Article Review – Page 2 – Best Essay Writers

Use of Chlorhexidine to Prevent Ventilator-associated Pneumonia

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Use of Chlorhexidine to Prevent Ventilator-associated Pneumonia: Research Critique

Introduction

The critical appraisal of articles is an important aspect in promoting evidence based practice. In nursing care, critical analysis is conducted for three major reasons; to broaden the nursing knowledge, to understand the evidence based practice and to improve nurse practice. During the critical appraisal, the nurse is required to evaluate the study findings, and relate their appropriateness in clinical practice. This helps assure delivery if effective and safety care in hospitalized patients and in intensive care unit (ICU).

In this context, this paper critically appraises the following article; Zhang, T., Tang, S. and Fu, L. (2013). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Journal of Clinical Nursing, 23(11-12), pp.1461-1475. doi: 10.1111/jocn.12312. The article’s problem statement, study purpose, research question, literature view and conceptual framework are critiqued.

Problem statement

This article explores the effectiveness of using chlorhexidine to prevent ventilator-associated pneumonia. Ventilator-associated pneumonia (VAP) is pneumonia that develops in people who have medical devices to assist in controlling respirations through tracheostomy and through endotracheal intubation. The risk factors for VAP include reintubation, aspirations, supine positioning, as well as failed subglottic aspirations. However, the most common mechanism for onset of VAP is colonised oropharyngeal secretions. Therefore, reduction in number of the oral microorganisms is important in preventing VAP (Zhang, Tang, and Fu, 2013).

Research indicates that chlorhexidine (CHX) has antimicrobial compound that effectively works against aerobic and anaerobic bacteria. However, the study results of randomised controlled trials (RCTs) findings are inconsistent. Most of the studies have indicated that CHX effectively prevent VAP but Pineda’s research indicates that use of CHX oral decontamination is not significant in reduction of nosocomial pneumonia in patients who had received MV (Pineda et al., 2006).

This indicates that if the use of CHX for oral care in preventing the onset of VAP is still controversial. Therefore, the article explores other published studies (meta-analysis) to determine the efficacy of CHX and to determine the appropriate concentrations as described by RCTs (Zhang et al., 2013).

The significance of the study is derived from the fact that VAP represents the most common nosocomial infection in ventilated patients. It occurs in about 9-27% of intubated patients. VAP is associated with lengthened hospital stay. It is estimated to increase hospital stay by $50,000-57,000 per occurrence. The disease mortality rate is estimated to be 15-45%. Therefore, it is important to establish the most effective strategy to prevent development of VAP in intubated patients (Zhang et al., 2013).

Purpose and Research questions

The author has not clearly stated the purpose of this study, but the purpose is well indicated as the study objectives and aims. The study aim is to determine the effectiveness of chlorhexidine in the prevention of VAP and to evaluate the preferred CHX concentrations for oral decongestants (Zhang et al., 2013).

The study research questions are as follows (Zhang et al., 2013). ;

a) Is CHX effective in reduction and prevention of VAP?

b) What is the preferred CHX concentration that can effectively reduce the rates of VAP pneumonia?

The purpose and research questions are related to the study problem. The qualitative methods are appropriate to answer these questions because it has the capacity to answer inconclusive study questions. This is attributable to the research method ability to identify sources across various types of studies which helps detect biased and unbiased information. Additionally, this method can help stimulate improvements in the data collected in order to optimize care (Zhang et al., 2013).

Literature review

The literature review is summative but conjoined with the introductory part of the paper. The researchers report the findings of other papers as a narrative. The literature review points out the controversial information on the effectiveness of the CHX and the preferred concentrations. The information provided is current and adequate to establish a logical argument. For instance, the study indicates that patients on mechanical ventilation drugs have their mouth wide open to facilitate the insertion of the intubation tube.

This breaks the balance of the oral cavity and production of saliva, which makes it easy for bacterial colonization. The literature also states that the mechanical process of intubation compromises the natural barrier that exists between the trachea and oropharynx, which facilitates the entry of the bacteria into the patient lungs (Zhang et al., 2013). Therefore, oral hygiene during intubation is important factor in the control of VAP in ICU and hospitalized individuals.

The literature review also summarizes the current knowledge relevant to research purpose and research questions that is, effectiveness of CHX in prevention of VAP and the preferred concentrations of CHX that effectively prevent the development of VAP. The authors have utilized both quantitative and qualitative studies that focus on prevention of VAP. The articles used also includes randomized controlled study on adults above 15 years who are receiving oral care with CHX as compared to placebo and standard care (Zhang et al., 2013).

The author has not indicated the weakness of the studies available. The articles used in development of the literature are current which are not older than 5 years. However, the study also evaluates studies that were published earlier to facilitate development of logical argument of the study (Zhang et al., 2013).

Theoretical Framework/ conceptual

The author has not identified specific perspectives in which the study was established. The theoretical framework is not well described, but the article has applied the classic grounded theory to analyse the secondary data collected (Maltby, 2010). The paper draws its conclusion from 18 research papers. The aim of the paper is to explore the various mechanisms for VAP management to identify the effectiveness of CHX.

According to this article, the implementation of effective oral care measures effectively reduces the incidences of VAP. However, the several randomised controlled trials conclusion on the effectiveness of chlorhexidine is controversial. Using the classical grounded theory, secondary data is explored to check if the use of CHX in different concentration will yield different outcome. Using this framework, the previous pre-framed data and small data set from the previous papers is improved by comparing the information (Zhang et al., 2013).

Conclusion

This article provides information that will help improve the delivery of care especially in hospitalized patients. It is important to critically appraise articles which help in identification of knowledge gaps (Burns & Grove, 2011). The article aims at establishing evidence based practice that prevents the development of VAP. The article concludes that VAP, which is the leading cause of mortality and morbidity in hospitalized patients and in ICU, is effectively managed through oral care. The article indicates that CHX can reduce the incidences of VAP. The preferred concentration identified by practice is 0.12%.

References

Burns, N., & Grove, S. (2011). Understanding Nursing Research (5th ed.). Elsevier. ISBN-13: 9781437707502

Maltby, J. (2010). Research methods for nursing and healthcare. Harlow, England: Pearson Education.

Pineda, L. A., Saliba, R.G., & El Solh, A. A .(2006). Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis. Critical Care 10, R35.in Zang et al., (2013). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Journal of Clinical Nursing, 23(11-12), pp.1461-1475

Zhang, T., Tang, S. and Fu, L. (2013). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Journal of Clinical Nursing, 23(11-12), pp.1461-1475. Retrieved from http://eds.b.ebscohost.com/eds/detail/detail?sid=9415ccf3-7260-4097-91b5-822ab962dfbd%40sessionmgr106&vid=0&hid=111&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=23952970&db=cmedm

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Teenage violence in School: Article Review

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Teenage Violence

Forster, M., Grigsby, T. J., Unger, J. B., &Sussman, S. (2015). Associations between gun violence exposure, gang associations, and youth aggression: Implications for prevention and intervention programs. Journal of criminology, 2015.

Summary

Forster, Grigsby, Unger and Sussman (2015) conducted a study that investigated the link between gang association, exposure to neighborhood violence and social self control to incidences of aggression at school. The study collected data from minority youths from three Southeast Los Angeles schools. In the literature review, the authors show that aggression is a serious problem in schools. According to Forster et al (2015), over 600,000 teenagers reported assault related injuries annually, in addition, between 20 and 40 percent of school going students had experienced a bullying incident at school. The literature review also revealed that between 700,000 and 1,000,000 teenagers were members of gangs.

Past studies have shown that exposure and association to gangs, affiliation with delinquent peers, and family processes are indicators of violence perpetration and victimization. To investigate the link between the variables, the study sampled 77 female and 87 male 7^th and 8^th graders in three South Los Angeles middle schools. Questionnaires were used to collect data on substance abuse, demographics, social self-control, and family and peer gang association, neighborhood violence and self-reported aggression.

The study reported that teenagers with high levels of social self-control were less likely to be involved in past week aggressive episodes. Students with friends who were members of gangs reported 91 per cent higher incidents of aggressive episodes. For girls, aggression was 46 per cent higher if the family was affiliated to gangs. Exposure and fear of gun violence also increased the incidence of aggressive episodes by 26 per cent. According to the study, students were most likely to be involved in aggressive incidents if they were male, had friends associated with gangs, and had low levels of social self-control.

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Critique

Forster, Grigsby, Unger and Sussman (2015) is useful study as it explores an area of research where there exist little empirical evidence to link the variables. It is worthwhile to note that the research provides an insightful background on the teenage and school violence. The author then seeks to investigate the factors that lead to high rates of aggression among teenagers and school going students. Unfortunately, the research only sampled 164 students which is a small sample to facilitate the generalization of the results of the study to the general population.

In addition, the study was conducted in only three schools in the South Los Angeles area where gang violence and gun crime is common (Forster et al, 2015). It is obvious that teenage aggression in other areas may be driven by other factors apart from association with gangs and exposure to gun violence. However, the results than link social self-control to lower levels of self-reported aggression can be generalizable to other student populations.

Using self-reported measures is also a major weakness of the study as the students may fail to report honestly on most of the data collected. Observation would have been a better option for collecting the data on past week aggression as opposed to self-reported measures of aggression. Using observation, the researcher would have been able to see and record incidents of aggression rather than hear about them from the participants.

The study rightly concludes that school based interventions can be used to disrupt the development of aggressive behavior. School based programs can help indeed help in the development of social self-control which has an inverse relationship with the development of aggressive behavior.

Application

Forster et al (2015) is a very useful study in research on teenage violence, and associated the associated study areas. The study provides valuable statistics on the state of teenage violence indicating that more than 600,000 school age children report aggression related injuries every year. The study helps to illustrate that teenage violence is a serious problem affecting many school going children and it is an area that warrants further research.

Most importantly, the research identifies some of the factors that are predictors of teenage violence perpetration or victimization. The study reveals that association with gangs and gang members is a contributing factor to aggressiveness among teenagers. Other impacts of gang association such as the tendency to use substances and other truant behaviors can also be investigated in future studies in the area.

The study also reports an inverse relationship between social self-control and incidents of teenage aggression. Further studies also need to be conducted to establish whether self-control can decrease aggression among teenagers who associate with gangs, and have been exposed to gun violence. The study also indicates that self-reported measures of aggression were limitations of the study, and thus another method of data collection like observation can be used for future studies. The study design also provides a research model that can be expanded for future research in the area of teenage truancy and violence.

The research sample for future research on the topic can be expanded to more schools from more heterogeneous school districts to ensure the results can be generalized. Therefore, Forster (2015) is an important research article that provides preliminary evidence linking association with gangs, social self control, and family association with gangs with teenage violence perpetuation. Most importantly, the study establishes several directions for future research in the area.

References

Forster, M., Grigsby, T. J., Unger, J. B., & Sussman, S. (2015). Associations between gun violence exposure, gang associations, and youth aggression: Implications for prevention and intervention programs. Journal of criminology, 2015.

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Motivation Mystery: How to Keep Employees Productive Article Critique

Motivation Mystery: How to Keep Employees Productive

The article “Motivation Mystery: How to Keep Employees Productive” by Patrick Hull is not only an interesting but also an enlightening resource. Inferring from the article, it is apparent that motivating employees in the workplace to ensure that they remain productive is a current pertinent event, which researchers have to address.

Managers have always focused on providing incentives to the employees to keep them motivated, and hence productivity. Among those that have produced the expected outcomes include bonuses, perks, amenities, education, and positive recognition. While these benefits might be optimal, it is of central importance to go well beyond the practice of providing incentives (Hull, 2013). This is especially due to the notion that incentives may not be sustainable. As such, they may change, and this might correspond with a shift in the motivation depicted by the employees.

For example, if the incentives are scaled down, it means that the worker motivation will also decline. In the light of this, while still providing the incentives, it is important to devise another strategy to maintain the employees’ morale. The course that Zappos, which is an online clothing and shoe company based in Las Vegas, is a benchmark model (Hull, 2013). The firm does not provide extraordinary perks for the employees. Instead, the Chief Executive Officer has created a corporate culture that elicits and maintains happiness, and which builds loyalty among the employees.

To conclude, it is perceptible that organizations have to be highly innovative in their employee motivation practices. Not all methods, such as the provision of integrated incentives, can ensure long-term motivation and productivity subsequently. It is suggested that managers should focus on creating a culture that creates happiness and loyalty among the workers.

Reference

Hull, P. (2013). Motivation Mystery: How to Keep Employees Productive. Forbes. Retrieved from www.forbes.com/sites/patrickhull/2013/05/23/motivation-mystery-how-to-keep-employees-productive/#24106dd2f525

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Nurse work environment: Article Critical Analysis

Introduction

Critical appraisal is conducted for 3 main reasons; a) to improve nursing practice, b) to increase nursing knowledge and understanding c) to provide a baseline for the study to be conducted. There is need for thorough understanding of the research study so as to establish the study strengths and weaknesses, and to evaluate the quality if strength of the evidence developed by the study as well as the appropriateness of its use in the reader’s practice.

In this context, this essay is a critical appraisal of the following article; Ma, C., & Park, S. H. (2015). Hospital Magnet status, unit work environment, and pressure ulcers. Journal of Nursing Scholarship, 47(6), 565-573.

Critical analysis

The article introduces the topic in a way that orientates the reader to the subject. It provides the background information using succinct statements. The last sentence of the introduction part is the thesis statement (Creswell, 2014; Jaul, 2013). Pressure ulcers are critical patient issue because they are associated with prolonged hospital stays, increases patient risks for adverse events and increased consumption of the healthcare costs (Cai, Rahman, & Intrator, 2013; Buttaro et al., 2013, p. 304).

Nurses play crucial role in preventing pressure ulcers. However, the degree of patient safety is determined by the nurse work place environment, “The organizational factors in work-environments facilitate or constrain the professional nursing practice” (Ma & Parks, 2015, p. 566). The article evaluates the nursing factors at both the hospital and unit level associated with Hospital acquired pressure ulcers (HAPU).

The research problem and its significance

The research problem in this study is the organization’s factors or nurse work environment that negatively influence patient’s outcome, such as increasing HAPU incidence. “The unit-level work environments have major impact on the nurse work environment” (Ma & Sharks, 2015, p.65). The research problem is a focal point of research. It is well stated in this article and generates questions in which the research study aims to address (Stafford & Brower, 2012, p. 11; Suttipong & Sindhu, 2011, p. 373).

On the other hand, the significance of a study is the rationale of the study. The researcher proves to the audience that the research is vital and worth doing it. For instance, the study indicates that the need to reduce hospital acquired pressure ulcers has gained national attention. “There are approximately 2.5 million pressure ulcers that occur in the USA, and coasts $9.1-11.6 billion (Ma &Sharks, 2015, p. 65).”

The research design and methods

Melnyk & Fineout-Overholt state that research design is the overall strategy chosen by the researcher to integrate different components of the study. It should be constructed in a logical manner to ensure that the researcher effectively address the research problem using the appropriate data collection method and analysis of data. In this context, design includes the study setting, description of the study sample, data collection method and data analysis. This part describes all the instruments used and their rationale; (Melnyk & Fineout-Overholt, 2014; Lewis, 2014).

The research method is used in this article is qualitative. The research design used in this article is the Cross-sectional observational study of data collected from the National Database of Nursing Quality Indicators (NDNQI). This research design is appropriate for this study because it examines the relationship of exposure and outcome in a defined population at one point in time.

In addition, the research design is inexpensive, less time consuming and provides a good but quick picture of prevalence of the research problem and its outcome. Although appropriate for this study, the main issue with this research design lacks time element making it difficult to determine the temporal relationship between the research problem and the outcome of the proposed intervention (Ma & Sharks, 2015, p.567).

Data used in this article was collected from NDNQI. NDNQI is a repository for nursing quality data in the USA that enables the researchers to conduct comparative analysis in order to develop evidence based practices for nursing-sensitive patient practices and outcomes at unit level.

The data collected was supplemented with the NDNQI RN survey, which collected information related to nurse work conditions such as work content, environments and demographics. The total participants for RN survey was 33, 845 from 1,381 units in 373 healthcare facilities in 44 States. The inclusion criteria for this survey were nurses who had spent 50% of their time in general units in the hospital within the last three months.

The researcher also established measures to ensure reliability of the data collected, “To ensure reliability of the aggregated unit measures…… units with RN response rate below 50% were excluded from data analysis (Ma & Sharks, 2015, p.566).”

Data analysis of the collected data was compare the nurse work environments, staffing levels, HAPU rates and the RN skill mix of the NDQI member hospitals. Three multilevel logistic regression models were used to estimate the effect of nurse work environment and healthcare facilities management of HAPU. The data analysis used is appropriate for this nature of the study as it provides conclusive comparative analysis (Ma & Sharks, 2015, p.568).

Findings and their relevance to contemporary nursing policy and practice

The study examined work environments impact on management of HAPU at hospital and unit level. The study findings indicate that improving working environments both at hospital level and unit level results to lower HAPU rates. The data findings presentation in this article is concise and appropriately used non-textual elements such as table summaries and figures to present data findings effectively. The data provided is critical in answering the research question. For instance, Magnet hospital units had 21% low odds of having HAPU as compared to the non-magnet hospital.

There are several limitations noted in this study. To start with, participation of hospitals in NDNQI is voluntary, which indicates overrepresentation or underrepresentation of hospitals with certain characteristics. Secondly, the study omitted some specific information such as ethnicity, socioeconomic status and other co-morbidities that could introduce residual confounding effects. In addition, patient level information in most of quality indicators is limited.

Despite the limitations, the study findings are consistent with the previous studies. The nursing implication of this study is that it improves the understanding of work environments in relation to patient’s outcomes. In this context, the nurse work environment refers to the context in which the nurses provide patient centered care (Guihan et al., 2016, Matsuo, Oie, & Furukawa, 2013).

The quality of care is influenced by the nurse work environment characteristics such as the administrative support, nurse-physician relations and nurse resource adequacy. Effective nurse work environments are established through better communication, team work between the healthcare providers and higher autonomy/practice control.

Nurses in such types of environments are less likely to suffer from burnout or express intent to quit their jobs, but are likely to function efficiently, deliver superior quality of care that ultimately improves patient’s overall outcome (Demarre et al., 2014, p. 392; Singh et al., 2015, p.7; Neilson et al., 2014, p. 21).

Conclusion

The study findings in this study facilitate the understanding the link between organizational environments and the patient outcomes. This study highlights the effectiveness of unit-specific quality improvement initiatives in today’s highly specialized care. This study generates new ideas that will help improve patient safety and quality of care in nursing practice.

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.

Cai, S., Rahman, M., & Intrator, O. (2013). Obesity and Pressure Ulcers Among Nursing Home Residents. Medical Care, 1. http://dx.doi.org/10.1097/mlr.0b013e3182881cb0

Creswell, J. W. (2014). A concise introduction to mixed methods research. Sage Publications.

Demarre, L., Verhaeghe, S., Van Hecke, A., Clays, E., Grypdonck, M., & Beeckman, D. (2014). Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs, 71(2), 391-403. http://dx.doi.org/10.1111/jan.12497

Guihan, M., Murphy, D., Rogers, T., Parachuri, R., SAE Richardson, M., Lee, K., & Bates-Jensen, B. (2016). Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI. The Journal Of Spinal Cord Medicine, 160204031040002. http://dx.doi.org/10.1080/10790268.2015.1114225

Jaul, E. (2013). Cohort study of atypical pressure ulcers development. International Wound Journal, 11(6), 696-700. http://dx.doi.org/10.1111/iwj.12033

Jaul, E. (2014). Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly. Chronic Wound Care Management And Research, 3. http://dx.doi.org/10.2147/cwcmr.s44809

Lewis, R. (2014). Reducing harm from pressure ulcers. Nursing Standard, 29(12), 74-74. http://dx.doi.org/10.7748/ns.29.12.74.s63

Matsuo, M., Oie, S., & Furukawa, H. (2013). Contamination of blood pressure cuffs by methicillin-resistant Staphylococcus aureus and preventive measures. Irish Journal Of Medical Science, 182(4), 707-709. http://dx.doi.org/10.1007/s11845-013-0961-7

Ma, C., & Park, S. H. (2015). Hospital Magnet status, unit work environment, and pressure ulcers. Journal of Nursing Scholarship, 47(6), 565-573.

Melnyk, B., & Fineout-Overholt, E. (2014).Evidence-based practice in nursing & healthcare: A guide to best practice, 3rd Edition. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins

Neilson, J., Avital, L., Willock, J., & Broad, N. (2014). Using a national guideline to prevent and manage pressure ulcers. Nursing Management – UK, 21(2), 18-21

Singh, R., Dhayal, R., Sehgal, P., & Rohilla, R. (2015). To Evaluate Antimicrobial Properties of Platelet Rich Plasma and Source of Colonization in Pressure Ulcers in Spinal Injury Patients. Ulcers, 2015, 1-7. http://dx.doi.org/10.1155/2015/749585

Stafford, A., & Brower, J. (2012). Let’s get comfortable. Nursing Management (Springhouse), 43(9), 10-12. http://dx.doi.org/10.1097/01.numa.0000418777.69056.f7

Suttipong, C., & Sindhu, S. (2011). Predicting factors of pressure ulcers in older Thai stroke patients living in urban communities. Journal Of Clinical Nursing, 21(3-4), 372-379. http://dx.doi.org/10.1111/j.1365-2702.2011.03889.x

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Quality of care: Article Review

Quality of care Article Review

Introduction

The international agencies and national nursing associations acknowledge the fact that unhealthy working conditions affect the quality of care, employee’s health, and are associated with nurse sensitive patient outcomes. In their article “Hospital magnet status, unit work environment and pressure ulcers,” Ma and Park explored the relationship between the RN environment nurse outcomes (job satisfaction, turnover rates and intent to stay) and patient safety outcomes (pressure ulcers, falls, and quality of care).

The article suggests that the hospital administration and nurse leaders should understand the importance of nurse work environments, as it sets the stage for quality care and provides competitive advantage in current’s value driven healthcare system (Ma &Park, 2015).

This essay is a critical analysis of Ma & Park article’s that aims to assess if the information improves nursing practice, increases nursing knowledge and understanding on patient safety. The main topics that will be critically analyzed include the article’s research design, data collection, data analysis, findings, discussion and nursing implication.

The research problem and its significance

Creswell states that a study’s research problem should be described using an approach that orientates the reader to the research subject (Creswell, 2014; Jaul, 2014). The article states that better nurse work environments are associated with lower hospital acquired pressure ulcers. Pressure ulcers are critical patient issue because they are associated with prolonged hospital stays, increases patient risks for adverse events and increased consumption of the healthcare costs (Cai, Rahman, & Intrator, 2013; Buttaro et al., 2013, p. 304).

The study hypothesizes that nurses play crucial role in preventing pressure ulcers. However, the degree of patient safety is determined by the nurse work place environment, “The organizational factors in work-environments facilitate or constrain the professional nursing practice” (Ma & Parks, 2015, p. 566). The article evaluates the nursing factors at both the hospital and unit level associated with Hospital acquired pressure ulcers (HAPU).

The research design and methods

Richardson-Tench and colleagues state that research design is the overall strategy chosen by the researcher to integrate different components of the study. It should be constructed in a logical manner to ensure that the researcher effectively address the research problem using the appropriate data collection and analysis approach (Melnyk & Fineout-Overholt, 2014; Richardson-Tench et al., 2014).

Data used in this article was collected from NDNQI. The data collected was supplemented with the NDNQI RN survey. The total participants for RN survey was 33, 845 from 1,381 units in 373 healthcare facilities in 44 States. The inclusion criteria for this survey were nurses who had spent 50% of their time in general units in the hospital within the last three months. The researcher also established measures to ensure reliability of the data collected (Ma & Sharks, 2015, p.566).

Data analysis of the collected data was analyzed using t tests to compare the nurse work environments, staffing levels, HAPU rates and the RN skill mix of the NDQI member hospitals. Three multilevel logistic regression models were used to estimate the effect of nurse work environment and healthcare facilities management of HAPU. The data analysis used is appropriate for this nature of the study as it provides conclusive comparative analysis (Ma & Sharks, 2015, p.568).

Findings and their relevance to contemporary nursing policy and practice

The study findings indicate that improving working environments both at hospital level and unit level results to lower HAPU rates. The data findings presentation in this article is concise and appropriately used non-textual elements such as table summaries and figures to present data findings effectively. The data provided is critical in answering the research question. For instance, Magnet hospital units had 21% low odds of having HAPU as compared to the non-magnet hospital.

Despite the limitations, the study findings are consistent with the previous studies that better nurse work environments is associated with lower hospital acquired pressure ulcers, lower readmission rated and a higher overall rating. The nursing implication of this study is that it improves the understanding of work environments in relation to patient’s outcomes (Guihan et al., 2016, Matsuo, Oie, & Furukawa, 2013).

Conclusion

Critical appraisal is important process as if facilitates a thorough understanding of the research study in order to establish the study strengths and weaknesses and to evaluate the quality, and if the study’s strength is effective and appropriate for its use in the reader’s practice. This study generates new ideas that will help improve the quality of care and patient safety and quality of care in nursing practice. The study findings in this study facilitate the understanding the link between organizational environments and the patient outcomes. This study highlights the effectiveness of unit-specific quality improvement initiatives in today’s highly specialized care.

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.

Cai, S., Rahman, M., & Intrator, O. (2013). Obesity and Pressure Ulcers Among Nursing Home Residents. Medical Care, 1. http://dx.doi.org/10.1097/mlr.0b013e3182881cb0

Creswell, J. W. (2014). A concise introduction to mixed methods research. Sage Publications.

Ma, C., & Park, S. H. (2015). Hospital Magnet status, unit work environment, and pressure ulcers. Journal of Nursing Scholarship, 47(6), 565-573.

Melnyk, B., & Fineout-Overholt, E. (2014).Evidence-based practice in nursing & healthcare: A guide to best practice, 3rd Edition. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins

Neilson, J., Avital, L., Willock, J., & Broad, N. (2014). Using a national guideline to prevent and manage pressure ulcers. Nursing Management – UK, 21(2), 18-21

Richardson-Tench, M., Taylor, B., Kermode, S., & Roberts, K. (2014). Research in nursing: Evidence for best practice (5th ed.). Cengage Learning Australia: South Melbourne.

Stafford, A., & Brower, J. (2012). LetÊ¼s get comfortable. Nursing Management (Springhouse), 43(9), 10-12. http://dx.doi.org/10.1097/01.numa.0000418777.69056.f7

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Comedy of Euros Article Essa

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Comedy of Euros

This article reflects the falling out of Britain with other members in the European Union. The depth of this crisis is explained. Various strategies of mending the solutions are proposed. Achievements of the Brussels summit are addressed and its failure to draw a plan for saving the Euro.

Why is this newsworthy?

Comedy of Euros

The European Union is a key economic pillar and represents the economy of many nations .A crisis in this union is bound to affect the people as the economy will suffer. For this reason this story has a huge impact on the financial backgrounds of citizens in the member nation’s .It is therefore important to follow the preceding of the story in order for the readers to make any preparation to protect their financial assets

Current financial information is newsworthy as it impacts business and people’s daily way of life. It is therefore important to keep abreast with business information across the globe by reading this financial news. The information is provide in a summarized nature helping to inform readers who do not have a significant background in business related topics.

The European union have a major impact on the economy of the globe and any news that describes changes taking place in the business environment are beneficial to different stakeholders across the global .Through these news major decisions are made that impact the economy of different countries .The story contains a detailed analysis of new ranging from economic, financial, business news across the globe .These news analyze the market trends across the globe and the drivers of these trends (economist , pg1).

A visual showing the Euro

Commodities Lose Allure; As demand from the Asian giant cools, investors should seek more exotic plays

This article discusses the various prices of commodities .Investor options are also evaluated in this article .A comparison of prices of gold and rare earth metals is made. An interview with industry players is also contained in the article.

How might readers use this information? Comedy of Euros

Business news contained in these financial magazines is vital as affects the decisions made by leaders from the various governments and businesses .Readers can therefore use the information acquired in various ways aimed at improving their economic status. The magazines contain news of models used by businessmen and governments across the globe in reduction of operation costs methods that the readers can use in their businesses (Wsj, pg1).

Readers are able to acquire information about the pricing of different shares and other financial instruments across the globe .They can therefore use the information acquired in making business decisions on whether to invest or divest their funds .This is usually easy as the magazines include a detailed analysis with various share price options from which the readers can make their decisions.

Readers can use the information acquired from these business magazines to make a decision on the performance of their leaders. The magazines contain various decisions that governments have implemented to growth their economies and the impact of these decisions. From this information the readers can judge on whether their leaders are implementing policies that have a positive effect on the economy and make decisions on whether to re elect them for office again (Wsj, pg1).

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Readers can use this information in making decisions on whether it is viable to invest in other countries .The magazines provide information of different markets across the globe. Readers can therefore use this information to tap on cheap production costs and availability of natural resources in the different countries .The readers can therefore follow business happening across the globe waiting for positive changes that may affect their business and capitalize on them .

A visual comparison of rare-earth metal prices vs. gold Comedy of Euros

A Rare Apple Compromise

Apple has been faced by tough competition. The company is softening its advertising strategies due to the rising competition .The article describe the strategies put in place by management to survive. Conversation with employees is also included.

What management decisions are involved?

Due to challenges faced in advertising Apple Inc has been forced to make management decisions aimed at ensuring the company is able to compete effectively. The management introduced the selling of advertisements within mobile applications. This has been a major decision aimed at increasing its income through advertising .The strategy was developed to compete with Google’s Admob service .This has been however difficult due to the pricing of the products as apple has introduced the product at a very high prices as compared to its competitors (Wsj, pg 5).

To counter changes in advertising the management has developed a strategy aimed at introducing flexibility in the prices of its products .This strategy will help increase Apple’s market share thereby driving its revenue upwards. The change in price represents the management bargain in compromising its business decisions by adjusting its prices to the match with the current market changes.

Management decisions have the effect of growing or destroying an organization. It is therefore important for managers to make decisions that are timely and accurate. These decisions can only be made where information is provided timely and is accurate.

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Management is involved in implementing key strategies as well developing concepts that will steer the company towards achievement of its goals and objectives.

A visual showing Apple’s positioning the market Comedy of Euros

Best Buy’s Profit Tumbles

Best buy is a leading electronics dealer .With immerses competition the company has been forced to make different strategies to survive. The article describes the strategies put in place and the financial results for the company .The impact of results may have different repercussions depending on their nature.

How might this affect stock prices?

Any information that is made available to the public domain whether positive or negative has an effect on the share price of stocks of a company. Negative information like decline of its profits may result to shareholders going into a panic and selling their shares. Negative information is associated with a declining value thus when a company posts negative results the news are bound to cause fluctuations in the stock market.

Company results are announced in their annual general meting with a report from the management explaining the reasons behind a company’s performance .Readers of the magazine are going to be influenced in making decisions regarding the shares of the company. Some readers may be tempted to purchase shares for speculative purposes where the will be aiming to make a profit should the price of the shares increase in the future .

Current share holders may dispose of their shares after reading this article in an attempt to minimize further loss in their investment in the stock market. The new may resulted to increase trading of the shares in the market as the demand from speculators is satisfied by suppliers who want to minimize their risks (Wsj, pg1).

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It is therefore evident that news of a decline or rise of a company’s profits has an effect on its share prices .Readers should therefore seek regular accurate information on company’s that they have an interest or are interested in to ensure they take full benefit of any information regarding the company .

A visual showing changes in share prices

Explaining high oil prices

Oil is a key driver of the economy in the world. The rapid rises in prices of oil has had major impact on different industries .It is therefore important to analyze the reasons behind prices increases. This article helps in explaining the key factors that have resulted in high prices

What are the risks and rewards involved?

The oil is a very risky industry due to the commodity involved .An accident arising in the oil industry may have hazardous effects and therefore the industry players must put in place measures to ensure there is minimal expose to risks .This will be achieved by the method used in handling oil and its related products .The methods used must ensure easy reconciliation of inventory .Oil leakage equipment must be set up to ensure the staff involved as well as other equipment are not damaged(Wsj, pg1).

High prices in oil will result in an increase in prices of other commodities .This will strain economies of countries across the globe as they depend on the oil industry to drive other industries .It is therefore important to make a detailed analysis on factors affecting the prices of oil. Political factors are the most causes of increase in the price of oil and their impact should be regulated to ensure they do not adversely affect economy of major countries across the globe.

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The rewards associated wit monitoring the price of oil is an increase in the growth and development of economies across the globe .Fair oil prices result in countries being able to develop their economy through increased investment in various industries.

A visual showing oil prices

Capping microfinance interest rates will hurt the poor. There are better ways to regulate the industry

This is a microfinance article on interest rates. Various ways of regulating the industry are explained .Microfinance in different areas is explained .The reasons behind the rapid development of the micro credit industry are explained

How does a visual improve understanding of the content?

The visual helps the reader to relate to the content of the article. The visual in this article showing currency notes .This will help identify the content of the article. The visual clearly depicts a financial content .Microfinance is mostly related to the poor communities and capping interest rates would affect their economic empowerment

The bank notes help the reader in analyzing the content provided in the article. These visual involve a mixture of different colors helping the reader to distinguish the difference in different data that is contained in the article. This helps them in analyzing what each color has been used to depict in the visual (Wsj, pg2).

Visuals help give content to the article in the magazines by providing readers with an outlook of all the key data that has been included. These helps the readers in understanding the articles through the summary presented in the visuals and help them in making informed decisions derived from a thorough analysis of the visuals

The visual must be placed in an appropriate area of the article where it stands out in making a detailed summary of every data that is in the article. It is therefore important for business related magazines to consider using a visual in their articles to help the readers in understanding the articles fully. The visual should therefore be as detailed as possible but should not include irrelevant information.

Visuals must be clear and price in order for it to achieve its intended objects .it must also be bold and colored so as to attract a reader’s attention. (Lam, pg5). Visual is important as it helps in summarizing the key data provided in the information .This visual is provided in form of tables and graphs and contains trends that the reader can easily relate to .The visuals are presented in a manner that helps attract the reader’s attention helping them to get the clear meaning of the articles.

A visual on the article

References

Lam, J .Enterprise Risk Management: From Incentives to Controls. Hoboken, New Jersey: Wiley. 2003, Pg 1-5

Online.wsj.com Where to Invest 2012 13.Dec 2011 <http://online.wsj.com/article/SB10001424052970204630904577055673093626632.html?link=SM_inv_mr_res>

Online.wsj.com, Commodities Lose Allure 13.Dec 2011 <http://online.wsj.com/article/SB10001424052970204630904577055673093626632.html?link=SM_inv_mr_res>

Online.wsj.com A Rare Apple Compromise 13.Dec 2011 <http://online.wsj.com/article/SB10001424052970204336104577094872512502942.html?mod=WSJ_hp_LEFTWhatsNewsCollection>

Online.wsj.com Best Buy’s Profit Tumbles 13.Dec 2011 <http://online.wsj.com/article/SB10001424052970203518404577096160252527328.html?mod=WSJ_business_whatsNews>

Online.wsj.com .Explaining High Oil Prices 13.Dec 2011The U.S. economy is no longer what’s driving the market >http://online.wsj.com/article/SB10001424052970203833104577072301052759854.html?mod=WSJ_hpp_MIDDLE_Video_Top>

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Good parenting

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Good parenting

Psychology Article Analysis: Good parenting heals your child’s brain

Psychology Article Analysis: Good parenting heals your child’s brain

The article ‘Good parenting heals your child’s brain,’ was written by Armin Brott and posted on hitched magazine on 21^st January, 2014. It can be obtained through the following link; http://www.hitchedmag.com/article.php?id=1765

Good parenting

Main ideas

Children who grow up in institutions as opposed to with their families have cardinal brain development deficits, similar to children who grew up in poverty. Poverty brings about stress that result to damaged DNA and cells, poor immune system function, and inflammation. Orphans in institutions possess more neurological and behavioral deficits compared to those who lived in family (Brott, 2014).

At the age of for and half years, more than forty percent of the orphans had anxiety disorders while four percent had critical depressive disorders. In addition, many orphans exhibited autism signs including stereotyping and repetitive behaviors (arm-flapping and rocking).

Good parenting

Children living in institutions possess less white and gray matter (this matter connects various brain regions) compared to those in foster homes or living with their families. In addition, they have smaller amygdala and hippocampus that are vital for memory, learning, and emotion (Brott, 2014). Reduced white matter is common in a majority of the psychiatric and neurological conditions such as ADHD, schizophrenia, and autism.

A developmental neuroscientist explained that the less white matter meant less brain electrical activity- ‘alpha power’. These brain differences were accountable for the behavioral variations in the different groups of children- higher levels of anxiety and depression disorders in children in institutions (Brott, 2014). Children in foster homes and institutions had higher levels of oppositional defiant behavior and ADHD.

This gives the implication that children are placed in foster homes too late after profound deprivations had been experienced. Children can never recover from early-life isolation and the social deprivation is devastating. The environment in a child’s life between 0-5 years is vital for their future.

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Good parenting heals your child’s brain

Article’s purpose

The article aims at creating awareness that poverty leads to children’s stunted brain growth. However, research indicates that good parenting reverses these impacts (Brott, 2014). Therefore, there is a need for families (particularly parents) to raise their own children and avoid leaving that responsibility to the community and other people. In addition, the brain requires stimulation for development and growth.

The field of psychology explained

Autism experts, behavioralists, and developmental neuroscientists have a key role in ensuring a community with healthy people (Brott, 2014).

Analysis

Viewpoint

The article’s viewpoint is that there is a need for enriched environments during childhood and infancy. Social deprivation is the reason why children living in institutions have higher levels of anxiety and depression disorders.

Reasonable information

The article offers reasonable information owing to the fact that the information was obtained from credible researches.

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Is the information believable?

The information is believable since the parents were assessed keenly before the report was written. The information has also been cross examined.

Persuasiveness

The article persuades parents to practice good parenting as this plays a great role in ensuring healthy and productive children.

Information that can be added

The study should have elaborated what factors in the different environments contributed to altered brain function and structure.

Good parenting heals your child’s brain

Reference

Brott, A. (2014). Good parenting heals your child’s brain. Retrieved on 21^st January, 2014 from http://www.hitchedmag.com/article.php?id=1765

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