Reimbursement Gap Between Nurse Practitioners and Physicians

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Reimbursement Gap

Many political and regulatory issues continue to plague nurse practitioners and their ability to practice autonomously. An issue that remains today is that of a reimbursement gap from third-party payers/insurance companies. Currently, fee-for-service structures and reimbursement systems are based on a provider’s discipline of preparation and not the care provided. These structures drive up the cost of care, decrease access, and create delays in care (NP, 2010). These disparities add to the already noticeable gap between physicians and nurse practitioners. In the paragraphs that follow we will discuss this regulatory issue in more detail.


Problems & Implications

The current issue at hand is the reimbursement gap between nurse practitioners and physicians from third-party payers. Presently, nurse practitioners can bill at 85 percent of the applicable fee schedule for that service if billed under their own provider number. If a physician bills for the services of an NP, called incident-to billing, Medicare pays at 100 percent of the applicable fee schedule (Wood, 2013). Therefore, the physician did not provide the service but is able to bill for services that the NP provided. Is it fraud to bill for a service that a physician did not provide? It is imperative that nurse practitioners be aware of how their services are billed.

How did the development of this issue occur? Reimbursement rates for Medicare were passed by Congress and signed into law by the president in 1997. These reimbursement rates for NPs became effective in 1998 and have remained untouched. Under this legislation, NPs are reimbursed at the rate of 80 percent of the lesser of the actual charge or 85 percent of the fee schedule number of physicians (NP roundtable, 2010). These rates, at the time, were the same rates that were paid to NPs in rural settings and those providing services in long-term care facilities. These rates were signed into law over two decades ago. The nurse practitioner role has changed tremendously since that date.

Current reimbursement rates have lasting impacts. Reimbursement rates discourage NPs from establishing independent practices as they would receive less reimbursement under their own NPI number than under a physician. If reimbursement rates were equal, it is believed that more NPs would establish their own independent practice. If services provided by NPs were authorized for payment, this may entice physicians to employ more NPs rather than hire additional primary care physicians. More money could be made with a lower cost to employ NPs versus physicians. In short, an NP salary is much less than that of a physician. If facilities can charge the same fee-for-service while paying an NP less, the facility pockets a higher return. Changes to current reimbursement rates would not only benefit healthcare facilities but the healthcare population in general, increasing access to much-needed services.


Proposed Solution

Current reimbursement guidelines of the Center for Medicare and Medicaid Services (CMS) have remained unchanged since 1997. Direct billing to nurse practitioners allows for 85% of the reimbursement rate that a physician would receive. If the services are reimbursed as “incident to” the physician, the reimbursement rate is 100%. Nationally, 87% of NPs care for Medicare beneficiaries (Kopanos, 2013). It is imperative that NPs are knowledgeable about appropriate billing to prevent incorrect or fraudulent billing even though it may bring higher reimbursement rates.

Solutions to this issue involve political organizations and the need for policy change. This is a large-scale issue that will require change on many levels. In 2012, legislation that would reimburse NPs at the same rate as primary care doctors failed to pass on the House floor (Waldroupe, 2012). Reasons for the bill not being passed were that insurance companies may decrease the rate of primary care physicians rather than increase the rates paid to nurse practitioners (Waldroupe, 2012). This legislation is about equal pay for equal work. Nurse practitioners are in high demand and often serve patients in rural areas. Without these providers, healthcare access becomes an issue. Until individuals speak up to federal agencies and state insurance commissioners, nurse practitioners will be denied direct and equitable payment for the services they provide.

It is each nurse practitioner’s responsibility to be involved at the policy level to enhance and create change. Nurse practitioners need to take a stand and make their stance known to the public. Simple ways to influence change are to be involved in the American Association of Nurse Practitioners (AANP). This organization allows individuals to make a difference in the strength of our profession and the health of this county. This organization has a passion for improving the health of our nation and supporting the advancement of the NP role (NP roundtable, 2010). This organization promotes policy change that supports the advancement of the NP role. Nurse practitioners can write to their state’s policies representatives to influence change, as well. Often, politicians are not well-versed on every bill that reaches their desk for review. Nurse practitioners are ultimately responsible for their own billing and it is imperative that they bill accordingly. By only billing for direct services, healthcare facilities will not be able to receive full reimbursement, which will impact the facility long-term. Until facilities see the importance of NPs and their role, reimbursement rates will remain stagnant. There needs to be evidence/statistics that reveal the value of NPs. Comparing nurse practitioners to physicians and their outcomes will assist insurance companies in determining that NPs should be receiving the same reimbursement rates. Ultimately, NPs have assisted with increasing healthcare access and decreasing healthcare costs.


Supporters/Opponents of Proposed Solution

With change, there are always supporters and opponents. Key supporters of decreasing the reimbursement gap are nurse practitioners, AANP, and healthcare facilities that employ nurse practitioners. Key opponents are insurance companies/third party payers and physicians. Barriers are public opinion, resistance to change, and money.

Supporters believe that nurse practitioners should be reimbursed commensurate with physicians for the same services when delivered to the same type of patients. Nurse practitioners are independently licensed providers of both primary and acute care. They have demonstrated the ability to provide high-quality healthcare and incur the same overhead costs as physicians who provide care to patients. Comprehensive documentation of service delivery is needed to support full reimbursement for and measurement of nurse practitioner contributions to care, patient outcomes, and development of team-based care models (NAPNAP, n.d.). Healthcare facilities are in favor of equal reimbursement as this would incur more money for services provided by NPs. The number of NPs in practice is increasing and more facilities are staffed by NPs, therefore, they are losing out on reimbursement money when NPs provide services independently. Many studies have demonstrated that with respect to clinical outcomes and patient satisfaction levels, NPs are similar to physicians (Bartol, 2016).

Physician groups in favor of restrictions of NPs envision a system in which physicians delegate the care of less complex patients to nurse practitioners. These groups argue that physicians are better able to manage complicated diagnostic problems, patients with multiple chronic diseases, and unstable patients. This group claims that patients prefer having a medical doctor as a primary care provider (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2014). Third-party payers are also in favor of current reimbursement practices as this requires less money to be dispensed to facilities that employ NPs.


Steps to Advocate

As mentioned earlier, implantation of this proposed solutions has many implications. First steps are to become a member of the national nurse practitioner organization, the American Association of Nurse Practitioners. Second, as an organization, AANP needs to advocate on a regional and national level with politicians to make policy changes. It is imperative that healthcare facilities obtain data that reveals how the nurse practitioner role decreases healthcare costs and increases access to care while providing the same services that physicians provide (NP roundtable, 2010). With data to back the request for equal reimbursement, it will be difficult for politicians to argue why equal reimbursement should not occur. Lastly, involving the public and increasing public knowledge is essential to make changes on a national level as many patients utilize nurse practitioners as their primary care provider. This can be done through advertisement on television, Facebook, Twitter, etc. Lack of awareness is one of the major reasons change does not occur.


Conclusion

In summary, equal reimbursement has been a long-standing issue since 1997, when legislation regarding reimbursement from third-party payers determined that NPs should receive less reimbursement than physicians for the same services rendered. In essence, stating that reimbursement is based on education and not on the services provided. There are many supporters and opponents for equal reimbursement, including third-party payers, healthcare facilities, physicians, nurse practitioners, etc. For change to occur, nurse practitioners must advocate for equal reimbursement at the local, regional, and national level.

References

Effect of Psoriasis on Cognitive Function

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Psoriasis, a painful, disfiguring, disabling lifelong disease affecting 125 million people worldwide, although 2-3% of the population has this disease there is no cure available, and it is still uncertain on how the disease affects the wellbeing of a person due to all the other factors and risks it contributes to the decline of one’s health. Current studies have suggested a correlation on one’s health, quality of life and mental health and how they are decreased altogether. Psoriasis is an autoimmune disease that starts out with white blood cells in the immune system called T- helper lymphocytes which overreact and produce excessive amounts of cytokines, which trigger chemicals to start inflammation in the skin and organs. This process leads to, widened blood vessels, the collection of white blood cells, and a rapid multiplication and build up of keratinocytes, which is the main cell in the outer layer of the skin. In normal skin the process of keratinocytes take a month to reach the level of maturity to migrate to the skin’s surface, with psoriasis the process only takes three to five days. Due to the rapid build up of keratinocytes, the skin is thick, red, inflamed, patchy and sheds the excessive amounts of keratinocytes in silvery scales. Although the cause of the disease is unknown, several factors have been linked such as: a third of those diagnosed have reported similar cases in their families, genetic abnormalities,. Environmental factors  have been reported of inflaming the skin’s surface more include: obesity, smoking, medication, certain medications and antibiotics.

Psoriasis is diagnosed through either a physical examination, or a biopsy of the affected area of skin, which will appear much thicker due to cell build up. If one has symptoms of arthritis, blood tests and xrays are run to determine if the symptoms are Psoriatic Arthritis, which is another form of psoriasis that affects the joints, swelling, and stiff joints.

Symptoms of the disease include: itching and burning of the skin, dry cracked skin, thickened nails, swollen and or stiff joints, red patches, and silvery scales from shedding.

Due to psoriasis being an autoimmune disease there is no cure, but there are treatments available to calm down the patches and soothe the pain. The treatments have a wide variety: topical ointments, light therapy, oral medications, steroid injections, and stress management are different forms available. The most effective method treatment for moderate psoriasis is creams, and ointments while more severe psoriasis requires light therapy, and stronger medications such as injections. The difference between moderate and mild psoriasis are, that mild cases cover only 1-3% of the body and they have flare ups that calm down over time and are triggered by environmental factors, such as weather, stress or weight. While severe psoriasis is called plaque psoriasis. Plaque psoriasis covers 50% or more of the body, and in most cases rarely clears up, and gets worse over time. Plaque psoriasis causes constant pain, and can cause many problems beyond the skin, such as diabetes, cardiovascular disease, liver and kidney failure ( from medications ), arthritis, and psychosocial disorders.

Some studies have suggested the connection between psoriasis and cognitive function, such as an increase in depression, due to lower levels of self- perception, isolation from society, and living in a constant state of pain. Studies also have shown a prefrontal cortex dysfunction is more likely to develop in individuals with the disease, which affects memory, social behavior, personality expression, planning complex cognitive behavior, and decision making.

An in depth understanding of beyond the skin will help improve the quality of life for those suffering with the already disfiguring, disease, For this reason, research will aim to answer the question, “To what extent does severe plaque psoriasis affect cognitive function?”

Recent studies on plaque psoriasis have shown a massive increase of depression in fact those diagnosed with psoriasis are 1.5 times more likely to develop depression. Studies suggest this is caused from lack of self esteem, due from self perception and is more common in those with plaque psoriasis due to the highly visible areas of patches of red silvery scales. Strains on relationships have as well been a major issue due to being stigmatized into isolation. Several studies have suggested that that those with the disease have an increase in stress and depression which may be due to the, circulating proinflammatory cytokines, which due to the already excessive amount produced, psychological distress may be raised by the process of inflammation itself, which the proinflammatory cytokines, may produce symptoms of depression. Due to the immune system being at a weakened state, the excessive amount of inflammatory cytokines being produced, which have a possibility of being derived from the immune system, the chances of psychological disorders have seen a correlation with the disease. Those with psoriasis are more likely to be less social, and have antagonistic behaviors, which could be linked to elevated levels of IL-6,  interleukin-6 is a pro-inflammatory cytokines that are found in inflammatory diseases, and cancers, and is a anti-inflammatory myokine which is encoded by the IL6 gene. Higher elevations of IL- 6 in the plasma is linked to the overproduction of cytokines, that correlate to other diseases such as. Diabetes, cardiovascular diseases, and metabolic disease.

One particular study conducted from, April to May 2017 at the Clinic for Skin and Vascular Diseases of the Clinical Centre of the University of Sarajevo. Studied patients with psoriasis depression levels, and their quality of life, to see if having the disease correlated with having the disease. The study contained 56 people all with the disease, all over the age of 18, verification of having the disease, and people who keep up with their regular check-ups, and visited the particular clinic in Sarajevo. The study used a 26 questionnaire which was provided by World Health Organisation Quality of Life Brief Version Questionnaire (WHOQOL–BREF), to find out socio-demographic characteristics which included the basics plus more. Age, gender, marital status, employment status and economic status, vocational qualifications, family history plus habits of smoking and consumption of alcohol. Another questionnaire was given which was called the standardized Beck Depression Inventory (BDI), which  is a four-stage scale self-assignment over symptoms of depression given each day over two weeks. The questions are asked and vary from 0 to 3. The questionnaire consists of 21 questions, which contained 4 ranks that describe the degree of depression. Which the highest degree of depression is ranked at scoring a 30 or above the max score is 63, 0-13 was the minimum, 14-19 mild, and 20-29 moderate depression. The results showed that out of the participants almost half were women, being 27 of the 56 while 29 men made up the other half. Two-thirds of the participants were married, 22 were retired, 19 were employed, and 15 were unemployed. 29 of the 56 were smokers, while only 15 had recorded regular drinking of alcohol. On the BDI assessment the participants average was 13, and had ranged from 5-24. On the BDI evaluation the members normal was 13, and had gone from 5-24. The indicated relationship among’s downturn and physical wellbeing of members with psoriasis demonstrated that from this examination the (rho = – 0.793 p = 0.0001) with the announced physical wellbeing. The connection was solid and negative, with the members with a more advantageous degree of physical wellbeing was accounted for, which demonstrated to be less discouraged, and the relationship among’s downturn and mental wellbeing was (rho = – 0.842 p = 0.0001) with the mental state. The members sadness demonstrated to be corresponded (rho = – 0.598 p = 0.0001) with their social connection. The relationship is of medium quality and negative, where the members with higher social levels on the appraisal demonstrated to be less discouraged. The downturn of members with psoriasis demonstrated to be related (rho = – 0.709 p = 0.0001) with the space of life. This connection is solid and negative, where the members with high and center qualities in the space of condition delineated on a scale from 0 to 100 demonstrated to be less discouraged. Relapse examination explored the impact of autonomous indicators on event of wretchedness among members that is displayed on the BDI scale. It has demonstrated that indicators of: sexual orientation, age, instruction, conjugal status, and work status are not measurably enough for reason of wretchedness among those with psoriasis. Because of the way that middle estimations of every one of the four areas of personal satisfaction (72, 63, 63, 63) of people experiencing psoriasis are above a large portion of the estimation of the scales, the personal satisfaction can be considered as agreeable. The degrees of misery and the space of personal satisfaction of people with psoriasis are contrarily related. As a mind-blowing nature diminishes their degree of discouragement increments, however not a huge sum.

Intellectual capacity is essential in discernment, judgment, basic leadership, and confidence. It holds a significant job in preparing data, learning, language abilities,attention, memory and complex mental procedures, for example, official capacities. Andactivity of a few cerebrum structures, handling, assessment and comprehension of the various circumstances, and passionate control. Information from neuroimaging ponders, reason that the fundamental structures of the cerebrum, significant for basic leadership, are ventromedial and dorsolateral prefrontal cortex. The ventromedial prefrontal cortex is in charge of the enthusiastic part of basic leadership, and numerous examinations demonstrate that an official choice is related with the movement of this structure. The dorsolateral prefrontal cortex is in charge of the investigation of dangerous circumstances, comprehension and approval of data pouring in from our environment and their fast combination. This procedure holds a key job which by official capacities, which depend on working memory. They are basic for the best possible lead and reconciliation of complex intellectual procedures, for example, arranging, reasonable reasoning, critical thinking, comprehension of the circumstance, and adjustment to changing natural conditions. Working of the working memory is for the most part subject to the action inside the dorsolateral prefrontal cortex. Because of its association with the limbic framework and subcortical structures (just as different zones of the cerebral cortex), this zone is in charge of the most mind boggling subjective and enthusiastic capacities.

An examination led by Marek-Józefowicz, Luiza et al, found that Prefrontal cortex (PFC) brokenness, is bound to create in those with the infection, than those without. The reason for this examination was to assess prefrontal psychological dysfunctions in patients with serious psoriasis just as discovering burdensome components and side effects. Ninety-seven patients with psoriasis 62 men and 35 ladies that were hospitalized in the Department of Dermatology in Bydgoszcz, Poland. The control gathering comprised of 91 solid people 39 men and 52 ladies, matured 22–65 years. History of head wounds, comorbid serious neurological and immune system sicknesses, medication or liquor fixation, admission of immunosuppressive medications in the previous 3 months, and treatment with oral operators for psoriasis in the previous three months were also recorded. Assessment and evaluation of seriousness of dermatological sores (Psoriasis Area and Severity Index – PASI) The conclusion of psoriasis depended on the clinical picture and information from an interview.The psoriasis region and seriousness record (PASI), which is a test that tests the seriousness of infection dependent on how much inclusion it does or an individual’s body surfac., The worth is the whole of the results of PASI for the four pieces of the body. The Trail Making Test (TMT)The test comprises of two sections, An and B. To a limited extent A the subject is approached to associate, as fast as would be prudent, a progression of circles numbered 1 to 25, in a numerical request. To some degree B, the errand of the subject is to interface on the other hand numbered circles set apart with letters as fast as could reasonably be expected, as indicated by the equation: 1-A 2-B-3-C, and so forth. Section A looks at psychomotor speed, and the effectiveness of visual spatial coordination, part B is a proportion of visual-spatial working memory and set moving . The hour of execution in the two pieces of the test was dissected in the present examination.

The STroop Color-WOrd Interference Test, This test is intended to assess verbal working memory and consideration proficiency. It comprises of two sections: RCNb (Reading Color Name In Black) and NCWd (Naming Color of Word-Different). The initial segment of the test requires the subject to peruse, as fast as could be allowed, words signifying hues which were printed dark on white. In the NCWd part, the subject is approached to call as fast as conceivable the shade of the words’ print. Print shading does not agree, be that as it may, with the shading, which name is composed. Here, in the wake of learning an underlying basis for activity, the subject needs to change to another, while the past rule is still recollected. The hour of execution in the two pieces of the test was examined in the present investigation.

BDI The scale comprises of 21 things identifying with different indications of despondency. Inside every classification, there are four potential answers demonstrating the power of the side effects, beginning with its nonappearance (0) up to high seriousness (3). The rating doled out to every reaction ranges from 0 to 3 points. Least by and large score is 0 points, and most extreme is 63. Edge for the acknowledgment of sorrow was embraced as 12 points.

Measurable investigation The appropriation of factors was evaluated by methods for the Shapiro Wilk test. As the appropriation of factors tried did not meet the ordinariness foundation, nonparametric tests were connected for measurable investigation. The essentialness of contrasts between gatherings was surveyed by methods for the Mann Whitney U-tests and Spearman’s rho coefficient was connected for the evaluation of relationships between factors. The consequences of neuropsychological tests in patients with psoriasis were altogether more regrettable than those of the solid controls. Beset subjects introduced altogether lower psychomotor speed (TMT test A), reduced productivity of spatial working memory and set moving capacity (TMT B), just as more unfortunate verbal working memory and consideration, as prove by the more drawn out time of execution in Stroop Test An and B. There was a critical connection between the aftereffects of neuropsychological tests, and the age of the members in both researched gatherings. Lower results got in neuropsychological tests were related with higher age both in psoriasis patients and solid control gatherings. A larger amount of instruction corresponded with better execution in neuropsychological tests, aside from no relationship between the degree of training and the Stroop B test brings about the psoriasis patients gathering

Patients with psoriasis demonstrate a huge hindrance of prefrontal neuropsychological capacities, which are autonomous from the degree of wretchedness and seriousness of the sickness.

  • Evers AW, Verhoeven EW, Kraaimaat FW, et al. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol. 2010;163:986–91.
  • Gisondi P, Sala F, Allessandrini F. Mild cognitive impairment in patients with moderate to severe chronic plaque psoriasis. Dermatology. 2014;228:78–85.
  • Journal of Investigative Dermatology, Volume 130, Issue 7, 2010, pp. 1785-1796
  • Journal of the American Academy of Dermatology, ISSN: 0190-9622, Vol: 41, Issue: 3, Page: 401-40. 1999
  • Leavitt, Melissa. The Link Between Psoriatic Disease and Mental Illness. 2015 https://www.psoriasis.org/advance/link-between-psoriatic-disease-and-mental-illness
  • Marek-Józefowicz, Luiza et al. “Cognitive impairment in patients with severe psoriasis.” Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 34, no. 2, 2017, pp. 120-125. doi:10.5114/ada.2017.67074.
  • Russo PA, et al. Psychiatric morbidity in psoriasis: a review.

    Australasian J of Dermatology

    . 2004;45:155-161.

We are all aware of the fact that basic nursing courses only mention nursing theories in broad and general terms and there is little focus on their application to practice. This is changing as nursing educators increase the levels of thinking and knowledge expected of a registered nurse.

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We are all aware of the fact that basic nursing courses only mention nursing theories in broad and general terms and there is little focus on their application to practice. This is changing as nursing educators increase the levels of thinking and knowledge expected of a registered nurse.

 

Nursing makes use of theories from other disciplines (a.k.a., borrowed theories). How does using borrowed theory support the development of nursing theory?

Class,

We are all aware of the fact that basic nursing courses only mention nursing theories in broad and general terms and there is little focus on their application to practice. This is changing as nursing educators increase the levels of thinking and knowledge expected of a registered nurse.

The same cannot be said for borrowed theories. Borrowed theories are discussed and applied as the student nurse begins to develop the knowledge and skills for safe, effective nursing care. How do we determine the priorities of our actions? Maslow’s Hierarchy of Needs. What do we know about the individual coping styles that protect the personality from anxiety? Freud’s defense mechanisms. Our reading this week reflects theories that advanced nurses have borrowed from the fields of sociological sciences and learning theories.

In this thread you will respond to and discuss: Nurses make use of theories from other disciplines (a.k.a. borrowed theories). How does using borrowed theory support the development of nursing theory?

The course outcome that will be used to guide the learning process is:

• Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic if the presentations, comprehensiveness, and utility to advanced nursing

Care and Management of Asthma

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Asthma is a common incurable disease that affects the small tubes carrying air in and out of the lungs in the airways; it is more common at childhood stage but can also occur at a later age (British Lung Foundation, 2011). The major cause of asthma has not been determined but it is believed that some factors as allergies, exercise and common cold contribute to its development. In the United Kingdom, asthma is being handled primarily by a General Practitioner or nurse. Healthcare can be provided in three major means: Primary, Secondary and Tertiary. They are delivered depending on the severity of an individual’s condition. General Practitioners (GPs), Pharmacists, Nurses, Dentists and Optometrists are the main classes of healthcare providers that deliver Primary care. It is the basically the first point of contact for most individuals (National Health Service Choices, 2010). Care distinctively provided in local hospitals is usually on referral from primary care health providers, such type of care is basically referred to as Secondary Care. The third aspect of care is the tertiary care which is provided by specialist such as neurologist and cardiologist in a majorly specialised hospital centre for long term treatment.

EPIDEMIOLOGICAL OVERVIEW OF ASTHMA

Major facts that make Asthma a major health issue in the UK are:

In 2008, a total number of 1,204 deaths were recorded from asthma in the UK, out of which 29 were children aged 14 years and under.

1 person every 7 hours or 3 people per day die from asthma

146,000 adults and 36,000 children currently are on treatment for asthma in northern Ireland making it a sum total of 182,000 people (1 in 10)In Northern Ireland 182,000 people (1 in 10) are currently receiving treatment for asthma. This consists of 36,000 children and 146,000 adults.

In Scotland 368,000 people are currently receiving treatment for asthma. This consists of 72,000 children and 296,000 adults.

In Wales 314,000 people are currently receiving treatment for asthma. This consists of 59,000 children and 256,000 adults (Asthma UK, 2011).

the number of adults with asthma in the UK has increased by 400,000 since the last audit of UK asthma in 2001

about 2% of adults consult their GP annually with asthma

ASTHMA CARE AND MANAGEMENT AND LOCALITY STUDY OF UK

Asthma exists in various forms hence; its heterogeneity has been well established by a variety of studies that have proven the disease risk from early environmental factors and susceptibility genes, inflammation and therapeutic agent response further induces accompanying diseases (Lang et al., 2011). Risk factors associated with asthma are family history of atopic disease, for example

Allergic rhinitis

Allergic conjunctivitis

Male sex, for pre-pubertal asthma, and female sex, for persistence of asthma from childhood to adulthood

Bronchiolitis in infancy

Parental smoking, including passive smoking

Premature birth, especially in extreme-preterm infants who required ventilatory support, with consequent chronic lung disease of prematurity (NHS Choices, 2011)

In the UK, asthma is more common among children than in adults and also has an increased rate in women than men (NHS choices, 2010). A condition referred to as acute asthma exacerbation could occur and could sometimes be life-threatening but is mostly rare. Asthma patients are treated with care by GPs and nurses trained for asthma management and such treatments are specific to the symptoms portrayed by each patient. This treatment (Primary care) basically involves:

  • A personal asthma procedural plan concurred with your GP or nurse
  • An annual regular check ensuring proper control of the patient’s treatment and positive response to the treatment
  • Proper seeking of the patient’s consent ensuring his/her decision is involved in decision making of his/her treatment

Comprehensive detailed information about how to control and manage the patient’s condition; while a Secondary or Reactive care is enforced in emergency cases to regain control of more high-risk symptoms.

In treating asthma, reliever inhalers are given to every patient by the GP; these inhalers serve as immediate relievers and ensure restoration of normal breathing. It functions effectively due to its composition of a short-acting beta2-agonist that works by relaxing the muscles surrounding the narrowed airways (British Medical Journal group, 2011). This further ensures the airways are opened wider, making it easier to breathe again. Salbutamol and terbutaline are common types of this inhaler. They have been proven to be generally safe except when their use is abused although they possess very few side effects. If the asthma is well controlled, then their usage will be minimal; if a patient uses the inhaler for up to three times or more weekly then it is advised that the treatment be reviewed

Secondary care and management of asthma is implemented when Patients exhibit a combination of severe asthma, behavioural and psychosocial features, they hence are at risk of developing near-fatal or fatal asthma. (BTS and SIGN, 2009).

Asthma care is dependent on the age of the patients in that children have a different mode of care as compared to adults, a critical look at the adult care is elaborated below. Prior considerations are basically that the patient is registered with his GP, will have to book for an appointment with his GP before visiting (except in emergencies as acute exacerbations), confirmation with the patient of their understanding of the role of treatment, adherence to treatment, inhaler technique, and appropriate elimination of trigger factors as: exercise, drugs foods, emotional factors, weather changes, allergens etc (Shiang et al., 2009)

In analyzing the delivery of care to asthma patients in the UK, data from Office for National Statistics shall be addressed. Table 1 below signifies that there was a remarkable decrease in hospital admission in 2000 for asthma; it showed a 45 percent decrease among children between ages 5 and 14 years and a 52 percent decrease among children below 5 years (Office for National Statistics, 2004).

TABLE 1

The management of asthma is patient-specific and is delivered by either the GP or asthma nurse; a respiratory nurse specialist works closely with the GP and the patient serving as the best form of encouragement to the patient in the procedural management of his/her asthma condition. The respiratory nurse specialist has a critical role in the management of asthma as elaborated that he/she:

  • Explains the need for various inhalers (ensuring the best is offered to the patient) and provides the patient with information on treatment administered
  • Advices on triggers and how to keep off them
  • Assists the patient in quitting smoking (if applicable)
  • Explicates on how to monitor the condition
  • Provides the action plan of treatment and explains it to the patient.
  • Is always available for assistance both at home and on the phone (NHS Choices, 2006)

Nurses are generally recruited into the NHS through the website www.nursebank.co.uk , the Association of Respiratory Nurse Specialists offer courses for development and training of nurses and promote clinical excellence in respiratory care delivery (Association of Respiratory Nurse Specialist, 2010). The selection of a professional nurse in a recruitment procedure is dependent on factors as Years of experience, area of expertise and personal record check.

CRITIQUE ON ASTHMA CARE

Asthma management involves a wide range of services including primary care, routine follow up, hospital inpatient and outpatient care, proper education and advice of patient, emergency calls and prescribed drugs; these services when combined with the intensity and level of use result to a high cost (Department of Health, 2011). In 2001, England recorded a net ingredient cost of £442million and around £33million for inhaled therapy Brocklebank et al (2001). In prescribing drugs, the patient is considered as whether or not to use the drug/device appropriately; the most effective and clinically proven cost effective drug is also reasonably considered. However, restrictions imposed on manufacturers make some inhalers commercially unavailable hence the use of more expensive drugs.

The British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) have clinical guidelines on the use of inhalers for asthma (BTS and SIGN, 2009) however; there are inconsistencies or absence of recommendations for inhaler devices from these guidelines. Evidence-based guidelines are currently being prepared by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN). There are criticisms on the effectiveness of the inhaler which largely depends on technique of administration by patient considering experience, physical ability and education on usage (NHS centre for reviews and Dissemination, 2003)

CONCLUSION

The role of a nurse in quality care delivery cannot be overruled especially in a health condition as asthma which could be critical and possibly fatal. The initial primary care given to asthma patients and subsequent secondary care has been proven to be appropriate in that the health status of patients is being improved. The incorporation of a respiratory nurse specialist has been a major milestone in achieving a better health status for asthma patients in the United Kingdom.


REFERENCES

Association of Respiratory Nurse Specialist (2010) professional development Available at: http://www.arns.co.uk/pages/professional%20development.html (Accessed: 11 March 2011).

Asthma UK (2011) For Journalists: Key facts and statistics Available at: http://www.asthma.org.uk/news_media/media_resources/for_journalists_key.html (Accessed: 5 March 2011).

British Lung Foundation (2011) Asthma, Available at: http://www.lunguk.org/you-and-your-lungs/conditions-and-diseases/asthma (Accessed: 9 March 2011).

British Medical Journal group (2011) Asthma in adults Available at: http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/531553.pdf (Accessed: 12 March 2011).

British National Formulatory (2010) NICE Technology Appraisal. Available at: http://bnf.org/bnf/extra/current/450034.htm (Accessed: 9 March 2011).

British Thoracic Society, Scottish Intercollegiate Guidelines Network (2009) British Guideline on the Management of Asthma: A national clinical guideline. Available at: http://www.sign.ac.uk/pdf/sign101.pdf (Accessed: 10 March 2011).

Brocklebank, D., Ram, F., Wright, J., Barry, P., Cates, C., Davies, L., Douglas, G., Muers, M., Smith, D., White, J. ‘Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature’ Health Technology Assessment 5 (26) pp. 1-149. Pubmed [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11701099 (Accessed: 4 March 2011).

Department of Health (2011) Prescription Cost Analysis 2001. Available at: http://www.doh.gov.uk/stats.pca2001.pdf (Accessed: 11 March 2011).

Lang M., Erzurum S., C., Kavuru M. (2011) Asthma. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/bronchial-asthma/ (Accessed: 12 March 2011).

Medicines and Healthcare Regulatory Products Agency (2007) vol (1) drug safety update. Available at: http://www.mhra.gov.uk/Publications/Safetyguidance/DrugSafetyUpdate/CON2033216 (Accessed: 12 March 2011).

NHS Centre for reviews and dissemination (2003) 8 (1) ‘Inhaler devices for the management of asthma and COPD’ Available at: http://www.york.ac.uk/inst/crd/EHC/ehc81.pdf (Accessed: 10 March 2011).

National Health Service Choices (2010) About the NHS. Available at: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx (Accessed: 5 March, 2010).

National Health Service Choices (2010) Acute asthma in adults-management in primary care. Available at: http://healthguides.mapofmedicine.com/choices/map/asthma_in_adults2.html (Accessed: 9 March 2011).

National Health Service Choices (2006) The role of your Respiratory Nurse Specialist. Available at: http://www.chelwest.nhs.uk/documents/patientLeaflets/Asthma%20-%20The%20role%20of%20your%20Respiratory%20Nurse%20Specialist.pdf (Accessed: 11 March 2011).

Office for National Statistics (2004) Asthma and allergies: Decrease in hospital admissions in 90s. Available at: http://www.statistics.gov.uk/CCI/nugget.asp?ID=722&Pos=1&ColRank=1&Rank=192 (Accessed: 8 March 2011).

Shiang, C., Mauad, T., Senhorini, A., De Araújo, B., Ferreira, D., Da Silva, L ., Dolhnikoff, M., Tsokos, M., Rabe, K., Pabst, R. (2009) ‘Pulmonary periarterial inflammation in fatal asthma’ Clinical and Experimental Allergy 39 (10) pp. 1499-1507 Wiley [Online]. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2009.03281.x/abstract (Accessed: 11 March 2011).

LEARNING OUTCOME 2

LEADERSHIP IN NURSING AND ASSOCIATED PROFESSIONS

A Leader is someone who guides or chairs a group of people or an organisation; it is common practice that a leader portrays some leadership skills to enable him/her be productive and effective. Cook (2001) describes a clinical nursing leader as someone who endlessly gets involved in direct patient care hence improving care by being of positive influence to others. All nurses (from those who provide direct care to the managers) need potent leadership skills. Mahoney (2001) emphasises that anyone (e.g. a nurse) who gives assistance to others or is responsible for other people is considered a leader; however, good leadership is reproducible superior performance targeted towards a long term benefit to everyone called for.

John, (2011) has defined a manager as an individual with the sole responsibility to plan and direct the work of a group of people, ensuring proper monitoring and directives are followed. Management in nursing involves regarding leadership functions of administration and making appropriate decisions within organisations that employ nurses.

SIMILARITIES BETWEEN LEADERS AND MANAGERS

Leaders and managers go hand in hand, none of them tend to possess abilities that make them stand on their own, and there is no unique or particular way of managing people. Some basic similarities between managers and leaders are:

People development: An effectual manager and leader have skills and abilities that tend towards the development of the people.

Partnership working: the work of both a manager and a leader tend to be of a partnership level (Mather, 2009).

Motivators: both leaders and managers are motivators of their subordinates

DIFFERENCES BETWEEN LEADERS AND MANAGERS

Thinking pattern: A major difference between a leader and manger is in their level of reasoning, Managers think incrementally, whilst leaders think radically; managers always work towards doing things rightly while leaders work in the perspective of doing the right thing (Richard, 1990).

Loyalty: Subordinates are mostly subordinate to their leader than to their manager; this applies often because the leader takes credit in times of achievement and allocating merit to subordinates (John, 1990).

Competencies: A nursing manager allocates resources and sets timetables while a nursing leader is someone who clarifies the big picture created by the manager and simplifies it, making the hospital/nursing home’s vision more understandable to the staff and patients (Kristina R, 2009).

Leadership is a very vital issue in the nursing practice because nursing requires knowledgeable, consistent and strong leaders, who inspire and boost people’s moral and support professional nursing practice. Nurses need to be both leaders and managers for some very key reasons as:

An Advocate for quality care: a head nurse who serves as either a leader has to stand out in ensuring the needs of both the patients and nursing staff are adequately met, sometimes it will require a robust and bold person to stand before the board in defending these needs.

An influential personality: the presence of an influential nurse handling an asthmatic patient will go a long way in guiding the patient in making informed choices; the patient becomes free and open to the nurse when she/he exhibits a high level of positive influence on the patient.

CRITIQUE OF NURSING PUBLICATIONS IN RELATION TO LEADERSHIP AND MANAGEMENT IN ASTHMATIC AND GENERAL NURSING CARE

A report by the Royal College of Nursing (RCN) on the support by Asthma UK on RCN’s frontline campaign published on 14th January 2011 is carefully analyzed highlighting the publisher’s aims of writing, lessons to be learnt, consequences of the article and its impact on positive care delivery.

It was rightly stated in this article that about three-quarters of asthma emergency admissions can be avoided if proper care is delivered (Royal college of Nursing, 2011). This implies that the need for proper managerial skills needs to be adapted by the healthcare leaders to manage asthma patients which will ultimately lead to the reduction of emergency care delivery for asthma patients. He went further to stress that specialist nurses are the cohesive source of support and stability for care for asthma patients; this issue is supported by the Relationship theory of leadership (also known as transformational theory) which highlights the connection between the leader and the led (Kendra, 2011). Leaders that possess this trait tend to motivate and stir their followers to ensure maximum productivity is achieved. Focus is geared towards the performance of the group members. When a leader with such trait is employed, the function of the specialist will be balanced on both as a helper of the patient and a confidant to the patient. He also said that the role of a specialist nurse has reduced hospital admissions from 22% to 6%, hence saving the National Health Service billions of pounds annually.

The writer concluded by turning down the practise of relieving the specialist nurses of their jobs and employing other nurses and ward clerks to fit into their roles which he said the adverse effects were of greater negative impacts as costing the NHS more finance and damage the lives of the patients already receiving care by the specialist nurses.

The lessons from this article cannot be over-emphasized in that there is an immediate need for the employment of more specialist nurses to manage asthmatic patients better and to save the lives of their patients.

A similar report by Akinsanya (2009) on the Exacerbations of severe asthma; psychosocial predictors and the impact of a nurse-led clinic stated that the need for alternate management approaches is paramount in caring for people with severe asthma. He also recommended further findings on the social and psychological aspects of asthma management. Recommendations were also made on the holistic approach for long-term management of asthmatic patients (Akinsanya, 2009).

This report clearly shows the application of the contingency leadership theory that postulates the influence of variables that relate to the environment on the determination of the specific leadership style fit for a situation (Kendra, 2011); it further implies the need for a paradigm shift on the care for acute asthmatic patients towards need for more nurse specialists.

PERSONAL REFLECTIONS ON LEADERSHIP AND MANAGERIAL SKILLS

As a major role player in healthcare delivery, nurses have inevitable functions. This Portfolio has given me an in depth understanding in various areas of my practice as:

Efficiency: I have learnt that my level of efficiency has a vital impact in saving asthmatic patients’ lives; it will help ease the huge financial burden on Government by saving extra expenses.

Leadership skills: According to the ‘great man theory’ of leadership (Management Study Guide, 2011a) which denotes that some people are born with inherent leadership skills which become apparent when great needs arise. I have understood that as a nurse, I can lead rightly and manage people if I can nurture the greatness in me. In enhancing my managerial skills, I will give room for creativity in my area of work by combining both human and non-human resources (Management Study Guide, 2011b) to achieve the designed goal. Team work is also a very good point I learnt from this report in that I cannot be an effective leader if I am regarded as the only member of my team succeeding, there has to be a cohesive effort from all.

Care delivery: The focus is on the nurses to serve as interlocutors between the GP and patient ensuring the patient adheres to prescriptions and that the nurse is always available for assistance by the patient.

CONCLUSION

The difference between a leader and manager is quite small and most leaders tend to end up as managers. Asthmatic guidelines need to be reviewed often to improve its managerial aspect of care. Nurses are relevant care deliverers and all need to develop leadership and managerial skills in order to safe guard the healthcare of the United Kingdom.

Health Promotion Education

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Health promotion or education strategies are applicable to all health problems and are not restricted to any particular health issue or particular group of behaviours. World Health Organization (WHO) (1986) explains that health promotion entails the processes which make possible people to enhance their understanding and control their health in order to improve their health. For a person to attain a state of full physical, psychological as well as social happiness a person or a group has to be able to recognise and understand goals, to satisfy their wants, and modify or deal with the environment as well as illness. Thus, health is viewed as a resource for daily life, and not the goal of living. More so, health is a constructive aspect stressing social as well as personal resources together with physical abilities. Consequently, health promotion or education is not only the duty of health sector, except tit entails much more than a healthy life-style. This essay seeks to address the role that health education/promotion can play in empowering patients to take more responsibility for their own health.

A lot of present day and tomorrow’s main causes of disease, disability and even death are issues which can be greatly reduced through preventive attitudes which are learned through health promotion or education in earlier ages and build through social as well as political strategies and stipulations.

However as Naidoo and Wills (2000):observes, Health promotion programs need to be harmonized through effective collaboration across all sectors, professions as well as health agencies, And should be conveyed in way which is sensitive to the culture of the people. Naidoo and Wills (2000) underscore the 1997 WHO Jakarta declaration which outlined five main approaches for effective health promotion /education.

  • Formulating a healthy public strategy
  • Creating a supportive atmosphere
  • Strengthening community action plan
  • Development of personal skills and abilities
  • Reorientation of health services

Partnership working

Health promotion delivery can be highly improved through creation of partnership working as noted by the WHO. Widening the foundation of health intervention approaches implies tackling socio-economic together with environmental aspects, improvement of accessibility to health services, reduction of inequalities in addition to targeting health education to each and every group regardless of age, gender, and status or age differences.

Addressing health inequalities

In order to formulate an effective health promotion strategy, health inequalities has to be addressed and taken as part of formulation of education plan (Braun et al, 2000). Professions in all health bodies have a duty of delivering successful local health interventions in order to decrease inequalities. In addition to that, all professions in health agencies have a duty to address health promotion or education and preventative measures which aim at reducing effects caused by sore throat

A lot of suggestions put forward by Braun et al (2000) can be undertaken within a local set-up, for instance raising the intake of advantages within a suitable group, formulating health education in schools, promoting waking and making sure that all the requirements from all groups of people even the ethnic minorities are considered when formulating health policies.

Frameworks

There are a number of models which have been formulated in order to help in heath promotion, these models are basically grouped into two main groups which are:

  • Health promotion concepts which describe health promotion as a scope of interventions (formulated by, Tannahill (1985); French and Adams (1986); Beattie (1991))

  • Health promotion model

    which analyse health determinants and suggest responsive measures (Laframboise (1973); Raeburn and Rootman, (1989); Hancock, 1993)

In these two main classes of health promotion models, Naidoo and Wills (2000) explains that, the health practitioners are viewed as leaders (figures with power) or as facilitators of activities (negotiators)

Beattie’s model of health promotion

According to this model, there are four main aspects entailed in health promotion. These main aspects are:

  • Health persuasion
  • Personal counselling
  • Community development
  • Legislative action

These four main aspects contribute in attaining a full picture when formulating a local health promotion action strategy for partnership collaboration. Ajzen, (1991) clearly observes that, all heath promotion models measures require understating by the patient’s own intent to change his/her behaviour. The concept of intended behaviour by Ajzen (1991) is among a number of behaviour modification outlined in health promotion main steps. According to this concept, there are three main steps regarding an individual’s intended behaviour these are:

  • A person’s attitude is determined his/her thinking regarding the consequences
  • The expectations from other people
  • The person’s supposed control and values in their capacity to change

Every agency or persons involved in health promotion is highly encouraged to apply these concepts in supporting their individual initiatives whilst formulating a multi-partnership long term plan.

Nurse practitioners

Nurse practitioners have more experience which they gain through extra training they get which gives the ability to see patients who have various minor illnesses as well as injuries. This entails going through the history of the illness, undertaking a physical analyses, instigating blood tests or performing any other test as it may be indicated. In addition to that the nurse practitioner has a duty of carrying out a diagnosis as well as giving treatment options to the patient. It is against this background that makes these nurse practitioners to be in a better position of performing health promotion/ education in order to empower patients with knowledge on how to manager a number of minor illness which are common but not alarming. As such nurse practitioners are in a central position of empowering patients on sore throat management.

Minor illness: Sore throat

Many of minor illness such as sore throat can be mainly be managed through O.T.C (over the counter) non prescriptions drugs which are able to offer relief to the symptoms. Nevertheless, it is Robbins et al (2003) notes that all minor illnesses have a possibility of turning out to be serious. Patients should be advised that they should seek for the services of a doctor or a nurse in case the symptoms of such an illness are sore throat turns to be severe or in case there is sudden change of symptoms upon taking the OTC drugs, or when they are not working. Robbins et al (2003) observes that, patients with sore throat can be advised not to sure any outdated drug or antibiotics which they used in the past, this information are also pertinent to patients with other minor illness.

Sore throat management

Sore throat is among the most common minor illnesses which affect persons of all ages all over the world. However, children have been known to suffer from sore throat more than adults, on an average it has been established that children suffer from sore throat five or six times every year (Health Development Agency, 2004). In UK, about 90 of children in pre-school age group are known to look for consultation form a doctor at on point or another, mainly for symptoms which are associated with sore throat. Sore throat is among top ten common illnesses which patients come for consultation in primary care, whereby children seek consultation than any other group. More so, about one child in every 7 children who consult because of sore throat will again seek for consultation for sore throat after some time (Health Development Agency, 2004). These numbers have changed just slightly over the years. Adult Patients on the other hand on many occasions show anxiety as well as hopelessness when dealing with sore throat. Such problems and worries can be effectively addressed through the provision of reliable clear information about health, through heath promotion activities. (Health Development Agency, 2004)

Nursing practitioner can use heath promotion to increase the ability of patients to manage sore throat. Sore throat management in general nursing practice and advancement to tonsillectomy in some cases lead to noteworthy use of health care services resources. In many cases, sore throat condition is comparatively minor and also self restrictive. Sore throat has got very little if any lasting adverse health consequences. Nonetheless, a considerable proportion of patients undergo undesirable morbidity and inconveniences caused by sore throat. Due to this many patients seek health practitioners who may keenly treat them, using antibiotics of substantial costs and questionable efficiency. (Health Development Agency, 2004)

Basing on data from national health care records, sore throat is ranked as the eighth very common appearance in primary health care for many people (NSH, 2000). This translates to about 1 person in every 30 people. National Health Services (NHS) has averaged that annually, there are 0.1 consultations carried out concerning sore throat. Assuming that each consultation made cost 10 sterling pounds, then it cost the National Health Services (NHS), about 60 million sterling pounds every year, before adding any other cost of investigating or treating sore throat. Hence, heath promotion becomes very important in reducing these costs and in empowering people on how to manage sore throat.

In addition many of sore throat illness gain exceptionally little from treatment through using antibiotics (Schalock 2000) Yet again; the use of these antibiotics continues to be common with many patients with sore throat receiving antibiotics. But, unnecessary prescription of antibiotic only results in wasted heath care resources, results in a cycle which promotes additional consultations in future for same sore throat illness and as well contributes a lot to the antibiotic resistance problem.

Factors which influence people to take a decision to seek consultations comprise concerns, beliefs, knowledge and also expectations. Patients often dread any illness, and they mainly worry that they may not be capable of recognizing symptoms of a grave aliment (Ajzen 2002). Some patients get anxious of ‘bothering’ their normal practitioners with sore throat illness. At the same time these patients do not have knowledge about have best to treat a sore throat. Patients might have certain belief regarding the causes of sore throat illness (Ajzen, 2002), the implications of the sore throat symptoms and also the effectiveness of drugs to treat sore throat.

Lazenbatt et al (2001) explains that, offering patients with information which is written regarding sore throat illness may assist to decrease the anxiety these patients suffer and improve the patient satisfaction as well as enablement. More so, the use these written information can reduce s re-consultations rates and use of antibiotics to cure sore throat.

Expectations with which patients come at consultations rooms may have an impact on the way patients may be treated. There is no doubt that a patient who walks into a consultation room being expected to treated with antibiotic may end up being prescribed by an antibiotic particularly from a drug stores. But, studies have indicated that patients value getting a through assessment, explanations, assurance and guidance or advice more that receiving prescriptions. Such revelations show the importance and the value of these patients being offered health education regarding the management of their illness, in this case sore throat. (Lazenbatt et al 2001)

Health promotion

The present scope of nursing does acknowledge the key role of nurse practitioners in health promotion /education, Prevention of diseases and treatment of these diseases, sore throat management through medications as well as through non medication treatment. The public frequently seek out nurse practitioners as their main source of health advice and also care for a number of minor illnesses since nurse practitioners are easily assessable. In 2001 a report by Department of Health (2001a) underscored the importance of nurse practitioners in health promotion and highlighted the advantages of using these practitioners in health promotion at the same time calling for them to collaborate with other professions in health promotion/ education regarding minor illness.

Sore throat

A number of measures have been formulated which nursing practitioners can use to in promoting health education regarding sore throat. National Health Services (NHS) recommends that the following steps should be followed by the practitioners in health promotion:

  • Throat swabs need not to be done as a routine in sore throat examination
  • Practitioners should not relay on clinical examination to distinguish between bacterial and viral sore throat
  • Do not perform rapid antigen routine in the case of sore throat, but it is suggested that research has to be carried out through the use of antibody titres.

Patients need to be told by nurse practitioners that the common cause of sore throat is a virus or bacteria, though some other causes can also lead to sore throat. But, when one gets a sore throat it is possible to mange the sore throat by undertaking the following steps.

  • Taking of pain killers, in specific soluble analgesia, dissolve tow tablets and take them three times each day, it has been proved to be highly effective
  • Rest your voice when having sore throat as much as you can
  • keep off smoking if you smoke and avoid smoky surroundings
  • Increase the amounts of fluids you take, keep your self warm and try going to sleep early.
  • Take antibacterial lozenges only or together with throat sprays which contains anaesthetics to get pain relief.

When a patient takes these steps, a lot of sore throat cases will be treated without necessary going to the get a doctor or seeking other heath practitioners’ services. However if a person takes the above mentions steps and still feels the following, then he/she needs to see the doctor.

  • Relentless sore throat
  • Having problems in swallowing or having severe pain when swallowing
  • Experiencing fever or chill
  • Wheeze for those patients who suffer from asthma or having difficulties in breathing
  • Experiencing lethargy

Sore throat Management

  • Paracetamol is successful and efficient in treating symptoms related to sore throat when administered within 48 hours.
  • Pateients can also use ibuprofen effectively to manage symptoms related to sore throat if they take it within the48 hours.
  • Patients need to take paracetamol as a medication of analgesia caused by sore throat , putting in consideration the high dangers which are related to other analgesics

When using antibiotics patients, its is important the nursing practitioners as well educate the general public and patients in particular on management of sore throat in relation to antibiotics. In particular these information needs to be delivered:

  • Penicillin seems to have a crucial (though small) advantage against analgestics/antipyretics specifically in initial lessening of symptoms in patients who have harsh symptoms of sore throat. Nevertheless, antibiotics must not be taken routinely to bring about symptomatic reprieve in cases of sore throat.
  • Sore throat need not to be treated using antibiotics particularly to avert the rheumatic fever development or severe glomerulonephritis development
  • Using antibiotics can avert cross infection of sore throat within the group A beta haemolytic in situation where institutions are closed for example boarding schools or barracks. However, the antibiotics must not be routinely applied to avert cross infection of sore throat within the common community. (Roberts, et al, 2002)

To prevent suppurative complication in sore throat infection does not imply specific sign for antibiotic treatment.

Preventing sore throats

It is not possible to fully prevent sore throat; however the nurse practitioners have to educate the patients on how to reduce the risks and the manner in which to take care so that one can avoid getting sore throat as much as it’s possible. The following steps are important preventative measure which needs to be undertaken by each individual:

  • Taking a well balanced and healthy meal with lots of vegetables and fresh fruits
  • Getting enough sleep in the night and enough rest
  • Not smoking
  • Avoiding surroundings which are smoky as much as one can manage

Indications of tonsillectomy in sore throat

In cases where tonsillectomy develops as a result of sore throat, then patients have to know that the following aspects may occur:

  • They mare suffer five or extra cases of sore throat each year, or may have sore throat symptoms through out the year.

It is recommended that patients should take six month duration being watchful of any symptoms before tonsillectomy in order to establish strongly the manner of the symptoms and permit patients to take into account the entire implications of having an operation.

The moment a decision is reached to perform tonsillectomy, then the operation should be performed as quickly as possible, in order to maximise the duration of benefit prior to natural resolution of symptoms occurring (without having performed tonsillectomy).

The health practitioners should know that sore throat which is related with respiratory problems or stridor is an utter warning for a patient to be admitted. But, at the same time practitioners have to be aware of the basic psychosocial influences among patients coming to seek medication because of sore throat (Morrell et al, 2000).

Heath promotion evaluation

In order to make any program more effective it is important that it should be evaluated. Nurse practitioners are advised to put into consideration all measures which have been taken. Planning processes, implementation of the program and evaluation of whole processes are all important elements of health promotion. As Whiteland, (2001) notes, planning and implementation phases of any specific health associated programme are essential for making sure that the program is successful. Have an effective plan and implementation process allows the practitioners to anticipate for proper evaluation processes. When carrying out health promotion/ education many nurse practitioners do not normally put into consideration every element of the program processes. In many cases planning stage is the one that is emphasized. Whiteleand (2001) adds that it is not common to see a proof of evaluative measures in health promotion. But:

  • Evaluation is important since it offers the crucial tool for health promotion practitioner
  • Knowledge base which shows various health promotion evaluation methods as well as approaches are need to effectively implement a successful health promotion.

Without carrying out an evaluative processes, there are reservations that health promotion program may not achieve its objective, and may fail to settle those funding the program. According to Schalock, (2000); South and Tilford (2000): there are a number of reasons as to why it is imperative that health practitioners undertake evaluate health promotion programs. For example, practitioner has to evaluate the level and degree to which the promotion program has and is attaining its objective. In addition to making sure that the program is cost-effective.

In accordance with the above mention reasons to appraise health promotion plan, are the rising rationalisation programs of health services. The present economic situation in UK’s National Health Services (NHS), together with latest deep-seated quality related changes, has resulted to increased attention of examining health promotion (South and Tilford, 2000; Raphael,2000). In addition to that, Tones (2000) highlights two major classes of evaluation, these are, assessing what has been attained and assessing the manner in which the objectives have been attained. Thus, nurse practitioners may use a number of available evaluation methods such as evidence-based, cost-effective or performance management (Lazenbatt et al, 2001; Morrell et al, 2000) to assess how effective health promotion regarding sore throat management is.

The long-standing viewpoint

Tones (2000) observe that, health promotion programs should incorporate socially empowerment as well as enabling activities. The program discussed here regarding sore throat was aimed at empowering patients to effectively control sore throat and reduces costs incurred in sore throat through promoting healthy lifestyles among measures encouraged. However, for health promotion program to be more effective, it should involve the whole community. The Beattie health promotion discussed earlier in this paper puts emphasis on building relations which last longer, and making sure that public health promotion/education, prevention, and protection are undertaken by the whole community, and not only nurse practitioners.

For the health promotion program to be more effective, Bakley (2001) proposes that health promotion /education has to create a healthy public strategy, create supportive atmosphere, foster personal or group abilities and skills, enhance community action program, and re-orient health services.

Conclusion

Health promotion/education is programs carried out in order to enable people increase their control and improve their state of health. The aim is to make people to attain complete physical, psychological and social welfare. A person or a community must be in a position to identify and acknowledge aspirations to satisfy the needs as well as modify or manage the environment, or illness. Health is taken as daily a resource which needs to be maintained. There are a number of models which have been formulated that by different health experts who are used in health promotion strategies, and Beattie, (1991) health promotion model is commonly used. As it can be seen, sore throat is a minor illness which should not cause any alarm to a patient yet many people when suffering from sore throat end up with a lot of anxiety and using expensive antibiotics which is not really necessary. Thus, health promotion becomes more important in sensitising people on how not only manage sore throat but any other minor illness. But, for any health promotion program to be effective and successful, it should be monitored and evaluated to measure its achievements and ensure that it attains its goals and objectives.

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Continuous Patient Satisfaction Improvement As An Innovation Nursing Essay

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In this project, the innovation proposed is a continuous patient satisfaction improvement process and is planed to be promoted in the local Public hospital’s haemodialysis unit.

The particular unit offers haemodialysis treatment to almost 120 patients suffering from End Stage Renal Disease (ESRD). All the patients are undergoing haemodialysis treatment which is last four hours per session, three times a week. Treatment is governed by the adequacy and mode of dialysis. Haemodialysis requires an access to patient’s circulatory system that will sustain a blood flow of 300 to 500 millilitres per minute per treatment session. The blood must be able to pass through the dialyser for a prescribed amount of time in order to guarantee dialysis adequacy. This is usually expressed as a Kt/V value which is a standard measurement of urea clearance during a specified time.

In order to manage all those patients the unit has 14 haemodialysis stations that are working 18 hours per day, every day including weekends. The dialysis program is spread in three shifts (morning, afternoon, and evening) with the majority of the patients coming in morning and afternoon shifts. The unit delivers approximately 300 haemodialysis sessions per week. In order to carry out all this workload the unit occupies 30 first grade nurses, two sisters in charge, and one nurse supervisor. Furthermore, along with the nursing staff there are 3 doctors specialized in nephrology contributing to the care of those patients.

With the growing changes due to the emergence of advance technology, globalization and other economic aspects, different organisations, particularly healthcare organisations are considering changes through the context of innovation (Shelton & Davila, 2005). Accordingly, innovation can be regarded as the creative and resourceful approaches as well as duties resulting to the effective and efficient function of a firm or organisation. It is essential for health care organisations to ensure high levels of their client satisfaction – in this case the patients- their personnel and the entire organisation. It can be noted that innovation focus on thorough management of the approaches involving the deliberation of the services or even products (Amsden, 2001).

Consequently, like any other firms and organisations, the healthcare industry should also adhere in having the knowledge of considering changes and innovation to ensure that the organisation always adapt to the newest trends and developments in providing quality healthcare, it may be in the facilities used or the knowledge of the personnel.

The context of innovation is very crucial in enabling the organisation to analyse its current situation and status so as to reduce costs, increase income, spot healthcare trends rapidly, and communicate efficiently with the target market. Nonetheless, to be able to complete such purpose, innovation approaches are required to be relevant, precise, thorough and timely. It is essential that the innovation team should be able to determine what part of the organisation needs change and how they are going to initiate such innovation activities. For instance, in healthcare institutions, it is important that the organisation should constantly adapt to the changes in providing quality health care.

The innovation opportunity

The importance of providing quality healthcare services has long been recognized by the health care providers. But, such has been influenced by the consideration of the quality assurance, improvement programs and also the participation of the patients (Darby, 1998). Quality assurance in the healthcare services has long been studied as one of the driving forces of innovation in these institutions. Quality is referred to as the creation as well as maintenance of a competent edge has been widely considered by different institutions. (Frangou et al., 1999). In line with the health care practice, recent decades have researched and noticed remarkable innovation even an evolution in the quality supervision in the health care organisation, (Millenson, 1997). Prior to these changes, the context of the quality assurance for patient care had been analysed thoroughly by professionals, frequently this is conducted a subjective approach for the patients and individuals (Iglehart, 1996). But the obligations for quality in this system are no longer considered as exclusive realm of the health care providers. Healthcare authorities, governmental institutions and also the accrediting sectors have to innovate for the improvement of health care system in quality assurance.

Nowadays in my country, an overhaul reconstruction of the entire health system is in progress therefore, major important changes are due to take place. Among these anticipated changes is public hospitals’ status. Until now these hospitals are totally dependent for financial support from the Government and particularly from the Ministry of Health. With the new plans, they will transform into autonomous organisations leading to independence from their current state. The implication of this transformation is that once independence is granted, each institution will have to seek for its own sources of funding and other facilities, as are necessary to maintain their services, just as is the case in the private sector. This means that, they will have to compete equally for their resources with other organisations existing in the private sector. However, to be successful competitors, public hospitals have to identify their present quality status and where necessary, to enhance their care provision in all areas. Therefore, all hospitals have to adopt quality assurance programs, even before they transform to autonomous organisations.

The new healthcare reformation which will come into effect in the near future, aims to give patients, wherever they lived in the country, better health care and greater choice of service. Therefore the concepts of the internal market will be introduced, according to which, the ‘providers’ of healthcare will be separated from the ‘purchasers’ of healthcare. The idea is that by giving the purchasers the freedom to choose where to buy the best care, including the private sector, the system would place competitive pressure on the providers to offer greater quality, efficiency and value for money. Therefore, measurements of patient satisfaction have to play an increasingly important role in the growing demand towards accountability among health care providers. Overshadowed by measures of clinical processes and outcomes in the quality of care equation, patient satisfaction measurement has traditionally been downgraded to service improvement efforts by hospitals.

However, in today’s hyper-competitive environment, how much satisfied the patients are can determine whether a healthcare provider become preferred provider and retain that status. Therefore, continuous monitoring of patients’ satisfaction level it is expected to have a positive outcome not only on how the patients perceive the care they receive but also on the quality of delivered care in general.

Finally, as quality matters are in a primitive stage in my country such a venture will be the first of its kind especially in haemodialysis settings and probably will open the doors for others to follow.

C. The innovation planned

The project’s aim.

The aim of the propose project is to establish a Continuous Patient Satisfaction Improvement (CPSI) process within the Local General Hospital’s haemodialysis unit by utilizing the PDCA circle (Plan Do Check Act) or as differently known by many as `the Deming Wheel’ along with having Patient Satisfaction Index (PSI).

Relevant objectives.

The major objectives of the proposed project are:

To establish the current levels of patients’ satisfaction towards specific aspects of the care they receive.

Caring and communication.

Quality of haemodialysis unit care and procedures.

Information dissemination.

To recognize and report on the patient perceived strengths and weaknesses of the health care service provided.

To report the results to haemodialysis unit’s authorities to assist them to integrate patient understanding of good health care into the provided services.

Establish benchmarks to allow unit’s authorities to compare their results with those of other units either domestic or international.

Individuals that you might consult or ask to support the project in question.

To be able to have an efficient and proficient initiation of the proposed innovation it is essential to recognize the stakeholders who will have specific participation in the proposed innovation. The intention of such analysis is to recognize who among the stakeholders will have a high interest on the innovation, which will have the highest effect and effect on others for the initiation and establishment of continuous patient satisfaction improvement process. Further, this stakeholder analysis also aims on recognizing who will be subjects, players, spectators and actors concerned in the said innovation. The stakeholder analysis will be discussed through the consideration of the stakeholders’ grid.

In this proposed innovation the potential stakeholders composes of the haemodialysis unit’s authorities (as they will have the main responsibility for the process, interpreting the results and promote and implement changes), the patients receiving haemodialysis treatment and medication (as they will provide the information and they will have a direct impact from the changes), the unit’s personnel (as they will be asked to apply the changes), the hospital’s authorities and of course the Ministry of Health as the hospital’s and consequently the unit’s funders. The different participants for this innovation have varying amounts and classification of power, and those with the greatest effect shape approach and methods from a number of precise decisions (Shafritz & Ott, 2001). Participants for innovation are provided with the utmost authority in any organisational setting, like in this situation the initiation of the innovation of the continuous patient satisfaction improvement process. Their power and significance is beginning to expand slighter advantage when compared to an institution’s management team. The innovation participants will give diverse effect to both kinds of institutions and authorities and they guide the people in the health care organisation that the innovation aims and purposes will be met.

Innovation plan

The following is an outline of initiation plan for the innovation of Continuous Patient Satisfaction Improvement through the process of PDCA circle.

Carry out research to establish the current situation on patients’ satisfaction.

The first stage is to consider a research study to identify the current situation regarding patients’ satisfaction in this unit.

Team Organisation

The innovation process will not be able to attain its purpose if the tasks rendered were not appointed to efficient individuals to implement CPSI. Task allocation is not merely a situation of handing out the various tasks on final lists to the individual healthcare personnel you have available; it is far more delicate as well as powerful than such context. Hence, the unit’s authorities should consider what each member of the team is capable to provide sufficient complexity of tasks to match that.

Identify the weaknesses or problems regarding patient satisfaction

The next thing to consider is the identification of the weaknesses and issues relating to patient satisfaction to know what specific approach needed to satisfy them in the future.

Plan the changes that will promote the patients’ satisfaction with the care they receive.

The management should elaborate and disseminate information regarding the modification needed to promote the satisfaction of the patients with the care that they receive. For this matter, the change will include the enhancements of communication process and healthcare provision in the unit.

Changes implementation.

Changes evaluation.

Report writing. A results report will be produced at the end of the cycle describing the methodology and the results of the first cycle. The report will be disseminated to the haemodialysis unit’s authorities, to the hospital administrators as well as to ministry of health.

Finally in this project, the time limit estimated to be about 9 months, however the exact time that will be requested will be decided by the innovation team after discussions with the unit’s authorities.

Conclusion.

In this paper the Continuous patient satisfaction process had been presented as an innovation opportunity. Implementing such a process within the haemodialysis unit of the Local General Hospital it is expected that the overall quality of the services provided there will be promoted and change in such a way that will meet its clients/patients expectations on the higher possible level. In the light of the forthcoming changes of the entire health system in the country where every healthcare institution will have to compete in equal terms with other institutions the concept of keeping the client/patient satisfy is imperative. Utilizing established and effective processes like PDCA and PSI to monitor the patients satisfaction levels the unit’s authorities will be in position to early identify any possible weaknesses and proceed to the necessary changes so that to keep its clients/patients as satisfy as possible which in return will become “loyal customers”.

This grade will be cumulative over the semester based on your effort to evaluate and present your experience with the book and the class. You are welcome to comment on particular readings outlining t

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This grade will be cumulative over the semester based on your effort to evaluate and present your experience with the book and the class.  You are welcome to comment on particular readings outlining their usefulness and their role in enhancing understanding of particular issues.  Your contribution is invaluable to me for reviewing my book for the next edition, and I thank you in advance for your honesty and your intuitive, thoughtful and  sensible participation.  You may post in this link every week, so that it will be easier to follow.  Your grade will be calculated in the end and will be based on participation, effort, thoughtfulness  and comprehension.

When you make you post please make sure to clearly indicate which Unit, or particular reading you are writing about in your post.

Thanks again for your participation/reflection :-)!!

Which of the following statements is true regarding brainstorming? Brainstorming fails to develop group cohesiveness. Brainstorming overcomes the problem of “production blocking.”

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Which of the following statements is true regarding brainstorming? Brainstorming fails to develop group cohesiveness. Brainstorming overcomes the problem of “production blocking.”

 

Like many other marketing strategy specialists, Mark Fritz relies heavily on creativity and originality. Members of his team are selected on the basis of their ability to think divergently, and Mark often conducts activities to ensure that this ability is developed. For instance, before any new project, Mark invites his team to sit together and churn out possible ideas about the new product, its theme, and ways in which it can be projected best in the market. These sessions usually provide him with a bank of potential ideas from which the team selects some strong concepts and develops them into a campaign. To encourage freedom in these sessions, Mark has a no-evaluation policy. This is an example of ________.

A. social loafing

B. brainstorming

C. in-group favoritism

D. groupthink

E. groupshift

Question 2

Which of the following statements is true regarding the effect of group cohesiveness and performance norms on group productivity?

A. If cohesiveness is low and performance norms are high, productivity will be low.

B. When cohesiveness is low and performance norms are also low, productivity will be high.

C. The productivity of the group is affected by the performance norms but not by the cohesiveness of the group.

D. If cohesiveness is high and performance norms are low, productivity will be high.

E. When both cohesiveness and performance norms are high, productivity will be high.

Question 3

Which of the following is an example of performance norms?

A. distribution of pay

B. rules in informal groups

C. the manner in which a job must be done

D. assignment of difficult jobs, pay, and equipment

E. dress codes

Question 4

Michael is devout and very active in his church. He is also a very dedicated employee. His manager offers him a promotion but the new role will require him to work Sundays. Michael would like the promotion, but realizes that it would force him to miss some church activities. In this situation, Michael is most likely to experience ________.

A. role fuzziness

B. social loafing

C. groupthink

D. groupshift

E. role conflict

Question 5

Which of the following is true with regard to groups?

A. A group influences our emotional reactions.

B. An informal gathering cannot be considered a group.

C. A group is characterized by the independence of its members.

D. A group typically lacks definite roles and structures.

E. The membership of a group does not affect how its members treat outsiders.

Question 6

Groupshift is seen when ________.

A. group members notice and emphasize identities that reflect how different they are from other groups

B. group members tend to exaggerate the initial positions they hold when discussing a given set of alternatives and arriving at a solution

C. group members fail to express alternative opinions and deviant views under the influence of the norm for consensus.

D. group members tend to prefer and endorse the products, ideas, and aspects of someone else’s culture over their own

E. group members view themselves in better light when compared to members of the out-group

Question 7

Which of the following terms indicates the tendency of individuals to spend less effort when working collectively?

A. social facilitation

B. collective efficacy

C. groupshift

D. groupthink

E. social loafing

Question 8

Which of the following is a contributing factor with regard to social loafing?

A. severe time constraints

B. dispersion of responsibility

C. high collective efficacy

D. heavy workload

E. difficult task assignments

Question 9

Hubert Gray needs an instruction manual developed for his new product. This is the last step of the project and he has severe budget constraints. He needs a small team of technical writers to work together closely to write the manual on fairly short notice. He needs them to communicate ideas quickly, creatively, and affordably. Which of the following group techniques should Hubert consider?

A. brainstorming and electronic

B. interacting and brainstorming

C. brainstorming

D. electronic and interacting

E. nominal and electronic

Question 10

In discussing a given set of alternatives and arriving at a solution, group members tend to exaggerate the initial positions they hold. This phenomenon is called ________.

A. halo effect

B. social loafing

C. social desirability bias

D. in-group favoritism

E. groupshift

Question 11

The second stage of the five-stage group development model is characterized by ________.

A. uncertainty about the purpose, structure, and leadership of the group

B. cohesiveness and close relationships among members of the group

C. pride in the accomplishments of the group

D. intragroup conflict within the group

E. strong feelings of group identity among members of the group

Question 12

________ is defined as the extent to which members of a group are similar to, or different from, one another.

A. Civility

B. Diversity

C. Homogeneity

D. Conformity

E. Universality

Question 13

The HR department at Bailey Services is considering offering telecommuting as an option to some experienced employees. At a meeting to formalize the move, the heads of the different departments met with Laura Watson, the HR manager. Laura, who thought this meeting would be a short one, was proven wrong when all the members, who had previously agreed that telecommuting would work in their company, began coming up with divergent views. By the end, two divisions claimed having major concerns about allowing employees to telecommute, and those in favor of it were equally vocal. This scenario depicts the operation of ________.

A. social loafing

B. conformity

C. role conflict

D. groupshift

E. groupthink

Question 14

Which of the following steps can be taken by a manager so as to minimize groupthink?

A. asking the group members to first focus on the positives of an alternative rather than the negatives

B. encouraging group leaders to develop a stronger sense of group identity

C. increasing the group size

D. seeking input from employees before the group leader presents his opinions

E. preventing all team members from engaging in a critical evaluation of ideas at the beginning

Question 15

The determination of the behavioral patterns and assumptions through which the group approaches the project is a function of the ________ phase in the punctuated-equilibrium model.

A. first meeting

B. transition

C. equilibrium

D. performing

E. inertia

Question 16

Joe Sullivan and Mark Holland, members of the top management at EuAir, an European airlines, were preparing for a meeting to discuss strategies to combat the recent rise in fuel prices. Before the meeting began, Joe and Mark were discussing how oil prices significantly impact the health of the world economy. Joe spoke of how higher oil prices since 1999, partly the result of OPEC supply management policies, contributed to the global economic downturn in 2000-2001. Mark agreed but added that the right kind of strategy can help them overcome and even profitably use this opportunity for hiking fares. Which of the following statements, if true, would weaken the argument that Mark experienced groupshift in the meeting?

A. Mark was of the opinion that oil suppliers were going to pressure them even more in the future and the company had to resort to alternatives like bio fuels.

B. Mark recommended that the company should establish a fuel hedging contract with its key suppliers to ensure protection from fuel price rises.

C. Mark believed that most of their clientele was not price sensitive.

D. Mark stated that the company should increase operations but at lower fares so they can regain control over the market share.

E. Mark felt that implementing a price rise was necessary to recover the costs in operating the flights.

Question 17

Which of the following statements is true regarding brainstorming?

A. Brainstorming fails to develop group cohesiveness.

B. Brainstorming overcomes the problem of “production blocking.”

C. Brainstorming encourages criticizing an idea as early as possible.

D. Brainstorming can overcome the pressures for conformity.

E. Research consistently shows that a group in a brainstorming session generates more ideas than an individual working alone.

Question 18

Similarity is a characteristic under the social identity theory that manifests itself in the ________.

A. tendency of people to use the group as a means of understanding who they are and how they fit into the world

B. tendency of people who have greater uniformity in values and characteristics to have greater group identification as well

C. tendency of people to link themselves to high-status groups in an attempt to define themselves favorably

D. tendency of in-group members to prefer and endorse the products, ideas, and aspects of someone else’s culture over their own

E. tendency of in-group members to notice and emphasize identities that reflect how different they are from other groups

Question 19

Uncertainty reduction is a dimension of the social identity theory that manifests itself in the ________.

A. tendency of people to use the group as a means of understanding who they are and how they fit into the world

B. tendency of in-group members to prefer and endorse the products, ideas, and aspects of someone else’s culture over their own

C. tendency of people who have greater uniformity in values and characteristics to have greater identification as well

D. tendency of in-group members to notice and emphasize identities that reflect how different they are from other groups

E. tendency of people to link themselves to groups of higher social standing in an attempt to define themselves favorably

Question 20

Janice Cooper has recently joined a hospital as a part of the internship program prescribed by the nursing school she attends. Janice, who was inspired to take up this profession by the story of Florence Nightingale, had very strong ideals about how she should behave as a nurse. She felt that as a nurse, she must be gentle, pleasant, and caring at all times so she could serve her patients well, and she often went to great lengths as an intern by putting in extra hours at the hospital and so on. The scenario reflects Janice’s ________.

A. role fuzziness

B. role status

C. role conflict

D. role ambiguity

E. role perception

Question 21

When the group energy is focused on the task at hand and the group is fully functional, it is said to be in the stage of ________.

A. inertia

B. storming

C. norming

D. forming

E. performing

Question 22

During the third stage of group development ________.

A. conflicts over leadership are common

B. members resist the constraints the group places on them

C. the group demonstrates cohesiveness

D. intragroup conflicts occur

E. groups disband

Question 23

________ is defined as the tendency to see members of the group of which we are a part of as better than other people.

A. Black sheep effect

B. In-group homogeneity

C. In-group favoritism

D. Xenocentrism

E. Hindsight bias

Question 24

Which of the following represents the acceptable standards of behavior within a group that are shared by the group’s members?

A. dyads

B. goals

C. norms

D. status

E. cliques

Question 25

The ________ norms dictate behavior such as with whom group members eat lunch and friendships on and off the job.

A. performance

B. organizational

C. appearance

D. reference

E. social arrangement

Question 26

Joe Sullivan and Mark Holland, members of the top management at EuAir, an European airlines, were preparing for a meeting to discuss strategies to combat the recent rise in fuel prices. Before the meeting began, Joe and Mark were discussing how oil prices significantly impact the health of the world economy. Joe spoke of how higher oil prices since 1999, partly the result of OPEC supply management policies, contributed to the global economic downturn in 2000-2001. Mark agreed but added that the right kind of strategy can help them overcome, and even profitably use, this opportunity for hiking fares. Which of the following statements, if true, would denote the occurrence of groupshift in Mark’s opinions during the meeting?

A. Mark proposed that the prices be hiked and additional customer service measures be included so costumers have the best experience flying with EuAir.

B. Mark felt that EuAir should suspend some of its less profitable flights in the short run in favor of the routes that have greater demand among consumers.

C. Mark agreed with Joe’s opinion that providing the best service possible, even if it meant incurring a loss in the short run, would be the best strategy.

D. Mark proposed that this was an opportunity for EuAir to use its brand name effectively and diversify into other products and services.

E. Mark encouraged the top-management team to consider laying off surplus employees and rightsizing EuAir to enhance its efficiency and lower costs.

Question 27

Aaron Dias was working on the last shift for the day at All Needs, a retail store owned by an Asian man, when he opened the cash register and stole some money thinking that nobody would witness him stealing. However, one of the customer attendants watched him steal the money and reported it to the manager the next day, following which Aaron was terminated. Subsequently, the manager became extremely strict with all his Caucasian employees and was often heard abusing them saying “you guys are all the same.” This scenario depicts ________.

A. in-group favoritism

B. social exchange

C. contrast bias

D. social loafing

E. groupthink

Question 28

Which of the following is true regarding formal groups?

A. They have negligible impact on employee performance and behavior.

B. They are natural formations that arise in response to the need for social contact.

C. A group of people who come together to protest against a new law make up a formal group.

D. They lack clearly defined structures and roles for their members.

E. They are marked by stipulated behaviors in pursuit of organizational goals.

Question 29

ICE is a non-profit organization that runs awareness campaigns and research programs that provide data to initiate the process of legislative changes on various aspects of the environment like forest cover, nuclear fuel, endangered species and others. The ICE operates through networks of grass-root level researchers who are grouped into flexible project teams whose roles and duties change with each new project. The ICE believes its employees to be like family and an informal environment pervades its functioning without any compromises being made in the efficiency. Recently, the project manager of the rainwater harvesting pilot project in the suburbs has been informed of two delays in the project. When the third extension request came to him, he looked into the matter by speaking individually with the five team members. Which of the following complaints by the team members, if true, would indicate the presence of social loafing in the team?

A. A team member complained that the residents of the suburb in which they were working were uncooperative and did not accept their most cordial requests for helping in data collection.

B. Two of the most experienced employees on the team reported having to shoulder a disproportionate amount of the current workload and asked for an internal transfer.

C. The team members were dissatisfied with the compensation package as they felt they were putting in a lot of work and being paid relatively less.

D. The scarcity of funds was one of the major concerns that all the team members mentioned.

E. Nancy, one of the new team members, reported that she felt the team was not cohesive enough.

Question 30

Which of the following represents the second stage in the five-stage group development model?

A. forming

B. storming

C. adjourning

D. performing

E. norming

Question 31

According to status characteristics theory, which of the following factors does not determine status?

A. contribution to goals

B. personality

C. talent

D. ability to conform to group norms

E. control over the resources needed by the group

Question 32

The important groups to which an individual belongs or hopes to belong are known as ________ groups.

A. nominal

B. reference

C. control

D. interacting

E. organizational

Question 33

Bonnie Patterson is a manager for seven years at Wayne and Watson, a legal consultancy firm. A good part of her work day involves holding meetings and she likes to get work on a time-bound schedule. For this reason, members of her team receive the agenda at the beginning of the meeting, followed by some time to contemplate over the issue at hand individually. Subsequently, the team members present their ideas one after the another, the group discusses them together, and lastly, a ranking is done to choose the most favored idea. This represents the ________ approach of group decision making.

A. brainstorming

B. interacting

C. nominal group

D. reference group

E. groupthink

Question 34

Status is a characteristic under the social identity theory that reflects the ________.

A. tendency of in-group members to notice and emphasize identities that reflect how different they are from other groups

B. tendency of people to link themselves to groups of higher social standing in an attempt to define themselves favorably

C. tendency of in-group members to prefer and endorse the products, ideas, and aspects of someone else’s culture over their own

D. tendency of people who have greater uniformity in values and characteristics to have greater identification as well

E. tendency of people to use the group as a means of understanding who they are and how they fit into the world

Question 35

Which of the following statements is true regarding the norming stage of group development?

A. This stage is characterized by a great deal of uncertainty about the group’s purpose, structure, and leadership.

B. According to the five-stage group development model, this is the second stage in the group development model.

C. During this stage the group completes the task at hand.

D. During this stage, members accept the existence of the group but resist the constraints it imposes on individuality.

E. During this stage, the group develops a common set of expectations of what defines correct member behavior.

Question 36

Which of the following is true with regard to deviant workplace behavior?

A. Leaving work early is an example of a property-related deviant workplace behavior.

B. Widespread deviant workplace behavior depends on the accepted norms of the group.

C. Research on deviance at the workplace has shown that employees operating individually engage in more deviant behaviors than those who function as a part of groups.

D. It has a negligible adverse impact on organization as it is accepted by some employees.

E. It is involuntary in nature.

Question 37

________ refers to the degree to which members are attracted to each other and motivated to stay in the group.

A. Authoritativeness

B. Assertiveness

C. Diversity

D. Cohesiveness

E. Social dominance

Question 38

Which of the following stages of the five-stage group development model is characterized by a great deal of uncertainty about the group’s purpose, structure, and leadership?

A. forming

B. norming

C. evolution

D. storming

E. introduction

Question 39

In the context of the social identity theory, distinctiveness refers to the ________.

A. tendency of in-group members to prefer and endorse the products, ideas, and aspects of someone else’s culture over their own

B. tendency of people to use the group as a means of understanding who they are and how they fit into the world

C. tendency of people to link themselves to high-status groups in an attempt to define themselves favorably

D. tendency of people who have greater uniformity in values and characteristics to have greater identification as well

E. tendency of in-group members to notice and emphasize identities that reflect how different they are from other groups

Question 40

Which of the following represents the major determinants of group development and functioning as depicted by the punctuated-equilibrium model?

A. role perception and expectation

B. better perspectives and patterns

C. promotion of diversity

D. deadlines and time constraints

E. group solidarity and collectivist goals

How does the NINR support novice and experienced nurse researchers?

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How does the NINR support novice and experienced nurse researchers?

How does the NINR support novice and experienced nurse researchers?

  • How does the NINR support novice and experienced nurse researchers?
  • Identify two current priorities for nursing research identified by the NINR.
  • Review the NINR section “Research and Funding” and discuss one of the highlights explaining how research in this area will promote better outcomes for individuals.

Ethical Dilemma: Brain Death

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The ethical dilemma is a situation that is common in many places of work including the nurse’s career. These dilemmas are always hard to solve since technically they weigh equally in the eyes of the professional nurses in question (White, 2001). Nursing as a career like any other has diverse ethical dilemmas. This paper aims at describing an ethical dilemma in relation to declaration of brain death by the nurse and refusal of this fact by the patient’s family

.

The work will entail the definition of ethical dilemma; main moral issues that arose in the scenario given; description of two bioethical principles and giving a view of how they relate to this scenario; explain my personal morality and how it relates to the dilemma of declaration of brain death and finally the conclusion.

Ethical Dilemma and How it Affects Nursing

According to Ong & Yee (2012), ethical dilemma is a situation that needs one to choose one from among two or more morally acceptable options or between equally unacceptable courses of action, whereby one of the choices prevents the selection of the other. Increase in economic stress, advances in medicine, rise in self determination of patients and differing values between patients, their family and health workers, especially nurses are among the many factors that contribute to the frequency and complexity of issues that are ethical in the healthcare. Example of these ethical dilemmas includes truth-telling and disagreement over the management plans. This therefore needs the nurses to be in a good stead so as to be aware of these issues and adopt a suitable approach towards dealing with such dilemmas. In addition, the health care facilities management should have a responsibility to ensure that systems are in place to minimize the occurrence of dilemmas and to ensure that in case it happens, staffs, including nurses, are supported on how to get through the process of resolving dilemmas and conflicts that may arise afterwards.

An ethical dilemma can also be a situation or state in which one must select between two or more adoptions that are equally unacceptable, where this is “Conflict between two or more nursing ethical principles and each solution may contain unpleasant outcomes for one or more involved parties”; and in my case the parties are the bereaved family and the management staff (Miwa et al, 2012).

The effect of a brain death and the family refusal scenario may be of great emotional impact of the nurses. Some might even end up losing it all, according the historical findings, but it always appropriate to note that these effects will differ from one nurse to another. The grade to which one feels a dilemma will always differ from each nurse and also differs in terms of the nurses educational background, how much clinical experienced is the nurse and also one’s nursing moral (Miwa et al, 2012). The dilemma consequences are always frustrating and upsetting nurses and more so when one does not have adequate experience dealing with the matter. The suffering that the nurses go through is known as the moral distress (Epstein & Delgado 2010). This is meant to happen since the nurses know the ethically correct action to take in reference to the brain death but feels powerless to take the action. This might lead to some nurses leaving their jobs, or even the profession altogether.

Main Moral Issues Raised

In a situation of ethical dilemma in the declaration of brain death and refusal on the part of the family, the main moral issues include the fact that the family is legally authorized to make decisions in relations to the patient even though they do not have the medical knowhow they desire an action; not declaring the patient brain death thus the patient will still be assumed to be alive and thus treated. On the other hand, the nurse who has the clinical knowledge opposes the idea and is about a desire for action that the patient should be declared clinically and legally dead so that other follow up procedures could be taken (Epstein & Delgado 2010).

This means that there are two courses of action, both of which can be justified ethically and neither of which is of lesser weight. If the desires of the family are followed, the patient will be in the hospital assumed alive and treated like any other patient. One may ask how beneficial is this to the family and what are the costs of this action? On the other hand, if the desire of the staff is followed, the patient will be declared dead and there is the likely hood of the family feeling abandoned and opinion, neglected thus angry thus would lead to other repercussions like court battles a situation that one would like to avoid due to the costs that come with it (Epstein & Delgado 2010).

Bioethical Principles

According to Crisham (1985), the bioethical principal has evolved over the years with some elements added and others removed until now we have only four broad bioethical principles: beneficence, non-maleficence, justice and autonomy. In this case will discuss autonomy and beneficence. This does not mean they override all other moral considerations, but they are the perfect match for this kind of ethical dilemma.

  1. Autonomy

Ethics entails the respect for autonomy. This is the principle of permission. In minimal terms, autonomy requires to decide for the as an individual and free from the control of others and with sufficient level of understanding that you will provide a meaningful choice. Autonomous persons should be capable to deliberate a course of action and develop an action plan then implement it. This principle comes with its share of problems, especially when the person is incompetent for our scenario the bereaved family. The issues, therefore, rise since the family is to give informed consent to the declaration of the patient’s brain death. The principle holds that there is a need for competence, disclosure, voluntariness and comprehension when it comes to the informed consent making the declaration even more difficult for our car (Gordon et al, 2011).

In relation to the ethical dilemma therefore, there is a need for informed consent from the parents for the declaration to take effect. And the fact that the family denies the declaration simply means they do not consent to it thus rendering it null and void (Gordon et al, 2011).

  1. Beneficence

This principle requires that we contribute to the welfare of others as an ‘embodiment of the Golden Rule’ (Gordon et al, 2011). This principle can be divided into two: utility and positive beneficence. The positive beneficence principle requires that there is provision of benefits from the moral staff while the utility principle requires that the nurses weigh the benefits and deficits as a means of producing the best result. There is therefore need for a risk benefit analysis.

In the scenario of brain death declaration and refusal from family, I will be preventing the ethical losses on part of the health facility by declaring that the patient is brain dead while I will be like issuing a loose statement to the patient’s family. The utility principle, therefore, requires me to weigh the risk associated with the declaration and come up with a sound decision (Gordon et al, 2011).

Personal Morality

Naturally, I am an empathetic person with great compassion, thus pride myself being a nurse. I always try to put myself in the patients and family shoes and try to understand the situation that they are in. I made great sacrifices on behalf of my career as a nurse and just to see that my role as a nurse is felt in the health facility. I am open and ready to lean in all the environments. I also enjoy socializing and comparing notes with my colleagues to ensure that the product of my decisions is holistic and meet the threshold that is set. My compassion has enabled me to appear friendly for both the patients and their family and friends. I always believe that am suppose to be dedicated to my place of work through hard work and ensuring flexibility whenever need be (White, 2001). The majority of these qualities is what I would call that makes part of me as a nurse if not all and therefore a situation that brings a collision between these qualities and the my occupation as a nurse does not only cause great confusion but perplexes.

The scenario of declaring the brain death and refusal of the family is therefore a hard nut to crack on my part. One side of the puzzle is, given the fact that I have been appearing to be the ‘friend’ of the patients and their family members and friends, and such a declaration will make me lose one of the morality that I intend to keep. Compassion is the morality that keeps me going in my career as a nurse (White, 2001). Empathy makes me understand the situation of the family and the pain that they are going through thus making the declaration even harder. On the other hand, a declaration is my duty in place of work. I have to declare that the child is brain dead to ensure me being a benefit to the facility. Failure of which will be like a denial to do an activity which is actually the same reason why I am a nurse. This might lead to results such as being sucked.

The declaration of brain death and refusal by the family is therefore an ethical dilemma. This is from the fact that it brings forward the controversy between the two bioethical principles: autonomy and beneficence. It is hard to determine whether to do what one is expected to do in the career or do what one views is right while all this does not solve the solution at hand; this is the scenario that comes with this ethical dilemma. The values of compassion and empathy makes enable one to understand the situation better and feel for the family even more and may end up forgetting his or her role as a nurse. In this case, the declaration of a brain death would be still a great ethical dilemma on part of the nurses if the family is against the declaration.

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