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Acupressure for Pain and Discomfort Relieve in Nursing

Acupressure for Pain and Discomfort Relieve in Nursing Order Instructions: Issue: Volume 115(12), December 2015, p 40–45

Publication Type: [Feature Articles]

DOI: 10.1097/01.NAJ.0000475290.20362.77

ISSN: 0002-936X

Accession: 00000446-201512000-00025

Keywords: acupoint, acupressure, acupuncture, complementary medicine, integrative health, integrative medicine, integrative nursing, traditional Chinese medicine

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CE: Incorporating Acupressure into Nursing Practice

Wagner, Judy DNP, RN, APRN, CNP, HWNC-BC

Author Information

Judy Wagner is an NP and co-director of the Integrative Health Program at the Minneapolis Veteran’s Affairs Health Care System. Contact author:

. The author and planners have disclosed no potential conflicts of interest, financial or otherwise.

Abstract

ABSTRACT: Rooted in traditional Chinese medicine, the use of acupressure to alleviate symptoms, support the healing process, promote relaxation, and improve overall health has grown considerably in the West. The effects of acupressure—like those of acupuncture, with which it shares a theoretical framework—cannot always be explained in terms of Western anatomical and physiologic concepts, but this noninvasive practice involves minimal risk, can be easily integrated into nursing practice, and has been shown to be effective in treating nausea as well as low back, neck, labor, and menstrual pain. The author discusses potential clinical indications for the use of acupressure, describes the technique, explains how to evaluate patient outcomes, and suggests how future research into this integrative intervention might be improved. Acupressure is a therapeutic intervention rooted in traditional Chinese medicine but also widely practiced in Korea and Japan. Like acupuncture, its theoretical framework can be best understood through the lens of a philosophy that sees health as the maintenance of the internal flow of vital energy, known as qi, within the body.1, 21, 2 According to this theory, when this flow of energy becomes stagnant or is blocked, symptoms or disease can develop. Whereas acupuncture seeks to restore the flow of qi through needle insertion at specific points on the body, acupressure seeks to do the same through the practitioner’s use of the fingertips (or, in the case of advanced practitioners, fingertips, palms, elbows, forearms, or various devices) to apply pressure at these points.1, 3-71, 3-71, 3-71, 3-71, 3-71, 3-7 Acupressure is used to alleviate symptoms, support the healing process, promote relaxation, and improve overall health.

Graphic Figure. Photo court…

While research into the use of traditional Chinese medicine and other integrative therapies has increased substantially over the past two decades, the mechanism of action at work in acupressure and acupuncture remains unexplained in terms of the anatomic and physiologic concepts of Western medicine.1, 4-6, 8-101, 4-6, 8-101, 4-6, 8-101, 4-6, 8-101, 4-6, 8-101, 4-6, 8-101, 4-6, 8-10 (See Principles of Traditional Chinese Medicine.1, 4, 6, 8, 9, 111, 4, 6, 8, 9, 111, 4, 6, 8, 9, 111, 4, 6, 8, 9, 111, 4, 6, 8, 9, 111, 4, 6, 8, 9, 11) Nevertheless, it is considered by its practitioners around the world to be an “entirely coherent system, with internal logic and consistency of thought and practice.”1

Graphic Box. Principles of T…

This article discusses clinical indications for the use of acupressure; describes the technique, which can be easily incorporated into nursing practice; explains how to evaluate patient outcomes, and suggests how future research into this integrative therapy might be improved. The article also includes figures that illustrate the acupoints involved in reducing nausea and alleviating low back pain, neck tension, and dysmenorrhea.

INDICATIONS FOR USE

Acupressure is used in various ways outside the health care setting—in community wellness centers, for example. A well-known form of acupressure called shiatsu blends the use of direct pressure at specific points of the body with a systematic form of massage to promote healing and wellness.5 One popular application of acupressure, used by thousands of people daily, is stimulation of the pericardium 6 (P6) point above the wrist, which many people believe can prevent motion sickness (see Figure 1 3). Stimulation may be achieved by finger pressure or by specialized elastic wristbands that apply direct pressure to the P6 point. While this practice is common, research on its efficacy for this specific symptom has produced conflicting evidence. Further research is warranted.

Graphic Figure 1

In the clinical setting, there are numerous indications for the use of acupressure, with most research, focused on nausea and pain. Acupressure has been shown to be effective in treating chemotherapy-induced and postoperative nausea, as well as low back, neck, and labor pain, and dysmenorrhea (see Figures 2, 3, and 4 for acupressure points and specific indications for their use 3).

Graphic Figure 2 Graphic Figure 3 Graphic Figure 4

Chemotherapy-induced nausea. A systematic review of 11 randomized controlled trials analyzed the effects of acupoint stimulation used concurrently with pharmacologic antiemetic therapy on acute and delayed chemotherapy-induced nausea.12 Stimulation was delivered to the acupoints through a variety of modalities, including acupressure, electroacupuncture, electrostimulation, and manual acupuncture. While acupressure reduced both mean and worst acute nausea severity, it did not reduce acute vomiting, delayed nausea, or delayed vomiting. Electroacupuncture and manual acupuncture were more effective than acupressure in reducing acute vomiting but did not reduce acute nausea.

A quasi-experimental controlled study compared the effects of standard antiemetic drugs alone or in conjunction with wristband-delivered acupressure on nausea, vomiting, and anxiety in 64 patients receiving chemotherapy for stage I to stage III breast cancer.13 Results showed that nausea and anxiety were significantly reduced in the experimental group compared with the control group, suggesting that acupressure applied to the P6 pressure point is effective in reducing chemotherapy-induced nausea and anxiety in patients with breast cancer. Vomiting and retching were also reduced in the experimental group, though these reductions were not significant.

A randomized controlled trial comparing the effects of standard antiemetic therapy alone or together with either P6-stimulating acupressure wristbands or sham wristbands on 500 patients receiving emetogenic chemotherapy found no statistically significant differences between the three groups in terms of vomiting, anxiety, or quality of life.14 When considered together, however, both wristband groups reported a nearly significant (P = 0.07) reduction in nausea compared with the group receiving antiemetic therapy alone.

Postoperative nausea. White and colleagues investigated the effects of acupressure on postoperative nausea and vomiting in a double-blind, sham-controlled study of 100 patients undergoing laparoscopic surgery with general anesthesia.15 In addition to giving patients standard antiemetic therapy, the investigators randomized half the patients to receive P6 stimulation using a disposable acupressure wrist strip and a half to receive a sham wrist strip. Strips were applied to patients’ wrists 30 to 60 minutes before anesthesia was induced, and patients were instructed to leave the strips in place for 72 hours following surgery. The acupressure group had significantly less postoperative vomiting than the sham group at both 24 hours (10% versus 26%; P = 0.04) and 72 hours (12% versus 30%; P = 0.03) following surgery.

In a randomized controlled trial investigating nausea and vomiting in 102 women undergoing elective cesarean section, participants were randomly assigned to receive one of three therapies: metoclopramide 10 mg iv immediately before anesthesia induction, acupressure bands applied at the P6 point on both wrists 15 minutes before anesthesia induction, or no prophylaxis for nausea and vomiting (the control group).16 The incidence of postoperative vomiting was higher in the control group (32.34%) than in either the acupressure (17.64%) or metoclopramide (11.76%) groups, and use of antiemetics was significantly higher in the control group than in either of the intervention groups. Investigators concluded that acupressure and metoclopramide were similarly effective in alleviating postoperative nausea and vomiting following cesarean section.

Lee and Fan conducted a meta-analysis of 40 randomized controlled trials that investigated the effects on postoperative nausea and vomiting of drug therapy, P6 acupoint stimulation (through acupuncture, electroacupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acustimulation device, or acupressure), or sham treatment.17 They concluded that P6 acupoint stimulation was as effective as antiemetic drugs in alleviating symptoms, with fewer adverse events. They also noted that more research is needed to determine whether the duration of P6 stimulation is an important factor and whether combining antiemetic therapy with acupressure produces better outcomes than either intervention alone.

Chronic pain. The most commonly studied use of acupressure is in alleviating chronic pain. In their systematic review of 71 studies in which acupressure was used to treat a variety of conditions, Robinson and colleagues rated the evidence for its effectiveness in treating pain as a category 1: a “generally consistent finding in a range of evidence from well-designed experimental studies.”18 Included among the pain studies they reviewed were four randomized controlled trials on low back and neck pain in which acupressure was compared either with physical therapy or with usual care and was found to significantly reduce pain.

Labor pain. A review and meta-analysis of 13 randomized controlled trials, representing a total of 1,986 participants, investigated the use of either acupuncture (nine trials) or acupressure (four trials) in managing labor pain. The investigators concluded that both interventions may play an important role in diminishing pain, reducing the need for pharmacotherapy, and increasing the mother’s satisfaction with pain control.19 They emphasized, however, the need for further research in this area.

Dysmenorrhea. A systematic review that analyzed data from 10 randomized controlled trials, with a total of 944 participants, compared the effects of acupuncture (six trials) and acupressure (four trials) with placebo, nonintervention, or conventional medical treatment.2 Researchers found evidence that both interventions improved pain relief compared with placebo but concluded that further research through well-designed randomized trials is warranted.

In another study of the effects of acupressure on pain and menstrual distress, investigators randomly assigned 40 nursing students younger than age 25 with dysmenorrhea characterized by a visual analog scale (VAS) pain score higher than 5 to either a control group that used only rest as an intervention or an intervention group that used acupressure at the spleen 6 (SP6) point.20 Patients in the acupressure group had a statistically significant decrease in pain scores as measured by both the pain VAS and the Short-Form McGill Pain Questionnaire after 20 minutes of point stimulation, as well as over the next three months in which they self-administered acupressure to the SP6 point at home.

Similarly, in a single-blind clinical trial of 86 medical students, ages 18 to 28, with dysmenorrhea and VAS pain scores higher than 4, within the first menstrual cycle participants treated with either acupressure at the SP6 point or sham acupressure experienced a reduction in symptoms immediately following the treatment. However, the reduction in dysmenorrhea severity was significantly greater in the intervention group at 30 minutes, one hour, two hours, and three hours following the treatment. During the next menstrual cycle, dysmenorrhea was again reduced in both groups immediately following the treatment, but this time the reduction was significantly greater in the intervention group, as it was again at all measured time points.21

ACUPRESSURE TECHNIQUE

The acupressure practitioner typically uses the distal finger pads to apply gently to firm pressure at specific locations designated as key energy points on the body in order to stimulate the flow of qi within the body, thus supporting the body’s self-healing capabilities. When receiving acupressure, it is important that patients focus their attention on their breathing in order to trigger the parasympathetic response, which enhances the treatment.6, 226, 22

The frailty or strength of the patient should determine the amount of pressure applied by the practitioner, an issue that was not addressed in any of the studies reviewed for this article. Frail, elderly patients and young children require less pressure than healthy adolescents and adults. Although acupressure points are frequently tender to the touch, this is not a contraindication for using the point, but rather an indication that the practitioner has located the point.6 If touching the point causes the patient to wince, start with a gentle pressure that is just slightly more firm than that required to check a radial pulse and gradually increase the pressure over the next minute. Advise the patient that the pain should never be greater than mild discomfort, and check in with the patient frequently to confirm patient tolerance and make any necessary adjustments.

Pressure is generally applied for approximately 15 to 20 seconds,6 but duration can be increased up to a maximum of one minute per acupressure point and can be applied simultaneously to bilateral points. If the patient’s anatomy or an injury prohibits simultaneous bilateral pressure point stimulation, unilateral pressure is acceptable. Remind the patient to breathe diaphragmatically, slowly and deeply, during the process. As with any nursing intervention, the acupressure practitioner must ensure that her or his fingernails are sufficiently short to avoid making contact with the patient’s skin.

Do not apply acupressure to bruised areas or open wounds, or administer acupressure to patients who are hypersensitive to touch.

Evaluating outcomes. Effective stimulation of the appropriate acupressure points should reduce or eliminate symptoms. Optimal results for a variety of symptoms have been achieved in one week with daily use in conjunction with breathing exercises and other relaxation techniques.6 As an NP who incorporates acupressure in my practice, I have observed prolonged patient relief from chronic symptoms (specifically neck and low back pain) with acupressure treatments administered three to four times weekly and from acute symptoms with daily acupressure treatments. If no improvement is noted after several days, other integrative or conventional modalities should be used.

INCORPORATING ACUPRESSURE INTO NURSING PRACTICE

A survey of more than 700 critical care nurses found that those who used integrative therapies in their personal lives were more knowledgeable about these therapies and more likely to use these approaches in their professional practice.23 Learning acupressure techniques for self-care allows the practitioner to gain confidence and experience that can be brought to the clinical setting. While it takes some advanced training to reap all the benefits of acupressure, Gach provides a short and reliable resource practitioners can use to guide them in using acupressure both personally and professionally to treat numerous symptoms and conditions.3 The techniques described previously for pain and nausea can be used in acute (hospital), outpatient (clinic), and long-term (transitional care or nursing home) settings. Many hospitals currently use manual P6 acupoint stimulation and nausea bands to prevent postoperative, chemotherapy-induced, and pregnancy-related nausea.

The integrative nursing practice uses evidence-based practice to promote patients’ ability to heal, emphasizing the use of the least invasive interventions.11 Integrative practice allows nurses to use acupressure alone or in conjunction with other approaches to treat moderate to severe symptoms.

Nurses are encouraged to check with their state boards of nursing regarding the use of integrative therapies. In many states, integrative therapies are within a nurse’s scope of practice; some state boards clarify this on their Web sites. Several states, including Minnesota, Texas, North Dakota, and North Carolina, include the use of integrative therapies in their scope of nursing practice guidelines.24-2724-2724-2724-27

NEED FOR FURTHER RESEARCH

While research on the use of acupressure and other integrative therapies within the nursing and medical communities is increasing, many investigators have pointed out that, to establish best practices, a greater number of well-designed trials are needed, as well as supportive funding. Current standardized research methodologies are not designed to capture all that integrative therapies encompass, such as the influence of the relationship between patient and practitioner, the senses the patient employs, or the patient’s past experiences and memories, all of which may affect the patient’s interpretation of the experience and therefore the outcomes. Innovative research methods are needed to capture these variables.

It is important that future researchers determine which symptoms, disease processes, and wellness practices are best treated with which of the multitude of integrative therapies available. Not all modalities are appropriate for all circumstances, and it is vital for practitioners, in partnership with patients, to choose the therapies that are most effective for the patients’ specific symptoms.

Acupressure for Pain and Discomfort Relieve in Nursing References

Hesketh T, Zhu WX. Health in China. Traditional Chinese medicine: one country, two systems BMJ. 1997;315(7100):115–7 [Context Link]
Smith CA, et al. Acupuncture for primary dysmenorrhoea Cochrane Database Syst Rev. 2011(1): CD007854 [Context Link]
Gach MR Acupressure’s potent points: a guide to self-care for common ailments. 1990 New York Bantam Books [Context Link]
Hsieh LL, et al. Treatment of low back pain by acupressure and physical therapy: randomized controlled trial BMJ. 2006;332(7543):696–700 [Context Link]
Jonas WB, Levin JS Essentials of complementary and alternative medicine. 1999 Baltimore Lippincott Williams and Wilkins [Context Link]
Weaver MT. Acupressure: an overview of theory and application Nurse Pract. 1985;10(8):38–9 42. [Context Link]
Zick SM, et al. Relaxation acupressure reduces persistent cancer-related fatigue Evid Based Complement Alternat Med. 2011 2011 [Context Link]
Quinn JF. The self as a healer: reflections from a nurse’s journey AACN Clin Issues. 2000;11(1):17–26 [Context Link]
Therapeutic Research Center. Natural medicines: acupressure. n.d. [Context Link]
Waters BL, Raisler J. Ice massage for the reduction of labor pain J Midwifery Womens Health. 2003;48(5):317–21 [Context Link]
Koithan Kreitzer MJ, Koithan M. Concepts and principles of integrative nursing Integrative nursing. 2014 New York Oxford University Press:3–16 Weil integrative medicine library [Context Link]
Ezzo J, et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting J Clin Oncol. 2005;23(28):7188–98 [Context Link]
Genç F, Tan M. The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer Palliat Support Care. 2015;13(2):275–84 [Context Link]
Hughes J, et al. OA01.04. The effectiveness and cost-effectiveness of acupressure for chemotherapy-related nausea BMC Complement Altern Med. 2012;12(1 Suppl): O4 [Context Link]
White PF, et al. Use of a disposable acupressure device as part of a multimodal antiemetic strategy for reducing postoperative nausea and vomiting Anesth Analg. 2012;115(1):31–7 [Context Link]
Derek and-Moghadam R, Khosravi A. Effect of acupressure on postoperative nausea and vomiting in cesarean section: a randomized controlled trial J Clin Diagn Res. 2013;7(10):2247–9 [Context Link]
Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting Cochrane Database Syst Rev. 2009;2 CD003281 [Context Link]
Robinson N, et al. The evidence for shiatsu: a systematic review of shiatsu and acupressure BMC Complement Altern Med. 2011;11:88 [Context Link]
Smith CA, et al. Acupuncture or acupressure for pain management in labor Cochrane Database Syst Rev. 2011;7 CD009232 [Context Link]
Wong CL, et al. Effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea Complement Ther Clin Pract. 2010;16(2):64–9 [Context Link]
Kashefi F, et al. Effect of acupressure at the Sanyinjiao point on primary dysmenorrhea: a randomized controlled trial Complement Ther Clin Pract. 2010;16(4):198–202 [Context Link]
Schaffer SD, Yucha CB. Relaxation and pain management: the relaxation response can play a role in managing chronic and acute pain Am J Nurs. 2004;104(8):75–82 [Context Link]
Lindquist R, et al. Personal use of complementary and alternative therapies by critical care nurses Crit Care Nurs Clin North Am. 2003;15(3):393–9 x. [Context Link]
American Holistic Nurses Association. Nurse practice acts by state: Nurse Practice Act (NPA) references to holistic nursing or CAM—analysis summary June 2014. 2014.

http://www.ahna.org/Resources/Publications/State-Practice-Acts

. [Context Link]

Minnesota Board of Nursing. Statement of accountability for uthe tilization of integrative therapies in nursing practice. Minneapolis; 2003 [reaffirmed 2010].

http://mn.gov/health-licensing-boards/images/Integrative_Therapies_statement.pdf

. [Context Link]

North Carolina Board of Nursing. Complementary therapies. Position statement for RN and LPN practice. Raleigh, NC; 2013 Feb.

http://www.ncbon.com/myfiles/downloads/position-statements-decision-trees/complementary-therapies.pdf

. [Context Link]

Texas Board of Nursing. Practice—Texas Board of Nursing position statements: 15.23. The use of complementary modalities by the LVN or RN. Austin, TX; 2013.

http://www.bon.texas.gov/practice_bon_position_statements_content.asp#15.23

. [Context Link]

For 14 additional continuing nursing education activities on topics related to complementary and alternative medicine, go to

www.nursingcenter.com/ce

Keywords: acupoint; acupressure; acupuncture; complementary medicine; integrative health; integrative medicine; integrative nursing; traditional Chinese medicine

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Acupressure for Pain and Discomfort Relieve in Nursing Sample Answer

Acupressure for Pain and Discomfort Relieve in Nursing

Acupressure gives the patient the sensation of relaxation with evidence suggesting the effectiveness of this non-invasive and non-pharmacological technique in treating menstrual pain, nausea, labor, anxiety, as well as neck and back pains (Wagner, 2015). Though the mechanism involved in the alleviation of symptoms is unclear from physiological and anatomical perspectives, acupressure surpasses placebo to an undoubted extent. In addition, it has been determined experimentally that application of pressure at specific points as guided by the technique stimulates the body in a manner that results in the relief of respective symptoms. As Wagner (2015) wrote, there has been sufficient evidence from clinical trials to approve acupressure as an indication for the above symptoms.

Registered nurses can train on using acupressure so that they can apply it in relieving the indicated types of pain, anxiety, and nausea in their patients. As Wagner (2015) put it, training, experience, and confidence are vital for practitioners to effectively handle symptoms using acupressure. However, registered nurses must conform to their scope of practice as defined by the relevant laws governing their profession in their respective localities or states. The professionals also need understanding when to use the technique solely or in combination with other approaches.

Considering the nature of the indications, nurses may find acupressure handy in settings such as acute care hospitals, long-term care facilities such as nursing homes, and in outpatient clinics (Wagner, 2015). The approach applies to a considerably wide range of settings on the basis that it can be used in managing acute, moderate, as well as severe symptoms. The non-invasive nature of acupressure also makes it widely applicable as it puts the patient at the minimum level of risks.

Acupressure for Pain and Discomfort Relieve in Nursing Reference

Wagner, J. (2015). CE: Incorporating acupressure into nursing practice. The American Journal of Nursing, 115(12), 40-45.

Utopian Literature Research Assignment Available

Utopian Literature

1. Read the Book ( Huxley A., Brave New World (1931)
2. Analyse a sociological theme developed within the work of your choice in for of an essay. Such themes might be, for example : the”state’,
‘family”, “power’, ‘truth”, “control” , “freedom” , ‘free will’, ‘role of language’,
“environmental sustainability”, “justice’ , ‘role of markets’; and so on. Keep in mind, not every utopia develops every theme to an equal extent, so if you have a specific theme that you want to explore in mind, you want to choose your corresponding literature carefully. The list of themes provided above is indicative, not exhaustive.
3. In your analysis: make sure you use adequate theoretical support in the form of relevant academic literature. (i.e., even though you explore the theme
within the utopian text, you DO want to use theoretical works like : books & journal articles. examining the theme in real world fashion.
4. Formal requirement: 1500 words (+/- 10%), including introduction and conclusion, but not the bibliography. Adequate regard for the academic conventions on citing and referencing is expected (using HARVARD SYSTEM).

We can write this or a similar paper for you! Simply fill the order form!

Peri Operative Nursing Assignment Paper

Peri Operative Nursing

Order Instructions:

15 APA REFERENCES IN TOTAL NOT OLDER THEN 5 YEARS. JOURNALS AND ARTICLES ONLY. ALL RESEARCH SHOULD BE VALID IN AUSTRALIA.

NOTE; MY NURSING SPECIALITY IS PERIOPERATIVE NURSING

AS IN EXAMPLE I AM ATTACHING ANOTHER STUDENTS WORK IN SAME SPECIALITY (PERIOPERATIVE) NURSING.

PLEASE GO THROUGH THE DOCUMENTS ATTACHED FOR ALL THE INFORMATION.
ONE FILES HAS QUESTIONS AND MARKING GUIDE.

SECOND FILE HAS READING AND ACTIVITIES FOR THE ASSESSMENT

THIRD FILES IS NNMBA WHICH TELLS THE LEGALITIES WHICH NEEDS TO BE CONSIDERED WHILE MAKING THE ASSIGNMENT

MAKE SURE TO FOLLOW THE MARKING GUIDE.

SAMPLE ANSWER

Peri Operative Nursing

Task 1- Safety issue

Perioperative refers to the practice of surgical procedure where patients experience surgical intervention. Perioperative nurses are tasked with the responsibility of taking care of the patient before, during and after the surgical intervention (Banschbach, 2016). During this time of surgery intervention and care, many safety issues many arise. According to Ford (2012), many safety issues such as emotional, physiological, and sociocultural safety issues may arise during the pre-operative, intra-operative, and post-operative phases of the surgical intervention because of the negligence of preoperative nurses.

Prior to the surgical procedure, perioperative nurses perform a patient assessment to evaluate the nursing care to be given in the operating room and after the patient returns to the nursing unit, or at home. This involves assessing the social, physical, and emotional needs of a patient. From the information obtained, the perioperative nurse can then predict the suitability of the surgical timing for the patient (Ford, 2012). However, studies have shown that during this assessment period, perioperative nurses are bound to making social mistakes that result in social safety issues. According to Steelman et al. (2013) perioperative nurses, at the interaction level with the patients, may fail to actively engage the patient’s family members who can furnish important information about the patient that can help in assessing the social and physical needs of the patient and consequently help in determining the care to be provided. In addition, Robinson (2016) states that sometimes the amount of and length of teaching recommended to a patient by the perioperative nurses is not sufficient enough to prepare the patient psychologically for the surgery type and procedure, leading to psychological safety issue during the intra-operative procedure where the patient can be more anxious and less cooperative.

According to the Nursing and Midwifery Board of Australia (2010), the information from pre-operative assessment helps in determining the surgery site and procedure for a patient. However, incorrect or insufficient information obtained from or about the patient can result in perioperative nurses recommending wrong site surgery for the patient, thereby resulting in physiological safety issue during the surgical intervention (Ford, 2012). Besides, insufficient or inaccurate information from the pre-operative assessment can result in verification errors, scheduling errors, medication error, and patient time-out errors (from the surgical room and out of hospital) (Steelman & Graling, 2013). Thus, wrong or insufficient pre-operative assessment can be a strong basis for physical, emotional, and social safety issues on the part of the perioperative nurses.

Further, according to the Nursing and Midwifery Board of Australia (2010), the information from the pre-operative assessment can be used in settling professional and legal issues concerning the surgical treatment of the patient as it depicts proof of the medical care provided. According to Steelman & Graling (2013), any documents completed by healthcare practitioners during the pre-operative assessment are legal documents and can be demanded by the court during legal proceedings concerning the health care of a patient. Thus, the pre-operative assessment should be undertaken with utmost care and keenness especially documentations such as pre-scribed medication, health care, and surgical areas. Ford (2012) adds that pre-operative assessment is part of the professional duty of perioperative nurses to the patients. And as such, accurate assessment and evaluation is a vital part of nursing practice as it forms the basis for efficient and safe care provided to patients.

References

Banschbach, K. S. (2016). Perioperative nurse leaders and their role in patient safety. AORN Journal, 104(2), 161-164

Ford, A. D. (2012). Advocating for perioperative nursing and patient nursing. Perioperative nursing clinics, 7(4), 425-432

Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards for Registered nurse. Retrieved from: http://www.nursingmidwiferyboard.gov.au

Robinson, L. N. (2016). Promoting patient safety with perioperative hand-off communication. Journal of PeriAnesthesia Nursing, 31(3), 245-253

Steelman, M., V. & Graling, P., R. (2013) Top 10 Patient Safety Issues: What More Can We Do? AORN Journal, 97(6), 679-701. Retrieved from: https://www.aorn.org/websitedata/cearticle/pdf_file/CEA13517-0001.pdf

Steelman, M., V., Graling, P., R., & Perkhounkova, Y. (2013). Priority patient safety issues identified by Perioperative nurses. AORN Journal, 97(4), 402-418

Task 2: Patient confidentiality and ethics in nursing

In their line of duty, perioperative nurses are bound to the duty of confidentiality and ethics. However, in executing their responsibilities, perioperative nurses find themselves in dilemma situations with regards to ethical issues and confidentiality concerns accompanying the sharing of patient’s health information (Ulrich et al., 2010). According to the Nursing and Midwifery Board of Australia (2010), ensuring confidentiality of the health information of a patient is at the core of nurses establishing and maintaining trusting relationships with patients, patient’s families, and other health professionals. With no assurance regarding the confidentiality of their health information, patients could be hesitant to provide sensitive yet important information regarding their health status/condition that can help in provision of high quality care (Price, 2015). However, perioperative nurses are faced with dilemma in situations where they consider appropriate to share a patient’s confidential health information to his or her family member(s) or caregiver for purposes of ensuring the patient continue to receive quality and safe health care. The ethical implication of this action is the violation of ethics duty by the nurse as well as the potential loss of trust in the nurse and other health professionals in the institution by the patient or family should it be discovered that such confidential information was shared.

Additionally, in situations where the health condition of the patient deteriorates, health professionals find themselves in a dilemma state with regards to protecting the patient’s privacy whilst addressing the carers’ concerns about the patient’s condition (Price, 2015). For instance, patients that have undergone brain surgery are often mentally and physically unstable because of the nature of the surgery and as such are not in a position to interact with family as well as make important decisions concerning their health information, which could be confidential. At the same time, the patient’s family members might request to know about the health condition of the patient, being unaware and unfamiliar of the hospital procedure and policies and health care code of ethics regarding the application of confidentiality in their context (Ulrich et al., 2010). In this situation, disclosing the patient’s confidential health information to the family members can be a complex task. Thus, the nurse must obtain the patient’s permission about the information that can be shared, to who and under what circumstances to minimise possible misunderstanding with family member(s) as well as evade possible legal implications accompanying such (Olson & Stokes, 2016).

According to the Nursing and Midwifery Board of Australia (2010), patients have an inherent right to autonomy, which allows for their informed consent or the withheld of this consent. The law of informed consent holds that patients have the right to withhold personal information unless it is required by law to provide such information; or make decisions concerning their own treatment (Taylor, 2014). Thus, perioperative nurses have ethical and legal obligation to respect and protect patient’s right to autonomy by allowing the patients to make their own treatment decisions or not to provide certain personal information deemed confidential. However, nurses may find themselves in a dilemma in situations where protecting and respecting patient’s right to autonomy could result in harm to the patient (Olson & Stokes, 2016). For instance, in situations such as multiple series of surgery or uneventful incidents, letting the patient make his/ her own treatment decisions or withhold important information to health care practitioners could result in self-harm or harm others altogether. In such scenarios, the nurse or health professional might be compelled to violate the duty of confidentiality through such means as disclosing important information concerning the patient to the family or deciding on the suitable heath care for the patient through the help of family and other health professionals without patient’s consent. This could result in an ethical break that can have legal implications on the nurse or health professional involved (Simek, 2016).

References

Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards for Registered nurse. Retrieved from: http://www.nursingmidwiferyboard.gov.au

Olson, L., L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses with Interpretive Statements: Resource for Nursing Regulation. Journal of Nursing Regulation, 7(2), 9-20

Price, B. (2015). Respecting patient confidentiality. Nursing Standard, 29(22), 50-57.

Simek, J. (2014). Specifics of nursing ethics. Kontakt, 18(2), 64-68

Taylor, H. (2014) Promoting a patient’s right to autonomy: implications for primary healthcare practitioners. Part 1. Primary Health Care, 24(2), 36-41

Ulrich, C., M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M. & Grady, C. (2010). Everyday Ethics: Ethical Issues and Stress in Nursing Practice. Journal of Advanced Nursing, 66(11). doi: 10.1111/j.1365-2648.2010.05425.x

Task 3: Reflection

The perioperative period includes various processes and procedures that bring about multiple and challenging changes to a patient (Nursing and Midwifery Board of Australia, 2010). A major surgical intervention is accompanied with multiple stressful components such as worries about survival, length of admission to hospital, one’s physical condition after the surgery, separation from the family, and the financial implication, factors that significantly impact on a patient’s recovery (Gouin and Kiecolt-Glaser, 2012). For example, based on my reading, the patient revealed that during pre-operative phase, he experienced psychological stress and anxiety brought about by the thoughts of fear of death, physical deformity related with the surgical intervention, longer stays in the hospital, longer recovery period, and the cost of the whole surgical procedure and care. He affirmed that the fear, anxiety and stress slowed his recovery (Hudson & Ogden, 2016).

The physical environment of a patient such as lights and sounds can also affect a patient’s recovery (Nelson, et al., 2016). The patient also described the sounds from the equipment and people in the vicinity of the recovery unity as having affected his sleep and sensory, occasionally bringing back the thought of the surgery procedure. This deprived him of emotional peace. Besides, the patient described his confinement to the hospital bed in the recovery unit under the extensive monitoring machines as a painful and scary experience that distressed him (Hudson & Odgen, 2016). According to Gouin and Kiecolt-Glaser (2012), pain and distress during perioperative period can be influenced by emotions triggered by the physical environment factors result in physical changes in a patient, thus slowing his recovery period.

Surgery also results in inability on the patient. During the perioperative period, a patient is unable to engage in certain duties, responsibilities and activities. This leads them to have low self-esteem and feels insecure (Marks, 2015). The patient also described that during his recovery period, he experienced sudden changes in his social and family life as he could not return immediately to his normal life and perform the duties he valued most. This made him loose sense of self-esteem and raise insecurity concern on his part. Besides, having to live with a life-changing diagnosis for the rest of his life was traumatizing and frustrating altogether as it was associated with some form of isolation from friends and family. Nonetheless, he acknowledged the contribution of his carers (immediate family and clinicians) who gave him hope in life (Hudson & Ogden, 2016).

Having read the patient’s experience, I have come to appreciate the need for social and spiritual support for a patient undergoing major surgical intervention. The social support is crucial for enabling the patient understand the aftermath implications of the surgery and consequently prepare him on how to live with it. Spiritual support offers the needed help to a patient to have hope in life again during and after the surgery and treatment procedure (Hudson & Ogden, 2016). Conclusively, I have come to understand the need for perioperative nurses to understand the possible implications of the illness from the patient’s perspective to facilitate their recovery and offer the needed emotional support during their recovery period (Nelson et al., 2016).

References

Gouin, J., & Kiecolt-Glaser, K., J. (2012). The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms. Immunol Allergy Clin North America, 31(1), 81-93

Hudson, B., F. & Ogden, J. (2016). Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery- A Systematic Review and Meta-Analysis. Journal of PeriAnesthesia Nursing, 31(2), 118-133

Marks, R. (2015). Non-Operative Management of Knee Osteo-arthritis Disability. International Journal of Chronic Diseases & Therapy (IJCDT), 1(2), 9-16

Nelson, G., Altman, A., D., Nick, A., Meyer, A., L., Ramirez, P., T., Achtari, C., Antrobus, J., Huang, M., S., Wijk, L., Acheson, N., Ljungqvist, O., & Dowdy, C., S. (2016). Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery after Surgery (ERAS) Society Recommendations- Part 1. Gynecologic Oncology, 140(2), 313-322

Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards for Registered nurse. Retrieved from: http://www.nursingmidwiferyboard.gov.au

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Applying Biblical Principles Template Assignment

Applying Biblical Principles

APPLYING BIBLICAL PRINCIPLES INSTRUCTIONS AND TEMPLATE
Part 1
Study Jesus’ parable of the “Good Samaritan” in Luke 10:30–35 (Hint: read Zuck’s (Basic Bible Interpretation) Chapter 9 on parables). Record your content in
this document.
1. What did the parable mean (teach) to the hearers in Jesus’ day?
2. What historical and cultural issues are different today?
3. What theological principles can be devised from the parable?
4. How should individual Christians apply the principles today?
Part 2
1. Study the immediate context of Philippians 4:13.
2. Write your own real-world scenario that parallels that of Philippians 4:13.
3. Here are the 3 criteria to use in writing your scenario. Your scenario can be personal but remember the context is that of Paul’s suffering for the
Gospel. We all face problems, pain, betrayal and a myriad of other possible calamities just as the unredeemed of the world do.
Element 1: A Christian is involved.
Element 2: The Christian is experiencing a variety of trying circumstances as a result of following Christ faithfully. Recall that Paul was in prison for
preaching the gospel when he wrote the letter to the Philippians.
Element 3: How did Christ give this Christian the strength or ability to endure the trials?
4. Your scenario should read like a story with characters and action. It should not read like a report. Word count requirement: 200 words.
Use Basic Bible Interpretation written by Roy B. Zuck Chapter 9 and the NASB version of the BIBLE

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Leadership Dysfunction and its Effect on Organizational Culture/Wellbeing

Order Instructions:

“Leadership dysfunction and its effect on organizational culture/wellbeing”
This will be the topic for the writer to develop for this Doc study. It is important that the writer pay attention to some details here. The writer must carefully read and follow the template provided.
The problem Statement
The writer will provide a one-paragraph statement (150 words max) that is the result of a review of research findings, appropriate peer-reviewed/government sources, and current practice and that contains the following information:

1. Hook: (a WOW statement supported with a peer reviewed citation no older than five years from anticipated date CAO will sign.)

2. Anchor (includes a number supported with a peer reviewed/government citation no older than 5 years from your anticipated CAO signature)

3. The general business problem is XXXX

4. The specific business problem is some (identify who has the specific business problem) has limited information on XXX

Review the Problem Statement Video tutorial to aid you in completing the Problem Statement. The video tutorial is located at: http://youtu.be/IYWzCYyrgpo
Pear review articles cannot be past 2012, the must be between 2012 and current.
Purpose Statement

The writer will also provide a one-paragraph Purpose Statement (200 words max) and that contains the following information:

Qualitative Study: (a) methodology, (b) design, (c) specific population, (d) geographical location, and (e) social change statement.

Please review the Purpose Statement Video tutorial to aid you in completing the Purpose Statement. Located the video tutorial at: http://youtu.be/pLP4r0mfT9A.

Nature of the Study

The Nature of the Study component serves two purposes. The first purpose is describing and justifying the methodology (i.e. quantitative, qualitative, or mixed-method). The second purpose is describing and justifying the design (i.e. case study, phenomenological, correlation). Therefore, a well-crafted Nature of the Study can be presented in two paragraphs but not exceed one page.

The first paragraph is to describe and justify the methodology. State why you selected a specific method and why other methods were not appropriate.
The second paragraph is to describe and justify the design. State why you selected a specific design and why other designs were not appropriate. Map to the rubric and only include the required content!

Research Question(s)/Hypotheses

List the research question that will lead to the development of the requirements in the study and steps for accomplishing the requirements. A research question informs the research design by providing a foundation for:

• Generation of hypotheses in quantitative studies,
• Questions necessary to build the design structure for qualitative studies (i.e. interview questions),

• Process by which different methods will work together in mixed studies.

Interview Questions (Qualitative)

The interview questions are to be informed by the conceptual framework. Please see the Theoretical/Conceptual Framework video tutorial at: http://youtu.be/P-01xVTIVC8.

Theoretical/Conceptual Framework

In one paragraph, describe the theoretical base or conceptual framework from the scholarly literature that will ground the study (providing citations). Base this description on the problem, purpose, and background of your study. Specifically, identify and describe:

(a) theory: theoretical base or conceptual framework,
(b) author of the theoretical base or conceptual framework (if applicable),
(c) date of the theoretical base or conceptual framework (if applicable),
(d) key tenets, propositions, constructs, variables, hypotheses, etc., and
(e) how the theoretical base or conceptual framework is applicable and fits to the study.

Review the Theoretical/Conceptual Framework video tutorial at: http://youtu.be/P-01xVTIVC8 to aid in completing Theoretical/Conceptual Framework section.

Significance of the Study

Provide one to two paragraphs, informed by the topic in the problem statement, which describe(s):

1. The value to the business/social impact.

2. Contribution to effective practice of business

3. Potential contribution to positive social change and improvement of business practice.

References

Include references formatted in the correct style (APA 6th edition, modeled at the end of the template provided) for all citations within the Doctoral Study Prospectus. ( all references Not older than 2012).

The writer will bear in mind that the study is been carried out in Maryland and he can research and use any location in the State of Maryland in the U.S. A

Also the writer will be using qualitative study for this paper. It is important that the writer read this instruction carefully and carefully follow the template provided. In the template the writer will be able to see a sample prospectus that he will aligned this one to.

SAMPLE ANSWER

Leadership Dysfunction and its Effect on Organizational Culture/Wellbeing

Problem Statement

Failure to lead an organization effectively may signal a lack of trust in the workforce and may jeopardize the employee’s behavior towards work and the ability to perform. This may lead to inefficient working relations which might eventually catapult into the failure of the business (Petty et al., 2012). Creswell(2014) estimates that about 544,000 new businesses formations crop up each year; however, the number of the busineses which fail are more tham=n those that are formed per year. Between 2012 and 2015, small businesses accounted for almost 98% of all the U.S. firms, their contribution to the gross demestic product (GDP) was nearly 37.8%, and they contributed about 54.9% of all the employees to the labor force (Silverman, 2013). The general business problem is that the effect of dysfunctional leadership to organizational culture continues to affect the progress and effectiveness of businesses (Dandira, 2012). The specific business problem is that small business firms lack strategies for ensuring functional leadership to affect progress and effectiveness of businesses

Purpose Statement

The purpose of this qualitative descriptve case study was to determine the entrepreneurial strategies that small retail busines leaders need to utilize to succeed in business beyond five years. Thereserch participants consisted of five companies or organization leaders located in the Baltimore, Maryland, with fewer than 50 workers that were profitable for at least five years. As of 2014, about 92% of the 209,103 small firms in Maryland had fewer than 50 employees, and 86% of the 209,103 establishments were located in Baltimore (Yin, 2012). Moreover, at least 15,497 of the 209,103small businesses were in operation for five years or more (Creswell, 2014). The region’s population contained over 100 study participants which made it be a suitable region for this research.

Methodology

Qualitative methodology refers to the broadest sense to research that produces descriptive data – people’s own written or spoken words and observable behavior (Taylor, DeVault, & Bogdan, 2015).

The main goal of this qualitative exploratory case study is to determine the significance of dysfunctional leadership to organizational culture.

Design

Research designs are kinds of inquiry in qualitative, quantitative, and mixed approaches that offer complete and precise direction for procedures in a research design (Creswell, 2013). This research will use a qualitative designs using a case study.

Targeted Population

The targeted population consists of five companies or organization leaders located in the Maryland.

Geographical Location

The focus of this research will be in Baltimore, Maryland. It will be conducted in companies located in the City.

Qualitative hypothetical example (case study).

Case studies are the design of inquiry found in numerous fields, particularly evaluation, in which the researcher develops an in-depth study and analysis of a case, often a program, activity, event, process or one or more persons. However, a case study is bounded by time and activity, and the researchers need to collect detailed data and information using a variety of data collection techniques over a sustained period of time (Yin, 2012).

Nature of Study

The qualitative studies, the usual designs are ethnography, grounded theory, phenomenology, and case study (Petty, Thomson, & Stew, 2012). Also, Myers (2013) stated that qualitative research method broadly explains the context, either social or cultural, within which people live. Moreover, qualitative research does not engage in statistical procedures; but, attempts to broaden and deepen the understanding of the causes or underlying reasons, opinions, and motivations (Creswell, 2014; Silverman, 2013).

According to Baškarada (2009), a qualitative case study is used for an in-depth investigation of a complex case which is gained by an extensive description of the analysis of the case. It is also considered as a whole and its context. Moreover, the advantageous stance of a case study in this research, allows the researcher to gain a deep holistic view of research problem than other approach used in qualitative research such as phenomenology or ethnography (Yin, 2014). Therefore, using a qualitative case study in this research will integrate, describe, understand and explain the situation that causes employees turnovers of several companies in Baltimore, Maryland, related to leadership dysfunction and its effect on organizational cultural/wellbeing.

Research Question

According to Petty (2012), using the word how or what, as the first word in a research question helped indicate that the design was a descriptive case study. The study had an overarching central research inquiry. The question proposed for this study was: What are the underlying factors of dysfunctional leadership in organizational culture?

Theoretical or Conceptual Framework

This study adopts the following framework to conduct research about the effect of dysfunctional leadership to organizational culture. Alemu (2016) identified four key underlying variables namely: decision-making, modeling, organizational goal achievement, and meeting ethical expectations as vital leadership characteristics that differentiate leaders of functional organizations/companies from those leading dysfunctional organizations/companies.

Decision-making

Modeling

Organizational Goal achievement

Meeting ethical expectations

Figure 1. A graphical model of dysfunctional leadership as it applies to examining organization’s culture/wellbeing.

Significance of the Study

The result of this study will redound to the advantage of the society especially in the business sector as excellent leadership is very valuable in any company or business endeavor. Thus, companies which apply the suggested approach derived from the result of this study will enable the companies to practice good leadership in an excellent manner. Managers and business owners will be guided on what they should be given more emphasized in relations to leadership and dealing with their employees to improve their business operations.

For the researcher, this will help him to uncover critical areas of the leadership of an organization or companies where some researchers were not able to explore. Thus, there could be new insights that can be provided after this research is done.

Dysfunctional dispositions may have produced significant behaviors in leaders that influence an employee’s aptitude and ability to function in an organization and endanger the success of the organization (Leary et al., 2013). Therefore, this study is conducted to assess how business owners able to control the risk of business failures due to dysfunctional leadership within the organization.

References

Baškarada, S. (2009). Information Quality Management Capability Maturity Model.

Wiesbaden: Vieweg+Teubner Verlag / GWV Fachverlage, Wiesbaden.

Creswell, J. (2013). Research Design. Thousand Oaks: SAGE Publications.

Creswell, J. (2014). Research design (4th ed.). Thousand Oaks, CA.: Sage Publications.

Dandira, M. (2012). Dysfunctional leadership: organizational cancer. Business Strategy Series, 13(4), 187-192. http://dx.doi.org/10.1108/17515631211246267

Leary, T., Green, R., Denson, K., Schoenfeld, G., Henley, T., & Langford, H. (2013). The relationship among dysfunctional leadership dispositions, employee engagement, job satisfaction, and burnout. The Psychologist-Manager Journal. http://dx.doi.org/10.1037/h0094961

Myers, M. (2013). Qualitative research in business and management (2nd ed.). Los Angeles, CA: SAGE.

Petty, N., Thomson, O., & Stew, G. (2012). Ready for a paradigm shift? Part 2: Introducing

qualitative research methodologies and methods. Manual Therapy, 17(5), 378-384. http://dx.doi.org/10.1016/j.math.2012.03.004

Silverman, D. (2013). Doing qualitative research. London, England: SAGE Publications.

Alemu, D. (2016). Dysfunctional Organization: The Leadership Factor. Open Journal of Leadership, 05(01), 1-7.

Taylor, S., DeVault, M., & Bogdan, R. (2015). Introduction to qualitative research methods, 4th ed. Hoboken, N.J.: Wiley.

Yin, R. (2012). Applications of case study research. Los Angeles: Sage.

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Health Care Ethics Assignment Paper

Health Care Ethics

Order Instructions:

APA REFERENCES NOT OLDER THEN 5 YEARS. ONLY CREDIBLE SOURCES ARE JOURNALS AND ARTICLES NO WEBSITES ACCEPTED.
PLEASE GO THROUGH THE FILE ATTACHED THAT CONTAINS THE MARKING GUIDE AND EXPLANATION.

THIS IS HEALTH CARE ETHICS ESSAY,!

Assessment Task 3: Essay – An Ethical Dilemma
Select a case study from the list below and address the following points.
1. Identify the stakeholders including two health care professionals in the case scenario;

2. Identify the ethical and legal conflicts and consider them from the following perspectives:
? The dignity and rights of all stakeholders in this case

? The principles and virtues of health care ethics that inform professional practice
? The relevant codes of ethics and/or codes of professional conduct

3. Propose a legally and ethically defensible resolution to these conflicts

Case scenario give below

CASE STUDY TWO

Alex Ng, a senior paramedic in a regional centre, is called out to attend a motor vehicle accident on the main highway, involving two cars and a large transport truck. On arrival at the scene, Alex finds passengers trapped in both cars; two children in a small car are not moving and show no other signs of consciousness while the female driver is slumped over the steering wheel, bleeding from a head wound. The male driver of the other car is conscious but trapped in the wreckage; he tells Alex’s partner that he cannot feel or move his lower limbs. The male truck driver is walking around the wreckage and appears confused and disorientated; at a glance, he does not appear to be physically injured. A woman who was driving past stops her car and comes forward; she tells Alex that she is an emergency physician and can help. Alex is grateful for the offer of help and asks her to attend to the children, however, he notices the smell of alcohol on her breath when she walks past him. After opening the door of the other car, Alex notices that the trapped driver is wearing earphones attached to his mobile phone and the phone screen indicates that he was on a call when the accident occurred. The driver is alone and Alex recognizes him as the local magistrate, and a good family friend. Just then, he hears the screech of brakes and turns to see that the truck driver has walked up the highway and into oncoming traffic. He is lying on the road and does not appear to be breathing

SAMPLE ANSWER

Health Care Ethics

Introduction

Ethics affects every part of healthcare setting, and this calls for healthcare providers to be vigilant when providing health care services. These settings include when providing direct care to patients, resource allocation, and staffing. It is important to note that in some situations ethics do not provide answers, but instead, they lead to getting solutions (Burkhardt & Nathaniel, 2013). Sometimes, healthcare providers are faced with situations which may or may not be life threatening, and they make decisions which go beyond their profession or technical concerns. Nurses and physicians often encounter challenges on what ought to be done event in ordinary situations despite the laid down ethics and professional code of conduct (Corey & Callanan, 2014).Consequently, it leads to the health care providers being faced with ethical dilemmas, where one is expected to make a choice from two alternatives. When dealing with ethics, healthcare professionals requires possessing skills, in processes of value clarification, ethical decision making. Health care professionals should be aware that when faced with ethical dilemmas evoke powerful emotions and strong opinions, however, these emotions and opinions are not enough to solve ethical dilemmas (Corey & Callahan, 2014).

Professional nursing actions are supposed to be both legally and ethically right. There are various factors which fuel discrepancies between law and ethics. They include, ethical opinions that reflect individual differences, human behaviors are usually complex to be accurately reflected in law, the legal system judge’s action rather than intention. Finally, rules change according to social and political influences. Therefore, some issues that may appear to be ethically right may in real sense appear to be legally wrong, and those that are legally right may be ethically wrong, therefore posing a challenge in provision of care by health care providers.

From the case scenario, the magistrate appeared to have been in a conversation through the earphones during the time the accident occurred. According to the law, it is wrong to drive while communicating with a cell phone. In this case, it appears as the accident occurred as result of the magistrate being on a call.

Rights

Clients are supposed to be respected and be treated with dignity, to make decisions regarding provision of care and to be actively involved in treatment plan. However, nurses and other health care providers are supposed to act as advocates for those clients who are unconscious, the minors and those that are not in their right mind. These rights should be considered in any set up where care is being provided. Awareness of the client’s rights increases the health care providers’ awareness of the need to treat the clients in an ethical manner and ascertain that the rights of the patients are protected ( O’Donnell, 2015). When nurses are providing care, they should always respect the values, customs and beliefs of their clients.

In the event of accident victims, like in the case of Alex, nurses and other health care providers might have a challenge in attending the accident victims since everybody is entitled to the provision of care. However, due to the limited number of health care providers in the scene one might not be sure who to attend to first. This is because everybody at the accident scene was entitled to medical attention.

Ethical Principles

Ethical principles direct or govern on the best course of action. When nurses and other healthcare professions are making ethical decisions, they should be based on principles. (González-PA chon & Romero, 2016). They reflect on what is best for the patients. When these principles are employed in the nursing field, nurses are in a better position in solving ethical conflicts. Furthermore, these principles can be used as references in analyzing ethical dilemmas and provide rationales to solving ethical problems. However, these principles are not absolute; hence there can be exemptions to every principle in any given situation.

The principle of autonomy outlines that an individual has a right to make a decision and act on it and nurses should respect the client’s rights and protect those unable to decide for themselves. Nurses uphold this principle by accepting the client’s decision even if they are not patient’s best interest (O’Donnell, 2015). Nonmaleficence means that every health care provider has a duty not to cause physiological, physical, social or spiritual harm to others either potential or actual. A nurse is responsible for weighing the potential risks and benefits of any plan of action. When upholding this principle, healthcare providers practices according to their profession and laid down legal standard (González-Pachón & Romero, 2016).

The principle of beneficence states that every health care provider has a fundamental duty to do good and prevent harm. Justice is a principle which is based on the fairness concept, both benefits and burdens should be distributed fairly. All individuals should be treated equally unless there is justification for unfair treatment (Myers & Venable, 2014)

A close relationship exists between ethics and values, and this makes it difficult for the nurses to balance between principles that apply to clients and those that apply to health care systems. Therefore, nurses should examine their value system to be in a position to provide care to clients whose values may differ. (Myers & Venable, 2014). Health care providers should be aware that values are different depending on individuals and are not alike to everybody. Therefore, nurses should be careful not incorporate and practice their values on their patients.

Code of Conduct

Professional code of conduct outlines the nurse’s obligations to clients and the society as a whole. The ethical code provides broad principles for determining and evaluating nursing care. There are professional bodies which deal with the nurses who act unprofessionally. For example, a nurse is supposed to provide care on human dignity and treat clients differently without considering any other factor. Nurses and other health care providers draw their moral guidance from their families, religious beliefs, family and parental values. However, they may not be the only guidance in professional ethics (Lee& Divaris, 2014).

Ethical Conflicts/Ethical Dilemmas

Ethical conflicts result when a person if faced with a decision to make and none is clear since it collides with morality, ethics, justice or personal situations. In health care settings, healthcare providers should evaluate the best choice to take since in some situations doing what is termed as morally right may yield negative impacts while doing morally wrong may result in a positive outcome (DeKeyser ,Ganz & Berkovitz 2011). Furthermore, the moral position can be substantiated or not substantiated. Alex and the colleague might have been faced with a dilemma on the accident victim to attend to.

However, when an ethical conflict is encountered, any healthcare provider should make the best decision which is in line with principles, laid down rules and the law. In the event a person is unable to resolve the conflict, he shall be required to address the consequences. Therefore, it is necessary for health professionals to consult a colleague before undertaking any plan of action and in case a conflict is unresolved, it will necessitate further consultation from the relevant professional body or legal counsel (DeKeyser ,Ganz & Berkovitz 2011).

From the case scenario, both Alex and his colleague might have been faced with a dilemma parting the first victim to attend to. Health care providers are supposed to attend to victims who urgently need care and for this case that’s what Alex did. Unfortunately, the truck driver appeared to be stable despite the orientation and he passed on before being attended to. It is unethical for health care professional to attend to clients when they are under the influence of alcohol. However, it becomes challenging in the event of an accident due to the limited number of healthcare providers at a scene

Ethical Theories

When making a choice between two alternatives, various ideas can be employed so as to help in solving the ethical dilemmas. Ethical theories are used to analyze ethical problems rather than provide answers to ethical conflicts. Teleology stipulates that importance of a situation is based on the outcome and not activity. This theory is founded on the principle of utility which states that for any action to be termed beneficial, it must impact a good number of people in any given situation. Every alternative is assessed for positive and negative outcomes (González-Pachón & Romero, 2016). The selected action is the one that maximizes benefits and minimizes occurrence of any harm.

Deontology applies the criteria of the action itself to determine what is right rather than the consequence. This theory is based on the categorical imperative concept which points out that one should take action if the act applies a universal principle. This means taking an action that one would take when faced with a similar situation (DeKeyser Ganz & Berkovitz, 2011).

Resolution to Ethical Conflicts and Ethical Dilemmas

When an ethical conflict of choice manifests itself, the nurse should be able to identify it and come up with the relevant resolutions. The following are some of the issues that should be factored in to before coming up with a resolution. This includes ethical theories; principals involved, parties that will be affected and the consequences of ethical options. Nurses can be able to make decisions to resolve ethical dilemmas if only they are done systematically (Lo, B, 2012). There exists a need to help address the ethical concerns in health care setting. Formation of an ethics committee will go a long way in addressing the ethical dilemma issue. Also, this committee should formulate policies and procedures which will help in prevention and resolutions of the dilemmas (Kangasniemi, Pakkanen & Korhonen, 2015).

It is of significance for nurses to understand the basis on which they make their decisions. This means that they should think through what needs to be done and provide a rationale for every activity (Shapiro & Stefkovich, 2016). Therefore, it would be important for healthcare providers to know that the decisions they make cannot be based entirely on intuition and emotions instead, they should be based on an ethical basis. Ethical decision making should be made in situations in which the right decision is not clear or where there are conflicts of rights and duties (Shapiro & Stefkovich, 2016).

Conclusion

As professionals, nurses and physicians are obliged to protect the client’s rights and interests. Consequently, sound nursing practice involves making ethical decisions. In every healthcare setting, health care providers are usually faced with ethical concerns, and they are required to balance their ethical responsibilities with their professional obligations. Often a conflict results when a nurse is trying to balance the two. It is, therefore, necessary for health care providers to handle situations putting ethics into consideration. This should necessitate the application of different principles in the profession, justification of actions through the use of ethical theories.

References

Berman, A., Snyder, S.J., Kozier, B., Erb, G., Levett-Jones T., Dwyer, T., Hales, M., Harvey, N., & Stanley, D. (2012). Kozier and erb’s fundamentals of nursing (2nd ed.). Vol 2, NSW: Pearson Sydney Australia.

Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Cengage Learning.

Corey, G. & Callanan, P. (2014). Issues and Ethics in the Helping Professions with 2014 ACA Codes. Nelson Education.

DeKeyser Ganz, F., & Berkovitz, K. (2011). Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. Journal of Advanced Nursing, 68(7), 1516-1525.

Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.

Faden, R. R., Kass, N. E., Goodman, S. N., Pronovost, P., Tunis, S., & Beauchamp, T. L. (2013). An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics. Hastings Center Report, 43(s1), S16-S27.

Gold, M., Philip, J., Mclver, S., & Komesaroff, P. A. (2012). Between a rock and hard place: Exploring the conflict between respecting the privacy of patient and informing their carers. Internal Medicine Joiurnal, 39(9), 582-587

González-Pachón, J., & Romero, C. (2016). Bentham, Marx and Rawls ethical principles: In search for a compromise. Omega, 62, 47-51.

Hunt, L., Ramjan, L., McDonald, G., Koch, J., Baird, D., & Salamonson, Y. (2015). Nursing students’ perspectives of the health and healthcare issues of Australian Indigenous people. Nurse education today, 35(3), 461-467.

Ingravallo, F., Gilmore, E., Vignatelli, L., Dormi, A., Carosielli, G., Lanni, L., & Taddi, P. (2014). Factors associated with nurse’s opinion and practices regarding information and consent. Nursing Ethics, 2(3), 259-313.

Ion, R., Smith, K., Nimmo, S., Rice, A. M., & McMillan, L. (2015). Factors influencing student nurse decisions to report poor practice witnessed while on placement. Nurse education today, 35(7), 900-905.

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.

Lee, J. Y., & Divaris, K. (2014). The ethical imperative of addressing health disparities in a unifying framework. Journal of dental research, 93(3), 224-230.

Lo, B. (2012). Resolving ethical dilemmas: a guide for clinicians. Lippincott Williams & Wilkins

Myers, M. D., & Venable, J. R. (2014). A set of ethical principles for design science research in information systems. Information & Management, 51(6), 801-809.

Nursing and Midwifery Board of Australia. (2010). Nursing and national competency standards for Registered nurse.

O’Donnell, P. (2015). Values and Ethics of Healthcare Social Work. Social Work Practice in Healthcare: Advanced Approaches and Emerging Trends, 127.

Petronio, S., & Sargent, J. (2011). Disclosure Predicaments Arising During the Course of Patient Care: Nurses’ Privacy Management. Health Communication, 26(3), 255-266.

Poikkeus, T., Leino‐Kilpi, H., & Katajisto, J. (2014). Supporting ethical competence of nurses during recruitment and performance reviews–the role of the nurse leader. Journal of nursing management, 22(6), 792-802.

Shapiro, J. P., & Stefkovich, J. A. (2016). Ethical leadership and decision making in education: Applying theoretical perspectives to complex dilemmas. Routledge.

Vayena, E., Salathé, M., Madoff, L. C., & Brownstein, J. S. (2015). Ethical challenges of big data in public health. PLoS Comput Biol, 11(2), e1003904.

Wilson, R. (2012). Legal, ethical and professional concepts with in the operating department. National Institute of Health, 22(3),81-5.

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Ways to Prevent Bias in Research

Order Instructions:

The writer will respond to this question bellow accordingly in a 1 page word documents using APA 6th edition.

All researchers must watch out for bias in designing their project, writing the literature review, conducting the project, and writing up the results.
How can you help yourself to prevent bias in your project in those four phases?

SAMPLE ANSWER

Ways to Prevent Bias in Research

Incidents of partiality both deliberately or accidentally when conducting a research, usually lead to bias in the research and its outcomes are not only inaccurate but also unreliable (Higgins & Green, 2011). According to Pannucci & Wilkins (2011), bias in research concerns systemic distortion of research interventions arising from inadequacies in designing and conducting a project, as well as reporting of the project results. This has far reaching effect from a business perspective, since decision-making on basis of these faulty results and conclusions obtained from a biased research can lead loss of profits or inability to solve operational or organizational problems (Higgins & Green, 2011). Bias can affect the research process at any stage, which means it should be prevented at all costs (McDonagh et al., 2013). In this response prevention of bias will be considered at four phases of a project such as designing the project, writing the literature review, conducting the project, and writing up the results.

Research bias arising from designing the project can be prevented through careful planning of the research design by studying the study group’s limitations. All category groups should then be chosen in order to avoid biasness (Pannucci & Wilkins, 2011). In addition, a keen consideration must also be given to the nature and scope of the research to ensure that all variables envisaged to arise from the study are reviewed in order to avoid experimental errors and subsequently biased results (McDonagh et al., 2013). The research design should be objective and random to ensure that the selected sample is a representative of the target population. Bias in writing literature review can be prevented through compliance to a stipulated inclusion and exclusion criteria for the research articles to be reviewed including the research design, language, setting, sample size as well as research interventions employed (Higgins & Green, 2011). The researcher should also avoid relying on one source of information when reviewing the literature, and thus should utilize online databases in order to access a vast range of research articles (McDonagh et al., 2013).

Furthermore, when conducting the project, the researcher can prevent bias by ensuring that a sizeable and representative sample is selected. Procedural and measurement bias can also be prevented by ensuring that, the research instruments such as questionnaires are sufficient and the respondents are allowed to amicably respond to all the questions (Higgins & Green, 2011). The research participants should not be pressurized to answer questions and their privacy and confidentiality should be assured to avoid impartiality. Finally, bias in writing up the results can be prevented by accurately recording the obtained, and reporting them without alterations to suit the intended or expected outcome (McDonagh et al., 2013). In conclusion, when these precautions are adhered to, bias which threaten or negatively impact accuracy and reliability of research findings can be prevented. A researcher, must therefore, be objective-minded and neutral in carrying out a research to avoid bias (Pannucci & Wilkins, 2011).

References

Higgins, J.P.T. & Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions. London, England: The Cochrane Collaboration. Retrieved on 8^th September 2016 from: http://handbook.cochrane.org/chapter_8/8_4_introduction_to_sources_of_bias_in_clinical_trials.htm

McDonagh, M., Peterson, K., Raina, P., Chang, S., & Shekelle, P. (2013). Avoiding Bias in Selecting Studies. Methods Guide for Comparative Effectiveness Reviews. (Prepared by the Oregon Health & Science University, McMaster University, and Southern California Evidence-based Practice Centers under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC045-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2013. Retrieved on 8^th September 2016 from: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

Pannucci, C. J. & Wilkins, E. G. (2011). Identifying and Avoiding Bias in Research. Plastic Reconstruction Surgery, 126(2), 619-625. doi: 10.1097/PRS.0b013e3181de24bc

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Organizational profile Essay Assignment Paper

Organizational profile

Order Instructions:

In your first submission to the Module Project requirements of this module, you produced a proposal that would identify a relevant change driver impacting upon an organisation with which you are familiar.

The proposal would:

•Suggest a suitable change process that would appropriately respond to that change driver

•Identify likely stakeholder reactions to the change process you advocate

•Describe how an existing organisational design might be amended to best accommodate the planned change.

In this week’s activity, you will design an expanded change management framework to support your intended change process. This will, in turn, function as a base for the final change management project plan, due in Week 7.

Scenario reminder

Your role in this project is to identify a specific change driver that you consider especially relevant to an organisation of your choice. You are challenged to apply the theoretical principles discussed in this module to the specification of an appropriate process that will successfully respond to the demands of that change driver. You are encouraged to use your own current employer, and its current operating environment, as a base for the preparation of this project. It is, however, permissible to use an alternative organisation with which you are sufficiently familiar.

To prepare for this Module Project:
• Review the material studied during the first 5 weeks of this module.

• Review the feedback received on your project proposal, and incorporate any feedback suggestions into the framework you present in response to this week’s requirement.

To complete this Module Project:

Prepare and submit a preliminary outline version (approximately 1100 words) of what will eventually be your final Module Project report due in Week 7. Your outline version this week should contain the following sections:

• Organisational Profile: what is the name of the organisation you propose to use, where is it located, what is its primary business and approximately how many staff does it employ? (If there are any concerns about any aspect of commercial sensitivity, it is permissible to use an assumed name for the organisation you select).

• Organisational Structure: how are human and other resources arranged within this organisation, what levels of seniority exist and how are those levels of seniority connected through formal reporting lines? (A structure diagram would be useful here.) To what extent is the decision process centralised in the senior management team, and to what extent is it devolved to lower levels in the organisation?

• Change Drivers: to what extent does this organisation currently align with the principle of punctuated equilibrium? What are the factors in either or both of the external or internal operating environments that suggest a significant element of change is needed to the way in which this organisation works? Each change driver you identify should be categorised according to the criteria presented in relation to the Week 2 Deseret News case.

• Key Stakeholders: who are the individuals, groups and organisations who will be most directly affected by the type of change that is indicated by change driver analysis? To what extent do you expect each stakeholder’s reaction to be positive or negative? What are the primary ‘unanswered questions’ that you expect to receive?

• Change Initiative Overview: what is the primary aim of the change initiative that you recommend be introduced, and how could this initiative be classified in terms of the parameters suggested by Nasim & Sushil? How will success or failure in this initiative be measured? What ethical considerations need to be taken into account as the initiative is designed?

SAMPLE ANSWER

Organizational profile

The organization I intend to use in identification of a relevant change driver affecting it is TLC Fashion Store. The real name of the company is not applicable to avoid misinterpretations. TLC Fashion Store is located in Oxford Street, London, and its core business is the sale of cloths and accessories. The company is strategic in offering high-end clothes, women shoes, jewelry, handbags, and also sunglasses for both men and women. As a small sized firm, the firm targets young adults between the ages of 18 to 35 with income averaging $30,000-40,000. Currently, TLC store has 11 employees with the number expected to increase over the years.

Organizational structure

TLC configures its resources, financial, human, and physical, in a way that it meets the demands of the industry and its stakeholders (Cavalcante 2014). Financial resources are handled by the accounting department, and continuous audit is carried out to ensure that the existing funds such as cash balances, working capital, and debt; and the potential of raising extra funds from investors and listing of the firm in Stock Exchange are consistent with the firm’s strategies. Human resources are managed by HRM manager who is mandated to recruit, select, and train employees to match to the needs of the various job categories. Finished products are bought from suppliers and stored in-house while the marketing and logistics department is given the role of warehousing, distribution, and advertising the products to potential customers.

Each department is managed by a manager who reports to the executive director. The executive manager is responsible for the design of strategic vision of firm including change processes. He then decentralizes operational decisions to the departmental managers. Since it’s a small firm, the CEO handles the corporate vision of the firm and the departmental are mandated with decisions specific to their functional units, which have to be in line with the overall firm’s strategic vision as illustrated in the diagram.

Source: Cavalcante, 2014.

Change drivers

TLC Fashion Store uses the traditional brick-and-mortar model of carrying out business. Customers have to come to the store to order and purchase products. With the evolution of technology and the rise in consumer bargaining power, it is impeccable for the firm to adopt the online business model. Apart from quality, affordability, and differentiation, modern consumers prefer time and place convenience (Reeves and Deimler 2011). Thus, the need to increase consumer’s value through the offered products is a significant change driver to TLC Company. To align the firm with the vision of becoming multinational, it is necessary to change the current organizational structure, which, according to the principle of punctuated equilibrium, will give the company a solid foundation in case of random market changes. The firm’s vision is clear and demonstrates the ability to perform tasks in different ways to achieve different results or the same results sustainably. Therefore the firm is in need of change due to the realization that customers are the most paramount stakeholders, and their changing needs have to be sustained. Moreover, the transformation is a long-term event that should be carried at the onset to avoid incurring heavy expenses, and if done at the right time, it is possible to align other stakeholders without much resistance. A firm aligned with the principle of punctuated equilibrium has sustained growth amidst periods of changes, and since TLC’s financial, human, and physical resources are strategically aligned and equipped to its vision, it is possible to initiate a change without disrupting its core structures.

TLC is supposed to combine the conventional model with the online business model so as to operate a multi-channel framework so that consumers can use either of the models or combine both of them at their convenience. An online platform allows consumers to order, purchase, and make payments online using their phones and other computerized gadgets (Mayfield 2014). It is, therefore, recommendable for TLC to institute an online model so that customer’s value is increased.

Key stakeholders

Customers, employees, shareholders, creditors, suppliers, employees, and the government constitute TLC’s stakeholders. All of these stakeholders are likely to be affected when TLC uses a multi-channel model to run its operations. Customers value is going to be increased since they will be able to purchase and pay for products online using their phones. Employees especially in the logistics, accounting, and sales department would have to be trained on the model to maximize its profitability and use. New employees may be added in the IT department or tasks added to some of the employees which would involve additional incentives to motivate them. Thus, human resource and operational management would have to assimilate the new model in the day to day activities of the firm which would require a change management program for the employees to understand its importance. Executive manager is endowed with the mandate of facilitating the implementation and maintenance of change process thus his he would also be impacted. Shareholders would likely get an increase in dividends and the firm’s share price, and public confidence would increase leading to sustainable growth.

Most of the stakeholders are likely to react positively to the change initiative with the exception of competitors who are already using the online model. Also, some employees may not perceive the change positively if extra tasks are added thus requiring the management to carry out extensive change management education to ensure that all employees are in line with the change (Muchanan 2011). Some questions that would be asked by employees is how the change would impact their roles in the firm, and customers might seek to know whether the price of goods will vary depending on the channel used to purchase them. For such, it is important to note to the employees that their roles may change depending on their functional unit; for instance, sales team would have to include online marketing and selling of the goods in their assignments. Price for goods may have to include distribution costs depending on the location of the customer.

The change initiative involves the formation of a multi-channel business model that combines the mortar-and-brick concept with the online platform. The change is aimed at increasing customer’s value and aligning the firm with the principle of punctuated equilibrium which will make it grow amidst market changes at a sustainable level. The initiative is categorized as an e-governance approach that encompasses all the functions of a firm to produce positive results. The success of the initiative will be measured by the changes in sales level, employee productivity, and the overall growth of the firm. To ensure the initiative is successful and aligned with the goals of the firm, ethical considerations that need to be considered include the provision of correct information about a product to customers, safeguarding customer’s confidential information while doing transactions, and maintenance of high levels of integrity.

References

Banks, S 2014, Drivers of change: Retail industry in Australia. SIES Journal of Management, 14, 1, pp. 3-8, Business Source Complete, EBSCOhost, viewed 29 August 2016.

Buchanan, DA 2011 Reflections: Good practice, not rocket science – understanding failures to change after extreme events. Journal of Change Management, 11(3): 273-288

Cavalcante, SA 2014, Designing business model change. International Journal of Innovation Management, 18(2): 1-20

Mawby, E 2011, How to succeed in the retail industry. Journal Of Business & Retail Management Research, 6, 2, pp. 1-12, Business Source Complete, EBSCOhost, viewed 27 August 2016.

Mayfield, P 2014, Engaging with stakeholders is critical when leading change. Industrial and Commercial Training, 46(2): 68 – 72

Overstreet, J 2013, What’s driving change in retail? Retail insiders on the evolution of the industry. Ekonomski Anali / Economic Annals, 54, 209, pp. 105-127, Business Source Complete, EBSCOhost, viewed 28 August 2016

Reeves and Deimler, 2011. Adaptability: The new competitive advantage. Harvard Business Review, 89 (7).

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Implementing the change management plan

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Implementing the change management plan

The pattern of change most frequently encountered in an organisational setting is one in which change is organic, progressive and largely imperceptible; although this default position is infrequently interrupted by single-event instances of extreme and disruptive change. This pattern of change generates a complex framework of demands to be made on those entrusted with guiding the organisation towards its desired future, and those demands are most effectively met by the application of strategic leadership principles.

This week’s Key Concept Exercise requires you to apply the theoretical concepts studied to date to the case study situation contained in the article by Abdullah and Siti-Nabiha (2012). In this context, you will review the situation at Pemancar as it would have appeared to Danial Tareq when he took over his new role, and then present a range of ideas on the best process to use in implementing the required change.

To prepare for this Key Concept Exercise:

• Read the Required Learning Resources sent by mail.

• Reflect on the ideas presented in the Week 5 Key Concept Overview and the assigned journal articles, in the light of your own practical experiences in the workplace.

• Read the Pemancar case study, as presented in the article by Abdullah & Siti-Nabiha, and prepare a report that addresses the following requirements:

• Examine the application of the theory of punctuated equilibrium to an assessment of the current situation at Pemancar.

• Analyse the change environment existing at Pemancar in terms of the parameters suggested by Nasim and Sushil.

• Identify the most likely problems or conflicts that Danial Tareq may face in implementing his change initiative. Each of those problems or conflicts should be classified as pluralities, contradictions or paradoxes, and their potential impact on the change management process should be assessed.

•Evaluate the degree to which Danial’s leadership will influence the effectiveness of the change management process.

When writing your responses, you should synthesise the theory with real world experience and use examples of the theories in action in a real organisation about which you have read, or one in which you have worked.

SAMPLE ANSWER

Odc Kce W5

Implementing the change management plan must require several significant processes that will promote to accept and adopt any attitudinal and behavioural adjustments. And the primary key to realising organisational success is determined by the strategic decisions of leaders. The number one priority of most managers should be to check the external and internal environments, understand and provide company resources, enhance capabilities, identify business threats and develop a vision that would create a positive future for the company. And according to Riwo-Abudho et al. (2012), in strategic leadership, managers must adapt “the art of strategic leadership since modern organisations work on in a dynamic setting which keeps on transforming.”

Addressing the case study of Pemancar (Abdullah and Siti-Nabiha 2012), the organisation had undergone a process of change implementation which is facing a sudden, drastic change. As an evident result, people who are most directly involved in the modification are starting to feel pressure; hence, these people are thinking of leaving the organisation. Looking into the way the organisation thinks and acts; the top management who is on a quest to improve the quality of performance had decided to establish organisation transformation. However, these implementations are often troubled with contradictions and paradox. Following the reviews of Nasim and Sushil (2011), the emergent of new approach had intensely shaken the structure. In their review, it is evident that the Revolutionary change had pushed the organisation into the struggle. The organisation was shaken and disrupted by intense and significant change after a long, punctuated state of continuous and large-scale strategic change.

Strategic Management Process

The role of the manager is to achieve competitiveness and to earn above average returns to the company with highly determined strategic decision concerning the wants and needs of the organisation within the given nature of the environment where it exists. Moreover, an effective change management process must require a combination of logical-rational approach to organisational strategy. Understanding Mr Adam’s standpoint in the case study; a faster and immediate approach towards change will put the members of the organisation in a state of pressure and stress. If Mr Tareq, on the other hand, will facilitate an incremental approach, it will contradict and negates the needs of the upper management. This contributing dilemma will result in entrapping the legitimate interest of the company. However, if there is an in-depth understanding of dualities, contradiction and paradox, it will help draw out a strategic management towards the case (Stoltzfus et al. 2011). Initiating the paradox of duality, interlinking the conflicting strategies of Incremental and Revolutionary change may respond into a seamless transition. For example, in the real world, every stable company must have change. The presence of bureaucratic features in a company has a positive effect on most large organisations in which it tries to maintain and control the benefits of bureaucracy and prevents the problem of slow response to rapid change.

In the case of Pemancar, the bureaucratic standpoint of upper management is envisioning a fast and significant impact on the company. Therefore, however contradicting it may show to those people who are directly involved in the organisation, in strategic leadership, the necessary attributes that a manager must follow within the existing environment – provide a visionary outlook to the employees that will encourage them to work hard. The setting of consistently high standards, provide a clear and concise communication on the vision of structural change. Building confidence with the employee’s works will establish a feeling of self-reward. Lastly, talk with other personnel about their struggles and difficulties and provide feedback to the upper management (2015 Laureate Education, Inc. 2015).

Conclusion

In addressing the case of Pemancar, it is evident that there is a need for revolutionary change. It may conflict with the interest of the members of the organisation but the change should be implemented because of the rapid increase of competitors within the industry. It is understandable that there are efforts in adapting rapid change as a strategic process for the benefit of the company. However, for the company to survive, adapting to change is a positive outlook for its future.

References

2015 Laureate Education, Inc. 2015, Implementing the Change Management Plan: KMGT 673 Organisational Design and Change. pp.2-3.

Abdullah, Z & Siti-Nabiha, A 2012, Leadership and Change Management: A Case Study of Pemancar. Asian Case Research Journal, 16(01), pp.115-132.

Nasim, S & Sushil 2011, Revisiting Organizational Change: Exploring the Paradox of Managing Continuity and Change. Journal of Change Management, 11(2), pp.185-206.

Riwo-Abudho, M Njanja, L & Ochieng, I 2012, The Role of Strategic Leadership during Change. 4(1), pp.49-53.

Stoltzfus, K Stohl, C & Seibold, D 2011, Managing organisational change: paradoxical problems, solutions, and consequences. Journal of OrgChange Mgmt, 24(3), pp.349-367.

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Evidenced Based Nursing Practice

Order Instructions:

APA REFERENCES NOT OLDER THEN 5 YEARS OLD. ONLY AND ONLY JOURNALS AND ARTICLES, NO WEBSITES ACCEPTED.

NMBA STANDARDS MUST BE FOLLOWED, FILE WILL WE ATTACHED IN THE ORDER. PLEASE READ THROUGH AND KINDLY FOLLOW IT.

Evidence based practice (EBP) is the clinical decision making process which is based upon the best available evidence, new research findings, clinical experience and patient preferences. Nurses are expected to implement research findings into their practice, but many are not trained on how to do this. Therefore, it should not be expected that nurses are at the forefront of EBP implementation in the clinical setting.

Hint:?
How does evidence based practice improve patient outcomes? ?How is evidence based practice applied theoretically and clinically? ?Is it feasible to expect RNs to implement EBP in the clinical setting without training / support?

SAMPLE ANSWER

Evidenced Based Nursing Practice

Introduction

Over the years, evidence based practice has become commonplace in as far as nursing profession is concerned. In Australia, Nursing and Midwifery board of Australia provides standards which advocate for utilisation of evidence based practice by nurses in provision of care (NMBA, 2013). Researchers believe that utilisation of evidenced based nursing goes a long way in improving patient’s outcomes. Moreover, nurses have come to a realisation that collaboration of research findings in clinical practice has led to major improvement in the field of nursing. Nurses have been able to identify the significance of evidence based practice in growth of the nursing profession as well as increased credibility of nursing practice (Pooler, 2014).

Implementation of the best evidence requires that nurses should have relevant skills and resources to enable them carry out proper appraisal and evidence synthesis. It is important to note that implementation of evidence based research has proven to be a challenge since most often than not, the evidence based practice are either partially successful or not successful at all (Polit & Beck, 2013). However, it has become a challenge for the healthcare sector to implement new findings in day to day practice due to limited funds. Therefore, it calls for the healthcare sectors to have funds which will help in endorsement of these research findings.

Impact of Evidence based practice on patient outcomes

Nurses who play part in research, utilise the NMBA standard 7 which calls for utilisation of research findings in evidence based practice (NMBA 2013). Evidence based practice has contributed to achieving significant changes in healthcare profession. Through utilisation of this practice which calls for respect of patient’s culture, patients tend to recover quickly when their culture and beliefs are recognised. Research has it that, recognition of a patient’s cultural beliefs in provision of care has a great impact on the treatment outcome (Godshall, 2016). In addition, research indicates that proper documentation of the assessments, diagnosis and interventions on patient help in continuity of care provided to patients (Melnyk & Fineout-Overholt , 2011). Nurses ensures proper documentation of any activity carried out on a patient and this ensures positive outcomes from the patient through continued care.

Through this practice, relevant strategies including effective health programs, quality services and efficient interventions have been put in place (Burns & Grove, 2011). All these result into positive patient outcome and cuts on cost. Nursing practice based on research evidence goes a long way in optimizing patient outcome and providing safe and cost effective healthcare (Burns & Grove, 2011).

EBP has led to improved information in the health sector. This is so because, in its utilization, health organisations are forced to source out new information and synthesise it properly. Health providers are there able to keep abreast with current trends by utilizing new research information and embracing new changes with efficiency (Burns & Grove, 2011). Health organisations therefore continue to evolve without stagnation. Moreover there has been increased funding in the health sector. Governmental agencies have been funding to heath organisations based on how these organisations have implemented evidence based practice (Stevens, 2013). When the health sector is funded, more resources including the human resources, pharmaceuticals and non-pharmaceuticals are made available for the utilization by the patient, hence better outcomes.

Evidence based approach has also promoted technological development in the health sector. Through technological advancements, patients are in a position to acquire better services (Godshall, 2016). For instance, through technological advancements, there has been invention of a 3D CT scan machine which helps in better diagnosis of some conditions. Furthermore, new radio therapy machines have been brought in to enhance management of cancer, therefore producing better patient outcomes. Organisations have made significant upgrades as well as substantial improvements (Godshall, 2016). Health providers should seek to apply the modern technologies in the broadest way possible in order to improve the quality of their services. Re-evaluation which is basically essential for EBP makes organisations retain relevance in a time when changes are encountered every other day.

Theoretical and clinical application of Evidence based practice

Evidence based practice is based on the premise that healthcare professionals should not base their practices on traditions, belief or myths but on information based on research. The practice involves three entities, identification of a clinical problem, literature, evaluation of research evidence and determination of appropriate interventions (Sandström, Borglin, Nilsson & Willman, 2011). Thus, EBP integrates research findings, theory and practice. Through creation of awareness on EBP, it has renewed appreciation of linkages among research, theory and practice. Research findings and clinical data provide evidence for EBP hence generation of practice guidelines and situation specific theories (Sandström et al., 2011). Many evidenced based practice models have been put in place with the major goal being establishment of EBP protocols, procedures or guidelines with other models focusing on implementation in the healthcare setting or institution.

According to Melnyk & Fineout-Overholt 2011, Implementation of evidence based practice has contributed too many benefits in the clinical setting. The practice has provided interventions for diagnosis and management of diseases through implementation of scientific evidence. For instance, there has been an improvement in the management of conditions such as, tuberculosis, HIV/Aids as well as cancer. Drug regimen for treatment of tuberculosis has been changing from time to time based on clinical trials conducted (Burns & Grove, 2011). In addition, new methods of cancer treatment are innovated leading to better outcomes in management of cancer patients, therefore, the lager part of the world tend to adjust to management of cancer as well as change of medications for HIV and patients with tuberculosis.

It is also important to note that, through implementation of evidenced based nursing, nurses have in a position to use the most current research evidence to provide rationales for the quality of nursing interventions (Godshall, 2016). In addition, nurses are able to pass this to the students in the clinical area when guiding them. As a result, these students are able to develop knowledge and skills required to enhance quality of care provided for improved patient outcome through provision of rationales or reason why a care is provided in a certain way. This is in accordance with the NMBA standard 7.1 which calls for the evaluation, monitoring of patient care to help in achievement of expected goals and outcomes.

How Registered Nurses implement Evidence Based practice

In the nursing profession, nurses have a responsibility in making sure as well as providing evidenced based practice (Pooler, 2014). Furthermore, nurses should question practices currently being implemented and utilize care which is evidenced so as to make the care more effective. In order to provide quality care, nurses should base their care on research and knowledge rather than care that is out-dated or care based on traditions or myths ( Mackey & Bassendowski, 2016). Research has shown that through implementation of evidenced based nursing practice, there has been an improvement in the quality of care provided leading to improved life of the recipients of this care. In modern nursing, there are some models which have proven to be effective in nursing practice. For instance, there is the utilization of nursing care plans ensures provision of quality care through evaluation and documentation. In addition, nurses are educating students on research based practice as form of preparing the in the nursing profession in future. This is in accordance with NMBA 2013 standard 3.3 which calls for use of long life learning process for continuing professional development of self and others.

Many a time, nurses are faced with ethical issues during their practice. Utilisation of NMBA 1.5 which requires nurses to utilise the ethical framework in making decisions will go a long way in solving various ethical issues encountered during practice. For instance, there may be a conflict between two ethical principles when dealing with a patient who has given a do not resuscitate order. Through utilisation of the ethical framework which entails ethical decision making, theories and principles, the nurse is in a position to make a decision which is not based on emotions or intuitions (Polit & Beck, 2013). This therefore shows how evidence based practice is crucial in nursing practice. Furthermore, nurses contribute to evidence based practice through participation in carrying out research. During nursing practice, nurses encounter gaps existing between the reality and already existing theories. Thus, they are prompted to do research so as to bridge the gap that exists as well as provide solutions to existing health problems.

Conclusion

In conclusion, it is clear that nurses are significant in implementation of evidence based practice. It therefore calls for training of these nurses to add on their knowledge and skills. Furthermore, there should be adequate provision of resources in the health care setting to help successful implementation of these research findings in research. In addition, implementation of evidence based practice requires relevant changes to be made in the healthcare systems rather than changing the healthcare workers working in these settings. The world is evolving day in day out and therefore, the healthcare sector should as well embrace change through Implementation of evidenced based practice which will be significant in provision of high quality care. Therefore, all health care workers should embrace the evidence based practice to ensure an improvement in the health care sector more so, in improving patient outcomes.

References

Boltz, M., Capezuti, L., Fulmer, T. T., & Zwicker, D. (2016). Evidence-Based Geriatric Nursing Protocols for Best Practice, Fifth Edition. New York, NY: Springer Publishing Company.

Burns, N., & Grove, S. K. (2011). The practice of nursing research. Conduct, critique & utilization, 4.

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-based nursing: A guide to clinical practice. Elsevier Health Sciences.

Godshall, M. (2016). Fast Facts for Evidence-Based Practice in Nursing, Second Edition: Implementing EBP in a Nutshell. New York: Springer Publishing Company.

Grove, S. K., Burns, N., & Gray, J. R. (2014). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.

Hoffmann, T., Bennett, S., & Del Mar, C. (2013). Evidence-based practice across the health professions. Elsevier Health Sciences.

Levin, R. F., & Feldman, H. R. (2012). Teaching evidence-based practice in nursing. Springer Publishing Company.

Lipscomb, M. (2016). Exploring Evidence-based Practice : Debates and Challenges in Nursing. London: Routledge.

Mackey, A., & Bassendowski, S. (2016). Original article: The History of Evidence-Based Practice in Nursing Education and Practice.Journal Of Professional Nursing,.

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410-417. .

Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing, 11(1), 5-15.

Polit, D. F., & Beck, C. T. (2013). Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins.

Pooler, A. (2014). An Introduction to Evidence Based Practice in Nursing & Healthcare. London: Routledge.

Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2015). Readiness of US Nurses for Evidence-Based Practice: Many don’t understand or value research and have had little or no training to help them find evidence on which to base their practice. AJN The American Journal of Nursing, 105(9), 40-51.

Sandström, B., Borglin, G., Nilsson, R., & Willman, A. (2011). Promoting the implementation of evidence‐based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence‐Based Nursing, 8(4), 212-223.

Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.

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