Rationale for Congestive Heart Failure Nursing Interventions

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Rationale for Congestive Heart Failure Nursing Interventions

Rationale for Congestive Heart Failure Nursing Interventions Congestive heart failure (CHF) is a medical syndrome associated with the constellation of symptoms that present from hypoperfused tissues and congested organs (Weber, 2004). Its manifestation is attributed to a salt-avid condition involving Na+ retention (like urinary K+/Na+ < 1.0) which is based on the activation of circulating renin-angiotensin-aldosterone system (RAAS), that has an effector hormone which overwhelms the effective performance of natriuretic peptides (Weber, 2004). This essay will provide a rationale on nursing interventions for Sallie Mae Fisher’s health condition (aged 82). She suffers from CHF, atrial fibrillation, and hypertension, which have prompted her to be hospitalized four times due to exacerbation of her CHF. Nevertheless, she has been discharged and the interventions have been put in place to help her manage her health condition. Ms. Fisher needs urgent medical care not only because of her age but also because of the myriad of life threatening illnesses she is suffering from. For instance, atrial fibrillation is a chronic heart rhythm disturbance that has been associated with thwarting the quality of life for about 4% of aged populations (Shea & Sears, 2008).

Do you agree or disagree that stem cell research should be prohibited?

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Do you agree or disagree that stem cell research should be prohibited?

 

Argu1nentative Essays Mani stones, Nepal An argumentative essay is an essay in which you agree or disagree with an issue, using reasons to support your opinion. Your goal is to convince your reader that your opinion is right. Argumentation is a popular kind of essay question because it forces students to think on their own: They have to take a stand on an issue, support their stand with solid reasons, and support their reasons with solid evidence. In a general writing test such as the TOEFL exam, you might encounter questions such as these: The U.S. Declaration of Independence states that “all men are created equal.” Agree or disagree with this statement. Support your opinion with reasons and examples. The most important element in a friendship is trust. Agree or disagree with this statement. Support your opinion with reasons and examples. 142 Chapte1£ 9 I Argumentative Essays 143 In an academic class, your instructor might ask questions such as these: CRIMINAL JUSTICE Some cities in the United States and the United Kingdom have passed laws establishing curfews for young people. Young people (usually age I 7 and younger) may not be out on the streets after 9 or 10 P.M. Do you agree or disagree with such curfews? Stem cell research offers a potential cure for many fatal diseases. Many people oppose stem cell research because it involves using cells from human embryos. Do you agree or disagree that stem cell research should be prohibited? Companies that do business abroad sometimes find that local business practices include activities considered unethical at home-offering gifts of money or awarding contracts to family members, for example. Should companies go along with local business practices in order to become successful, or should they refuse to do so and risk failure as a result? HEALTH SCIENCES BUSINESS ETHICS What is unique about an argumentative essay is that you do not just give reasons to support your point of view. You must…; Argu1nentative Essays Mani stones, Nepal An argumentative essay is an essay in which you agree or disagree with an issue, using reasons to support your opinion. Your goal is to convince your reader that your opinion is right. Argumentation is a popular kind of essay question because it forces students to think on their own: They have to take a stand on an issue, support their stand with solid reasons, and support their reasons with solid evidence. In a general writing test such as the TOEFL exam, you might encounter questions such as these: The U.S. Declaration of Independence states that “all men are created equal.” Agree or disagree with this statement. Support your opinion with reasons and examples. The most important element in a friendship is trust. Agree or disagree with this statement. Support your opinion with reasons and examples. 142 Chapte1£ 9 I Argumentative Essays 143 In an academic class, your instructor might ask questions such as these: CRIMINAL JUSTICE Some cities in the United States and the United Kingdom have passed laws establishing curfews for young people. Young people (usually age I 7 and younger) may not be out on the streets after 9 or 10 P.M. Do you agree or disagree with such curfews? Stem cell research offers a potential cure for many fatal diseases. Many people oppose stem cell research because it involves using cells from human embryos. Do you agree or disagree that stem cell research should be prohibited? Companies that do business abroad sometimes find that local business practices include activities considered unethical at home-offering gifts of money or awarding contracts to family members, for example. Should companies go along with local business practices in order to become successful, or should they refuse to do so and risk failure as a result? HEALTH SCIENCES BUSINESS ETHICS What is unique about an argumentative essay is that you do not just give reasons to support your point of view. You must…

A 92-year-old nursing home patient is brought into the emergency department with hyperosmolar hyperglycemic nonketotic coma (HHNC).

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A 92-year-old nursing home patient is brought into the emergency department with hyperosmolar hyperglycemic nonketotic coma (HHNC).

A 92-year-old nursing home patient is brought into the emergency department with hyperosmolar hyperglycemic nonketotic coma (HHNC). Her fluid and electrolyte imbalances are at a critical level. Consider the types of fluid and electrolyte imbalances she may have, and what kinds of clinical manifestations due to these imbalances that you are likely to see

Implement a comprehensive care team utilizing IT resources

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Implement a comprehensive care team utilizing IT resources

Paper instructions:
1) Explore your own level of readiness in informatics. Discuss the integration of nursing informatics and health information technology on patient outcomes in healthcare.
2)Suppose you are asked to provide services to a small island in the Chesapeake Bay which is geographically isolated. Based on your readings and understanding of telehealth and IT resources, how could you implement a comprehensive care team utilizing IT resources. Please make suggestions for improving care coverage for this population.

Note: I have two different topics, one page each. Just put forward the ideas (no introduction and conclusion for each one of them

Critique of a Model of Bereavement

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Grief is the reaction to loss, which might have been aroused through the loss of someone or something that one has established a bond with. Death of friend, family member, or companion can activate grief and this is common to human experience. Grief is an unavoidable human experience more common in women than men (Love, 2007). Studies have shown that specific emotions play a central role in coping with the grief process of late pregnancy loss, such as guilt and loss of self esteem (Forray et al. 2009).

This essay will explore the eight-state model called the Process of Grieving which was developed by Schneider (1984). The eight-state holistic model will be used to illustrate my personal experience of loss and grief when I had a six-month miscarriage. The essay will also discuss and critique the relevance of Schneider’s process of grieving to Social Care practitioners.

Professor John M. Schneider is a psychologist at the Psychiatry Department in the University of Michigan. Schneider is interested in how the process of grief can lead to creativity, growth, and forgiveness. Schneider’s grief process attempts to incorporate an individual’s physical, emotional, behavioural and spiritual manifestation into a circumstance of nurture and growth. Schneider stated that his eight-state holistic model of grief helps personal growth (Metzger, 2008). My own personal experience of grief is compared to Schneider’s model.

The eight stages of the Process of Grieving are as follows:

1. Initial Awareness of Loss

2. Attempts at Limiting Awareness by Holding on

3. Attempt at Limiting Awareness by Letting go

4. Awareness of the Extent of the Loss

5. Gaining Perspective on the Loss

6. Resolving the Loss

7. Reforming Loss in the Context of Growth

8. Transforming of Loss into New Levels of Achievement

The initial awareness of loss or the awareness of an imminent loss will activate various responses in the body system such as shock, confusion, disbelief, detachment and numbness (Metzger, 2008).

Relating this to my experience, when I observed that I had discharged amniotic fluid uncontrollably, the fear of imminent loss of another baby gripped me. This had already happened three times before. When I remembered my tribal belief about crying during miscarriage, I was numb, confused, shocked and disoriented about the next step of action to take. In my tribe it is believed that crying after miscarriage will lead to the reincarnation of the miscarried baby, hence, causing another miscarriage. It was difficult to believe that, despite the fact that I adhered to my doctor’s advice and instructions. My experience of miscarriages was becoming spiritual to me because of the frequency and the reactions of my in-laws. According to Love (2007) an individual may find it difficult accepting their loss and this can lead the person to feel numb and shocked. In some cases it may take hours or a few days before the person will believe what had happened because of the response of people around the individual (Love, 2007).

An attempt at limiting awareness by holding on is a strategy of making use of the individual’s inner strengths to help the situation (Metzger, 2008).

I was alone in a shop when I realised the imminent loss. At this stage, I deliberated on what next to do without raising any alarm to the people in the next shop. I gathered my inner strength without feeling helpless and called my husband. My husband came over and accompanied me to the hospital. He was reassuring me but I did not find this helpful.

The second stage is the attempt at limiting awareness by letting go. The detachment and habit to the individual’s loss is divided at this level. Acknowledgment of one’s personal limits with regards to the loss is turned loose, by letting go the unnecessary assumptions so as to create means for future adaptive behavior and attitudes. The loss reactions associated at this level are depression, rejection, anxiety, shame, self-destructiveness, disgust, ideation, cynicism, ideals and values (Metzger, 2008).

I had to give up on the six-month pregnancy when the physician regretfully confirmed there was nothing that could be done to save the situation. I was induced again the fourth time, at this stage I had accepted my fate of not being able to have that baby. I became very ashamed and helpless, thinking of a divorce since I couldn’t successfully perform the task of womanhood. It was my fourth miscarriage; I became very forgetful and I felt rejected within the family based on the reaction of my mother-in-law. Neugebauer and Lok (2007) did a qualitative study on psychological morbidity following miscarriage. They found out that 40% of women that had miscarriages displayed symptoms of grief after miscarriage (Neugebauer and Lok 2007).

The third stage is the awareness of the extent of the loss. The assimilation or acceptance that the loss had occurred is well-known at this level. Depending on the extent of loss, the individual reflects on the relation and association with what one has lost. It is the period of mourning, where the individual feels weak in accepting the certainty of the loss that has occurred. Reactions at this stage include; weakness, emptiness, existential loss and preoccupation. Others are pain, silence, loneliness, helplessness, sadness, and exhaustion.

After the birth of the fetus – a baby boy – I became exhausted, empty and very weak because the joy of having a live baby was just dashed away. On realising this, I was exhausted, pain occupied my physical system and I preferred to be alone. I thought of the progress of the pregnancy up to that day as being part of me. Bronquet (1999) looked into the psychological consideration of pregnancy loss. She stated that women see the fetus as part of them rather than as a separate being growing in their uterus. In case the pregnancy ended up in miscarriage, most women feel part of them has been lost. This can lead to the feeling of loneliness and worthlessness (Bronquet, 1999).

Gaining perspective on the loss is the stage at which acceptance of the loss is cognitive and accepted. The individual that is bereaved will be given time to make peace with the past and the reality of the situation. According to Schneider (1984:190), the reactions associated to this stage of loss are endurance, separation, approval, mercy, honesty, recollection, healing and peace (Metzger, 2008).

When I was discharged from the hospital, I was confused. People came around to sympathize with me. This time my mind split in two: one side blaming myself for the miscarriage and the other side blaming the lack of facilities available in Nigeria for such late miscarriages. I weighed my loss and my future chances of getting another pregnancy. I forgave my in-laws for their utterances during the healing process so as to allow peace to prevail. A study of 46 women conducted on grief of late pregnancy loss showed that emotions have an impact in coping with late miscarriage such as guilt and loss of confidence (Forray et al., 2009).

Resolving the loss is not the stage when the bereaved is seen to be doing things or activities that are not connected nor have any reference to the loss. The bereaved must have ‘let go’ at this stage, by accepting responsibilities for actions and saying goodbye to grief in order to forge ahead into the future. Some characteristics of this stage may include self care, relinquishing, forgiveness of self and others, determination, and peace.

I left home one afternoon and decided to run away. I left a note for my husband, who was away at the time, that he can carry on with his life without me. Unfortunately for me, he met me at the bus station, which was about 450km from home. When he realised my intentions, he counseled me and made me realise that I had to let go of the past, forgive him, myself and others and be determined to begin again. He rekindled my hope and aspiration and made me go back to my normal life. Mary (1992) cited in Payne et al. (2000) stated that grief is a psychological process of integration in order to escape from painful reminders of the loss.

Reforming loss in a context of growth is the seventh stage. This stage is resolving the grief over a period of time and it entails realization of potential rather than limitation; accepting problems as challenges; becoming inquisitive again; and looking for a balance among the different aspects of self. The characteristics of this stage include genuineness, endurance, truthfulness, the awareness of illusion, and curiosity (Schneider, 1984 cited in Metzger, 2008).

I realized that life must go on, and weighing the support accorded to me by my husband, I accepted the loss as a challenge to be a mother in my marital life, and I researched into causes and preventions of miscarriages. I was afraid of searching my innermost self in case the situation repeated itself for the fifth time. I heightened my curiosity for womanhood and was very alert to any changes within my physical system. Anxiety is a common response to bereavement because an individual will be afraid of how to cope with it in the future (rch.org).

The final stage is the transforming of loss into new levels of achievement. This stage is the combination of physical, emotional, cognitive, behavioral and spiritual aspects. Transformation after the loss occurred and can generate a new person capable of doing things she was not capable of before the loss. The characteristics of this stage include awareness of inspiration, fulfillment, understanding, unconditional love and commitment (Metzger, 2008).

I became a new being; I got pregnant and moved to Ireland. I decided to live separately from my husband whom I am highly fond of. The transformation of the loss changed me for the better; I now have children of my own; I am more independent than before; I returned to school to change my career; and the level of commitment and creativity of whatever I do is higher compared to before.

I agree with Schneider’s process of grief and loss because it relates to my own experiences of miscarriage. However, Schneider’s eight-state models of process of grieving has been criticized. Schneider fails to consider cultural effects on the process of grief. This is evidenced in my experience because it is not only the news of the loss that can make you numb but cultural beliefs may also contribute. In addition, some people may not grow due to their loss experience because it depends on individual perceptions to grief and loss.

It is important for Social Care workers to study the process of grieving because they work with vulnerable people in society. The client’s vulnerability may be because of the loss of a family member, loved one or friend. The study of grief and loss empowers practitioners to support people in making choices about placing a child for adoption, and pre-bereavement support. It also helps Social Care workers to support clients experiencing loss. For instance, it helps in supporting people with chronic disability, people that are mentally ill and palliative care support for the dying (Machin, 2009)

In conclusion, Schneider’s eight-stage model for the Process of Grieving can be of great reassurance. Considering the behaviour and characters displayed in this process will help in understanding ourselves and the people around us. The process of grief in my experience helps me to understand my husband’s family better, especially my mother-in-law. Grief also brings awareness, freedom, and a change of attitude to life.

For Carla’s care in this case study, draw a picture or a diagram of the overall care process. Flowcharts and stick figures both work very well.

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For Carla’s care in this case study, draw a picture or a diagram of the overall care process. Flowcharts and stick figures both work very well.

 

 

Week Nine Assignment – Written Assignment

Case Analysis: A 30-year old in the Nursing Home https://www.ihi.org/education/ihiopenschool/resources/Pages/Activities/AdvancedCaseStudy2010.aspx

Download Participant Version here: https://www.ihi.org/education/IHIOpenSchool/resources/Documents/Participant_Advanced%20Case%20Study.pdf

Use the following outline to complete an in-depth case analysis. To learn about fishbone diagrams, see Patient Safety 104: Root Cause and Systems Analysis.

1. Overall Process Map

For Carla’s care in this case study, draw a picture or a diagram of the overall care process. Flowcharts and stick figures both work very well.

Show the major steps in her story.

2. What contributed to this adverse event?

From the overall care process map, create a list of things that went wrong in the care experienced by Carla and her providers. These do not need to be in any particular order.

Group these problems and errors into sensible categories. Examples include “communication breakdown” and “equipment failure.”

Use the “ask why five times” method and/or a fishbone diagram to organize your thinking. (To learn about fishbone diagrams, see PS 104: Root Cause and Systems Analysis.)

3. Create Rules for the System

Read “Redesigning Health Care with Insights from the Science of Complex Adaptive Systems.”

To download this free article, go to the Institute of Medicine’s Crossing the Quality Chasm page.

Select PDF BOOK – Free; click Download Report.

You will be asked to establish an account with National Academies Press. Enter your information and click “Continue.”

You’ll be directed back to the original Crossing the Quality Chasm page. Select “PDF Chapters.” Click “Appendix B: Redesigning Health Care with Insights from the Science of Complex Adaptive Systems.”

Open or save article.

Based on this article, create one or more simple rules that might guide the development and evolution of Carla’s ideal health care system.

4. The Ideal Process Map

Based on the rule(s) you just developed, draw a picture or a diagram of the ideal overall care process for Carla. Feel free to use diagrams or a process map here rather than text.

5. Improving Part of the System

For each of the processes you identify, create an aim statement for improvement.

A good aim statement specifies “how good, by when, for whom.”

6. How would you know the changes made a difference?

Suggest measures that could be used to

Track the progress of your improvement effort (process measures)

Assess the impact of improvement on the targeted population (outcome measures)

Monitor the costs associated with improvement (balancing measures)

7. What changes will you make?

What changes in the current system of care would you recommend testing? (i.e., are there small-scale, incremental changes that would be beneficial? Are there new care processes that need to be designed and implemented?)

8. Plan Your Tests

Provide a plan to test the changes you have proposed.

What questions do you hope to answer with this test, and what do you predict the answers are?

What changes will be tested?

How will the changes be tested (consider small scale early)?

Who will run the test?

Where and when will the test take place?

What information is important to collect?

Why is it important?

Who will collect the data?

Who will analyze the data prior to study?

Where will data be kept?

When will the collection of data take place?

How will the data (measures or observations) be collected?

9. What challenges might leadership face?

What obstacles might the organization’s leaders need to overcome in order to implement your suggested changes?

How could you help leaders overcome these challenges?

This paper should be in APA format, 10 pages maximum (not including title and reference pages), with at least 5-10 references. See Grading Rubric_Case Analysis_Nursing Home to ensure all required areas are covered in your paper.

This paper is very long. I will upload articles for you to read and to refer to in order to answer the questions. Please follow directions carefully. I am paying top dollars to earn the maximum points.

Thank you

DESCRIBE EACH QUALITY PRINCIPLE AND SHOW HOW IT IS ILLUSTRATED IN THE ARTICLE.

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DESCRIBE EACH QUALITY PRINCIPLE AND SHOW HOW IT IS ILLUSTRATED IN THE ARTICLE.

There are three principles of total quality: customer focus, continuous improvement, and teamwork. Find three articles that describe current practices in healthcare organizations. Each article should illustrate one principle of total quality. Refer to professional journals such as Modern Healthcare, Provider Magazine, and Nursing Homes. Write a paper based on your review of the articles. Include the following in the paper:

Describe each quality principle and show how it is illustrated in the article.
Analyze the relationships among the three quality principles.
Examine whether the principle in one example might apply to other examples.
Submission Details:

Present your analysis as a 5-page report in a Microsoft Word document formatted in APA style.
On a separate page, cite all sources using APA format.
Cite sources less than five years old

Increasing Paternal Bonding in the Neonatal Intensive Care Unit

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Introduction

Nurses play a critical role in the integration of quality improvement initiatives to progress and promote effective care within the healthcare setting. Nurses must use leadership and management strategies to address areas in need of improvement and change. Nurses have a duty to identify when there is opportunity to advance and reconstruct the quality of healthcare for the better (Huber, 2018, p. 268). For instance, a problem in paternal bonding within the neonatal intensive care unit (NICU) would call for an opportunity for nurses to fix and respond to the problem. With this responsibility nurses in management and leadership positions must be willing to educate, inform, and keep up with current medical research and evidenced-based practices, while encouraging and teaching other nurses to do the same (Huber, 2018, p. 298). Nurses continually have the opportunity to be crucial part of change for the healthcare system.

The problem in the NICU setting is that fathers are not bonding with their infant due to a lack of education and enforcement of bonding practices by nursing staff. This issue will be addressed by the Quality and Safety Education for Nurses (QSEN) in the topic of quality improvement.

Quality improvement

is defined as the use of, “data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (Quality and Safety Education for Nurses [QSEN], 2019). This problem fits into the QSEN topic of quality improvement because there is a need for enhancement and enforcement of techniques to encourage and guide paternal bonding in the NICU setting. Specific interventions and outcomes should be used and monitored to see which method is the most effective to fix this issue. Since there is not a present protocol on paternal bonding within the NICU, the use of data from paternal experience within the NICU would be beneficial step towards solving the problem.


Assessment and Analysis

The problem of paternal and infant bonding in the NICU was identified through reviewing current research and scholarly journal articles. This problem involves fathers, infants, and nursing staff. A study observing paternal bonding conducted in the NICU setting found that many fathers felt like an “outsider” to the mother and nurses and did not participate in care as much as they would have liked to during their infant’s stay (Logan & Dormire, 2018). Fisher et al. (2018) states that engagement of fathers in the NICU has been immensely disregarded in healthcare facilities resulting in fathers having feelings of “powerlessness” and “exclusion.” Many parents may also have a hard time bonding with their infant because of restrictions within the NICU due to their infant’s medical condition, stress from having a sick infant in the hospital, and financial strain. Fathers, may specifically feel left out with the immense amount of focus on the mother.

Currently there are no policies or procedures that directly focus on how to increase paternal bonding in the NICU, but there are suggestions and evidence-based practices to facilitate parental and infant bonding during the NICU period. Some practices within the NICU include: skin to skin contact (SSC), involvement in care, and frequent visitation (Feeley, Genest, Niela-Vilen, Charbonneau, & Axelin, 2016). Although there is currently not a problem with these practices, the lack of enforcement and education of it regarding the benefits of these practices, or how often they are practiced is a problem, especially concerning fathers. Hence, more education and enforcement of these practices should be offered to fathers by nursing staff in the NICU setting.

Based on the evidence, the direct inclusion of fathers should be encouraged through education and nursing practices. With this proposed change nurses will be able to inform, educate, and encourage fathers to be active participants during their infant’s stay. Education about paternal and infant bonding among the nurses, physicians, and healthcare staff should be implemented on the unit. This change could help adverse events such as impaired paternal and infant bonds from forming combating future attachment issues. Much of the care is focused on the maternal bond, rather than the paternal bond. Evaluating needs of both parents individually should be a priority for each NICU experience. Fathers, if willing and abiding by the procedures or practices of the unit, should feel competent and confident when practicing bonding techniques with their infant with the help of nursing staff.


Literature Review

Research on the topic of paternal bonding in the NICU was found through the use of databases such as PudMed, Google Scholar, and OVID. After researching the topic, recommendations and interventions to fix the problem were found. According to QSEN (2019), pursuing information regarding outcomes in care, and identifying practice gaps is a vital skill to form when practicing in the nursing field. Huber (2018) mentions that nurses in leadership positions addressing quality improvement must have “a devotion to data collection and analysis as the foundation of problem solving.” When research and data is collected it is up to the nurse’s judgement whether these recommendations or findings will be utilized to improve the quality of care on their unit.

Valizadeh, Mirlashari, Navab, Higman, and Ghorbani (2018) conducted a phenomenological study to examine the neglect of fathers in family-centered care (FCC) and the nurses role in fostering FCC in the NICU. This study, guided by Heideggerian philosophy, included nurses working in the NICU for at least three years and three different level three NICUs (Valizadeh et al., 2018). Valizadeh et al. (2018) stated father participants explained that they were limited educational and participation opportunities available during their NICU experience, and if they were offered such opportunities they reacted enthusiastically to the nurses efforts to get them involved in the infant’s care (Valizadeh et al., 2018). They further discovered that nurses play an imperative role in establishing paternal attachment with the infant (Valizadeh et al., 2018). Another phenomenological study recruited and interviewed seven fathers of infants and analyzed their experience on level three NICUs of two hospitals (Logan & Dormire, 2018). With their findings they recommended that nursing staff promote paternal engagement and involvement, educate on the importance of frequent visitations, and recognize opportunities for fathers to practice skin to skin contact (Logan & Dormire, 2018). Lastly, they specifically state that nurses should explain medical terms, test results, diaper changes, and skills to console the infant to the fathers to increase bonding cohesion (Logan & Dormire, 2018).

Similarly, to the study conducted by Logan and Dormire (2018), a qualitative study conducted by Noergaard, Johannessen, Fenger-Gron, Kofoed, and Ammentorp (2018) interviewed and observed fathers in NICU. The authors also questioned nursing staff on how they involved fathers in their care of their infant during this period (Noergaard et al., 2018). Noergaard et al. (2018) suggested that nurses help destroy preconceived notions of masculinity, and help fathers see that they are just as essential as the mothers during their infant’s NICU stay. Nurses should also inform the fathers directly about their infant’s condition and include them in infant care. (Noergaard et al., 2018). A qualitative study done by Feeley et al. (2016) dives deeper into parent and nurse relationship in the NICU. Through their data analysis the authors discovered that parents and nurses helped establish closeness with the use of decision-making strategies, organization of care, and support provided by the nurses to the parents (Feeley et al., 2016).

A study done by Kadiva and Mozafarinia (2013) examined paternal knowledge deficiency and stress in the NICU. In their study they discuss the integration of nursing staff to support and lead fathers throughout their infant’s journey in the NICU (Kadiva & Mozafarinia, 2013). The authors designated twenty-three fathers to the control group and twenty-three fathers to the intervention group (Kadiva & Mozafarinia, 2013). Kadiva and Mozafarinia’s (2013) interventions of a HUG Your Baby DVD and a “family-friendly educational program” resulted in an increase in paternal knowledge and confidence. Years later, Fisher et al. (2018) discussed their review of literature regarding fathers in the NICU and the benefits of establishing a paternal-infant bond. The authors state that mother and father interaction and education should be equal; they offer twelve recommendations to improve the practices (Fisher et al., 2018). Some of the recommendations for the NICU staff to address include: accessible access to the NICU for fathers, improved communication, a creation of a father auditing tool, training for staff to working more efficiently with fathers, and education provided by nursing staff on co-parenting (Fisher et al., 2018).

A study done by Varela, Tessier, Tarabulsy and Pierce (2017) focused more on a specific intervention to facilitate bonding known as SSC. The authors recruited forty-nine fathers in the NICU and tested their cortisol levels and blood pressure during SSC (Varela et al., 2017). They concluded that they was a substantial decrease in physiological stress responses from the fathers, and recommended that hospitals continue to enforce and practice SSC to assist in bonding in the NICU (Varela et al., 2017). In an additional randomized controlled trail conducted by Chen, Gau, Liu, and Lee (2017) they observed the effects of SSC on paternal-infant attachment. The authors’ study included eighty-three fathers; the intervention group received standard care, an

“Early Childcare for Fathers”

pamphlet, and practiced SSC (Chen et al., 2017). With the use of a Father-Child Attachment Scale, the authors were able to conclude that attachment was higher in the intervention group than the control group (Chen et al., 2017). They further recommended that nursing staff provide educational pamphlets and demonstrations, while encouraging fathers to participate in their care of their infant (Chen et al., 2017).

Mahon, Albersheim, and Holsti (2015) highlights the evaluation of paternal satisfaction and support needs within the NICU. Mahon et al. (2015) study supports the use of Fathers’ Support Scale: Neonatal Intensive care unit (FSS:NICU) to evaluate paternal needs and plan accordingly to the father’s response. Lastly, a qualitative study done by Feeley, Waitzer, Sherrard, Boisvert, and Zelkowitz (2012) interviewed eighteen fathers in the NICU and recorded their perceptions of difficulties and aids in NICU that affected their participation involvement (Feeley et al., 2012). Three categories were acknowledged: infant factors, interpersonal factors, and NICU environmental factors (Feeley et al., 2012). In conclusion, the authors suggested that nurses should be concise in their education, provide demonstrations, and explain potential boundaries to care (Feeley et al., 2012).


Interventions

To help address and fix the problem of paternal-infant bonding in the NICU, an intervention involving nursing education and enforcement of practices will be explored throughout this section of the paper. This intervention of educational sessions and demonstrations of bonding techniques will be offered to fathers of infants in the NICU. Nursing staff will be first provided with educational material and detailed instructions about paternal-infant bonding followed by being implementors of providing education and demonstrations to fathers on the unit. A leadership theory called transformational leadership, a management style theory called systems theory, and change model known as Lewin’s Change Process will help explain the direction of the planned intervention.

Transformational leadership

is defined as someone who helps their followers perform to the expected level with the use of guidance and change techniques (Huber, 2018, p. 13).

Systems theory

highlights that change or shift in one part of the system affects the system as a whole (Huber, 2018, p. 25). Lastly,

Lewin’s Change of Process Model

involves “used ideas of equilibrium within systems.” (Huber, 2018, p. 35).

To begin this proposed change a leadership nurse will need to go through the phases of Lewin’s Change Process, which involves unfreezing, moving, and refreezing. The first step will be the unfreezing phase. In this phase the nurse leader will hold a meeting addressing the topic of change (paternal-infant bonding). In this meeting the leadership nurse will inquire what the staff already knows about paternal-infant bonding, lack of education on the topic, and discuss why more education and enforcement of techniques should be offered to fathers in the NICU by nursing staff. Fisher et al. (2018) stated in their review that some nurses tended to run into more “difficulty” relating to fathers compared to mothers, with this result, they recommended that staff training be mandatory for nurses for strategies on how to engage with fathers and increase their involvement in the NICU. In this phase the leadership nurse will use transformational leadership techniques such as presenting the topic in charismatic attitude to help staff correctly implement the change on the unit. Like, transformational leadership, the leadership nurse will also push nursing staff to rise above their owns needs to meet the needs of father within the NICU (Huber, 2018, p. 13).

The next step of the process is the moving phase. The moving phase involves planning and implementation (Huber, 2018, p. 35). Based of Fisher’s et al. (2018) recommendation of mandatory training, the leadership nurse will provide the staff with an educational class that will take place in the NICU and last one week. This class will address ways to engage the father in care of their infant and promote bonding through the use of visual aids and demonstrations. The nurse will then use Logan and Dormire’s (2018) proposal of including information on: SCC, when opportunities for care are appropriate for the fathers, educational necessities the father needs to know about their infant, and bonding techniques. Since it was founded that fathers act eager to such opportunities of participation (Valizadeh et al., 2018). The visual aids will also include qualitative data collected from paternal experiences within the NICU, and include the reports of fathers feelings of “powerlessness” and “exclusion” (Fisher et al., 2018). After nursing staff has been through the course they will be ready to implement the intervention of education and enforcement to fathers on the unit.

In the last step, the refreezing phase, the leadership nurse will use systems theory to explain to staff that once this proposed change of education and enforcement of bonding is implemented paternal experience in the NICU will change as a whole. During this phase evaluation and any question to change happens (Huber, 2018, p.35). In the phase the leadership nurse will educate staff on the potential barriers and restrictions to this purposed change. The leadership nurse will explain to staff to keep in mind systems theory’s idea of, all the parts relate back to the main goal, in this case the goal is improving paternal-infant bonding.


Evaluation

evaluate how well the nurses have been implementing changes on the unit. To do so, the leadership nurse will use father-friendly service auditing tool that


References

  • Chen, E., Gau, M., Liu, C., & Lee, T. (2017). Effects of father-neonate skin-to-skin contact on attachment: A randomized controlled trial.

    Nursing Research and Practice,2017

    , 1-8. doi:10.1155/2017/8612024
  • Feeley, N., Genest, C., Niela-Vilén, H., Charbonneau, L., & Axelin, A. (2016). Parents and nurses balancing parent-infant closeness and separation: A qualitative study of NICU nurses’ perceptions.

    BMC Pediatrics,16

    (1). doi:10.1186/s12887-016-0663-1
  • Feeley, N., Waitzer, E., Sherrard, K., Boisvert, L., & Zelkowitz, P. (2012). Fathers’ perceptions of the barriers and facilitators to their involvement with their newborn hospitalized in the neonatal intensive care unit.

    Journal of Clinical Nursing,22

    (3-4), 521-530. doi:10.1111/j.1365-2702.2012.04231.x
  • Fisher, D., Khashu, M., Adama, E. A., Feeley, N., Garfield, C. F., Ireland, J., . . . Teijlingen, E. V. (2018). Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting.

    Journal of Neonatal Nursing,24

    (6), 306-312. doi:10.1016/j.jnn.2018.08.007
  • Huber, D. L. (2018).

    Leadership & Nursing Care Management

    (6th ed.). St. Louis: Elsevier.
  • Kadivar, M., & Mozafarinia, S. M. (2013). Supporting fathers in a NICU: Effects of the hug your baby program on fathers’ understanding of preterm infant behavior.

    The Journal of perinatal education

    ,

    22

    (2), 113–119. doi:10.1891/1058-1243.22.2.113
  • Logan, R. M., & Dormire, S. (2018). Finding my way.

    Advances in Neonatal Care,18

    (2), 154-162. doi:10.1097/anc.0000000000000471
  • Mahon, P., Albersheim, S., & Holsti, L. (2015). The fathers support scale: Neonatal intensive care unit (FSS:NICU): Development and initial content validation.

    Journal of Neonatal Nursing,21

    (2), 63-71. doi:10.1016/j.jnn.2014.09.007
  • Noergaard, B., Johannessen, H., Fenger-Gron, J., Kofoed, P., & Ammentorp, J. (2018). Fathers’ needs and masculinity dilemmas in a neonatal intensive care unit.

    Journal of Intensive and Critical Care,04

    (04). doi:10.21767/2471-8505.100119
  • Quality and Safety Education for nurses. (2019).

    QSEN competencies

    . Retrieved from http://qsen.org/competencies/pre-licensure-ksas/#quality_improvement
  • Valizadeh, S., Mirlashari, J., Navab, E., Higman, W., & Ghorbani, F. (2018). Fathers: The lost ring in the chain of family-centered care-A phenomenological study in neonatal Intensive care units of Iran.

    Advances in Neonatal Care,18

    (1), E3-E11. doi:10.1097/ANC.0000000000000449
  • Varela, N., Tessier, R., Tarabulsy, G., & Pierce, T. (2017). Cortisol and blood pressure levels decreased in fathers during the first hour of skin-to-skin contact with their premature babies.

    Acta Paediatrica,107

    (4), 628-632. doi:10.1111/apa.14184

This student written literature review is published as an example. See

How to Write a Literature Review

on our sister site UKDiss.com for a writing guide.

You have invested $6-000 in plant improvements and financed $6-000 Long-Term debt to pay for it. You have also elected to retire $6-000 of Long-Term Debt. Now- your closing cash position reads -$3-000

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You have invested $6,000 in plant improvements and financed $6,000 Long-Term debt to pay for it. You have also elected to retire $6,000 of Long-Term Debt. Now, your closing cash position reads -$3,000.

How can you fix the current financial decisions so that you have a healthy cash position at the end of the year?

Importance of Accountability in Health Care Industry

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Importance of Accountability in Health Care Industry

Introduction

In health care reform debates and planning, discussions emphasize on making health institutions and physicians accountable for the patient outcomes (Brinkerhoff, 2003). Some of the challenges that the health care industry is facing are barriers to attain measurable and achievable procedures to maintain patient safety. It is therefore important to transform the prevailing medical culture so as to ensure that these institutions and physicians are held accountable for patient safety. Accountability generally includes the procedures and processes designed to make an entity justify and take responsibility for its activities (Brinkerhoff, 2003). All stakeholders in health care industry must account for all their activities as they try to achieve their goals. These include employers, management, insurers, and healthcare providers. Portery & Malloch (2010) point out that accountability is the most overused and misunderstood element of leadership today. Therefore, health care providers must strive to improve efficiency and quality in their institutions. This can be achieved by employing quality improvement initiatives and effective performance management systems. Accountability in health care industry can be measured in several ways (O’Hagan & Persaud, 2009). They include routine performance evaluations, customer satisfaction measures, employee assessment or appraisals as well as checks and balances.

Importance of Accountability in Health Care Industry

The central goal of creating and maintaining a culture of accountability in any entity is to create a continuously learning organization. O’Hagan & Persaud (2009) point out that it is very important to create and maintain a culture of accountability since it pivotal in achieving organizational success because accountability is the basis for measuring and improving performance.

The second reason why a culture of accountability is important in health care is improved quality of patient care and value for money spent on health care services (Sullivan, 2012). Increasing the accountability of physicians and the involved management teams will also minimize misuse, overuse, and underutilization of resources while possibly reducing costs for patients or tax payers. The quality of patient care is improved by increasing the use of evidence-based medicine and performance measurement with the aim of reducing inappropriate care (O’Hagan & Persaud, 2009).

Portery & Malloch (2010) also highlights that accountability encourages the assessment of evidence from process and outcome measures carried out routinely by relevant management teams. Supervisors or managers can use feedback from performance measurement to improve processes and outcomes of health care activities. Finally, O’Hagan & Persaud (2009) adds that accountability enhances learning behavior; thus reducing, variability. This is based on utilization of evidence-based protocols or practices, such as clinical practice guidelines (CPGs). According to O’Hagan & Persaud (2009), if the parties involved in healthcare demonstrate high levels of accountability, then there is an increase in the desire to make use of evidence-based practice during the provision of healthcare services This will result in reduced variabilities in healhcare provision, which can be attributed to a culture that places emphasis on accountability.

How to Measure an Employee’s Accountability in the Health Care Industry

Employee accountability is a critical element of achieving goals in any institution (Portery & Malloch, 2010). According to O’Hagan & Persaud (2009), health care performance management systems are the foundation for measuring an employee’s accountability. Employers use routine performance appraisal review as the primary tool to measure accountability (Brinkerhoff, 2003). Employees must be held accountable for performance standards of their respective institutions or the health care industry as a whole to improve employee engagement. The impact of employee accountability must also be factored in institutional philosophy. Harbour & Ball (2003) suggest that, clear direction, regulations, standards, performance accountability, and an efficient work environment must be presented to employees for them to feel more engaged and accountable.

Performance standards used for annual reviews must be well established and tested for efficiency (Portery & Malloch, 2010). Standards can be predefined employee output levels aimed to achieve institutional goals morally. An example of a performance standard for a clinician could require attending to a patient four times in a shift. Another example of performance standard in the health industry is attendance. Absenteeism must be formal and communicated in time at all costs. Performance standards are usually incorporated into an annual performance appraisal (Brinkerhoff, 2003).

Responsible management teams should also provide timely feedbacks to demonstrate their attention to employee performance. This acts as a channel of conveying messages that employees are being held accountable for performance standards and acknowledged for important input to their institutional success (Portery & Malloch, 2010).

The Effect of Accountability on an Organization’s Working Culture

Accountability can foster any organization’s working culture. This is based on accountability elements such as common vision, mission and belief (Harbour & Ball, 2003). Accountability culture spontaneously crops the desire and need for continuous learning and improvement at personal or institutional levels. Since it accountability it tied to employee engagement, it ensures that resources are efficiently utilized while giving stakeholders maximum benefit (Portery & Malloch, 2010). Accountability also ensures that performance standards are established and rewards can be based on this. Motivated employees perform well this improves production. Accountability also leads to creation of strategies that can effectively handle challenges that emerge in the dynamic health care organizations (Brinkerhoff, 2003). These strategies can benefit health care providers and leaders in related fields to create a fair environment for all stakeholders of health care (O’Hagan & Persaud, 2009). Since accountability requires people to have ownership or control of their work, personal promises are made to achieve measurable work. For instance, an institutional CEO can be held accountable for improving the physician or staff morale.

How to Maintain a Positive Working Culture and Avoid a Working Culture of Blame

Issues such as defensive behaviors among employees, anti-learning culture, blame avoidance, infighting and the tendency to shift blame are some of the causes of dysfunction in health care industry. For instance, in Canada, provinces blame the central government for lack of funding; the central government blames the provinces for mismanagement, while health institutions and local boards blame both (Harbour and Ball, 2003). Patients and health practitioners blame them both. Harbour & Ball (2003) suggest that all the parties involved in healthcare industry need to move beyond the “blame game” to a culture of accountability and best practices in delivering high quality health care. Since this needs transformation of mindset to positive working culture, they outline six principles to maintain a working environment characterized by accountability as well as transformation of corporate governance in health care; these includes: being accountable for things you have control; activities/efforts or processes must be available and enough for tangible outcomes as well as real empowerment and room for personal discretion and judgment for results to be accountable. Harbour & Ball (2003) also highlight that accountability must be dynamic, subject to the fact that, outcomes and targets change as circumstances change. They also add that a positive working culture should be tied to the observation that accountability and stewardship for any institution belongs to every employee. Lastly, it is worth absorbing the fact that, for accountability to be meaningful and fair, appropriate consequences must be defined to all involved parties (Harbour & Ball, 2003).

Conclusion

All stakeholders involved in health care industry must conceptualize a performance management system and construct efficient performance appraisal methods to measure both individual and institutional accountability. It is very important that all levels of management embrace a culture of accountability. Managers, front-line workers, supervisors and executive leadership should be accountable for their performance at all times. Mutuality is a critical success element in accountability processes that are effective and efficient. The health care system should therefore be shifted from deeply rooted hierarchical command-and-control structures, leadership styles, process and systems.

References

Brinkerhoff, D. (2003, January). Accountability and Health Systems – World Health Organization. Retrieved March 27, 2013, from World Health Organization: https://www.who.int/management/partnerships/accountability/AccountabilityHealthSystemsOverview.pdf

Harbour, B., & Ball, T. (2003). From the Blame Game to Accountability in Health Care. Washington DC: Institute of Reseach and Public Policy.

O’Hagan, J., & Persaud, D. (2009, April/June). Creating a Culture of Accountability in Health Care. Retrieved March 27, 2013, from Lippincott’s Nursing Center: https://www.nursingcenter.com/lnc/static?pageid=935642

Portery, T., & Malloch, K. (2010). Quantum Leadership: Advancing Information, Transforming Health Care. Sudbury, Massachusetts, USA: Jones & Bartlett Learning.

Sullivan, E. (2012). Effective Leadership and Management in Nursing: International Edition. Boston: Pearson Education.