, body temperature to ensure
hemodynamic stability.
3. Assess and document the integrity of the epidural catheter transparent dressing and report presences of excessive leakage or displacement at site.
4. If hemodynamically stable, initiate PCEA per physician’s order.
GUIDLINE: Initiation of Patient Controlled Epidural Analgesia (PCEA) and Assessment of Motor and Sensory Response in Hip and Knee Surgery Patients Post Combined Spinal Epidural Anesthesia
5. Continue to assess and monitor vital signs, pain level, and adverse responses to PCEA every 15 minutes.
a. If hypotension occurs as a result of any pain medication administered,
notify physician and monitor vital signs more frequently.
b. Assess for adverse responses such as respiratory depression, nausea, vomiting, pruritis, local anesthetic toxicity, urinary retention/incontinence,
hallucinations, and dense/high block. If any occur, notify physician.
c. If pain is unrelieved while receiving PCEA, administer prn pain medication orders per xxx orders to initiate “Clinician Dose” of xxx per order set. The
patient’s pain level dictates which medication and dose to administer, (See Physician order set).
d. If unrelieved pain continues, notify MD for additional orders until acceptable level of pain control has been achieved.
e. Following initiation of the PCEA, the local anesthetic agent( e.g. Bupivicaine) may adversely spread to the intrathecal space causing motor weakness or worsening sensory blockade (Bourne, Campbell, Mushambi & May, 1997; Patel, Sadoughi & Zadeh 2010).
6. Continue to assess and document every 15 minutes
a. Both lower extremity movement and sensory response
b. Pain level
c. Vital signs
7. Continue monitoring and documentation until patient meets criteria for discharge from xxx
a. Hemodynamically stable one hour following initiation of PCEA
b. Resolution of CSEA has occurred as demonstrated by dorsi-flexion of the unaffected foot.
LOC- Awake and alert.
RELATED RESOURCES
Adult Pain Management Nur-Hs G1006
(2003). Efficacy of postoperative epidural analgesia, a meta-analysis. JAMA, 290(18), 2455-2463.
Bourne,T.M.,Campbell, F.,Mushambi, M.C.,M.C.,May, A.E.(1997) Patients’ assessment of sensory levels during epidural analgesia in labor. International Journal of Obstetric Anesthesia,6,239-241.
Mulroy, M.F., (2002). Regional Anesthesia, An Illustrated Procedural Guide (3rd ed), Philadelphia, PA: Lippincott Williams & Wilkins.
Patel, N.,Sadoughi,A.,Zadeh,B.(2010). Anesthesia Dept.Santa Monica/UCLA
Smet,I.,Vlaminck,E.,and Vercauteren,M.(2007).Randomized controlled trial of patient controlled epidural analgesia after orthopaedic surgery with sufentanil and ropivacaine 0.165% or levobupivacaine 0.125%. British Journal of Anesthesia, 1-5. Doi:10.1093/bja/aem309,1-5.
Standl,T.,Burmeister,M.,Ohnesorge,H.,Wilhelm,S.,Striepke,M.,Gottschalk,A.,Horn,E.,Esch,J.(2003).Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery. Canadian Journal of Anesthesia. 50(3). 258-264.
Guiding questions and points to help you critically appraise a protocol Notes / bullets (for completion by student
What topic does the protocol address?
What are the component parts of protocol?
Were there aspects of the protocol which you found unclear, and if so, why?
What were the different types of evidence which were used to develop the protocol (e.g. research studies; systematic reviews; government policies; grey
literature)
Where does the evidence that underpins the protocol fit in a hierarchy of evidence?
Evaluate the key pieces of evidence which were used to develop the protocol looking at, for example:
• how current the evidence is
• the relevance of the evidence
• the quality of the research carried out
Evaluate the strength of the body of evidence used to develop the protocol (i.e. taken all together, does the evidence support the aims and outcomes of the
protocol?)
How much confidence can be placed in the evidence which underpins the protocol?
What are the practice guidelines and requirements you can identify in the protocol?
What are the implications of these findings for your own practice?
References must not be more than 5 years old
We can write this or a similar paper for you! Simply fill the order form!
