Effect of hydration on blood pressure

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Introduction

Water is the key to all life; without it, life as we know it would not exist. So it is natural to believe that hydration should have an effect on blood pressure and heart rate, considering our heart is also one of the keys to our life as humans. So we will be testing what affect hydration has on blood pressure and heart rate, if any. Blood pressure is the pressure of the blood within our arteries. The measurement is recorded as the systolic pressure (pressure when heart contracts) over the diastolic pressure (pressure when the heart is relaxed). (Weedman, Sokoloski 2009)

A study was done at Franz-Volhard Clinical research center that examined how water drinking affected blood pressure in the body. The results showed that drinking 500mL of water increased patients’ blood pressure and also increased heart rate (Schroeder 2002). Although it was only a slight increase, it still had an affect on the pressure and heart rate.

Jens Jordan also did a study on how water affects blood pressure and found that the older the patient was the more of an effect drinking water had on blood pressure. In fact, in some of the younger patients drinking water had no effect at all. However, when the water did have an effect it increased blood pressure every single time. Some of the reasons for this increase, Jordan describes, are because water and plasma have different osmolarities (concentration of solute vs. solution), the pressure in the blood increases. Also, water may cause different plasma concentrations in the blood which would also cause an increase in blood pressure (Jordan 2002).

Rats and humans are very alike organisms. Our bodies both function and are made similarly. So when David Belanger and Samuel M. Feldman did a study on the effects of water deprivation on rats, we can predict that something similar may happen in humans. The rats’ heart rates decreased the longer they were dehydrated (Belanger and Feldman 1962). The study did not test what hydrating the rats would do, but since the heart rates decreased without water, it is possible that they would increase with water.

One reasonable explanation of why dehydration affects blood pressure is due to the tightening of blood vessels. The volume of blood in the blood vessels and veins of the body will begin to lessen when water is drawn from them. As a result, the vessels and veins will contract in order to stay full of blood (otherwise there is extra space, leaving room for gas to build up). This contracting results in high tension, or high blood pressure (Healthy-water-best-filters).

I hypothesize that hydration will affect blood pressure and heart rate. I predict that the blood pressure and heart rate will increase. The significance of this experiment is determining how hydration affects blood pressure and heart rate. It is important to know this because high blood pressure is a dangerous condition, and many people suffer from it. If hydration can affect blood pressure (and heart rate) in a good way, it may produce many ways to help keep blood pressure and heart rate at a healthy state.

Materials and Methods

First, the variable to be tested (hydration) was decided by the class and a question to test was determined. The dependent variable was blood pressure and heart rate (beats per min). The independent variable was hydration (and time). Basal readings (resting blood pressure and heart rate) for each student were used from the last experiment. Each student did not drink any water over the duration of the class (about 2.5 hours), and at the end of class, each student drank roughly 16oz of water. Each person recorded their blood pressure and heart rate at time zero by using their basal BP and HR from the past experiments. Immediately after drinking the water, a partner began timing the other partner. Every three minutes each partner measured their partner’s blood pressure (systolic/diastolic pressure) and heart rate (beats per min) using a digital sphygmomanometer (which expressed both heart rate and blood pressure). A measurement was taken every three minutes for 12 minutes. There were 13 groups who gathered data, so 26 total students’ data was obtained and put into excel. Averages, T-Tests, and ranges were then attained and analyzed. (Weedman, Sokoloski 2009)

Results

After all 26 students in the class drank about 16oz of water, each found a partner and started to record the blood pressure and heart rate of each other every 3 minutes for 12 minutes. The data for each student was obtained and analyzed in an excel spreadsheet.

The basal readings (resting rate) for blood pressure (systolic/diastolic pressure) for all 26 students ranged from 83/57 to 158/105. After every student took three basal readings, the averages for each basal reading were taken, and all three averages were averaged at 108/69. The blood pressures at time zero ranged from 91/58 to 175/134. After the outliers were removed, the average for time zero was 117/74. At 3 minutes, the blood pressures ranged from 86/63 to 157/117 and the average was 111/69 after outliers were removed. At 6 minutes, the blood pressures ranged from 85/52 to 150/75 and the average was 109/70 after outliers were removed. At 9 minutes, the blood pressures ranged from 91/53 to 140/80 and the average was 116/75 after outliers were removed. At 12 minutes, the blood pressures ranged from 91/59 to 137/69 and the average was 113/70 after outliers were removed. After performing a T-Test, we can determine that the data is significant (the result of the test was 0.33). (Table 2)

Graph 2 illustrates how the systolic and diastolic pressures didn’t change over time. After drinking 16oz of water, the blood pressure was not affected at all. The slope of the trendline for average systolic pressure is -0.1. We can determine that this is extremely close to zero. It’s not enough of a slope to say that the systolic pressure decreased at all. The slope of the trendline for average diastolic pressure is -0.07. Again, this is close enough to zero to determine that there was no change in diastolic pressure.

The heart rate basal readings for all 26 students ranged from 53 beats per minute (bpm) to 122 bpm. The overall average basal reading for heart rate was 76.57 bpm. At time zero, the heart rates ranged from 44 bpm to 116 bpm and the average was 69.5 bpm after outliers were removed. At 3 min, the heart rates ranged from 52 bpm to 106 bpm and the average was 67.25 bpm once outliers were removed. At 6 min, the heart rates ranged from 51 bpm to 108 bpm and the average was 66.3 bpm once the outliers were removed. At 9 min, the heart rates ranged from 55 bpm to 116 bpm and the average was 68.67 bpm once outliers were removed. At 12 min, the heart rates ranged from 42 bpm to 100 bpm and the average was 69.33 bpm once outliers were removed. (Table 1)

Graph 1 illustrates the changes in the heart rate over the 12 minutes. From 0 to 6 minutes, the heart rate decreases by 3.2 bpm, but from 6 to 12 minutes, the heart rate increases by 3.03 bpm. However, since the average basal reading was 76.57 bpm, we can see that after drinking water, the heart rate immediately decreased by 7.07 bpm, and didn’t recover after the 12 minutes. Since we didn’t measure recovery rate, we don’t know how long it took the body to recover.

Discussion

I hypothesized that hydration would affect blood pressure and heart rate. I predicted that hydration would cause the blood pressure and heart rate to increase. The data did not completely support my hypothesis and prediction. Hydration did not affect blood pressure, but it did affect heart rate.

Graph 2 illustrates that once students drank 16oz of water their blood pressure was not affected. The slopes of both of the trendlines for systolic and diastolic pressures were extremely close to zero, showing that the blood pressures did not change due to hydration. Although the pressures increased a bit from the basal readings, it still follows the trend of the graph, and would not affect the trendlines. So we determine that hydration did not affect blood pressure.

Graph 1 illustrates that heart rate was affected by hydration. From time zero to 6 minutes, the average heart rate decreased by 3.2 bpm. From 6 to 12 minutes, the heart rate increased by 3.03 bpm. These increases and decreases of the heart rate are very close to each other. If we measured heart rate longer, we would be able to determine if this was a pattern or not. With the amount of data we have, it’s hard to determine if this is a significant increase and decrease. However, from the average basal reading of 76.57 bpm (Table 1) to the reading at time zero, there was an average decrease of 7.07 bpm. Compared to the other decrease in the graph, this is a much larger one. So we can conclude that hydration does affect heart rate, but only for a brief period of time. It decreases heart rate immediately, but after about 6 minutes, the heart rate begins to increase again. We can’t determine if the heart rate is recovering because we didn’t measure until the rate completely recovered. So we can only conclude from our data that hydration decreases heart rate for about 6 minutes, and then it begins to recover.

An alternative hypothesis for the effect of hydration on blood pressure and heart rate would be that it would not affect blood pressure, and it would affect heart rate. The results of the study conducted at Franz-Volhard Clinical research center do not match the results we got in our experiment. They discovered that hydration increased both blood pressure and heart rate (Schroeder 2002). Our study showed that hydration does not affect blood pressure, but it does increase heart rate (for a certain period of time). Jens Jordan’s study, however, supports our results. In some of the younger patients in his study, hydration had no effect on blood pressure. But in the older patients, blood pressure increased (Jordan 2002). Since the patients of our experiment are all young, our results match Jordan’s. The study done my David Belanger and Samuel M. Feldman was conducted with rats, not humans and was the effect that dehydration has on heart rate. Their results showed that the longer the rats were dehydrated, the more the heart rates decreased (Belanger and Feldman 1962). I predicted that since the heart rates decreased without water, they would increase with water. Since the experiments and variables were a little different, it’s hard to compare the results of our experiment with theirs. But, my prediction that was based on their experiment was not supported by our data.

I have identified several weaknesses in our experimental setup. If the amount of time allowed to measure the blood pressure and heart rate were extended, we could have determined when the blood pressure and heart rate recovered, and that would have helped with the analysis of our data immensely-especially the heart rate. We may have been able to determine if the heart rate actually did decrease, or if it was just a pattern that the body and heart have naturally. So recovery time would have helped with the significance of our data, as well as the analysis. Also, our data might have been more accurate with a larger group of people. More people would have solidified our data as more accurate.

Works Cited

Belanger, David, and Samuel M. Felman. 1962. “Effects of water deprivation upon heart rate and instrumental activity in the rat.” Journal of Comparative and Physiological Psychology 55.

“Dehydration And Blood Pressure Are Linked. Treat HBP with Water!” Dehydration symptoms= Sickness. Chronic Dehydration,Treatment, Hydration. 31 Jan. 2010.



.

Jordan, Jens. 2002. “Acute effect of water on blood pressure.” Mini-Symposium: Review Article.

Schroeder, Christoph, Victoria E. Bush, Lucy J. Norcliffe, Friedrick C. Luft, Jens Tank, Jens

Jordan, and Roger Hainsworth. 2002. “Water Drinking Acutely Improves Orthostatic Tolerance In Healthy Subjects.” Clinical Investigation and Reports.

Weedman, Donna, and Erica Smith Sokoloski. Biology of Organisms: A Laboratory Manual for LIFE103. Vol. 5E. Mason: Cengage Learning, 2009.

Rolfe- Freshwater and Jasper (2001) Framework for Diabetes

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Reflective account, using

framework from Rolfe

, Freshwater and Jasper (2001) of a patient with regards to a long term condition and identification of a learning need to be achieved during the module.

This essay is reflective based on my experience while on a clinical placement. The aim is to demonstrate an understanding of my views encountered in practice using the Rolfe, Freshwater and Jasper (2001) framework with regards to diabetes mellitus which is a long term condition. According to Bennett and Morisson (2009), Diabetes mellitus is a lifelong condition marked by high level of sugar in the blood and a failure to transfer this to the organs that need it. The framework will show how it has been used to reflect on the condition, what has been learnt and the outcome on current and future practice. It also based on learning needs to be achieved during the module.

It was an eight week placement on an acute unit which consist of a male bay, one female bay and three side rooms. My mentor and I was assigned to the male bay. This was when I came into contact with Mr. A. Pseudonym will be used to conceal patient identity. Confidentiality will be maintained throughout in accordance with the Nursing and Midwifery Council (2008).

Mr. A was a 64 year old gentleman who was admitted to a critical unit from Accident and Emergency (A&E), in my third week of my first year as a nursing student but my second placement. He had several conditions inflicted on him. They were acute pulmonary oedema secondary to silent myocardial infarction (MI), acute kidney injury (AKI) and CKD. Past medical history of Type 2 diabetes mellitus (T2DM), quadriplegic amputee and HONK. He was basically admitted for hyperglycaemic control

It became clear during hand over that this was a challenging and interesting case for effective learning to take place especially as a student nurse. Learning is a relatively permanent change in knowledge, skills or ability as a result of experience (Bennett & Morrison, 2009). However, I felt anxious as this was just my second placement for my first year as a student nurse and I did not feel experience enough to deal with all I was hearing about this patient.

My first impression when I saw Mr A. was a sad one because of his quadriplegic amputee. I realised that hearing or reading about a condition and actually giving hands on care is different. According to Bulman and Schultz (2008), thinking can be intellectual, thus emphasising the importance of practical as well as theoretical for learning.

My first encounter with Mr A. on the ward he appeared to be drowsy and somewhat confused from the conversation we had. For instance, his wife was sitting at his bedside and he told me he took his wife to a party last night. During the time he was mentioning he was hospitalise. Drowsiness can be a sign of hyperglycaemia as in Mr. A Case. As nurses and other health professionals, we are faced with challenging and unique situations in practice, therefore, by reflecting on these experiences it allows learning to take place and again flexible ways in which to respond to these situations (Burns & Bulman, 2000).

While caring and carrying out assessment of Mr A., it was noticed he had intravenous infusion (IV), urethral catheter, insulin pump, heparin infusion and central venous pressure line (CVP). I was assigned to monitor hourly observation because the patient was critical and this had to be done until they were stable, especially the blood sugar which was elevated. According to Dougherty and Lister (2008), maintenance of normal blood glucose should be within 4-7 mmol/l. I can remember at one point it was 27 mmol/l. Whenever I noticed any abnormalities in the observation I would inform my mentor. I noticed increase in insulin administration via pump when blood sugar level is elevated and decrease when lower readings.

Also, the patient was unable to carry out self-care or assist in his care because of his quadriplegic amputee. He was totally dependent on the nursing staff to take responsibility for all his basic needs and to promote high quality care (NMC, 2004). However he was given the care that he needed with consent. For example, wash in bed and assisted with nutritional needs such as feeding. When food was given he would refuse, but with much encouragement on my part in a good way he would. I can remember Mr A. asking me to scratch his head because he was unable to.

Strict fluid balance I maintained because the patient was reluctant to drink. I informed my mentor and I was advised to give at least 30 mls of fluids per hour. I asked Mr. A. what was his favourite drink, he told me tea. I remembered going to the kitchen after informing my mentor of my intention to make sure an eye was kept on him. The patient was also monitored using a water loo chart. This was used mainly because of his immobility and he was prone to pressure ulcer if proper care is not given.

During one of my encounters while nursing Mr. A, I remembered him saying to me diabetes is not good because it leave him without limbs. At that moment I felt compassion for him. At the same time he said that to me, I was pricking his earlobe to monitor his blood sugar. I felt sad for him thinking about the pain he was going through pricking his earlobe every hour.

At times I felt impotent because of my lack of experience and been unaware of how to deal with situations such as Mr. A condition. I was limited in my experience and it was my first hospital placement. I wanted to reassure patients, support my colleagues, and give sound advice but I did not have enough confidence and experience to do that.

I didn’t know how to ask Mr. A. about the pain he was experiencing when pricking his earlobe, but I gained the confidence to approach him and ask to tell be about when his earlobe is been pricked. My reason for asking is because I noticed every time his earlobe was pricked he would grimace on his face He said it hurts and is painful. Mc Caffery and Pasero (1999) states pain is what the patient says it is.

However, I have learnt something about myself. I have learnt basic communication skill especially listening just by sitting at Mr A. beside and listening to his conversations he would tell me about his country of birth Barbados and how he ended up living in Trinidad. I did not know that with just a few simple words of empathy and encouragement it would please and calm the patient. According to McCabe & Timmins (2006), communication is the process of conveying information between two or more people. Communication is essential in building relationships with patients and gaining trust. To highlight how important communication is in the nursing profession, NMC identified it as being an essential skill and only if a student is competent in this skill they can go on and register as a nurse (NMC, 2007).

Communication has been describe as being both simple and complex process. For communication to be effective, the sender has to be very clear about the purpose of the message (McCabe & Timmins, 2006).

The care the patient receive has direct potential to improve through reflective practice it helped to make sense of complicated situations and staff can become motivated and empowered. This has given me a chance to link theory to practice. The way I communicated with Mr. A., had a positive outcome for both of us in that all his needs were met, and I learnt effective communication helps in building trusting bond between patient and nurses (Almond & Yardley, 2009).

A PATIENT IS EXPERIENCING SERIOUS VENTRICULAR ARRHYTHMIA’S AND SHOCK FOLLOWING A HEART TRANSPLANT. The physician has ordered isoproterenol and dopamine to be administered to the patient.(learning objective 2,,4 and 5).

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A PATIENT IS EXPERIENCING SERIOUS VENTRICULAR ARRHYTHMIA’S AND SHOCK FOLLOWING A HEART TRANSPLANT. The physician has ordered isoproterenol and dopamine to be administered to the patient.(learning objective 2,,4 and 5).

CASE STUDY #30. A patient is experiencing serious ventricular arrhythmias and shock following a heart transplant. The physician has ordered isoproterenol and dopamine to be administered to the patient.(learning objective 2,,4 and 5).

(A). What is the therapeutic action for isoproterenol?

(B). What are the adverse effects of isoproterenol?

(C). What are the therapeutic action for dopamine?

(D). What are the adverse effects of dopamine?

(E). what are the key nursing implementation considerations for patients receiving an adrenergic agents?

CASE STUDY#36. A second- year nursing student has to prepared medication cards for clinical on adrenocortical agents. The specific medication cards that have to be prepared are for prednisone (Deltasone) and fludrocortisone (florinef). Additionally, the student nurse has to prepared a patient teaching plan for mineralocoricoids.( learning objectives 1,2,,4 and 5).

(A). What are the physiological effects of the adrenocortical agents?

(B) What are the key nursing implementation teaching points that need to be reviewed with a patient receiving an adrenocortical agent?

(C).What are the common adverse reactions for fludrocortisone (Forinef)?

(D). What are the indcations for prednisone (Deltasone)?

CASE STUDY#38 A diabetes registered nurse educator is preparing an in-service presentation for student nurses on agents to control blood glucose levels for diabetes agents. The in- service will include a brief review of the pathophysiology of diabetes mellitus .Drugs to be included in the presentation will include insulin chlopropaminde (Diabinese), glyburide (Micronase), andmetformin (Glucophage). ( learning objectives 1,4,and 5).

A What alterations in metabolic pathways and change to basement membranes occur with diabetes mellitus?

(B). What are the key nursing implementation considerations for patients taking insulin?

(C). What are the indications for chlorpaminde (Diabinese)?

(D). What are the most common adverse effects of glyburide (Micronase)?

(E). What are the therapeutic actions for metformin (Glucophage)?

(F).What are the lifespan considerations for children who use antidiabetic agents?

Journal Assignment Week 11 Practicum Weekly Resources

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Journal Assignment Week 11 Practicum Weekly Resources

Journal Assignment Week 11 Practicum Weekly Resources

Select a peer reviewed article published in the last 5 years from the Walden University Library or a web site related to the components of the health IT function, the health care environment from a patient’s point of view, or critical success factors for health IT professionals.


In a minimum of 550 words, answer the questions below in APA format and apply the required references as noted below.


Journal Assignment—Part 1

After reviewing the Practicum Weekly Resources, record responses to the following in your Journal:

1)       Describe the key points and/or critical success factors you identified when conducting your search. (search the net for a scholarly peer-reviewed article or website to answer this question and cite it in APA format)

2)       How can you use your Practicum experience to assist you in meeting your career goals?


Journal Assignment—Part 2


Note:

Each week, you are responsible for locating a scholarly journal article in the Walden Library related to your area(s) of interest. Include in your Journal the reference in proper APA format, and provide a brief summary of the article. (See Attached PDF file) and citation below

McCarthy, L., Xinru (Wendy), S., Crown, N., Turple, J., Brown, T. R., Walsh, K., & … Rochon, P. (2016). Medication reconciliation interventions in ambulatory care: A scoping review. American Journal Of Health-System Pharmacy, 73(22), 1845-1857. doi:10.2146/ajhp150916


Journal Assignment—Part 3


Practicum Onsite Visits

Summarize the key activities of your visits to your Practicum site (as appropriate), including with whom you met, what you did, and what you gained from the experience.

This week, I finalized my flowchart. The onsite visit was actually done in week one!




ORDER NOW FOR CUSTOM-WRITTEN, PLAGIARISM-FREE PAPERS




You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.


A bloated bureaucracy and an inclusive supreme court

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Initial Post Instructions

For the initial post, respond to one of the following options, and label the beginning of your post indicating  Option 2:

Option 2: Identify a recent decision by the U.S. Supreme Court and discuss the nature of the case and the basis of the argument the Supreme Court used to reach the decision. Explain why you agree or disagree with the ruling?

Describe key challenges for your selected health care department in ensuring that its sensitive data are secure. Illustrate with specific examples, and address not only technological issues but also human factors involved in ensuring its system security. What are some implications of security breaches of its health care data?

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Describe key challenges for your selected health care department in ensuring that its sensitive data are secure. Illustrate with specific examples, and address not only technological issues but also human factors involved in ensuring its system security. What are some implications of security breaches of its health care data?

 

For ethical, legal, and business reasons, the security of health care data must be a top priority in health care organizations. HIPAA, for example, requires that health care organizations safeguard patient data, and there are serious consequences for breaches of privacy. Yet organizations have many types of sensitive clinical or administrative information they need to protect. To make their systems secure, health care organizations put in place policies as well as technical safeguards such as encryption and passwords. There can be a tradeoff, however, between system security and ease of use by health care providers.

Prepare for this Application Assignment as follows:

Select a type of health care organization, such as an outpatient clinic, nursing home, or hospital, and a specific department or function in this setting, such as a nursing unit, radiology department, or admissions, that would make use of sensitive health data.Bring to mind specific ways in which these data might be improperly accessed, lost, stolen, and so on.
Review this week’s Learning Resources, and conduct online research, as needed, to clarify for yourself the ramifications for individuals and organizations of security breaches in this department, and the solutions that have been devised to protect these data. In what ways might these security measures interfere with the staff’s ease of use of the system? Consider how best to balance these competing interests of data security and convenience for staff.
Then write a 2- to 3-page paper that addresses the following:

Describe key challenges for your selected health care department in ensuring that its sensitive data are secure. Illustrate with specific examples, and address not only technological issues but also human factors involved in ensuring its system security.
What are some implications of security breaches of its health care data? Who might be impacted and how?
Summarize security measures that might be taken as well as their potential impact on the staff’s ease of use of the information system.
Explain what you believe is the appropriate balance between data security and ease of use.

Incorporating Bloom’s taxonomy in learning domains (cognitive, psychomotor, and affective).

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Incorporating Bloom’s taxonomy in learning domains (cognitive, psychomotor, and affective).

Using Part I (previous order), write and revise the original learner objectives submitted.
Use the A-B-C-D method of writing objectives. The objectives should incorporate Bloom’s taxonomy, be written at the appropriate level for the audience, and include at least two learning domains (cognitive, psychomotor, and affective). Refer to “NUR-649E – Nursing Education Seminar II: A-B-C-D Approach to Objective Writing.”
Refer to “NUR-649E – Nursing Education Seminar II: Learning Domains.”
Map out a class time frame, outlining when to cover each of the content areas. Refer to “NUR-649E – Nursing Education Seminar II: Lesson Plan Template.”
In addition to the content area, include the class time frame:
1.Time frame for covering each topic area
2.Teaching strategy for each objective
3.How the learning will be evaluated
Include rationale for each selected instruction and the evaluation method used.
Support your rationale by citing at least three scholarly, peer-reviewed resources (less than five years old) in addition to the course materials.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
It is intended that each student will develop a class that can be utilized in the student’s selected area of education (Nursing).

Financial Management of the National Health Service (NHS)

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Introduction

This academic paper described a public sector in health care particularly on its financial management. The chosen public sector is the National Health Service (NHS). A description of the sources of funds and expenditures of NHS is provided. Financial decision-making, control and monitoring in public sectors are analysed within the context of this organisation. Specifically, a discussion of financial accountability and budgeting in public sector are explained. At the end of the paper, the tender process and specification for NHS England was provided and a criteria for selection was devised.


The National Health Service (NHS)

The National Health Service (NHS) is a publicly funded organisation that provides health care services to residents of United Kingdom. It was established in 1948 and currently provides a wide array of services including antenatal screening, treatment of chronic diseases, emergency care, transplantations, preventive care and end-of-life care (NHS, 2013). The Washington Commonwealth Fund, this organisation is the best health care system in the world in 2014 (NHS Confederation, 2014).

With the exception of some prescription, optical and dental services, all health care services by NHS are free for all the 63.2 million residents of United Kingdom (NHS, 2013). Health services being provided are determined by the Secretary of State for Health (England), the Minister for Health and Community Care (Scotland), the Minister for Health and Social Services (Wales) and the Minister for Health, Social Services and Public Safety (Northern Ireland) (Harker, 2012).


Funding

Harker (2012) released vital information on the way the NHS gets its fund. The funds of the NHS are being given by the Department of Health and come from the taxes collected from the people. For 2012/2013, the latest published fund was £108.9 billion (NHS, 2013). An estimated 80% of NHS funds go to the 151 existing Primary Care Trusts and the amount they receive would depend on the serviceable population and their need (Harker, 2012). In addition, the money primary care trusts are getting can be dispensed by commissioning health services from NHS, independent and voluntary sectors they deemed most needed by their local residents (Harker, 2012).

For prescription charging in England, patients pay an amount of £7.20 while Wales, Northern Ireland and Scotland charge none (Harker, 2012). The Department of Health Resource Accounts for 2010/11 estimated that £450 million were raised from prescription charging in England. For dental treatment, on the other hand, the amount being paid by patients cost around £17.50-£209 depending on the dental case in England, £12 to £177 in Wales, up to £384 in Northern Ireland and Scotland (Harker, 2012). The amounts of funds raised were estimated to £614.3 million in England and £27.3 million in Wales for 2009/10 (Harker, 2012). Other sources of funds would overseas patient charging, treatment of private patients and hospital parking and telephone use fees (Harker, 2012). The funding and expenditures of the NHS per year is made known to public through the government’s annual reports.


NHS Public Accountability

Maybin et al (2011: 7) defined accountability as the “relationship involving answerability, an obligation to report, to give account of, actions and non-actions”. Primary care trusts who are the main recipient of most of the NHS funds and the commissioners of health services are held accountable in terms of: 1) management by the strategic health authority and the Secretary of State for Health; 2) regulation on the quality of commissioning by the Care Quality Commission; 3) scrutiny for financial management and disbursement of resources by the Audit Commission, local overview and scrutiny committees, non-executive directors of the boards and patient and public representatives of local involvement networks (Maybin et al, 2011). In the future, commissioners will likewise be held accountable by the new national NHS Commissioning Board, standing rules of the Secretary of State, Monitor, new health and well-being boards, local HealthWatch, and the National Audit Office’s consolidated annual accounts (Maybin et al, 2011).

The NHS Trust are accountable to primary care trusts, Care Quality Commission, local involvement networks, Audit commission, local overview and scrutiny committees, and externally appointed non-executive directors of the boards (Maybin et al, 2011). For the NHS Foundation Trust are likewise monitored the same as that of NHS Trust with the addition of the governor and Monitor (Maybin et al, 2011). In addition, independent sector providers are held accountable only by the primary care trusts, Care Quality Commission and local involvement networks (Maybin et al, 2011).


Financial Control and Monitoring

Good financial control and monitoring are keys to effective financial management in the health care sector (Cichon, 1999). A formal management control system includes the following processes: 1) programming, 2) budgeting, 3) operating measurement, 4) reporting and evaluation, and 5) feedback and correction (Finkler et al, 2007). Programming involves selecting the programmes that the organisation wants to engage at in the future (Finkler et al, 2007). Control of the future programmes will ensure that adding these to current programmes can meet the mission, vision and objectives of the organisation. Next is setting the budget. The budget is used to compare the budgeted amount with the actual amounts used by the organisation in a fiscal year and would mainly tell if the organisation has met its targeted operating and financial performance (McLean, 2002). Moreover, the management must be able to produce reports of its operating finances for evaluation, feedback and correction (Finkler et al, 2011).

In the NHS, the chief executive is the one responsible for the organisational finances and he/she is held answerable to the Permanent Secretary or the Chief Executive of NHS (Audit Commission, 2004). Meanwhile, the director of finance is tasked to ensure that all practises and procedures related to the organisation’s finances are sound and in place (Audit Commission, 2004).

The Audit Commission (2004) explicitly suggests way to improve financial management especially in controlling and monitoring. The first step is financial planning. A financial plan should be able to project the revenue and the capital needed in a particular period of time while placing consideration on possible shifts in capital spending. NHS bodies are suggested to consider extra investments that can improve the services such as spending for technology and research. In the long run, these may lessen capital costs and provide more revenues. After the financial planning, the budget must be set and prepared to ensure proper allocation. The budget must be created consistent with the vision, mission, goals and objectives of the organisation. In NHS, a combination of zero-based budgeting and incremental budgeting are being used. In zero-budgeting, the organisation starts from none while in incremental budgeting, the budgets are carried forward and adjusted yearly. Budget reporting and monitoring comes next wherein the budget is reported to budgetholders especially the variances so that corrective actions can be applied. Board reporting comes next wherein financial information is relayed to NHS boards so that they can take corrective actions as early as possible whenever necessary. Financial reports are also produced as part of the statutory obligation of NHS bodies. Through financial reports produced annually, the NHS is able to inform the public where their taxes for health go. Treasury management, on the other hand, ensures the sufficiency of cash through receipt and payment management, borrowings and investments, and cashflow monitoring. The Department of Health sets the amount of cash expenditures that NHS bodies are allowed to spend. The NHS also implements system for financial control to ensure public accountability. This is signified by the chief executive’s annual statement on internal control. Lastly, the NHS must ensure value for money by fostering learning, transparency and openness in using new resources.


Financial Information and Decision Making

Decision-making is a process of selecting course of actions from a pool of actions that may be feasible or applicable (Cleverly et al, 2010). In terms of finances, the management must be able to utilise financial information in aid of decision-making. The information must then be accurate, timely and relevant in order to arrive at an effective and high quality decisions (Cleverly et al, 2010). For example, a financial forecast of a new technology serves as the information for the NHS. Based on the forecast, the decision question now is to whether the new technology must be purchased or not. Supposing that the decision was to purchase the technology and the result was significant earnings for the NHS, then the financial information was successfully utilised to aid in making the right decision. Khan and Jain (2007) suggests that to arrive at financial decisions, the finance manage must be able to determine sources of short-term and long-term financing and their alternatives at a given point in time. In the case of the NHS for example, short-term financing could be the dental charges from patients while long-term financing would be the tax funds coming from the government. Supposing that there is a shortage of funds for the coming fiscal year, the finance manager must ask what could be a good source of readily available short-term and long-term financing at the moment to meet the first quarter needs.


Tender Process and Documentation

The tender process may be used by organisations which need a particular service (Oakley, 2008). The organisation is expected to release a tender specification which provides the details of the type of services they need, volume of work, locations and costs (Oakley, 2008). In the NHS, there are five stages in the tender process namely: 1) assessing sustainability; 2) submission of the pre-qualification questionnaire; 3) invitation to tender; 4) final interview and presentation; and 5) contract award (Royal College of Nursing, 2005). Assessing sustainability includes performing pre-tender checks, finding a tender notice, obtaining a copy of the tender and evaluating it, providing an expression of interest and completing subsequent forms (Royal College of Nursing, 2005). The next step would be to submit the pre-qualification questionnaire which is then decided by the Commissioner. Once the Commissioner gave a favourable decision, an invitation to tender will be issued to which a response would be needed for final evaluation of the Commissioner (Royal College of Nursing, 2005). A final interview will be conducted together with the Commissioner and a positive response would end with the awarding of the contract (Royal College of Nursing, 2005).

Based on the NHS process, tender criteria have been devised (Morledge and Smith, 2013; Ward, 2008). The scoring will be based on organisation details (10%), workforce information (10%) , financial standing (10%), relevant experience and technical ability (15%) , health and safety (15%) , insurances (5%) , references (5%), quality assurance (15%), equal opportunity declaration (5%), and evidence of registration with the regulatory bodies (5%) (Royal College of Nursing, 2005). A corresponding score will be given which range from 0=failed to 5= very high standard. The score will be multiplied with the percentages per item to get the weighted score. The weighted score will be totaled. The total weighted score will serve as basis for ranking (Ward, 2008).


Summary and Conclusion

They say that the health of the people reflects the richness of a nation. Health care is a fundamental right and a public concern. Thus, a public organisation such as NHS must be able to exercise effective financial management, control and decision-making so that more citizens can be given the right quality care that they pledged to provide for free. Since most of the funding of the NHS come from the money of the people, accountability must be observed by those in-charge of handling the organisational finances. A system of check and balance through transparency in financial auditing and reports and vigilance of the public are necessary in ensuring that the people’s money are spent rightly on where it is needed the most.

In public sectors, the tender process is usually applied in evaluating and selecting suitable suppliers. Before one can enter into public contracts, the tender process is usually observed as a means to determine the quality of the services being procured by the government. It also ensures that every purchase has clean documentation and has gone through a thorough process of screening. For public organisations, the tender process is usually followed since the money being allocated are in huge amounts and most of all from the people who pay their taxes.

ELM 510 WEEK 4 ASSIGNMENT, CLASSROOM PROCEDURES AND DIVERSITY

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Description

ELM 510 Week 4 Assignment, Classroom Procedures, and Diversity Presentation (Two Powerpoint)

Establishing classroom procedures and routines helps to optimize time for instruction and allows the learning environment to operate efficiently. Students and teachers need to have procedures for everything, based on the needs of the particular class.

For this assignment, identify a class of students in terms of grade level, K-8, and the number of students in the class. Create a 10-12 slide digital presentation for the first day of school that will demonstrate how you will introduce expectations, processes, and diversity to your class.

Your digital presentation must include three parts:

Part 1 – Introduction
  • In what way would you introduce yourself to your students
  • In what way would the students will introduce themselves to each other
  • How the expectations, procedures, and behavior management will be introduced
  • How the procedures and expectations will be enforced, along with possible consequences
Part 2 – Expectations for Policies and Procedures

Choose five policies and procedures, applicable to your chosen grade level, from the list below or of your own, and describe how to implement them in your future classroom:

  • Entering the classroom
  • Using the restrooms
  • When students may go to the trash cans
  • The use of technology in the classroom
  • Turning in classwork and homework
  • Talking to others in the classroom
  • Gaining student attention
  • Transitions

Part 3 – Incorporate Diversity

  • How to address diverse needs in your class (e.g., a student in a wheelchair, a student who does not speak English, a student who does not celebrate traditional holidays, a student who cannot eat certain foods because of religion, a student who is a different race than the rest of the class, etc.)
  • In what manner would you instructionally support various diverse needs, including language, family backgrounds, skills, and abilities in your classroom
  • In what way would you develop a culture in your classroom that values each students’ diverse background
  • How to establish and maintain a positive and collaborative relationship with families. ELM 510 week 4

 

Review the overall research design in the Ohio Lottery case (See Exhibit OL-1). What are the advantages and disadvantages of this design? Would you select a different research design? Why or why not?

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Review the overall research design in the Ohio Lottery case (See Exhibit OL-1). What are the advantages and disadvantages of this design? Would you select a different research design? Why or why not?

 

 

Case study:-
Read the case study Ohio Lottery: Innovative Research: Design Drives Winning. Answer the following questions:
a. What is the main research question the researchers are trying to solve for?
b. Review the overall research design in the Ohio Lottery case (See Exhibit OL-1). What are the advantages and disadvantages of this design? Would you select a different research design? Why or why not?
c. Evaluate the MET process (Exhibit OL-2). What are some of the strengths and weaknesses of the MET technique?
d. Review the sample questions provided (Exhibit OL-3) Why might the lottery attitude and lottery importance questions have presented the most challenge to the professional researchers?
e. Evaluate the MET discussion guide for the Ohio Lottery Research.

Case Studies: Prepare a double-spaced paper (2-4 pages without title, references, etc). Please follow the APA rules for completing this assignment. Be sure to support your answers with at least 4 references( you must cite our book:
Required Books
Business Research Methods by Donald Cooper, Pamela Schindler. McGraw-Hill Companies, Inc. 11 edition (2010) ISBN:0073373702 ISBN-13:9780073373706 eISBN:9780077550684

Writing Assignments:
There may be writing assignments due each week. Students are to apply critical thinking in all writing. While content is very important in a writing assignment, students are expected to check the spelling (do not always rely on the spell check on your computer) and to use correct grammar in all assignments. All papers should follow APA Guidelines (ex: Introduction, Body, Conclusion, use headers, references, etc) 75% of the grade will be based on content. 25% of the grade will be based on style and format including such items as clarity of communication, sentence and paragraph construction, punctuation, spelling, and grammar. In order to receive all points for the weekly assignments, be sure to answer ALL of the questions in the assignment, from the syllabus. Outstanding papers should make a strong argument. All written assignments must utilize and site at least three different texts or articles. Assignments missing 3 references will have point reductions. Please see Appendix A for my Grading Criteria and Rubric. Be sure to review academic standards and referencing guidelines from APA. Plagiarism will not be tolerated.
Academic Dishonesty and Plagiarism:
Academic dishonesty includes such actions as cheating on examinations or assignments, turning someone else’s work in as if it were your own, and plagiarism. Plagiarism includes failing to adequately cite sources of information, using someone’s ideas, information, or words as if they were your own, etc.

Academic dishonesty also includes turning in work submitted for a grade in another course. For example, it would be considered academic dishonesty to turn in a paper that you wrote for English 101 as if you had written it for Philosophy 202. In addition, turning in a paper that you constructed by simply cutting and pasting sections from a paper you wrote previously, is also considered academic dishonesty. Although the consequences of plagiarism and/or academic dishonesty may vary, depending on the nature of the violation, the Student Handbook states, “The penalty for plagiarism or any other form of academic dishonesty will be failure in the course in which the academic dishonesty occurred”.
GRADING CRITERIA FOR WRITTEN ASSIGNMENTS
75% Content and Development
? All key elements of the assignments are covered in a substantive way
? Content is comprehensive, accurate, and/or persuasive
? Major points are stated clearly; supported by details, examples, or analysis; and organized clearly
? Where appropriate, the paper supports major points with theory relevant to development of the ideas, and uses the vocabulary of the theory correctly
? There is integration of theory and practice whereby the writer is able to link theoretical information to practical experience
? Research is adequate and relevant for the topic
? The context and purpose of the writing is clear

10% Organization, Readability, and Style
? The structure of the paper is clear and easy to follow
? The paper’s organization emphasizes the central theme or purpose, and is directed toward the appropriate audience
? Sentences are complete, clear, and concise
? Sentences are well-constructed, with consistently strong, varied structure
? Sentence transitions are present and maintain the flow of thought
? Words used are precise and unambiguous
? The introduction provides sufficient background on the topic and previews major points
? Paragraph transitions are present and logical, and maintain the flow of thought throughout the paper
? Ideas flow in a logical sequence
? The conclusion is logical and flows from the body of the paper
? The conclusion reviews the major points of the paper
? The tone of the paper is appropriate to the content and assignment

15% Grammar, Punctuation, Spelling, and Format
? Rules of grammar, word usage, and punctuation are followed
? Third person is used unless otherwise specified
? Spelling is generally correct, and there’s evidence that the paper has been proofread
? Sentences and paragraphs are constructed in accordance with accepted rules of grammar
? Colloquial or slang expressions and *buzz* words are not used
? Writing of numbers is appropriate (“eight” v. “47”)
? Contractions are constructed and used appropriately
? Parallel construction, subject/verb agreement, unambiguous and congruent pronouns, and appropriate use of plurals are evident
? Title includes: student name, date of submission, name of the course, and faculty name.
? Pages are numbered starting with the first page of the paper, and including the last name of the student in page header format
? One inch margins are utilized throughout the paper
? 11 or 12 point font on all pages – please use Times New Roman (or Times in some programs) or Arial only
? The paper, including citations and reference page, follows APA format
? The paper is laid out effectively and uses reader-friendly aids (sections, summaries, table of content, appendices) when appropriate. Assignments that have fewer than eight pages do not require either an abstract or table of contents.
? Source material is cited appropriately and included on the reference page
? References are utilized appropriately and cited within the body of the paper
? Headings are used as specified in APA Guidelines
? The paper is neat, with attention given to appropriate format requirements
? The student’s original work is evident
Important APA Requirements
Most universities require that all major papers be written in American Psychological Association (APA) writing style. While you are not required to master all of the details of APA style writing, there are basic elements that you are required to use. Hopefully, you have kept The Bedford handbook (Hacker, 2005; 2006) or A Writer’s Reference (Hacker, 2007) from Proseminar or Seminar I, as you will need it to guide you in writing course papers.
Writing “Voice”
While APA style writing now permits use of first person pronouns (e.g., I, we), some instructors prefer that papers be written in third person, or research, voice. Ask your instructor which “voice” he or she prefers. If the instructor prefers third person voice, if you need to refer to yourself, do so as “this writer,” “this author,” this “investigator,” or “this researcher.”
Double Spacing
Double-space the entire paper. This includes everything from the title page through the reference page. Set the word processor up for double spacing with no additional points before or after paragraphs. There will be no need to change this setting, even for the reference page.
Page Numbers and Running Head
Place page numbers in the upper right-hand corner of every page, starting with the title page as page one (1). The page number is accompanied by the running head, which appears on the same line, at the left margin and in all capital letters. The running head consists of two or three major words from the title of the paper. For example, if the title is “Breaking Through the Glass Ceiling,” the running head could be Glass Ceiling.
Title Page
The first page of the paper is the title page. It should consist of at least the following: title of paper, type of assignment, student name, course number and name, instructor name, and date. See the sample APA paper in The Bedford handbook or A Writer’s Reference for how to format this page.
Headings
Main headings (e.g., Introduction) should be centered on the page. Capitalize the first letter of each major word in the heading. Headings are in boldface, but do not underline. Second-level headings should be flush with the left-hand margin and bold—not italicized. In all likelihood, you will not need a third-level heading. If you do, indent the heading five spaces, use boldface, use lowercase for all words other than the first word, and end it with a period(.).
Sections of the Paper
The exact titles of the sections of the paper will vary, depending on the particular course, nature of the paper, and the individual instructor’s preference. Some of the common titles of sections are: Introduction, Review of the Literature, Findings (if you are doing original research), Discussion, Conclusion and Implications, and References (as a separate page). Papers that are less formal may be divided into sections that make sense for the particular topic of the paper.
Citing Sources of Information
One thing that distinguishes an academic research paper from other papers is the citation of sources used in the development of the paper. Failure to cite one’s sources is considered plagiarism. According to Aaron (2005), “Plagiarism is presenting someone else’s words and/or ideas as if they were your own” (p. 459). In other words, if all of the information in a paragraph is not your own thinking, ideas, opinions, or research, then credit needs to be given to the source(s) of the information. Make conscious and deliberate attempts to distinguish others’ work and words from your own. Plagiarism can result in serious consequences—anything from an “F” on the paper, to an “F” in the course, to expulsion from college. Cite your sources when:
1. You are using someone else’s words, ideas, and/or research. Even when paraphrasing, the source needs to be cited.
2. Cite the source when writing about a controversial statement or using a unique idea from something you read. The citation should include the author(s) and year of publication.
3. You are using a direct quotation, in which case you indicate the author(s), year of publication, and the page number(s). For short quotations, use quotation marks. For longer quotations (over 40 words long), indent the entire quotation five spaces. Regardless of the length of the quotation, the page number(s) should be indicated.
4. You are citing specific statistics, dates, or numbers. The page number(s) need to be included.
5. If you find the same information in several sources, it is reasonable to assume that the information is “common knowledge in the profession.” If this is the case, you probably don’t need to cite the source(s).
The particular mechanics of citing sources are explained in The Bedford handbook or A Writer’s Reference
Examples of Citing Sources Using APA Style
According to Rice and Dolgin (2005), “Computer games first appeared in the 1970s, and since then, their use has skyrocketed as they have incorporated more complex themes and better graphics” (p. 17). As computer games have become increasingly available and popular, many parents, psychologists, and educators have raised concerns about whether the violence portrayed in the video games leads to more aggressive or violent behavior in children. Buchman and Funk (1996) found that almost half of the games played by children, ages nine to twelve, involved aggression (p. 24). Another study concluded that a significant percentage of the violence was directed toward women (Dietz, 1998).
Anderson and Dill (2000) suggested three reasons that playing violent games might be even worse than watching violence on television or in movies. First, video games “actively reward a player’s aggressive actions. By killing, the player earns points and moves closer to succeeding at his or her goal” (p. 17). Second, the authors point out that video games require active participation, which “promotes the development of aggressive scripts and develops the habit of selecting violent responses” (p. 18). Third, “When playing a violent computer game, the player takes on the role of the hero, who succeeds by killing ‘the bad guys’ . . . the more a television viewer identifies with an aggressive hero, the more deleterious the effects of televised violence” (p. 19).
Constructing an APA-style Reference Page
The last page(s) of a paper is(are) the reference page(s). The main heading for this section is simply References. The following are some basic requirements for listing references:
1. List only those references that you actually cited within the text of the paper.
2. Alphabetize the entries by the last name of the first author.
3. Use only the initials of the first and middle names of authors (not full names).
4. If the same author has published more than one work, cite the oldest entry first.
5. If the “author” is an organization, use the name of the organization as the author (e.g., American Red Cross).
6. If there is no author, the title of the work moves to the author position.
7. Indent (use a hanging indent) the second and subsequent lines of each reference.
8. Consult The Bedford handbook or A Writer’s Reference for more details (e.g., what information is italicized, placement of periods, commas, etc.).
References
Aaron, J. E. (2005). The little brief brown handbook (2nd ed.). New York, NY: Pearson.
Anderson, B. J., & Dill, P. A. (2000). Mass media and violence in children. New York, NY: Norton.
Buchman, R. R., & Funk, C. (1996). Children’s video games: A content analysis of the ten top-
selling video games. Journal of Personality and Abnormal Psychology, 36, 24-27.
Dietz, M. B. (1998, July). Videogames likely to demean women. Telehealth News, 2(2).
Retrieved from https://www.telehealth.net
Hacker, D. (2007). A writer’s reference (6th ed.). Boston, MA: Bedford/St. Martin’s.
Hacker, D. (2005; 2006). The Bedford handbook (7th ed.). Boston, MA: Bedford/St. Martin’s.
Rice, C. F., & Dolgin, P. S. (2005). Are video games hazardous to your child’s health?
[Electronic version]. Journal of Child and Adolescent Psychology, 5, 17-19