Identify the social, economic, political and historical factors shaping the implementation and development of your chosen policy in the relevant policy area.

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Identify the social, economic, political and historical factors shaping the implementation and development of your chosen policy in the relevant policy area.

 

CASE STUDY: SOCIAL SCIENCES POLICY ANALYSIS Social science analysis of an area of policy – Australian Refugee/Asylum Seeker Policy – (mandatory detention/offshore
processing). Critically analyse, critique, move beyond, come with creative critical ideas, what is missing, where is the gap, what out should be there, what are the
limitations, and consequences haven’t been addressed, you are not limited. When making a claim, you have to provide evidence. Use the citation to support your
regiment. support the argument with examples.
we can use 2 essential resources and build upon. Importantly, mention what is the tension between global and national engagement, what is the role of United nations
and human rights
This assessment takes the form of a social science policy analysis of a chosen policy area
Your task is to build on the work you have completed in Assessment 2 by undertaking an analysis of the broader social, economic, political and historical factors
operating within your chosen policy area. Your single-case for this case study is the policy you critically reviewed in assessment 2.
Your policy analysis must address the following:
• Locate the policy you reviewed as part of assessment 2 within the broader policy area within which it is located (i.e. public health, counter-terrorism,
refugee/asylum seeker, higher education). ·

• Identify the social, economic, political and historical factors shaping the implementation and development of your chosen policy in the relevant policy area. Here,
you must provide an analysis of the relationship and intersection between various aspects of the policy making process, including relations of power/interests,
operating within the relevant policy area.

• You must support your argument with evidence when determining factors that are currently at play and factors that have been overlooked.

In order to complete this assignment, students must:
Actively participate in the online discussion 3 forum · Clearly address all of the points above · Demonstrate critical engagement with all aspects of the policy
process and all relevant readings from Weeks 1-12 · Produce a social science analysis that demonstrates your understanding of and engagement with the policy literature
· Produce a social science analysis that is well written, edited and referenced · Use a minimum of 10 scholarly sources. It has to be academic Scholarly resources
You can connect between the policy formation and policy implementation
Global policy making
Idea of elitism
Use theoretical ideas through the workshops
Note: You can use an essay format to structure your work. Your introduction must identify the policy area that will form part of your social science analysis. It must
also document the approach you will take to analyse your chosen policy area. Your body section must contain headings that address the content noted above. Your
conclusion must contain a summary of your analysis. The purpose of this assessment is to demonstrate your understanding of the policy process and your ability to
analyse a relevant policy area.
support your position using relevant literature, empirical evidence and a convincing argument.

Health and Wellness Units 1 Discussion

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Health and Wellness Units 1 Discussion

Health and Wellness Units 1 Discussion


Unit outcomes addressed in this Assignment:

  • Identify the goals and types of needs assessments.
  • Explain how needs assessments are conducted using one or more needs assessment models.
  • Identify the key components of advance planning and organizing for a community needs assessment.
  • Complete an assessment of health priorities among the target population based upon epidemiological data.
  • Discuss various methods of data collection for epidemiologic data.
  • Identify and describe the importance of secondary data.


Course outcomes addressed in this Assignment:


HW425-2:

Identify key constituents involved in designing health and wellness programs.

HW425-3:

Discuss administrative tasks, functions, and responsibilities in designing and administering health and wellness programs.


Instructions:

This is a two-part Assignment. Both parts of the Assignment are due at the end of Unit 2. Submit both parts of the Assignment in one document to the Unit 2 Dropbox.

Part 1 of the Assignment should be approximately 2â4 pages in length, written in essay format and include appropriate supporting citations and references in APA format. Create one reference page for both parts 1 and 2.

Part 1: Review a local needs assessment.

Locate, read, and critique a health needs assessment that has been performed for your community or county.

Within the Assignment, address the following points:

  • Identify the community being assessed.
  • Identify the agency that took the lead role in performing the assessment (i.e. was it a hospital, health department, insurer, etc.) and discuss their interest or stake in the community. Also describe the any partners identified within the assessment as stakeholders or members of coalition (advisory committee).
  • Describe the process or model used to conduct the assessment. If the model is not specified, use your knowledge of models of needs assessments to make a determination. Support your conclusion.
  • Describe the main conclusions and/or health priorities identified by the assessment.
  • Briefly address the extent to which the needs assessment reflects the nine-step World Health Organization (WHO) framework presented in the text.
  • Conclude part one of the assignment by critiquing the assessment and its conclusion. Use data to support your critique.


Part 2

: Perform a Mini-Needs Assessment for your community.

Part 2 of the Assignment should be approximately 2â4 pages in length, written in essay format and include appropriate supporting citations and references in APA format. Create one reference page for both parts 1 and 2.

Address the following points:

  • Identify the community or county.
  • Describe the demographic and socioeconomic profile of your community or county based on US census data.
  • Identify one or more sub-groups within the population as the target population for your health program.
  • For the sub-group(s) chosen, use epidemiological data to identify one or two health issues that should be considered priorities for intervention. Provide relevant statistics, such as morbidity and mortality rates, to support your choice(s).
  • Describe at least three sources of data that provide information about the overall quality of life within your community.
  • Discuss quality of life in your community based on the data sources you identified. Frame your response based upon the concepts of âbeing, belonging, and becomingâ described in the text.
  • Explain the concept of âcommunity capacityâ and its relationship to the needs assessment.
  • Describe the steps you would take to evaluate community capacity in your area.
  • Conclude with a summary of the target population that addresses sociodemographic information and the health priority area(s) that will be the focus of the community-based health promotion program you complete in the Final Project.




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Health and Wellness Units 1 Discussion

Identify a theory that can be used to support your proposed solution.

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Identify a theory that can be used to support your proposed solution.

 

Order Description
Details:

Identify a theory that can be used to support your proposed solution.

P – Hemodialysis patients with central line catheter

I – Proper hand washing and following good infection control practices

C – Proper hand washing prevents hospital acquired infections for healthcare workers and patients compared to not properly hand washing before and after patient contact and acquiring an infection or not following good infection control practices

O – Reduce infections by continuous education and surveillance

Write a summary (250-500 words) in which you:
1.Describe the theory and your rationale for selecting the theory.
2.Discuss how the theory works to support your proposed solution.
3.Explain how you will incorporate the theory into your project.

Refer to the “Topic 2: Checklist.”
Review of Literature
• Analyze and appraise each of the 15 articles identified in module 1. (15 articles).
• Analysis organized using the sample provided in “Sample Format for Review of Literature.”
Incorporating Theory • Identified a theory that can be used to support proposed solution.
• Main components of theory described.
• Rationale for selecting theory provided.

• Discussed how theory works to support proposed solution.
• Explained how theory will be incorporated into project.

A Change Of Nursing Management Proposal

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This report gives the thorough analysis of the current situation and an informed view of the future of Parkway Nursing Care. This report then provides a series of recommendations to close the gap between the current situation and desired future.

This study aims to investigate the implications, forms of resistance, and stress which are present in the daily work of Parkway Nursing Care and the way they handle these occurrences, as well as the types of mediating processes which occur within relationship which produce confrontation and the way these help them to comprehend and transform their own work.

The study concluded that problems, forms of resistance, and stress not only exist but also contribute to the reproduction of unequal relationships on the job and that these relationships occur between nurses and supervisors, home directors and auxiliary individual. Responding to this situation, nurses have been utilizing individual and informal resistance resolution. To avoid this resistance some collective resistance strategies suggest to overcome the resistance in Parkway Nursing Care.

Profit and growth these two are the major drivers of any company strategy. All companies mainly focus on profit and growth. In Parkway also, the management focused on profit and growth and in fact it has achieved these through its outstanding leadership in spite of many challenges. The current size of Parkway, numerous awards and its reputation in the market demonstrate these achievements. However, as the pressure for growth continues, especially when the focus is not supported by right resources/facilities and well motivated staffs, there bound to be some chances of occurring certain problems hindering to the momentum of growth. This may affect the company’s long-term performance. We cannot just go for profit and growth alone, but need lot of strategic thinking followed by implementation of the right plans through vital investments to meet the long-term objectives. It is important to have the right key people focused on these long-term objectives and also create a good image of the company. Developing a rigorous execution plans and its successful implementation will bring good outcome. As part of growth development plan, a good management should always be concerned about the warning signals that come out from its survey results.

The survey results shows the injuries, absences, turnover rate of staff and incidents per patients for the Parkway Nursing care between the 2000 to 2009.

First of all the total number of patients increased slightly between 2000 to 2007.In 2000 there was total number of patients about 21,200 .This rose sharply to about 24,500 an increase 15.57% between 2000 to 2007. In 2009 there was sudden increase in number of patients by 4.98% .There was significant increases in number of patients in both years 2001 and 2009 .The number of patients went up by 5.19% and 4.98% respectively.

It can be seen that there were significant changes in injuries per staff member, incidents per patient and certified absences per staff and others. The injuries, incidents, and absenteeism increased with the increase of patients in Parkway Nursing Care.

On contrary , we can see that the increase of injuries, incidents per patient, absences of staff cause to turnover rate. Turnover and absenteeism are the withdrawal behaviors and work-related injuries are a significant problem in the nursing profession and are commonly attributed to the stressful nature of the job.

The survey results indicate that many problems have developed while the organization was focusing on achieving its growth and profit objectives.

Number of patients increasing but all categories shown decline.

Costs associated with the problems exert pressure on profitability.

Problem exacerbated by reduction in funding and increased documentation.

All the above will make it difficult to meet stakeholders’ needs especially the venture capitalist.

3.PROBLEMS IDENTIFICATION

As per surveyed the following problems has been identified in the Parkway Nursing Care.

3.1.Staffing :

Parkway Nursing Care has been facing one of the challenging problem is staffing. The staff injuries, absences, turnover these are main problems in parkway Nursing care. The major sources of injuries to nursing care workers are lifting and moving patients and overexertion. The injuries problems will contribute the work-related absenteeism and turnover in Parkway nursing care. Turnover is the one of the issue impacting the performance and profitability of Parkway Nursing Care. “voluntary” or “regrettable” turnover that occurs when a nurse that the organization would like to retain chooses to leave their job. Losing critical employees negatively impacts the bottom line of Parkway nursing care in a variety of ways including that decreased quality of patient care, loss of patients, increased contingent staff costs, increased staffing costs , increased accident and absenteeism rates. Employees are then forced to work harder and sometimes longer hours to make up for the lack of a sufficiently sized nursing staff. The Parkway Nursing Care facing another problem is hiring new employee .This was under scrutiny of Government requirement to hire skilled employee or registered nurse in nursing care industry.

3.2.Physical Demands :

Standing or sitting, listening to the patient, family, other health care workers, pushing the beds, gurneys, and wheelchairs, monitor poles, laundry and trash containers doors, pulling beds, gurneys, and monitor poles. Objects from shelves such as linen, supplies monitors, laundry and trash containers and doors these are essential physical functions nursing care .The problem is nurses demand the mechanical equipment to lifting patients and move patients from place to another place in order to prevent stress ,injuries and heavy load .These demand impact the other job turnover .The parkway not willing to purchase mechanical equipment because of it is cost oriented. This will increase the input cost and impacting the profitability of parkway nursing care.

3.3.Documentation:

The Parkway Nursing Care has been facing one of the problem was documentation. This was occurring due to Generation gap between old caregivers and young caregivers. It is the difference between the young and the old in priorities and perceptions. The younger generation is always quick to adapt to new situations. It is often the inability of older generation to accept the vigor ,vitality and extreme views of younger generation that leads to the generation gap and communication gap in workforce. This is one of problem is Parkway Nursing care due to this some of them uncomfortable with Electronic Documentation. In an age of rapid changes it is quite obvious that the gap widens , inevitably ending in conflicts. It is high time we accepted the need for an ideal society where the aspirations and views of both generations could be converged to make job more comfortable. Documentation is the mandatory thing in Nursing care industry. The government impose restriction on mode of documentation especially in the E-documentation.This leads to one of the problem in the parkway.

3.4. Focus on filling beds

This is the economic problem in the parkway nursing care .The parkway is focusing at filling of beds in order to get profitability. But this may cause the problem to workforce in terms of patient care and reputation. This problem contradict the sales of parkway nursing care why because it affect sales down and also impact on profit of parkway and also reputation. So this problem makes the dilemma to management of parkway nursing care.

These are the major problems impacting the performance and profitability of Parkway Nursing Care.

4. CHANGE MANAGEMENT STRATEGY

Change management isn’t working as it should. Both groups know that vision and leadership drive successful change, but far too few leaders recognize the ways in which individuals commit to change to bring it about. Top-level managers see change as an opportunity to strengthen the business by aligning operations with strategy, to take on new professional challenges and risks, and to advance their careers. For many employees, however, including middle managers, change is neither sought after nor welcomed. It is disruptive and intrusive. It upsets the balance. Senior managers consistently misjudge the effect of this gap on their relationships with subordinates and on the effort required to win acceptance of change. This leads to resistance in the organization.

Resistance to change:

Most people don’t like change because they don’t like being changed. When change comes into view, fear and resistance developed. Resistance to change is the action taken by individuals and groups when they recognize that the change may threat their interest. Resistance may be active or passive, overt or covert, individual or organized, aggressive or timid.

4.1 Forms of resistance:

Psychological Resistance :

The psychological Resistance can be fear of the unknown and fear of failure .No one can say precisely about the consequences of change, and this uncertainty builds up discomfort. The uncertainty and discomfort cause negative reactions among people and they are encouraged to resist change. The change may require advanced skill and abilities that may be beyond employees’ capabilities. In such situation, the employee may feel that his interests regarding jobs, power or status in an organization are at risk and this fear lead him to resist the change.

Logical Resistance :

The logical resistance can be of power and conflict, misinterpretation of change and not agreed with the impact of changes: Power and conflict comes from resistance to change also occurs when a change may benefit one department within the organization while harming another. Another reason is Misinterpretation of change. People resist change when they do not understand it. Such situation occurs when the proposed change is not consulted with the employees and supposed to be enforced as an order. People like to know what going on in their organization, especially if something is related with their jobs. When employees feel that the change would increase their working hours and duties and disturb but the benefits and rewards are not seen as adequate, they resist.

Sociological Resistance

The sociological resistance comes from group norms and disturbance in established pattern. Over a period of time, the members of a group develop understanding and interpersonal relationship. The group members resist the change when they believe that it will alter interpersonal relation and coordination among group. The employees and management are tending to develop a pattern of working. When they recognize that the proposed change can force them to modify their established pattern, they resist the change.

4.1.Resistance in Parkway

Parkway staffs also have some type of resistance to change . Inadequate information, failure to accept the need for change ,communication problem ,untrained staffs , etc are the examples in case of Parkway nursing care. In Parkway one of the reason to resistance comes with respect to documentation. Government kept some restrictions on healthcare industry should maintain the record in the form of E-documentation. This leads to communication problem between supervisors and workers. This old care givers resists change because of they have their own perceptions and organizations are resisting this change because this change impacting the operating cost of organization in order to maintain old records .These problems demand the Parkway nursing care recruit the new employee and accompanying training programs have been increase compensation costs and Parkway mainly focuses on filling their beds. This needs high physical demands of staffs. So staffs always resist this attitude of management. Staffing problem is another reason for resistance. The shortage of enough staffs also leads to the high physical demands of current staffs. So they definitely resist the changes. Nurses are increasingly dissatisfied with staffing reductions at hospitals. They are overworked, and they often do not have enough time to maintain a high quality of patient care. This is a direct result of spending more time with paperwork instead being “bed side” with the patient and having too many patients to care for. The next reason is that the experienced staffs also resist changes, because they have to give training for the new staffs. This is an extra work to the experienced staff, so they resist the attitudes of the management. Most of the staffs may resist to any changes which may affect their work-life balance such as security, friends and contacts, money, freedom, pride and satisfaction.

4.3 Overcoming the resistance

It is recommended that giving opportunities in change participation and involvement of staff to feel them ownership of the change. If staff understand the needs for change and what is involved they are more likely to co operate in that case management need to educate them and communicate with staff properly. Assess individual and team’s leadership effectiveness and also provide feedback to determine individual strengths and developmental priorities facilitate a session with the executive team to review team profile. This will contribute increased awareness regarding individual and team’s overall leadership effectiveness (strengths and gaps) and team dynamics. Individual and company objectives. Managers expect employees to be loyal and willing to do whatever it takes to get the job done, and they routinely make observations and assumptions about the kind of commitment their employees display. The terms of a job description rarely capture the importance of commitment, but employees’ behavior reflects their awareness of it. Employees determine their commitment to the organization along Nurses of all stripes have the need for open communication with their nursing leaders. Many feel resentment when not told pertinent information. Communicate regularly with your nursing staff so that they feel assurance when they hear from their nursing leadership. Remember, communication works both ways so prepare yourself to listen attentively when engaged by your nurses. Never underestimate the power of a hand-written note to express your thoughts. Check to see if your older nurses know how to be plugged into technology to receive the full benefit of all electronic communications. Remind your younger nurses that instant feedback may not be possible on all issues and to patiently wait for responses to issues that arise.

5.Implementation

Facilitating the growth and development of staff is an important nursing leadership function.” Nursing depends on motivated nurses performing to their fullest potential. While many challenges face nurses in leadership positions, using nursing leadership strategies that motivate appropriately, communicate regularly and encourage effectively will ensure success for any nursing staff.

5.1.Creating Leadership Strategy

The first step in formulating the leadership strategy is to review the business strategy for implications for new leadership requirements. This analysis usually requires a team of experts composed of some people who know the business intimately and others who are familiar with processes for acquiring, retaining and developing leadership talent. Beginning with the business strategy, the first step is to identify the drivers of the strategy. Drivers are the key choices that leaders make about how to position the organization to take advantage of its strengths, weaknesses, opportunities and threats in the marketplace. They are the things that make a strategy unique to one organization as compared to another and dictate where tradeoffs will be made between alternative investments of resources, time and energy. Drivers are few in number and help us understand what it is absolutely essential for leaders and the collective leadership of the organization to accomplish.

5.2.Recommended leadership style :

Although many great nursing leaders emerged in the past ,most nurse were kept insubordinate positions .This subordinate has diminished as more nurse have learnt to apply their leadership skills to attain the ultimate goal of improved patient care. Nurses with leadership skills effect desired changes in the patients ‘health patterns , in the medical treatment facility , in the nursing profession and in the community. With education ,training and practice, every nurse can develop the following leadership qualities.

Professional Knowledge: Nursing involves knowledge in biology ,nursing science , social science , psychology and many other areas .Learn how to find and use appropriate reference materials and resource persons quickly and efficiently .Keep up with current nursing practices for validity ,reliability and applicability and share your knowledge with the peers and your subordinates.

A positive self -Image :Leaders must be enthusiastic , dynamic and self-directed. They must be comfortable with themselves and act as role models to their followers.

Assertiveness : Ability to state family and confidently and do quietly what you think to be right assertiveness enables a nurse to be professional.

An understanding of human needs :The highest level on Maslow’s Hierarchy of needs it’s self actualization which is the need for individual to reach her /his potential through development of her . his unique capabilities .Nursing is often described solely in terms of tenderness , love, devotion and similar qualities that are generally associated with mothers and angels.

Qualities That a nurse Needs :Nurses are the only healthcare professional dealing with hospitalized patients 24-hours a day. Nurses provide expert , skilled care when patients are acutely ill. Nurses also work outside the hospital settings in many different roles , including health promotion activities ,health lifestyle practices and disease prevention

People skills are essential , along with a sincere desire to help others. Leadership is another necessary .This includes organization and management skills ,good work ethics , and inner calm in the face of emerges .In our technologically advanced society computer skills , manual dexterity and the ability to operate various equipment are important.

Let us in mind that all the scientific and technological advancement cannot replace a caring nurses, professional competence and empathetic expertise .Her commitment on duty and selfless service make nursing a bole profession.

5.3.Leadership behaviors of home directors

The company is going to be making some major changes from top-level management to operational level management. The top-level home directors have the ability to prioritize the work, time management, good decision making, and also have good communication skill. The top-level management always communicate with middle level management and middle level management communicate with bottom level management and vice-versa. In Parkway, there are different departments and all these departments have different home directors. The management should communicate with these home directors. The management sends all relevant information to these directors and these directors send messages to supervisors. Also they send back information to top management. In all organization, successful leaders typically develop largely by first learning to be good followers. The home directors should have the clear vision and mission about the organization. The management gives permission to directors to involve in the decision-making and strategic planning. They should reduce employee dissatisfaction and actively involves in the effective process of delegation. The home directors should have more personal and active attitude towards goals. The home directors need to be continually engaged to co ordinate and balance to compromise conflicting requirements. The main jobs of home directors are planning, controlling, organizing and directing the activities.

5.4.Leadership behaviors of supervisors

The middle managements act as a bridge between top-level management and bottom level management. In Parkway, supervisors are in the middle of staffs and home directors. The supervisors collect the instructions from the home directors and send to the staffs. They also collect feedback from the bottom level and send to the directors. The supervisors do this to create team spirit around him and near him. They also involve in certain quality improvement activities. Supervisors should be good listeners and also a good communicator. Finally supervisors should be an influence for others, work wise as well as ethically. And also should be a good motivator. The supervisors should mainly focus on encouragement, motivation, and communication.

6.Job stress in Parkway

Over the past two decades, there has been a growing belief that the experience of stress at work has undesirable effects, both on the health and safety of workers and on the health and effectiveness of parkway. This particular concern has been expressed for the effects of stress on health-care professionals and, in particular, on nurses in Parkway nursing. The high turnover rates lend themselves to one of the stress-causing points in nursing, which is the very common experience of being short-staffed. Employees are then forced to work harder and sometimes longer hours to make up for the lack of a sufficiently sized nursing staff. Health care cost cutting is another factor contributing to this overwork problem. Enough nurses to fill the workload are often simply just not employed for financial reasons.

6.1.Sources of Stress

The main sources of stresses that may be affected in parkway are environmental factors, organizational factors and personal factors. Environmental factors include economic problems, political problems and technological problems. Organizational factors comprised of task demands, role demands and interpersonal demands. Finally, personal factors include mainly family and personal relationships, earning capacity and personality problems. All these three types of stresses are existing in Parkway. These stresses will affect the job of staffs, management and patients. Some stresses are related with challenges; i.e. workload, pressure to complete tasks, time urgency, etc. Some stresses are related to goals, etc. In parkway, there are mainly three different types of stresses.

Staffs cannot take time off when they need it. Some time they need some emergency time off due to personal problems. There is no contingency plan for these emergency cases. Most of the staffs have parents, children, etc. and they need to balance their family life with work life. In reality, the staffs do not get leisure time to get together with their family. There may be chances to develop stress in such situations. The staffs also have got high workload due to shortage of staff and more patients. This will leads to high physical demand of staffs and therefore stress for the staffs.

The communication gap is one of the reason that causing stress to staff in the parkway and there is no coordination between staff with paper based documentation. When a new shift begins, they don’t have much time to check on what happened in the previous shift. This communication gap will make conflict between the staff and also produce high stress to the staffs.

6.2.Stress Management plan

Actions or situations that place physical or psychological demands on people over time will cause stress. Both physical and mental stress are required for normal and healthy growth and moderate amounts in the workplace can increase productivity. But if not managed properly, stress can eventually lead to burnout as well as to physical problems. In the workplace, one of the chief causes of stress is the feeling of inequity or unjust treatment. Effective stress management addresses employees both physically and mentally. Easy and economical treatment at the workplace includes provisions for music and physical exercise with suggestions for rest, diet, and meditation. Management can also reassign tasks and provide more flexible work schedules. Workplace stress is expensive because it can cause absenteeism, increased sick leave and medical costs, and high turnover rates.

Parkway can give some relaxation programs to the staff like meditation, yoga etc. so that they can get relaxation. It helps people to reduce stress temporarily and also reduce the symptoms of stress. Few organizations have already established this for their staffs. We can also implement this in our organization. Another plan is biofeedback system. Conducting regular medical checkups to the staffs, their welfare The feedback provides the bio information of the staffs wherein the heartbeats, brain waves, etc. are measured. Parkway can coordinate some programs allowing sabbatical leaves to encourage stress relief and personal education. And also include some personal wellness program me . All these programs definitely reduce the stress of the staffs.

Parkway can also provide counseling sections to the staffs. It will help to employee to cope up with difficult situations. It seeks to staff’s mental health. Good mental health means that people feel comfortable about themselves, right about other people, and able to meet the demands of life. Counseling usually is confidential so that employees will feel to talk openly about their problems. Staffs can share their job problems as well as personal problems and reduce their stress through proper guidance. Some times the manager can do this counseling. Giving proper training to the staff is another way to effectively reduce the stress. For example, some staffs do not know how to use electronic machines, new technologies etc., and proper training to such people will help them a lot to reduce their stress. Always maintain a good communication with staffs as the communication controls the stress of the jobs. Having sufficient number of employees to work effectively will reduce workload stresses. The management can also provide some leaves related with employee sabbaticals. Conducting welfare programs that reduces the stress of employees will be another approach. These are planes can be implemented in Parkway.

6.3. Summary

In summary, the following are recommended to enhance the overall long-term performance of the Parkway:

Recruit additional staff in workforce to reduce workload

Mechanical lifting systems.

Flexible time schedule.

Electronic Documentation

Training to staff for new software/ equipment

Family outings/ social gatherings/ sports

Performance based bonus

Regular communications from top management to staff

Feedback from staffs

Personal wellness/ medical check up

Counseling services

7.Conclusion

It is recommended that the parkway’s management has been ambitious for profit and growth in the current competitive business model. For that They set some demanding goals for growth .The management should always be looking for better performances and changes necessary within the organization to meet the long-term objectives .This long-term gain may be possible by taking certain risks and through some short-term pain their earnings. This can only be accomplished with safety and security of its own employees which is the intangible asset of the company.

Health Promotion and Education for HIV

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Introduction

The prevalence of HIV infections has increased rapidly in recent years in the UK. In 2006, it was estimated that a total of 73,000 people were infected with HIV, with a further new 6,393 cases reported in 2007 (Health Protection Agency 2007). The epidemiology of HIV infection has changed over the years. In the mid-1980s, the three groups of people considered to be at the highest risk of HIV infection were men who have sex with men, injection drug users and those who have received blood products (e.g. through blood transfusions). However, since 1999, the majority of new infections have been reported among heterosexuals (Health Protection Agency 2007). The prognosis for HIV-infected individuals has improved over the past ten years. Although there is currently no vaccine and no cure for HIV, HAART (Highly Active Antiretroviral Therapy) has proven highly effective in delaying the onset of AIDS and lengthening the lifespan of infected individuals (Rutland et al. 2007).The increased prevalence of HIV infections in the UK means that healthcare professionals in all settings are more likely to care for patients with HIV than in past years.

A number of studies have been conducted worldwide to examine healthcare professionals’ knowledge and/or attitudes to HIV in countries including the UK (Tierney 1995; Laraqui et al. 2002; Pisal et al. 2007). Findings showed that healthcare workers are frequently fearful, negative, ill-informed and discriminatory towards HIV-positive patients. Furthermore, fears regarding perceived risks when caring for parents with HIV may hamper quality of patient care (Pisal et al. 2007). As a result, HIV-positive patients may experience stigma and dehumanisation, together with feelings of isolation and guilt. There is an unmet need for effective education programmes to increase healthcare professionals’ knowledge about HIV, modes of transmission and precautions that should be taken when caring for HIV-positive patients. Studies have shown that education programmes to increase levels of knowledge among nurses significantly reduced fears about interacting with HIV-positive patients (Pisal et al. 2007).

This paper discusses the development of an educational leaflet aimed at healthcare professionals, analyses the methodology used and evaluates the leaflet and the process of development.


Leaflet development

When devising health promotion and education programmes, the three main components which must be considered are planning, implementation and evaluation and it may be helpful to use a health promotion model in this process (Whitehead 2003). The Ewles and Simnett model (1992) proposes five different ways of considering health promotion which include a medical approach, behaviour change approach, educational change approach, client-centred approach and social change approach. Our health education approach best fit the educational and behavioural change approaches. By educating the target group of individuals, the knowledge they gain will empower them to make informed decisions and will act as an important influencer on their behaviour (Aghamolaei et al. 2005). In their model, Ewles and Simnett identified 9 stages which were used in the planning of the health education initiative discussed in this paper and which include:

  1. Identification of the target group
  2. Identification of the needs of the target group
  3. Establishment of the goals of education
  4. Formulation of specific objectives
  5. Identification of resources
  6. Planning of content and method
  7. Planning of methods of evaluation
  8. Implementation of education
  9. Evaluation of effectiveness.


Planning

The target group for this health education strategy was healthcare support workers who may come into contact with clients infected with HIV or AIDS. As discussed, there is a clear need for education programmes for healthcare professionals who may have contact with HIV-positive clients. The main goals of this strategy were to increase levels of knowledge about HIV with a view to reducing fears and stigma surrounding HIV-positive individuals, and alleviate any existing misconceptions surrounding the spread of the HIV virus in clinical practice. The approach taken in this strategy was to develop an educational information leaflet. Previous research has demonstrated that leaflets that promote knowledge of HIV are effective in reducing fear and anxiety among healthcare workers, while also increasing overall knowledge of the disease (Pisal et al. 2007). Leaflets have been shown to provide a number of benefits. For example, they can be used to re-enforce information delivered verbally and can deliver a greater volume of information that via verbal communication alone (Secker 1997). Furthermore, leaflets may be retained for future reference and can be shared with others. However, there is evidence to suggest that health promotion leaflets needs to be carefully designed, since not all leaflets communicate their messages effectively to their target audience (Shire Hall Communications 1992).


Methodology


Sources of information

Information on the HIV was sourced by searching the Pubmed electronic database and Department of Health websites. Up-to-date, high-quality publications were selected where possible. The Health Protection Agency websites was also search for recent UK-specific epidemiology data. Information relating to the design of the leaflet was gathered from both Pubmed and Google searches. All information sourced was read carefully, findings were accurately summarised and key points were highlighted.


Leaflet design

The design of educational leaflets should assist the reader’s understanding of the content within (Secker 1997). The leaflet title was chosen carefully so as to be appealing and encourage readers to want to read the entire leaflet. A design theme was chosen which was applied consistently throughout each of the pages. Black and red text was used against a yellow background which demonstrated good readability and made the leaflet stand out on the shelf among a group of other leaflets. The choice of colours was designed to reflect a ‘danger/hazard’ theme which was intended to motivate the reader. While it could be argued that the association of red with danger may actually re-enforce existing negative beliefs about HIV, we believe that our choice of a strong and positive leaflet title negates this possibility.

The Times New Roman font in a 12 point size was used for the main text. Research suggests that this is one of the best fonts for educational materials, and that a 12 point font size is the minimum size for readers without visual impairment (Secker 1997). Although it is acknowledged that using a font size as large as this limits the amount of text that can be accommodated, a shortcoming of many educational leaflets is that they contain text which is too small to read comfortably (Albert and Chadwick 1992).

The images used in the leaflet were relevant to the content. Research has shown that the use of illustrations is an important factor to consider in leaflet design and that illustrations should always be informative and relative to the content of the leaflet, otherwise they will detract from the information being conveyed (Rohret and Ferguson 1990; Albert and Chadwick 1992). By using ‘before’ and ‘after’ versions of similar images, we aimed to convey some of the feelings that HIV-positive clients may experience in healthcare settings and how a change in the behaviour and attitude of healthcare workers can have a positive impact on the client’s experience as well as improving the interaction between the client and care provider. Another important factor which must be considered when using images, pictures and other illustrative materials is their source and whether there are copyright issues associated with their use. Unfortunately, we did not consider the legal implications associated with our choice of illustration, which subsequently prevented the leaflet from being distributed to the target audience.

A folded one third A4 size leaflet, printed on yellow paper with a gloss finish was chosen. This is a popular choice of size for educational leaflets and provides good portability, being small enough to put in a bag. The use of folding negates the need for staples which add to cost.

[Client: you didn’t mention anything about leaflet size, stock of paper or finish so I’ve added in what I have found from my own experience of designing educational materials, although I’m not sure of the exact stock of paper that would be the best for a leaflet of this description and no papers discuss this

]


Language

According to Bennett and Heller (2006),

“


Speaking the language of the audience is crucial in attempting to appeal to them and change their understanding of any issue”.

The language in this leaflet used simple terminology that is easily understood and is jargon free, two factors which have been shown to be of importance in educational materials (Ewles and Simnett 2003). Personal and colloquial terms were used which were designed to engage the reader and encourage critical thinking and reflection of their own clinical practice. The use of personal pronouns has previously been shown to be effective in making the reader feel that the leaflet is addressing them directly, thereby making it more appealing (Glasper and Burge 1992; Albert and Chadwick 1992).

The use of long words was limited and sentences were generally short and succinct, with each attempting to explain a single idea (Manning 1981). Evidence has shown that this facilitates the integration and storage of information into memory. This is an important factor since the cognitive load theory proposes that redundant forms of information may require longer processing and may prevent the reader from learning (Doak et al. 1996). Research has also demonstrated that the more long words and long sentences used, the more difficult the leaflet will be for the reader to understand (Pastore and Berg 1987; Bernier and Yasko 1991). Simplicity in both choice of language and sentence structure is also of value if the leaflet were to be translated into other languages or into Braille. While this leaflet was only designed for target groups within the UK, it could also be translated successfully if required.

Readability may be assessed more accurately by performing a readability test to determine the reading age of any written material. These tests typically relate the number of long words and sentences to the reading age necessary to understand the materials. Evidence shows that the reading age of the majority of adults in many developed countries is 10-14 years (Vahabi and Ferris 1995). Although we did not employ a readability test when developing this leaflet, it is an activity that would have been helpful to confirm the readability of the material we had developed and would be particularly valuable when developing patient educational materials where reading age would be of greater importance.


Content and organisation of information

It is important that educational materials are accurate and up to date (Secker 1997). As previously discussed, the most recent information was selected for inclusion in our leaflet. Summarised information was discussed for suitability and then reviewed for accuracy by several members of the team as a quality control exercise. The content of this leaflet is quite specific and should be applicable for the foreseeable future, unless a vaccine or cure for HIV/AIDS is developed or there are changes to universal precautions. Nonetheless, it may have been worth including a publication date on the leaflet to enable the reader to quickly see how old the leaflet is and if a more up-to-date version may be available.

The organisation of text within the leaflet is a very important factor influencing whether the material makes sense to the reader (Secker 1997). Studies have shown that educational information should be presented in a way that reflects the priorities of the reader (Bernier and Yasko 1991). Therefore, paragraphs of text were arranged so that the most important and relevant facts were discussed first. This arrangement has been shown to facilitate the assimilation of information and re-enforce learning (Manning 1981). Sequential lists of bullet points were used to present the text included in the leaflet. These have also been shown to enhance assimilation, when compared with blocks of bulk information delivered in a narrative form (Manning 1981). Key points within the text were emphasised in bold type since the use of colour has shown to be ineffective (Kitching 1990) and a number of colours were already employed in the design theme. The text in the leaflet was justified which is not in line with the recommendation of unjustified, left-aligned text using indentations for ease of readability (Kitching 1990).


[Client: you don’t mention whether headings were used in the leaflet. Sentence case headings in bold type placed again


st the left-hand margin with plenty of space around are effective in standing out from the main text and will assist the reader in quickly locating the information they require within the leaflet (Dixon and Park, 1990) Reference: Dixon, E. & Park, R. 1990,


‘Do patients understand written health information?’, Nursing Outlook, vol. 38, no. 6, pp. 278-81

.]

Evidence has shown that leaflets should convey only essential information and contain references to further reading in a separate section (Vahabi and Ferris 1995). In our leaflet, the name of the first author and the year were included in the text as citations for source references. For a more continuous flow, it may have been better to replace the author name with a superscript number which relates to the full reference which would be included in a reference list at the end of the leaflet. Since this leaflet is aimed at healthcare professionals who aim to use research-based evidence to inform best practice, it would be particularly important to include the sources of the reference materials to encourage further reading; however, due to space constraints, we were not able to include this reference list in our leaflet.


Implementation

The leaflet has not been distributed to the intended target group due to legal implications surrounding the images used. The original implementation plan included: (1) distribution of the leaflet after infection control study days held within the hospital, or at study sessions focussing on HIV/AIDS as a method of re-enforcing the verbal information already delivered; (2) inclusion of the leaflet as part of the induction package for relevant new members of staff; and (3) inclusion of leaflets on stands already located in hospital common rooms or other venues.


Evaluation

As discussed above, since the leaflet has not been distributed to the target audience, it has not been possible to evaluate the success of our approach. We planned to pilot our leaflet to a selected group of healthcare support workers and gain feedback both verbally and via the use of a questionnaire designed to address the quality of content, readability and use of language within the leaflet. Gaining preliminary feedback on the leaflet may have helped us to address any issues identified prior to implementation.

The specific limitations identified in our leaflet have already been discussed within the relevant sections of this paper. However, when reflecting on our approach to producing this leaflet, we were able to identify a number of other areas where we feel that the process could be improved in the future: (1) experimenting with other colours may make the leaflet aesthetically more appealing; (2) including the address of the charity listed, instead of just the website, would enable those individuals without internet facilities to also access this valuable resource more easily; (3) when searching for published literature on knowledge and attitudes of healthcare professionals to HIV, although many studies were identified, there were few recent studies conducted within the UK. For this reason, it may have been worth considering designing a preliminary questionnaire to gather the attitudes and beliefs of the healthcare workers within our particular setting to ensure that we were designing a leaflet which addressed their specific needs; and (4) we believe that the use of an interactive tool, such as a quiz, would further engage the target audience, serving to re-enforce and challenge what they have learnt from the leaflet.


Conclusions

Our leaflet met the majority of published criteria for well-designed educational material, in terms of content, language and design. The leaflet contained up-to-date, accurate information which was relevant to the target audience. The overall look and feel of the leaflet was appealing and uncrowded with good readability, while the use of relevant images helped to convey the important messages contained within the leaflet. The major limitation of our methodology was the use of images with surrounding legal implications which prevented the leaflet from being distributed. This made is impossible to evaluate the success of our approach which was very disappointing. Nonetheless, developing this leaflet has provided valuable experience which can be applied when designing similar health promotion and education programmes in the future.


Bibliography

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BROADENING PERSPECTIVE NURSING

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BROADENING PERSPECTIVE NURSING

Paper, Order, or Assignment Requirements

COURSE WORK ONE
Course work one requires student to produce two, one thousand word reflective assignments. Each assignment must address at least one of the areas identified by the NMC e.g. communication, compassion etc. The word limit suggests one area per essay would be best. It may be reasonable to address the same topic in both essays as a comparative study but this must be approved by a lecturer before commencing the work and must demonstrate extensive development of the theme.
Each of these assignments should investigate an area of nursing outside of the domain for which the student is training. Adult nurses may select from mental health nursing, childrens nursing, maternity care, care of the elderly or learning disabilities. Mental health nurses clearly must choose anything other than mental health. Learning disabilities is an option available for mental health students.
A reflective model should be demonstrated and be used to structure the work. Accordingly, these assignments should emphasise the first person singular (‘I’ statements) rather than the detached third person analytical expressions usually associated with academic work in Nursing. Since both assignments will be submitted as one unit of work it is unnecessary to replicate the chosen reflective model in both essays,- indeed marks may be lost for unnecessary repetition. A tip is to offer the reflective model as a precursor to both reflective accounts. Each reflective analysis account thus becomes a derivative of the common descriptive stem (the reflective model).
The reflections, regardless of the model used, should account for the Affective, Cognitive and Behavioural elements of the experience being analysed. Emphasis is on analysis rather than description of the event and the marks will be awarded accordingly. This assignment though is a ‘Pass or Fail’ exercise.
Examples of previous assignments include;-
• Communicating with a learning disabled client relating to their diet,
• Expressing compassion to relatives of a dying child
• Explaining a pre-operative checklist to a non-English speaking patient.
• Administering an injection for the first time
• Undertaking a wound dressing for the first time
• Bathing a member of the opposite gender.
• Communicating with distressed and angry relatives
• Delivering a patient summary at staff shift handover.

THINGS NOT TO DO:-

a) BROADENING PERSPECTIVE EXPERIENCES

DON’T;
• Put yourself into a dangerous situation;- avoid war zones and areas of civil unrest / conflict. Also consult with local supervising personnel about safety issues.
• Depend on the University for expenses or other financial support
• Work in isolation or unsupervised
• Engage with vulnerable service users
• Try to cover all of the NMC requirements in all of the essays / reflections. One subject per assignment will suffice.
DO;
• Respect the needs of all patients, clients, service users and service providers.
• Investigate the organisation NOT the clients
• Provide details of your proposed experience to lecturers BEFORE embarking upon it.
• Produce your posters to demonstrate and validate your activities
• Record your experiences in your portfolio

b) COURSE WORK 1

DON’T;
• Identify individuals or organisations either directly or by implication unless they either agree to it or they are a public body… and even then discuss this with lecturers before writing.
• Try to accommodate all of the areas of nursing in all of the assignments. One per assignment will suffice.
• Offer only superficial description;- you must investigate and analyse deeply in order to pass these essays.
• Be late with your submission

DO;
• Analyse and criticise
• Discuss the work with lecturers as required

First 1000 words essay
Use Gibbs reflective module to reflect how communication is been implemented in maternity service. I have selected the use of an interpreter as a mode of communication with a woman with limited English. Please use Harvard style referencing and UK research

Second 1000 words essay
Use Gibbs reflective module to reflect on how safeguarding is been implement in maternity service. I have selected a woman undergoing domestic abuse. Please adapt every part of it to the uk.

FACULTY OF SOCIETY AND HEALTH

GENERIC ASSESSMENT CRITERIA Society & Health: LEVEL 7

A
(85-100%) (70%-84%) B
(60-69%) C
(50-59%) D
(40-49%) E
(34-39%) F
(33% – 0%)
Level 7 Criteria >8.5 7-8.4 6-6.9 5-5.9 4-4.9 3.4-3.9 12.7 12.6-10.5 9-10.4 7.5-8.9 6-7.4 5.1-5.9 <5.1
2. References

15
The Harvard system must be used consistently and accurately throughout the work.
It is expected that students will demonstrate a range of reading appropriate to the topic and the academic level. Although difficult to prescribe, it is anticipated that students will draw on a range of literature, and other forms of evidence, using this to extend perspectives and elaborate on current thinking. The Harvard system must be used consistently and accurately throughout the work.
It is expected that students will demonstrate a range of reading appropriate to the topic and the academic level. Although difficult to prescribe, it is anticipated that students will draw on a range of literature, and other forms of evidence, using this to extend perspectives and elaborate on current thinking. Able to extrapolate from a diverse range of evidence. Harvard System used consistently and accurately.
Wide range of reading evident and utilised appropriately throughout the work. Harvard System used consistently and accurately.
Wide range of reading evident and utilised appropriately for the majority of the work. Harvard System used consistently and accurately in the majority of the work. Some evidence of wide reading within the work. Harvard System used with minimal errors in referencing evident.
Some evidence of wide reading to support parts of the discussion.
Harvard System used but referencing incomplete and multiple errors evident. References not always utilised appropriately to support the work.
Limited evidence of wide reading to support discussion.

Using Gibbs: Example of reflective writing in a healthcare assignment
• Description
In a placement during my second year when I was working on a surgical ward, I was working under the supervision of my mentor, caring for a seventy-two year old gentleman, Mr Khan (pseudonym), who had undergone abdominal surgery. I had been asked to remove his wound dressing so that the doctor could assess it on the ward round.
I removed the dressing under my mentor’s supervision, using a non-touch procedure, and cleaned the wound, as requested by the doctor. My mentor was called to another patient at this point, so at her request I stayed with Mr Khan while we waited for the doctor to come to see him.

The doctor had been with another patient, examining their wound, and I noticed that she came straight to Mr Khan to examine his wound, without either washing her hands or using alcohol gel first. I also noticed that she was wearing a long-sleeved shirt, and I was concerned that the cuffs could be contaminated. I thought for a moment about what to do or say, but by the time I had summoned enough courage to say something, I thought it was too late as she was already examining Mr Khan.

Feelings
I was alarmed by this, as I had expected the doctor to wash her hands or use alcohol gel before examining Mr Khan. However, I felt intimidated because I felt that the doctor was more experienced than me as a second year nursing student; and I didn’t want to embarrass her. Also, I didn’t want to make Mr Khan concerned by confronting the doctor in front of him.

Later, I spoke to my mentor about the incident. She suggested that we speak to the doctor together about it. My mentor took the doctor aside, and asked her whether she had washed her hands before examining Mr Khan. She looked quite shocked. She said that she had been very busy and hadn’t thought about it. My mentor discussed the importance of hand hygiene with her, and the doctor assured her that she would wash her hands before examining every patient in the future.

Evaluation
The incident was extremely challenging for me. I regret that I did not act to challenge the doctor’s practice before she examined Mr Khan. However, I am pleased that the doctor responded so positively to the feedback of my mentor, and I have observed that she has now changed her practice as a result of this incident. I too have learned from the incident, as it has taught me the importance of acting assertively with colleagues, in a sensitive manner, in order to safeguard patients’ well-being.

Analysis
The Royal College of Nursing (2005) states that hand hygiene is the single most important activity for reducing cross-infection, and points out that many health care professionals do not decontaminate their hands as often
as they should. Recent guidance published by the Department of Health (2007) highlights the possibility of staff transmitting infections via uniforms, and the need to review policies on staff dress. The Nursing and Midwifery Council Code of Professional Conduct (2004, section 8) states that as a nurse ‘you must act to identify and minimise the risk to patients and clients’. As the student nurse caring for Mr Khan under my mentor’s supervision, this also applies to my own practice as a student nurse.

Conclusion
Looking back on this incident, I can see that I should have acted sooner, and that I should have ensured that the doctor washed her hands before examining Mr Khan. I can now see that my inaction in this incident put Mr Khan’s well-being at risk. After discussion with my mentor, I recognise that I need to develop the confidence to challenge the practice of colleagues, putting the well-being of clients at the forefront of my mind. I realise that I need to be supportive to colleagues, understanding the pressures that they may be under, but ensuring that their practice does not put clients at risk.

Explain how policy, politics, and global health relate.

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Explain how policy, politics, and global health relate.

 

competencies: 7007.1.1: Organization and Financing Healthcare – The graduate analyzes the organization of healthcare delivery and financing systems in the United States and other nations. 7007.1.2: Policy Process – The graduate analyzes the historical, economic, and political factors that affect healthcare policy development and the impact of those policies on healthcare cost, quality, and access. 7007.1.3: Effects of Legal and Regulatory Policies – The graduate analyzes the effect of major legal and regulatory policies on nursing practice, healthcare delivery, and health outcomes for individual, families, and communities. 7007.1.4: Ethical Theories Applied to Nurses’ Policy Positions – The graduate analyzes the values that drive policies. 7007.1.5: Advocate for Policies That Improve the Health of the Public and the Profession of Nursing – The graduate analyzes strategies that healthcare advocates use to affect policies with the goal of improving the public health and the profession of nursing.

Reducing the Risk of Transmission of Nosocomial Infections

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CHAPTER 1


INTRODUCTION

The standard precautions (SP), proposed by the United States Centers for Disease Control and Prevention (CDC) in 1996, are guidelines for reducing the risk of transmission of nosocomial infections in hospitals. It proposes that body fluid, patient blood, secretions, and excrement are infectious, hence preventive measures are necessary to protect both patients and medical personnel. These preventive measures include avoidance of direct contact with patients and air-borne particles, and require hand washing and sterilization, the use of personal protective equipment (PPE), the safe disposal of sharp instruments and waste management (Luo, He, Zhou & Luo, 2010).


1.1


Background of the Study

Standard precautions are specifically designed to reduce the risk of acquiring occupational nosocomial infections from both known and unknown sources in the healthcare setting. Awareness and compliance with these recommendations is crucial for the prevention of occupational nosocomial infections in healthcare personnel and patients (Abdulraheem, Amodu, Saka, Bolarinwa & Uthman, 2012).

Standard precautions include hand washing; use of personal protective equipment (gloves, gown, cap and mask); care with devices, equipment and clothing used during care; environmental control (surface processing protocols and health service waste handling); adequate discarding of sharp instruments; and patient’s accommodation in accordance to requirement levels as an infection transmission source. Hand hygiene is most important measures among the standard precautions advocated (Abdulraheem et al., 2012). Stringent observations of these measures protect the personnel against blood-borne viruses and to decrease transmission of cross infections among patients (Atif et al., 2013).

Nurses are the group of health care providers with the most direct contact with patients while providing care. Therefore, nurses’ adherence to infection prevention precautions would have a profound effect on reducing nosocomial infection rates (Al-Hussami & Darawad, 2013). The causal agents that bring infections are transmitted mainly by hands, after failure to comply with hygiene procedures. Hand washing is considered the most important measure in preventing infections. However, according to Jusot et al. (2004), in their study in the southeast of France, compliance of healthcare workers (HCWs) with SP was variable and often poor. In terms of knowledge, Chan et al. (2002) reported that in Hong Kong, nurses’ knowledge on SP was inadequate, in terms of applying precautions inappropriately and inadequately. In addition, Abdulraheem et al. (2012) in their study that conducted at North Eastern Nigeria also found that only a very small proportion of HCWs had a good knowledge on SP.

Different epidemiological characteristics of nosocomial infection in children results from the specificities of anatomy, physiology, medical conditions, therapeutic and surgical conditions and type of pathogens in pediatric populations. Besides that, the pediatric-hospitalized population is very heterogeneous, varying in age, diagnosis, and underlying illness, ranging from infants with congenital anomalies to adolescents with multiple traumas. Consequently, even patients admitted to the same ward pose a different risk for hospital-acquired infections (Lopes et al., 2006). Pediatric cancer patients have an increased risk of potentially life-threatening infectious complications due to their underlying illnesses and intensive anticancer treatment (Simon et al., 2008). Thus, SP are very crucial in preventing these nosocomial infections.

It is clear that SP reduces the extent to which HCWs exposed to the blood of others, and, presumably, this in turn reduces their risk of occupational infections with blood borne pathogens. Although it has been routinely practiced in high-income countries for a long time, it is hard to achieve full compliance. Noncompliance has been associated with a range of factors, which include lack of knowledge, interference with work skills, risk perception, not wanting to offend patients, lack of equipment and time, uncomfortable PPE, inconvenience, work stress, and perceiving a weak organizational commitment to safety climate (Kermode et al., 2005).


1.2


Problem Statement

The reality of adopting SP within the hospital setting is far from what is recommended and had proved to be somewhat problematic (Gammon & Gould, 2005). Efstathoiu, Papastavrou, Raftopoulos and Merkouris (2011) also reported that adherence with SP among nurses in Cyprus in order to avoid exposure to microorganisms was low. More specifically, compliance was found insufficient regarding hand hygiene guidelines, use of gloves when exposure to body fluids was anticipated, eye protection, mouth and nose protection (mask use), wearing a gown when required, avoid recapping the needle after it was used for a patient, and provision of care considering all patients as potentially infectious. According to Gammon, Samuel and Gould (2008), in United Kingdom, staff compliance to SP was generally deficient, and practice interventions to improve adherence were generally limited in their effect.

Hospital acquired infections (HAI) or nosocomial infections (NI), which pose a serious problem, threatening the health and safety of patients and medical personnel worldwide due to poor compliance towards SP. Nosocomial infections, defined as those occurring within 48 hours of hospital admission, three days of discharge or 30 days of an operation, affect one in every ten patients admitted to hospital. These infections affect the quality of medical care and increase medical care costs (Inweregbu, Dave & Pittard, 2005). According to the World Health Organization (WHO) (2009), hundreds of millions of patients develop HAI around the globe every year and as many as 1.4 million cases occur in hospitals alone each day.

In pediatric setting, HCWs always assumed that children are low-risk patients. Although it was acknowledged that the children can also carry contagious diseases, but they often do not implement SP (Efstathoiu et al., 2011). Nosocomial infections are a crucial clinical complication in adult and children patients at the different hospital wards worldwide. Nosocomial infections bring considerable morbidity and mortality associated with prolonged hospital stay and increased health care costs (Nagliate, Nogueira, Godoy & Mendes, 2013). Kinnula et al

.

(2012) in their study at Finland and Switzerland found that 8.4% of children in a ward for pediatric infectious diseases acquired a viral HAI during their hospitalization, although only 13% of the HAIs manifested themselves during hospitalization, the majority, 87%, occurring after discharge. So, from here can be proved that, SP are very important to be implemented in the clinical settings. Without these measures, NI will occur.

For Hospital USM, pediatric oncology ward, 6 Utara (6U) showed the highest rate of NI if compared to others pediatric ward (Unit Kawalan Jangkitan & Epidemiologi Hospital, 2013). This may be due to the low immune system of those children. Pediatric cancer patients are at an increased risk for specific HAI. These adverse events can result not only in significant morbidity and mortality, but also in an increased expenditure of limited financial and personnel resources (Simon et al., 2008). According to Unit Kawalan Jangkitan & Epidemiologi Hospital (2013), the average NI occurred per month from August 2012 to August 2013 was 3 cases, which contributed to 4.62% of total admission of the patient. This was quite a high number. Thus, interventions should be taken to investigate the compliance level of the pediatric nurses towards SP and thus to reduce the infection rates.


Table 1.2.1 Total nosocomial infection occurred per month at 6Ufrom August 2012 to August 2013

(Source: Unit Kawalan Jangkitan & Epidemiologi Hospital, 2013)


Date
Total NI
Total no. of admission
Total % of admission in ward
August 2012 4 58 6.89
September 2012 3 47 6.38
October 2012 2 82 2.45
November 2012 0 50 0
December 2012 1 74 1.35
January 2013 2 65 3.0
February 2013 5 60 8.33
March 2013 3 62 4.84
April 2013 2 65 3.06
May 2013 4 71 5.6
June 2013 3 67 4.4
July 2013 1 76 1.31
August 2013 4 67 5.97

AVERAGE
3
65
4.62

Guidelines or policies that guide an individual’s behavior exist in a variety of settings (including health care settings), but people do not always comply with them. In order to explain and understand the factors that influence an individual’s adherence with certain guidelines, which consequently may bring to the adoption of certain behavior, a number of conceptual models or theories had been developed (Efstathiou et al., 2011).

Conceptual framework that used in this study in explaining the knowledge and compliance towards SP among pediatric nurses at Hospital USM was adapted from the Theory of Planned Behavior (TPB) by Ajzen (1991). The TPB provides a model that has potential benefits for predicting the intention to perform a behavior based on an individual’s attitudinal, normative beliefs and perceived behavioral control. As for this study, the knowledge on SP, self-efficacy (attitude), awareness on the importance of standard operating procedures (SOPs), and some individual factors of nurses will influence their practice towards SP in healthcare setting.


1.3


Research Objectives


1.3.1


General Objective

The general aim of this study is to identify the knowledge and compliance towards standard precautions among pediatric nurses at Hospital Universiti Sains Malaysia (Hospital USM).


1.3.2


Specific Objectives

  1. To identify the level of knowledge regarding standard precautions among pediatric nurses at Hospital USM.
  2. To identify the level of compliance with standard precautions among pediatric nurses at Hospital USM.
  3. To determine the association between selected socio-demographic data (working ward, clinical working experience in years and highest nursing educational level) and level of compliance with standard precautions among pediatric nurses at Hospital USM.
  4. To determine the association between levels of knowledge regarding standard precautions and level of compliance among pediatric nurses at Hospital USM.

  5. To determine the association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM.


1.4


Research Questions

  1. What is the level of knowledge regarding standard precautions among pediatric nurses at Hospital USM?
  2. What is the compliance level among pediatric nurses towards the application of standard precautions in the pediatric ward at Hospital USM?
  3. Is there any association between working ward and level of compliance with standard precautions among pediatric nurses at Hospital USM?
  4. Is there any association between clinical working experience in years and level of compliance with standard precautions among pediatric nurses at Hospital USM?
  5. Is there any association between highest nursing educational level and level of compliance towards standard precautions among pediatric nurses at Hospital USM?
  6. Is there any association between level of knowledge regarding standard precautions and level of compliance among pediatric nurses at Hospital USM?
  7. Is there any association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM?


  1. Research Hypothesis


1.5.1


Hypothesis 1

  • H

    O

    : There is no significant association between working ward and level of compliance with standard precautions among pediatric nurses at Hospital USM.
  • H

    A

    : There is a significant association between working ward and level of compliance with standard precautions among pediatric nurses at Hospital USM.


1.5.2


Hypothesis 2

  • H

    O

    : There is no significant association between clinical working experiences in years and level of compliance with standard precautions among pediatric nurses at Hospital USM.
  • H

    A

    : There is a significant association between clinical working experiences in years and level of compliance with standard precautions among pediatric nurses at Hospital USM.


1.5.3 Hypothesis 3

  • H

    O

    : There is no significant association between highest nursing educational level and level of compliance with standard precautions among pediatric nurses at Hospital USM.
  • H

    A

    : There is a significant association between highest nursing educational level and level of compliance with standard precautions among pediatric nurses at Hospital USM.


1.5.4 Hypothesis 4

  • H

    O

    : There is no significant association between level of knowledge and level of compliance with standard precautions among pediatric nurses at Hospital USM.
  • H

    A

    : There is a significant association between level of knowledge and level of compliance with standard precautions among pediatric nurses at Hospital USM.


1.5.5 Hypothesis 5

  • H

    O

    : There is no significant association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM.
  • H

    A

    : There is a significant association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM.


1.6


Definition of Operational Terms

Knowledge – Knowledge is defined as the level or degree of information acquired in a particular field. It is a basic requirement so that the positive changes in behavior can be developed. Knowledge can further bring into awareness and in turn leads to action. To develop nursing knowledge, it comes from both theoretical and practice perspectives. By gaining knowledge, it raises awareness of personal and professional accountability and the dilemmas of practice (Ndikom & Onibokun, 2007). In this research, it was referred to the knowledge regarding SP and its application.
Compliance – Compliance is defined as the extent to which certain behavior (for example, following physician’s orders or implementing healthier lifestyles) is in accordance with the physicians’ instructions or health care advice. It can be influenced or controlled by a variety of factors such as culture, economic and social factors, self-efficacy, and lack of knowledge or means (Efstathiou et al., 2011). In this research, it was referred to compliance or adherence towards SP to prevent NI.
Standard precautions – The standard precautions are defined as guidelines to reduce the risk of transmission of blood-borne and other pathogens in hospitals. It proposes that body fluid, patient blood, secretions, and excrement are infectious. Hence these measures are necessary to protect both patients and HCWs (Luo et al., 2010). Standard precautions include hand washing; use of personal protective equipment (

e.g.

, gloves, gown, cap, mask); care with devices, equipment and clothing used dur­ing care; environmental control (

e.g.

, sur­face processing protocols, health service waste handling); and adequate discarding of sharp instruments including needles (Vaz et al., 2010). In this research, SP referred to those policies that protect patient and HCWs such as hand washing, use of PPE, safe sharp disposal and waste management.
Nosocomial Infections – Nosocomial infections are defined as infections that occur within 48 hours of hospital admission, three days of discharge or 30 days of an operation (Inweregbu, Dave & Pittard, 2005). In my research, it was referred to the infections that acquired within the period of hospitalization.
Self-efficacy – Self-efficacy is defined as the confidence to control and guide one’s own activities. General self-efficacy is a general confidence when the individual deals with changeable environments and faces new experiences (Luo et al., 2010). In this research, it was referred to the self confidence in implementing SP to prevent NI.


1.7


Significance of the Study

Nosocomial infections control requires a combination of interventions, including knowledge about the use of SP, rational use of antimicrobials, hand washing and compliance with SP and manuals for prevention and controlling microorganisms. Health professionals’ low compliance with and difficulties to use SP had been demonstrated in some research though (Efstathiou et al., 2011; Luo et al., 2010). Hence, in view of application and even compliance failures that compromised patient and professional safety (Sax, Uckay, Richet, Allegranzi & Pittet, 2007), it is necessary to assess nurses’ knowledge and compliance about SP (Nagliate et al., 2013). By assessing the knowledge and compliance level toward SP among the nurses, interventions could be taken to improve the quality of health care services as well as provide a holistic nursing care to reduce the morbidity and mortality worldwide.

In order to reduce HAI and protect the health of patients and HCWs, the relevant authorities and hospital infection control departments should pay more attention to nurse compliance towards SP, strengthen SP training, and provide sufficient practical PPE. Through learning, the attainment of knowledge and skills, and the formation of health beliefs and attitudes, health activity habits can be formed. Only when individuals are familiar with the content and meanings of the SP, with strengthening of the individual’s health concepts, can individual practice change so as to improve compliance with SP. For nurses, the study on adherence towards SP and factors impacting compliancy should be strengthened in order to improve concepts of health and self-efficacy, to increase compliance with the SP and hence reduce the chances of NI (Luo et al., 2010).

The reason that the researcher wished to conduct this research was because from the researcher’s observation during clinical posting, it was observed that, the nurses often neglected the importance of SP. For example, they did not apply the proper ways in implementing SP, some even did not adhere to it at all due to time saving and other reasons. On the other hand, the reason that this study been conducted at pediatric ward was because children is having low immunity if compared to adults, they are at high risk of acquiring NI, so the implementation of SP is very important to ensure a quality health care.

In addition, no research on the knowledge and compliance towards SP had been done at Hospital USM before this. Thus, this study is crucial to assess the knowledge and compliance level towards SP among pediatric nurses at Hospital USM to provide a preliminary data that is crucial for the hospital. This study can provide a better insight into the magnitude of the problem of infection control in this hospital. By knowing all these, interventions can be taken if the knowledge and compliance level are disappointing to increase the knowledge and compliance towards SP among the pediatric nurses to reduce the morbidity and mortality rate.

Essay on Neonatal Abstinence Syndrome

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This assignment is based on my experience of caring for an infant with Neonatal Abstinence Syndrome (NAS) in a Special Care Baby Unit (SCBU). NAS is a set of signs and symptoms experienced by certain infants after a sudden withdrawal of passively transferred intrauterine opioids or other psychoactive substances used by mother during pregnancy (Gomez-Pomar et al, 2018). Most commonly, these babies demonstrate the following: tremors, hyperirritability, excessive crying, loose stools, vomiting, poor sleeping, yawning, myoclonic jerks, and seizures in severe cases (Wexelblatt et al, 2018). Using the 5Rs Framework for Reflection, this assignment will focus on skin-to-skin contact (SSC) as a non-pharmacological intervention for NAS. SSC involves direct touch by placing a naked infant to a mother’s bare chest (Feldman-Winter et al, 2016). To protect patient confidentiality, the neonate under discussion will be referred to as Star (NMC, 2018).

Star was born at 38 weeks gestation and admitted to SCBU. Star’s mother had used 7 different prohibited substances during pregnancy. Both her parents abused drugs and had visiting restrictions due to continued substance use and aggressive behaviour. Star initially received 170 mcg of oral morphine 4 hourly but was weaned to 150 mcg that day. Using the Modified Finnegan Scoring System (see Appendix), Star’s withdrawal scores were graded an hour after each dose. At the beginning of my shift, Star’s withdrawal score was 8 with symptoms including inconsolability, high-pitched cry, sweating and loose stools. I gave another dose of oral morphine but she remained agitated with a withdrawal score of 7 an hour after. A few hours later, Star’s mom came to visit. She appeared calm and appropriate and showed acceptable behaviour. I encouraged her to at least do cares and SSC but she was reluctant. Moreover, a 1-hour restricted visit was not enough for mother to bond with baby and to provide the best care she needs.

The main challenge of the situation was the inability of Star’s mother to provide infant supportive measures due to time constraints and social issues. Thus, not only was SSC unlikely to be provided but, maternal-infant attachment was clearly compromised. This led me to ponder on the nurses’ role in strengthening this bond and in the care for NAS babies without maternal presence.

The post-natal period is crucial for infants in establishing connection to a primary caregiver, which can have long-standing impacts on emotional regulation and attachment patterns (Bystrova et al, 2009). According to Canfield et al (2017), although current health and social policy generally recognise the significance of primary attachment relationship to the infant’s health and well-being, the reality is many substance-exposed infants have limited to no interaction with their biological mothers while hospitalised. The reasons for this lack of interaction may include poor maternal physical or mental health, issues of addiction and, most commonly, the intervention of child protection services.

As for Star’s case, attachment was not facilitated because of mother’s sporadic visits and unwillingness to participate. When mothers do not actively partake and visit their newborns, nurses must ensure they incorporate a caregiving role (Velez et al, 2008). Although many aspects of care must be done by a trained nurse, there are also many tasks that mothers could accomplish to develop attachment. Thus, it is important for nurses to support mothers in fully establishing their role by including them in such tasks when possible so they can contribute to their child’s care in meaningful ways (Cleveland et al, 2013). Promoting maternal-infant connection by engaging mothers with addiction in the care of their infants is one of the most effective ways to improve outcomes for this population (Pajulo et al, 2001). Providing opportunities for mothers to care for their babies is essential to maintain family-centred care.

Non-pharmacologic care of substance-exposed newborns involves performing a thorough assessment of the infant and his mother, providing interventions towards reducing environmental stimuli and promoting social integration for better neuro-developmental and physiologic outcomes (Velez, et al 2008). “An essential component of non-pharmacologic care is the education and facilitation of maternal involvement with the infant” (Velez, et al 2008, pp.113).

One way to encourage a mother’s involvement in her infant’s care can be through simple bedside non-pharmacologic measures such as SSC. Numerous studies have proven the effectiveness of SSC in improving physiologic stability in infants (Feldman-Winter, et al 2016). Through an evidenced-based project, Hiles (2011) found improvements in sleep after mothers implemented skin-to-skin care to NAS infants 1 hour post-feeding (cited in Maguire, 2014). A skin-to-skin/cuddling initiative, part of a coordinated rooming-in model and environmental controls of care described by Holmes (2016), found a 41% reduction in the proportion of opioid-exposed infants treated pharmacologically. A similar, multifaceted model of supportive care initiated with a cohort of 287 NAS neonates described by Grossman (2015) resulted in a decrease in length of stay and need for pharmacological treatment. Interestingly, non-pharmacological interventions were viewed as equivalent to medications; when increased intervention was required, parental involvement was increased. In a retrospective cohort study, Abrahams et al (2007) also found that avoiding separation, particularly in the crucial 4-6 weeks of life, promoted a strengthened mother-infant bond resulting to fewer withdrawal symptoms and required fewer treatment interventions for the newborn. Encouraging mothers to touch, hold, talk to and look at their babies not only has positive effects upon the recovery time of infants with NAS, it also improves the infant’s responses to sensory stimuli (Kenner et al, 2000).

Although the above evidences show that SSC can be a helpful intervention, there is limited study of it on its own, but rather a part of the entire non-pharmacological management to treat NAS alongside with medication therapy. Nevertheless, SSC is convenient, non-invasive and readily available if the mother is involved with care. However, in some inevitable situations like Star’s, I have learned how vital it is for nurses to provide a holistic day-to-day care to babies with absent biological mothers. Murphy-Oikonen et al (2009) advise the requirement for specialist and sensitive training programs for nurses caring for infants with NAS. Furthermore, Kraynek et al (2012) recommend the use of volunteer ‘baby cuddlers’ to reduce symptoms and length of hospital stay in substance-exposed infants. These volunteers provide human contact and comfort by holding, rocking, and soothing the infant. The Developmental Care Team within my unit has just introduced a new incentive where volunteers provide cuddles to babies whose parents are not actively involved in care. Indeed, such supportive touch will be beneficial rather than relying solely on pharmacological interventions which involve more potential risks to the neonate.



REFERENCES:

  • Abrahams, R.R., Kelly S.A., Payne, S., Thiessen, P.N., Mackintosh, J. and Janssen P. (2007) ‘Rooming-in compared with standard care for newborns of mothers using methadone’,

    Canadian Family Physician,

    53 (1), 1722-1730.
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  • Uvnäs‐Moberg, K. and Widström, A. (2009) ‘Early contact versus separation: effects on mother-infant interaction one year later’,

    Birth: Issues in Perinatal Care

    , 36(2) pp. 97-109.
  • Canfield, M., Radcliffe, P., Marlow, S., Boreham, M., Gilchrist, G. (2017) ‘Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care’,

    Child Abuse & Neglect,

    70, pp. 11–27.
  • Cleveland, L., and Gill, S. (2013) ‘Try not to judge: Mothers of Substance-exposed Infants’,

    The American Journal of Maternal/Child Nursing

    , 38(4) pp.200-205.
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    Pediatrics

    , 138(3), pp.e1-e10.
  • Gomez-Pomar, E. and Finnegan, L. (2018) ‘The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its’ Origins, Assessment, and Management’, Frontiers in Pediatrics, 33(6), pp. 1-8.
  • Grossman, M., Berkwitt, A., Osborn, R., Xu, Y., Esserman, D., Shapiro, E. and Bizzarro, M. (2017) ’An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome’

    , Pediatrics

    , 139(6), pp.e1-e8.
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    Pediatrics

    , 137(6), pp.e1–e9.
  • Kenner, C., Dreyer, L., and Amlung, S (2000) ‘Identification and care of substance-dependent neonates’

    , Journal of Infusion Nursing

    , 23 (2), pp. 105-111.
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    Journal of Obstetric, Gynecologic and Neonatal Nursing

    , 41 (1), pp.S45–S45.
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    28(3), pp. 204-211.
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Appendix

The Finnegan Scoring System, which relies upon discrete nursing observations, is a widely used tool in current practice to assess the condition of a newborn with NAS (O’Grady et al, 2009). Our unit has adopted the use of a Modified Finnegan Scoring System to examine the efficiency of the medical management. Scores above 8 suggest neonatal withdrawal that can be managed with non-pharmacological treatment while scores above 9 on at least two occasions indicate the urgent need to start medication therapy (Zimmerman-Baer et al, 2010). The table below shows the different signs and symptoms of NAS with corresponding scores and the total is then obtained as the final withdrawal score (Zimmerman-Baer et al, 2010).

A critical exploration of nursing-led interventions in improving patient’s adherence in the management of diabetes:

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A critical exploration of nursing-led interventions in improving patient’s adherence in the management of diabetes:

E.G carry out a literature search analyse the available evidence, apply to a case study from your practice. Section 7 This needs why topic is of importance? What will

be the impact it needs to set the scene for your research topic and question, why is it going to be useful in practice? What current evidence is include. Section 8

Outline the study and medthods Design How you conducted a literature search?with which databases Dates used?why? Search terms used? How will be search limit?E.G only

English paper or international â?? why? Methods How will address your aims and objectives? Literature review? Is your question comparative or observational You will

apply to a case study. What will you evaluate and include. Plan Brief outline of what you will include. Timeline â??what will you achieve by when? Limitations-

anything can you pretict that may impact on the timeline/completion. Section 9 Remember that you are carrying out research- secondary research not primary. Debriefing-