Beavers System Model: Movie Review

Beavers System Model
Beavers System Model

Beavers System Model

Introduction

 Similar to writing, film uses techniques with the aim of eliciting different response from their audiences. The movie is designed such that they produce specific effect on as intended on their audiences. “Remember the Titans (2000)” is a great film directed by Boaz Yakin. The movie is not only entertaining but also helps one to understand the characteristics and behaviors of a family, as well as its dynamics.  This paper conducts a family assessment on Coach Boone family.

Movie setting and story

This is a movie based on real life events racial discrimination that prevailed in the early 1970’s. The settings take place in a small town in Virginia. During the desegregation of high school in 1971 saw an African American head coach – Herman Boone be hired at the T.C. Williams High School as the lead coach of the School’s football team. He is assigned to work under Bill Yoast- the current coach nominated for Virginia School Hall of Fame (IMDb, 2000).

During the training camp, the football players (black and white) would clash frequently in racially motivated conflicts. However, forceful coaching and rigorous training by Coach Boone including a run early in the morning to the Gettysburg cemetery and motivational talk; the team learns to understand one another. Throughout the training season, Boone and Yoast mixed race football players learns to accept one another and to work together because football knows no race. 

Their coaches learn from them and in turn the whole team understands the importance of family. Consequently, the team prepares adequately to pursue the State Championship and to deal with all unthinkable tragedy that would threaten their capacity to perfect their team (IMDb, 2000).

 After returning from football camp, the school board informs Coach Boone that if he loses even one game, he would be dismissed with immediate effect. Fortunately, the Titans go throughout the season as champions and succeed in fighting racial prejudice simultaneously. However, the chairman of the school board informs Coach Yoast that he would be inducted in hall of fame if he helps titan’s loose one game. 

This implied that school board wanted to dismiss Boone because of his race.  During the game, the referees are shown to be biased towards the Titans. The satisfaction on the school board faces makes Yoast to threaten them that he will expose their scandal unless the referees would officiate the game fairly. The teams win, which makes Yoast loose his candidacy for induction.

When celebrating the victory, Bertier becomes injured severely in a car accident. He remains paralyzed the rest of his life but still continues to support the Titans. He goes ahead and wins a gold medal in shot put in Paralympics games. A decade later, Bertier dies in another automobile accident. His family, teammates and coaches reunites and attend his funeral as one big family (IMDb, 2000).

 Assessment of movie family

The movie assessed from this movie is Coach Herman Boone. She has a wife (Carol Boone and two daughters (Nicky and Karen). In reference to socio-cultural process, there is increased desegregation of the society based on racial differences. However, Coach Boone tries to unite his family so that they can be culturally competent enough to fight racial prejudice that prevailed in the 1970s. He even gives a motivational talk to empower his children to make them understand the importance of remaining united and as a family even during challenges (IMDb, 2000).

Initially, the movie setting or environment is not peaceful. There are increased incidences of racial prejudice to an extent that the school board wants to dismiss Coach Boone due to his race. Later, the Titans help in uniting his family and the entire community by developing friendship and teamwork beyond their racial identities, and in overcoming the obstacles (IMDb, 2000).

 There is effective communication within his family. They listen to Coach Boone motivational talk, and his instructions about understanding one another irrespective of their values and beliefs differences. 

Decisions regarding the family are made by Coach Boone. However, occasionally he gets advice from his wife, friends and coach Yoast.

Coach Boone takes his father role seriously throughout the movie and tries to remain an influential leader as much as possible. For instance, he pushes his family to work as hard as possible thereby making them a champion.  His wife Carol embraces her   role effectively by supporting his husband battle racial prejudice (IMDb, 2000).

Coach Boone and his wife are able to unite their family members. They are able to make their daughters to develop love and respect as their core family value.

The family dynamics of socialization revolves around the racial segregated community, desegregated community and the love between the neighbors and friends. For instance, the community shows empathy, respect and love when they congregate to bid the final farewell to one of the Titans member (IMDb, 2000).

Although Coach Boone struggled to make the family to be as normal as other family, he helped them to adapt into their new environments and learn to respect each other’s opinions. Although it was challenging at first, Coach Boone motivational talks with his daughters made them to adapt and co-exist with ease, which was spread across the community (IMDb, 2000).

 Comparison to Beavers System Model

 Beavers system Model is used to assess family competence based on the following concepts (Beavers and Hampson, 2000);

  1. Family structure: Coach Boone is perceived by his commitment to his team and the indistinct boundaries with each of the team members irrespective of their socio-cultural background.
  2. Mythology of the family varies from congruent to incongruent. They had conflicting communication but always reached for an understanding.
  3. Goal –directed negotiations are witnessed when the family re-strategizes their values and loyalty to accommodate their differences so that they could support their father to help the Titans to take the States Championship.
  4. Autonomy is not well witnessed in the movie, but each member of the family members accepted their responsibility.
  5. Family affect is witnessed by the expression of love, respect and care for one another.

 Summary and conclusion

 This is one of the most influential tasks. It is important to take time and assess family structure and styles so as to effectively develop and appropriate care plan. Getting to understand the family and the role they play in treatment manage helps the healthcare provider to develop patient centered care and to effectively assess the strengths and barriers that determines the family’s health status.

References

Beavers, R., and Hampson, R. (2000). The Beavers systems model of family functioning. Journal of family therapy 22(2), 128-143

IMDb. (2000). Remember the Titans. Retrieved from http://www.imdb.com/character/ch0010206/

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Five Year Trajectory Plan

five year trajectory plan
Five Year Trajectory Plan

Five Year Trajectory Plan

Introduction

            The need for a trajectory plan cannot be ignored in the life of a nurse. This is based on the fact that it ensures that goals are set to guide the career path. Despite the career path chosen by a nurse, there is a great need to have this plan, both on a short- and long-term basis, and revise it regularly so that appropriate adjustments can be made. For a novice advanced practice nurse intending to transit successfully to a professional informatics role and specialize in the same, the trajectory plan can help to a very great extent.

Purpose statement; for me to be able to transition properly to the informatics nurse specialist role, being very dynamic and focused can promote efficiency.

The plan

            As a nurse I possess some strengths that have enabled me practice effectively with time, as well as ensure positive outcomes at the work environment and for the patients. I possess strong communication skills and I can manage applying problem solving skills to different scenarios to solve practice issues. Whenever offering care, I use the patient-centered or individualized approach, that enables me assess the personal factors contributing to the state of health.

I have strong critical analysis and judgment skills, and I normally apply the various ethical frameworks and code of practice, as well as the professional standards when offering care. This enables me practice based on the requirement. To develop as the informatics nurse specialist, I would need to be more computer competent and be more knowledgeable about the various technologies (Robin, Xavier & Agrawal, 2016). My coordination and time management skills would also need to improve so that I would not cause delays and inconvenience other multidisciplinary team members.

            As an informatics nurse specialist, I can easily become a nurse educator or nursing administrator. In case I intend to concentrate on information technology, then I would easily become an information technology nursing advocate or even a chief information officer. At the same time, I would be acting as the bridge between information technology and the clinical universe spheres. Therefore, both professional growth and career opportunities are immense in this role (Robin, Xavier & Agrawal, 2016). Other related specialties include consumer needs consultant, research nurse or public health nurse.

            The talents and strengths that I would need to focus on so as to be highly competent in the role include decision making and judgment. This would enable me choose appropriate actions considering the relative benefits and costs. Moreover, critical thinking, active listening, and reading comprehension would enable me remain highly relevant to the needs of my patients. At the same time, the complex problem solving skills would need to be emphasized. Monitoring and assessing performance would enable uptake of proper actions at all times.

            Additional skills and knowledge would also help. One of these is instructing, that is, teaching others on how they can do different things. Technology design would enable me adapt and generate technology and equipment to the server user needs. At times, it would be necessary to apply mathematics in solving problems, making this a very essential skill.

The coordination skills would greatly help me to adjust actions based on the actions of other people. With negotiation skills, I can easily manage personnel resources by directing, developing, and motivating people as they carry out their various roles. These skills and knowledge are indispensable in enabling me function appropriately as an informatics nurse specialist (Nelson & Staggers, 2013). 

            One of the strategies for promoting a successful transition would be reading and attending trainings where I would learn more about the role and what it requires to be effective in it. While acquiring the different knowledge and skills, I would visualize myself in the role and begin practicing while applying these. The second strategies would be talking to people who are already practicing as informatics nurse specialists.

This would be done with the aim of ensuring that all the challenges they face are highlighted so that while getting into the practice, I can know what to expect. The essentials would also be highlighted, making me prepare my mind effectively so as to be effective (Robin, Xavier & Agrawal, 2016). Apart from attending trainings, I would also carry out personal researches to know how the experiences of people has been. At the start of my role as an informatics nurse specialist, I would work alongside a more experienced person who can guide and orient me accordingly.

            Within the next 2 or 5 years, I intend to join a network of informatics nurse specialists, either online or at the workplace. this will enable me remain connected and be conversant with all the issues that are coming up and how to address them. I intend to contribute actively in the network and in case there is none at the moment, I can create an online group. I also intend to have explored one or more of the career growth and advancement opportunities I have.

I am really interested in being a nurse education, as this will enable me transfer  the immense knowledge and skills I have to others (Fitzpatrick & Ea, 2012). While doing this, I will also be learning a lot. At the same time, I intend to explore the research nurse role, where based on the issues that are being raised by the nurses I am educating, I can conduct some researches. This would enable me transform the practice and promote the uptake of the evidence-based practice.

            To achieve these goals, I intend to manage my time very well. On a daily basis, I will have a list of the most important things I should do and ensure that procrastinating is avoided. Through proper time management, I will have adequate time to do many of the things I intend to engage in, as well as assist my colleagues (Fitzpatrick & Ea, 2012). 

The second action will be ensuring that I am focusing on efficiency and keeping away from errors. This will greatly prevent a  situation where the errors can make me keep going back, which would mean wasting a lot of time. at the same time, the need for a proper work-life balance cannot be ignored. This will constitute of ensuring that work time is dedicated to work while personal issues and family have their time.

Conclusion

            The trajectory plan above can greatly promote success as an informatics nurse specialist. It is apparent that there are career growth opportunities with this role, and proper time management and planning can greatly promote success. Moreover, coordinating with others through networks can promote acquisition of knowledge. More importantly, efficiency would ensure that errors are avoided, which would prevent time wasting.

References

Fitzpatrick, J. J., & Ea, E. E. (2012). 201 careers in nursing. New York, NY: Springer.

Nelson, R., & Staggers, N. (2013). Health informatics: An interprofessional approach. New York, NY: Springer.

Robin, M., Xavier, T., & Agrawal, D. (2016). Use of Nurses in Tele-Consultation for Patients in Remote Areas. Studies in Health Technology and Informatics, 225, 113-7.

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THE HANGING STRANGER: Story Analysis

THE HANGING STRANGER
THE HANGING STRANGER

THE HANGING STRANGER

PART ONE

Outline.

Foremost, one can argue that the ultimate goal of every human being is to thrive and live in a free world where their activities are not controlled or even restricted by some form of authority. However, every person has interests and needs that would often differ from another person’s. This means that conflicts are bound to happen when each person wants to take a different path that would eventually lead to a satisfaction of their endeavors.

Naturally, human beings are dependent on each other for survival (Qizilbash, 2014). For example, if a person has capital to start up a business, they will need workers to run the day to day operations of the business. Equally, human beings depend on the same resources to achieve different ends.

For instance, one person may use land to cultivate crop and another person may opt to use the same land for real estate development. In the same token, when a person acquires property, he naturally expects that another person would respect such property and refrain from trespassing or unwanted interference in its usage and vice-versa.

From the aforementioned examples, then it is evident that society generally is a unit that is modeled on the aspect of mutual co-existence. These sprouts up the concept of rules and regulations that are meant to guide the conduct of the people. These rules are often based on norms and acceptable codes of behavior supplemented by sanctions and punishments for any violation that may result (Urmonas & Naciscionis, 2016).

However, not all rules may be good for society but the authorities in charge of enforcing these rules may initiate manipulative ways to blind the people to presume the rules to be good. Take for instance a rule that requires one to kill another for trespassing in his property. Such an action may be justified but is it justifiable that another person’s life has been lost.

Thus, when one chooses not to adhere to the set rules, then such a person is presumed to be a crook deserving harsh punishment so as to conform to the set rules. In doing this, violent or even negative consequences may emerge all in bid to try and transform such a person to conform to the crude system.

PART TWO

Concisely, the story about the hanging stranger describes a society that has been indoctrinated into believing that certain acts are ordinary. These acts, from a reasonable man point of view should be nerve-wracking such that they demand proper action to be taken but it is not the case in our given story. Ordinarily, one would expect that if a dead man is found hanging in a lamppost, then the authorities would be informed and conduct immediate investigations on the same.

Nonetheless, the story depicts that even in such a crooked situation; there will be always one or two sane people that would see the problem. However, this means that pointing out such a problem would paint a person as an outlaw. This is the situation that Loyce finds himself in. Hence, in such a state, Loyce must first protect himself from being trapped in the same situation and livelihood as the others but this means that the concerned authorities will do everything possible to make sure he abides by the same rules and way of life. His life and that of his family is thus in danger.

In the story, Loyce is characterized as an ordinary person going about his everyday life. However, owing to the change of events his life suddenly turns into turmoil. Foremost, such a characterization portrays the picture that laws in the society seemingly affect the normal person on the street. Similarly, the residents of the town who are characterized as ordinary people represent a different role in the story of having accepted the codes of the corrupted system.

Therefore, by making a comparison of the two characters, then one is able to clearly see the variation of what ought to be right and what is wrong. Thus, when Loyce notices that a dead man is hanging from a lamppost and none of the other people is worried, then it makes him an outlaw that must face consequences of not following the established code.

As portrayed in the story, the rot in the society begins from the highest authorities. Considering these are the people with the power over the society, then whatever they propose or impose would be deemed to be right. Thus, if anybody objects to the same, they will take action which in the eyes of the other societal members will be taken as appropriate.

Undisputedly, rules require that a person be of a certain character in order to be accepted in the society. When this does not happen like in the case of Loyce, then negative consequences may emerge. For instance, Loyce is forced to move out of his home. Equally, when a person does not share in the same rules, views and opinions as the majority members in the society, it essentially means that there deferring personality would not be taken friendly. Hence, to contain ones behavior, it will take more than the use of rules. This means that force or even harm to the person may be used.

Importantly, the main aim of rules within the society is to limit or prevent the occurrence of conflicts. This means that every person must obey the rules imposed without question. Raising an alarm on any of such rules would mean one is corrupting the minds of the people following such a system and this could potentially lead to a revolution. For instance, when Loyce noticed that all the people were not worried about a body hanging from a lamppost; it hit him that they had been corrupted by the system.

The body was there to act as a bait to expose anyone that reacted to it because that was what any sensible man was expected to do. Such a reaction meant Loyce was a potential threat to the system as he was bound to lead to a struggle between him and the authorities thus endangering his life as afterwards he was attacked by a creature while in his house (Philip, 2015).

To conclude, it is averred that regardless of existence systems that indorse rules within the society that are bound to raise insurgencies for their violations, such rules can be defeated in the long run because they do not get to everybody. But these exceptional people must fight against such systems and take firm stands.

References

Philip K. Dick (Jan 29, 2017). The Hanging Stranger. American Literature. Retrieved from

https://americanliterature.com/author/philip-k-dick/short-story/the-hanging-stranger

Qizilbash, M (2014). Are modern philosophical accounts of well-being excessively ‘individualistic’? International Review of Economics, 61(2), 173-189.  http://dx.doi.org/10.1007/s12232-014-0204-x     

Urmonas, A., Dr soc, & Naciscionis, J., Dr iur (2016). SOURCES OF ADMINISTRATIVE LAW IN LITHUANIA AND LATVIA. Acta prosperitatis (7), 153-170, 174. Retrieved from https://search.proquest.com/docview/1864520138?accountid=4049

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Implementation Plan, Strategic Controls, and Contingency Plan Analysis

Implementation Plan, Strategic Controls, and Contingency Plan Analysis
Implementation Plan, Strategic Controls, and Contingency Plan Analysis
Strategic Plan: Implementation Plan, Strategic Controls, and Contingency Plan Analysis

Introduction

Netgear is a global American networking company dealing with delivery of goods to service providers, businesses and consumers. The company engages in three different business segments including commercial, retail, and service provider. Most of its products are proven technologies including Ethernet, power line and wireless-Wi-Fi. The products distributed by the company are usually reliable and easy to use. The company has over 28,000 retail shops all over the world with its headquarters in San Jose, Calif (Mandy, 2015).

Implementation, strategic controls, and contingency plan

Netgear requires new methods of growth, revenue sources, and product distribution. The implementation plan will identify the best course of action that will steer the business forward including, set objectives action plans, milestones, task and task ownership, resource allocation and tactics. Financial projection with breakeven analysis chart is included in the implementation plan.

The strategic implementation plan is essential because it gives the company as the sense of direction that will lead to its success. An implementation is a strategic option where it gives reasons to draw closer to customers, get a competitive advantage and pursue growth within the organization. It helps in setting dimensions to be followed to achieve the desired outcome (Mandy, 2015).

Planning is the first step in implementing a strategy.  This involves contracting the advertising company for them to run the advert. Communicating the change to employees is an important step to ensure that they fully understand what is going on in the organization. Motivating employee especially those that will be involved will ensure the success of the plan. The management of workload that come with change will ensure that employee is not overwhelmed by contracting external resources to assist with other activities especially the advertising company (Mandy, 2015).

Objectives

Objectives, as describe by many authors, refer to measurable, achievable outcomes that are meant to be reached in less or within one year. Goals are usually simple to be easily communicated to all employees from those in top management to those at the lower level. Short term objectives enable those responsible for the company desired needs to break down long-term needs and make them a reality (Mandy, 2015).

Goals are usually broken down into time frames typically from weeks, months, to below one year. Netgear primary objective will be to grow its pool of customer to ensure the increase in sales, maintain customers already in the system by coming up with more reward systems to provide revenue increase and overall growth. The marketing campaign includes giving incentives and rewards to get more clients and to maintain those already in the system (Peter & David, 2014).

Functional Tactics

Functional tactics are statements detailed with activities that the company will use to achieve its short term goals while establishing a competitive advantage.  The key activities that to be undertaken in each area include; marketing, finance, and operations that will give the company opportunity to provide services to its clients. Within the organization, corporate managers, business managers, and functional must all agree to come up with a unified strategy and functional tactics that will lead to the achievement of organizational goals (Mandy, 2015).

Outsourcing

Implementation process would then be followed by the outsourcing of different services. Outsourcing is the process of assigning certain jobs traditionally handled by company employees to outside source to take care of it.  Outsourcing services is a strategy applied by most companies to help save money and time. Netgear will outsource the services of the best advertising company for them to market our products and services to reach our target audience (Mandy, 2015).

Policies

Policies give guidance to employees on action to be taken that will benefit the organization. Netgear Company, therefore, needs to establish a set of policies that will drive the implementation of the strategy designed. Systems usually control the actions of employees and assigning the right personnel to the task and coming up with strategies that will be used should a problem arise during the implementation process. Policies help the organization to have a clear line of operations through assigning the right employees to take up the job. The set policies include giving Netgear employees actions that are expected to be done by them to ensure the success of set objectives (Mandy, 2015).

Compensation

Payment plans are used to reward employees for their good deeds or for going an extra mile to do tasks assigned to them. This happens when the company set policies to be followed by employees and those who follow them are rewarded for their actions. Netgear Company seeking to improve its overall sales will give incentives and commissions to employees who meet targets given to them as a measure to encourage everyone within the organization to go an extra mile to improve the company sales hence boosting revenue (Peter & David, 2014).

Marketing Operations

Netgear Company will resort both to internal and external marketing to promote products and increase its overall revenue. The main aim of marketing will be to get the customers to know about us and to gain their trust through providing quality services. Marketing activities will be done through TV advertisement and social media platform to ensure broad audience coverage. Those in the company front end will also be encouraged to speak freely with walk-in customers to tell others about Netgear product and services (Peter & David, 2014).

Action items

Action plans are processes carried out within or outside the organization to achieve set strategic goals. Netgear strategic goals are focused on revenue growth, increased sales and marketing activities. Action plans aim at getting customers to trust us more than our competition to ensure their continued support.  Contracting an external company to brand our advertisement will be the next step in our action plan. Company employees will also be trained on our new marketing strategies to make them equipped with the knowledge to explain to customers about our new and improved products and services (Mandy, 2015).

Milestones

Milestones are objectives set by a business at a particular span of time assess its achievements. Milestones play a role in reducing investor risks regarding marketing activities, reward systems and time. Netgear corporation marketing segments will be for a span of six months at most depending on the amount to be used on a daily basis and the money quoted by the advertising company. However internal marketing will be carried out up to ten months. After all the general activities the company will then assess the impact of both internal and external marketing to determine if it was a success (Mbaidheen & Alawneh, 2017).

Task and Task ownership

Advertising Company will design the advert and to run it on TV and social media. Front end employees will be trained to equip them with skills that improve business sales. Those assigned with tasks will foresee that it’s complete as they are rewarded (George & Yimin, 2017).

Resource allocation

Netgear Corporation will allocate enough funds to meet its advertising needs and rewards for performing employees. Training of employees to give them required skills will be budgeted for.

Implementation

Successful implementation will be possible through following the set objectives and tactics. The plan will involve looking into the long term strategies and breaking them into manageable short-term goals, functional tactics, Marketing, outsourcing, setting policies and compensation. Following the plan of contracting an advertising company and training internal employees will increase our sales and ensure business growth (Mbaidheen & Alawneh, 2017).

The process of implementation

All the key employees will be engaged or included in the plan and the process of implementing change. Different employees will be assigned specific tasks to work on. They will provide their insights, their fears, challenges and concerns. The next step will be to communicate to them the strategic implementation that the company will be undertaking to make them understand and to feel to be part of the decision. The last step will be to implement the changes once everyone is on board. That is running the advert both with the advertising company and with the help of front end employees.

Risk Management

Netgear Corporation will select the best advertising agency to develop the advert that will ensure growth or increase our customers. Once the advert has been rolled out its impact will be analyzed based on growth of customers immediately and over a period of time. Three month into running the advert; it it’s not successful then the company will reconsider its other option of using internet advertisement.

The verification of strategy effectiveness will be analyzed based on response collected from customers.  The marketing strategy will possibly work because of Netgear competitive advantage of having a global brand name which will trigger new customers and those already with us to start taking note of the company and plan to buy from us (Mbaidheen & Alawneh, 2017).

The plan, however, may face the challenge of not reaching a wider market during advertisement since the mediums used may not be effective. The risk will be avoided by contracting efficient advertising company even if we will spend more money. Employees may not be motivated, but we will reward them more to ensure their continued support in internal marketing (Mbaidheen & Alawneh, 2017).

Performance analysis chart for the period 2014-2019

The series 3 represents profit and loses posted; Series 2 represent Company spending while the first series represent growth in customer numbers. The growth in customer number will be high during the first year of implementing advertising activities however the trend will stabilize once all the potential list of clients has been reached hence there will be no big different in our client list over the years.

The company spending will be a bit high in the first two years from rolling out the strategy because it means more resources will be allocated than the normal budget. However, the situation will stabilize later and the budget will go a little bit down. The company during its first two year of implementing the strategy will get little returns in terms of profit but once the number of customers buying from us increases the company will post more profits over the year (Canadean Company Reports, 2013).

Financial position of Netgear

     Year Ending
Dec 2016
Year Ending
Dec 2015
Year Ending
Dec 2014
Year Ending
Dec 2013
Assets
Cash and Equivalents240.47M181.94M141.23M143.01M
Receivables313.84M290.64M275.69M266.48M
Inventories247.86M213.12M222.88M224.46M
Total Current Assets962.78M821.14M822.97M800.11M
Property, Plant & Equipment, Gross123.49M126.54M118.59M98.94M
Accumulated Depreciation & Depletion104.02M104.15M88.89M71.75M
Property, Plant & Equipment, Net19.47M22.38M29.69M27.19M
Intangibles37.90M48.95M66.23M84.12M
Other Non-Current Assets7.98M7.93M9.38M26.59M
Total Non-Current Assets221.67M229.43M225.72M293.82M
Total Assets1.18B1.05B1.05B1.09B

Netgear Company has experienced increase in cash flow for the past four years. The subsequent increase is attributed to growth of its business right from increased number of client who subscribes to the company services.  For example the company received 143.01 Million dollars in the year 2013 but the cash flow by the year 2016 has risen to reach 240.47 Million dollars. From the financial report Netgear is expected to post increased cash flow this year (Netgear, 2017).

Key Success factors, budget, forecasted financials and break even chart.

The company marketing estimates are 300, 000 thousand dollars for the nine months advertising period.

This excerpt taken from the NTGR 10-Q filed May 7, 2009

Break even chart

  Sales and Marketing

   Nine Months Ended 
   March 29,
2017
  Percentage
Change
  November 30,
2017
 
   (In thousands, except percentage data) 
Sales and marketing expense  $25,902  (21.6%) $33,028 
Percentage of net revenue   17.0%   16.7%

During the first month of implementing the strategy the company will use 25,902 dollars in its spending to get 17.0% net Revenue. In the following months the company will post an average of 21.6% net revenue while spending 33028 dollars monthly in sales and marketing.

References

Canadean Company Reports, (2013). NETGEAR Inc. – Company Capsule: Basingstoke. Dec 18, 2013.

George, G., Yimin, L., (2017). Innovation: Analytics, innovation, and organizational adaptation. Organization & Management; Abingdon19.1. pp. 16-22.

Mandy, L., (2015).Tackling uncertainties in plan implementation: lessons from a growth area in England. The Town Planning Review; Liverpool86.1.

Mbaidheen, M., Alawneh, A. R., (2017). Assessing the Risk of Corporate Strategic Change: The Development of a Framework to Assist the Risk Management Process Adapted By a Contracting Company. International Journal of Information, Business and Management; Chung-Li9.1. pp. 45-57.

Netgear, (2017). Financial Statements. Retrieved From http://investor.netgear.com/financials-Statements.cfm

Peter, W., David, B., (2014). Why, how and to what effect do firms deviate from their intended marketing plans? Towards a taxonomy of post plan improvisations. European Journal of Marketing; Bradford48.3/4. Pp. 453-476.

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Quota Sampling

quota sampling
Quota Sampling

Quota Sampling

Introduction

There are two types of sampling; probability sampling and non-probability sampling. Of the two, probability sampling is the best, since there is a higher likelihood of obtaining a representative sample, and sampling error can be taken into account. In this report, we will discuss exclusively about quota sampling.  This is a non-probability sampling. By definition, this is a sampling technique which aims at obtaining representative data from a sample.

Let start with the definition of some terms. Sample, is simple terms means a subsection, subgroup, or portion of the population. Sampling, is the process of acquiring a representative portion of population and population is the entire elements under investigation.

There are a number of reasons as to why investigators may opt to use a sample instead of the entire population, despite sampling error. First, it has an economical advantage since fewer resources are used than when a census is carried out (Levy & Lemeshow, 2013). The sampling has timelessness factor, where the information required can be obtained faster than when a complete enumeration of objects is carried out.

Further, the researcher sort to use sampling when the population has infinite and when some of the population units/objects are inaccessible. Lastly, but not least, when the assessment destructs the objects under investigation (Levy & Lemeshow, 2013). Not forgetting, that sometimes a carefully selected sample may represent the population well than a sloppy conducted census. That is, the sample will truly mirror the population from which it was drawn from (Hu et al., 2017).

Literature review

As stated earlier, quota sampling is a nonprobability sampling. A nonprobability sampling in accordance with (Trochim & Donnelly, 2014) is a technique that is based on the judgement of the researcher. The collected sample has the same proportion of the mother population with identical traits and the targeted phenomenon. More importantly, the final sample obtained should have the composition criteria of the quota set. Since this paper discusses one of the nonprobability sampling, it is imperative to highlight some principles of nonprobability sampling.

Principle of quota sampling

In this type of sampling, the quantity of each sampling is find out in advance, however investigators look to find in each quota. For each type, the quotas are of fixed numbers, which the investigators would like to add in the sample. Let consider an example in which an investigator would like to have a sample in which the proportion of each gender by different age levels are approximately the same and the sample size is 1000. Let the population proportion is given in Table 1 and the quota of individual type of sampling unit is the sample size multiplied by the population proportion and the results are shown in table 2. (Chang-Tai Chao) 

     Table 1 Population Proportion

                                                                    Age
Gender    20-29     30-39     40-4950-5960-Above
Female   0.10    0.10    0.09 0.11  0.12
Male   0.10    0.08     0.1 0.11  0.09

                Table 2 Quotas

                                                                    Age
Gender    20-29     30-39     40-4950-5960-Above
Female   100    100      90  110   120
Male   100     80     100  110     90

Principles of nonprobability sampling.

Quota sampling falls under the class of non-probability sampling. Sampling involves the selection of a lot of the population being considered. In probability sampling each element in the population has a known nonzero chance of being selected through the utilization of an irregular determination system, for example, basic arbitrary testing. Non-probability examining does not include known nonzero probabilities of choice. (Paul J. Lavarakas) Or maybe, subjective techniques are utilized to choose which components ought to be incorporated into the specimen.

In non-likelihood inspecting the populace may not be very much characterized. Non-probability examining is frequently isolated into three classifications: purposive inspecting, comfort testing, and share examining. Share examining has a few similitudes to stratified inspecting. The essential thought of standard testing is to set an objective number of finished meetings with particular subgroups of the number of inhabitants in intrigue.

The testing strategy then continues utilizing a nonrandom choice component until the coveted number of finished meetings is acquired for every subgroup. A typical illustration is to set half of the meetings with guys and half with females in an irregular digit dialing phone talk with study. A specimen of phone numbers is discharged to the questioners for calling. Toward the begin of the overview, one grown-up is haphazardly chosen from a specimen family unit. It is by and large more hard to get interviews with guys.

So for instance, if the aggregate sought number of meetings is 1,000 (500 guys and 500 females), and meetings with 500 females are gotten before meetings with 500 guys, then no further meetings would be directed with females and just guys would be arbitrarily chosen and met until the objective of 500 guys is come to. Females in those specimen family units would have a zero likelihood of choice.

Additionally, on the grounds that the 500 female meetings were in all probability gotten at before call endeavors, before the example phone numbers were altogether worked by the questioners, females living in harder-to-achieve family units are more averse to be incorporated into the specimen of 500 females. Shares are frequently in light of more than one trademark. For instance, a standard specimen may have questioner appointed shares for age by sex by business status classes.

For a given example family unit the questioner may request the rarest gathering in the first place, and if an individual from that gathering is available in the family unit, that individual will be met. On the off chance that an individual from the rarest gathering is absent in the family, then a person in one of the other uncommon gatherings will be chosen. Once the quantities for the uncommon gatherings are filled, the questioner will move to filling the amounts for the more typical gatherings.

In that regard are both hypothetical and down to earth justification for using this kind of examining in research. In hypothetical reasons, this progress of information testing permits the utilization of subjective, blended research techniques and furthermore quantitative strategies. (Paul J. Lavarakas) By the time, when quantitative research is received, this inspecting procedure is oftentimes if not generally seen as sub-par compared to likelihood examining. This system helps in accomplishing objectivity of the specialist.

For instance, the analyst may utilize portion testing for intentionally protecting the incorporation of an uncommon segment of the populace. In any case, it ought to be specified that the fragment won’t not vary altogether contrast from the parent populace. The most common example of the limitation of this type of approach pre-election surveys to anticipate the consequences of the 1948 U.S. presidential decision. The field questioners were offered shares to fill in view of qualities, for example, age, sexual orientation, race, level of urban city, and financial status.

The questioners were sans then to fill the standards with no likelihood examining system set up. This subjective choice technique brought about an inclination for Republicans will probably be met inside the quantity bunches than Democrats. This brought about the example containing an excessive number of Republicans and bringing on the pre-race surveys to inaccurately foresee Thomas Dewey (the Republican applicant) as the victor.

Share inspecting is infrequently utilized as a part of conjunction with region likelihood testing of family units. Zone likelihood examining systems are utilized to choose essential testing units and fragments. For each specimen portion (e.g., city obstruct) the questioner is told to begin at a side of the section and continue around the fragment, reaching lodging units until a particular number of meetings are finished in the portion.

A noteworthy issue with quota sampling is the introduction of the unknown sampling biases estimates in survey. On account of the 1948 U.S. presidential decision, the testing inclination was related with an excessive number of Republicans being chosen. Another issue with quantity examining is that the inspecting technique regularly brings about a lower reaction rate than would be accomplished in a likelihood test.

Most amount tests quit endeavoring to finish interviews with dynamic example families once the standards have been met. In the event that a lot of test is dynamic at the time the amounts are shut, then the reaction rate will be low. (Paul J. Lavarakas)

However, some practical reasons of using quota sampling are that; this approach gives the investigator exploratory power to determine whether the problem exists when no theory exists that such problem exists. Therefore, the researcher may opt only to use sample that he/she thinks will portray the problem, which saves resources and time.

Ethical approach is important when deciding the sampling technique, as it may be unnecessary to subject fewer participants for an in-depth examination. Above all, it is imperative to determine whether quota sampling is a better sampling method to be used with the designed research strategy.

In accordance with (“Definition of ‘Quota Sampling’ – The Economic Times,” 2017) quota sampling is simple, yet effective approach a researcher can gather information in the initial phase of research. As earlier pointed out, quota sampling is ideal when the researcher wants to investigate whether a certain problem exists. As an example, there might be a notion that people in Iowa are against the death sentence.

A researcher may be interested in assessing the situation. However, the researcher may want to include people from Muslim religion. The researcher sets the minimum percentage of Muslims to be included in the sample, say 5%. Through this, the researcher is able to compare the views of people, including from the set quota.

Is quota sampling adequate method as an alternative to probability sampling?

A research was performed to assess whether quota sampling is an alternative to probability sampling (Yang & Banamah, 2014). Although probability sampling remains popular among many researchers and businesses. The research was driven by the fact that collecting data have become expensive and the response rate decreased.

Therefore, the researcher thought that quota sampling as a nonprobability sampling can be used as an alternative to probability sampling. The representativeness of quota sampling with probability sampling was compared as well as the assessment of the between the two sampling techniques using the survey topic and the response rate as factors (Yang, & Banamah, 2014).

It was established that the survey topic greatly influences the response rate, and response rate correlates with sample mean. Nonetheless, the researcher concluded these for that reason; quota sampling is not an alternative to probability sampling (Yang, & Banamah, 2014).

Types of quota sampling

Generally, there are two types of quota sampling:

  • Controlled quota sampling (proportional quota sampling)

The researcher, in this case, first impose the restrictions or the limit number of subjects to include. That is the researcher set a quota of each category. This is done to ensure that the major population or characteristics are well represented (Sharan, 2009).  For instance, it may be known that the number of female workers in a certain bank is 60% and 40% are males. The researcher may be interested in 100 sample people. Therefore, he samples 60 females and 40 males, and when 40 males are obtained, even if a potential and informed male come he will not sample them. This technique helps in limiting the researcher’s choices ((“Quota sampling – Research Methodology,” 2017))

  • Uncontrolled quota sampling (Nonproportional quota sampling)

In this case, the researcher in not limited in any way and thus selects the subjects as he/she wishes. This is considered as a sample of convenience, or simply it is less restrictive. The researcher just specifies the minimum number in each category, and one does not need to know the proportion. This sampling technique is more of a convenient sampling since the researcher can opt to use any number of participants so long as they meet the minimum requirements (“Quota sampling – Research Methodology,” 2017).

When to use quota sampling

There are scenario or situations that call for the researcher to use quota sampling technique. First, is when the researcher or the organization do not have sufficient time and resources to carry out stratified sampling. Therefore, due to effective and ease of conducting, the researcher uses this technique. Second, this sampling method is used when the accuracy of the information is not important.

For instance, when the researcher is conducting a pilot survey, or when there is no adequate information about the research topic. Also, when the researcher is just interested to study some subsections or subgroups, he sorts to use this nonprobability sampling. That is, when the interest is limited to certain traits, this method is ideal. If the main interest of the researcher is to determine the relationship between groups, then the ideal method is quota sample. Also, when the main aim is to compare the groups.

The sampling frame may be unavailable. Notably, mostly, if not all, of probability sampling, required. In the absence, of the list of all the subjects, the researcher uses this technique. That is, since the probability sampling the researcher should know the selection likelihood of each unit in the population.  Lastly, the research accuracy is not important and also the results are not for generalization purposes.

Thus the researcher can use quota sampling technique. This method results should not be used for generalization purposes since the units selected may sometimes not truly represent the parent population.  Therefore, the researcher can purposefully select quota sampling to investigate certain predefined traits.

Steps of creating quota sampling

There are three acceptable steps in creating quota sampling:

  1. Categorize or stratify the population.

First, the researcher divides the population into mutually exclusive groups. For instance, a researcher can stratify by gender, race, ethnicity, career, courses taken, religion and so on.

  • Computing quota for each stratum.

The researcher needs to determine the number of subjects to be used in each category. As illustrated earlier, the proportion of each category can be determined depending on the population proportion. Also, the researcher may set purposively a quota to a sample that might have a small likelihood of being sampled (as discussed in the Muslims case). In some cases, the researcher may not involve proportions when he just selects conveniently.

  • Continue selecting subjects until quotas for each stratum are obtained.

The researcher continues with selection until the exactly required number is obtained. When the quota of one group is attained, the researcher does not select any other subject even if he obtains a viable sample. However, he/she continues to select items for the other groups that quota has not been attained.

Difference between quota sampling and stratified sampling

Notably, the two sampling techniques are different, although they might be confused. First, in quota sampling the individuals are not selected randomly, that is why it is a nonprobability sampling. The samples are selected based on the researchers’ convenience. On the other hand, the stratified sampling, subjects are randomly selected into the sample (Sharan, 2009).

All the units or subjects in the population have an equal likelihood of being included in the final sample. In quota sampling, there are no call-back for particular samples. This implies that when a subject is missed, the researcher goes on and uses the available subjects. On the other hand, STRICTLY, there is a call-back, since if there are no call-backs the sampling will not be different from quota sample (sample of convenience) (Sharan, 2009).

Last but not least, since quota sampling is based on the judgement of the researcher it is full of biased and the most common type is a non-sampling error. Stratified sampling is not subjected to biasedness since the elements are randomly selected the only common error is sampling error.  

Advantages of quota sampling

This sampling technique is helpful when the researcher is unable to obtain a probability sample, but still, the researcher is aiming at obtaining a representative sample. This technique is adopted as a non-probability sampling that is closely equivalent to stratified sampling. Second, this technique is easier and quicker to carry, unlike probability sampling like stratified sampling (Trochim & Donnelly, 2014).

For this reason, this sampling method is adopted by masters’ students in dissertations where the target populations can be divided into categories. When quotas are used, they ensure that some groups are not overrepresented or other underrepresented. That is the main reason why in the computation of minimum units to be included from each category (quota) the population proportion is useful (Trochim & Donnelly, 2014).

A good example is as illustrated earlier, where a population consist 60% female and 40% male. These proportions were used in obtaining a sample of both categories, out of 100 sample required 60 females were selected, and 40 males were selected. Also, when quota sampling is used, there is stratification, which is ideal when the researcher wants to compare the two strata.

A good example is; in an organization, the researcher may select male and female and compares their average. The averages will determine which gender gets higher pay. Lastly, this sampling method is not dependent on the sampling frame. This implies that it can be used when a list of all subjects is absent, quota sampling can still be used. Therefore, it remains the most appropriate sampling technique when sampling frame is not there.

Disadvantages of quota sampling (limitation)

There are limitations of quota sampling. First, since the sample are not obtained through probabilistic means, it is impossible to estimate the sampling error. It is possible for subjects to be sampled based on the researcher’s convenience and resource usage consideration. This leads to sampling bias.  Results from such data cannot be used for generalization purposes, or cannot be used in inferential statistics. In particular, the results are only recommended for the sample used and not the entire population.

Therefore, limiting generalization. Another limitation is that the population should be able to be dived into two distinct groups. Otherwise, the process of data collection will not be possible. As examples, indicated, the population should have mutually exclusive strata; like gender, male and female (if there are no transgender issues). When the sample requirements are required to be compared, more categories are added.

A good example is, when the researcher is interested in assessing how male and female supporting death sentence changes depending on the religious such as the Muslims and Christians. Notably, the subject should be in one stratum and here there are four criteria. Therefore, the researcher needs to collect data from “male Muslims,” “Female Muslims,” “male Christians” and “Female Christians.”

Evidently, more subjects need to be sampled, increasing the cost and time of carrying out the survey. Further, the researcher needs to understand the population well, so that he/she can make the right stratification, calculate quota, and lastly keep on sampling to meet the quota specifications. Without proper knowledge, one is not able to use quota sampling as he/she might to obtain a representative sample.

Although the sample obtained may be proportional to the population, some of the characteristics may not be disproportional. Incompetency of the researcher or lack of proper skills may increase the biasedness of the sample since the subjects’ collection is based on the researcher’s judgement (Sharan, 2009). Thus, is of great importance that before, using quota sampling researcher should have adequate skills to collect representative samples.

Conclusion

There are a number of important aspects of quota sampling highlighted in this paper.  For instance, it has been indicated that this technique is a non-probability sampling, where the selected samples represent certain characteristics. Two types of quota sampling; controlled and uncontrolled sampling were also adequately discussed. When this sampling method should be used was also highlighted among another important aspect. As highlighted, the three steps are used in designing data collection using quota sampling method.

There are important factors that have been pointed out, in the literature of this paper, such as; the question whether quota sampling is a good alternative to probability sampling. Based, in the previous study by prominent scholars, it was established that this method is not is not an alternative to probability sampling.

A clarification was made on the underlying difference between stratified sampling, despite the two having some similarities like stratifying the population into mutually exclusive first. To support some claims or issues brought forward, different examples were given designed to clarify, how the quota sampling will work.

Some of the reasons for using quota sampling brought forward include, the researcher only selecting groups that only interests him. Investigate some traits or characteristics that have not been investigated before, or there is no preexisting literature and when the researcher is interested in comparing the groups of interest.

Despite this being a nonprobability sampling, it has proven to be helpful, especially when the sampling frame is absent. That is, all probability sampling techniques are dependent on the availability of the list of all population subjects. Therefore, the only option is resorting nonprobability sampling. This is also the ideal method when the researcher has less time and limited resources, as it is considered an alternative to stratified sampling.

It is advisable to use this method when the researcher has a deep understanding of the steps and process of data collection. Also, the researcher should avoid so much biasedness so that he can have a representative sample. Lastly, the findings obtained using data obtained via this technique should not be used for inferential purposes; rather they should make conclusion about the sample used.

References

Chang-Tai Chao, “Quota Sampling” (Incomplete information provided about the journal paper)

Definition of ‘Quota Sampling’ – The Economic Times. (2017). The Economic Times. Retrieved 23 March 2017, from http://economictimes.indiatimes.com/definition/quota-sampling

Hu, X. F., Young, K., & Chan, H. M. (2017). Background Bivariate random-effects models represent a widely accepted and recommended approach for meta-analysis of test accuracy studies. Standard likelihood methods routinely used for inference are prone to several drawbacks. Small sample size can give rise to unreliable inferential conclusions and convergence issues make the approach unappealing. This paper suggests a different methodology to… BMC Medical Research Methodology, 17(1), 1-12. https://www.infona.pl/resource/bwmeta1.element.springer-a4c4ef0e-2be0-30d3-9d87-a2c2297724c4

Levy, P. S., & Lemeshow, S. (2013). Sampling of populations: methods and applications. John Wiley & Sons. From https://books.google.com/books?hl=en&lr=&id=XU9ZmLe5k1IC&oi=fnd&pg=PT14&dq=Sampling+of+populations:+methods+and+applications.&ots=oaeRJfQxUr&sig=oUVgwHhuzBCm1bjAZIEHR-uSHyQ

Paul J. Lavarakas, “Encyclopedia of Survey Research methods,” Volume 1 & 2

Quota sampling – Research Methodology. (2017). Research Methodology. Retrieved 23 March 2017, from http://research-methodology.net/sampling-in-primary-data-collection/quota-sampling/

Sharan, (2009). Quota Sampling. Slideshare.net. Retrieved 23 March 2017, from https://www.slideshare.net/sumanto123/quota-sampling

Trochim, M. K., & Donnelly, J. P. (2014). Nonprobability sampling. The Research Methods Knowledge Base website. From https://books.google.co.ke/books?id=0yxBBAAAQBAJ&pg=PA106&dq=Non+Probability+sampling.+The+Research+Methods+Knowledge+Base+website&hl=en&sa=X&redir_esc=y#v=onepage&q=Non%20Probability%20sampling.%20The%20Research%20Methods%20Knowledge%20Base%20website&f=false

Yang, K., & Banamah, A. (2014). Quota sampling as an alternative to probability sampling? An experimental study. Sociological Research Online, 19(1), 29. doi: http://www.socresonline.org.uk/19/1/29.html

Paul J. Lavarakas, “Encyclopedia of Survey Research methods,” Volume 1 & 2

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Nurse work environment: Article Critical Analysis

Nurse work environment
Nurse work environment

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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Clinical Roles: Coding and Billing

coding and billing
Coding and Billing

Clinical Roles: Coding and Billing

            My clinical role largely involves billing, coding, and documentation of patients’ data to facilitate easy communication between insurance companies and the healthcare organization that I currently work for. My healthcare facility often sends the coding and billing information to insurance companies to claim payments. As a coding, documentation and billing specialist, I am charged with the responsibility of keeping clear health data and reviewing those records before assigning proper codes to specific diagnoses (Benoit, Bergeron and Bertrand, 2016; & Deloitte, 2016).

Coding, billing, and documentation of patients’ health data are governed by strict ethical, legal, and regulatory standards because they involve usage of confidential information. In this regard, clinicians have strict ethical and legal responsibilities to observe as far as documentation strategies, coding, and billing are concerned (Benoit, Bergeron and Bertrand, 2016).

            Personally, I feel that it is in order for documentation strategies, coding, and billing to be governed by strict ethical, legal, and regulatory standards. Since clinicians have access to private patient’s records, they must maintain total confidentiality in their documentation strategies, coding, and billing (Deloitte, 2016). In addition, these clinicians have an ethical responsibility to access only that information that is related to the issue being addressed at any given time.

Their actions must comply with the ethical standards documented in the American Association of Professional Coders and the American Health Information Management Association (Benoit, Bergeron and Bertrand, 2016). As far as their legal and regulatory responsibilities are concerned, documentation, coding and billing specialists must maintain confidentiality requirements as outlined in the Health Insurance Portability and Accountability Act, (HIPAA). The ethical, legal, and regulatory standards that govern documentation strategies, coding, and billing, play a significant role in minimizing healthcare fraud and abuse (Deloitte, 2016).

            Evidence-based research has become an important aspect of the healthcare industry in the recent past due to the role that it plays in improving healthcare delivery. According to JoAnn (2017), evidence-based research is necessary because it helps clinicians to generate the right type of data that they can use to improve the effectiveness of care. Clinicians often rely on different kinds of knowledge for them to make the right decisions in their relationships with sick patients.

Furthermore, they are expected to have a comprehensive understanding of the physiological, psychological, emotional, and social factors affecting their patients’ health for them to deliver the most appropriate care. Although clinicians can quickly obtain this information from existing literature, they must complement it by evidence from empirical research. Evidence-based research, therefore, provides clinicians with practical facts that they can integrate with their experiential knowledge to improve patient care (Kristensen, Nymann and Konradsen, 2015). 

            I incorporate evidence-based research to a large extent into my role as a clinician. I firmly believe that the safety of my patients depends on the availability of evidence that can adequately support the nature of care that I deliver to them (JoAnn, 2017). For this reason, I rely on data obtained from evidence-based research to improve healthcare services which serve to promote better outcomes for my patients.

I do not only rely on evidence-based research to change my care practices, but I also develop available evidence to fulfill existing knowledge gaps as far as improvement of patient safety is concerned. Over the coming years, I aspire to utilize evidence-based research to improve my skills as a clinician (Kristensen, Nymann and Konradsen, 2015).

 Falls are common among seniors, especially those who are suffering from chronic health problems such as diabetes (Graveande and Richardson, 2016). According to Graveande and Richardson (2016), a geriatric fall is a sudden occurrence among the elderly that signifies a decline in their homeostatic reserve. Geriatric falls pose a great risk of loss of independence to the elderly in the society today.

This calls for the greatest need to identity and implements the most appropriate health maintenance strategies that would improve care for this population and their families. Mazur, Wilczynski, and Szewieczek (2016) critically explore the importance of health maintenance specific to geriatric falls as it pertains to the care of the patient and their family.

            According to Mazur, Wilczynski, and Szewieczek (2016), exercise is the most appropriate health promotion strategy for geriatric falls because it helps to improve balance and minimize the risks of repeated falls. Exercise is a recommended health promotion strategy for geriatric falls because it serves to generate a greater amount of homeostatic reserve for the elderly patient. In addition to exercise, elderly patients who are at high risks of falling should eat a balanced diet as this provides them with energy that they may need to regain physical activity. 

As Mazur, Wilczynski and Szewieczek (2016) explain, social support can help to reduce risk factors for future falls among the seniors because it drives away the fear that typically develops from past falls. Family members of elderly patients who are recovering from the effects of falls should pay attention to physical activity, nutritional strategies, and social support in their effort to promote positive health outcomes for their patients (Mazur, Wilczynski and Szewieczek, 2016).

I agree with the solutions provided by Mazur, Wilczynski and Szewieczek (2016) because they are supported by evidence-based research. In a well-organized research, Burton, Cavalheri and Hill (2015) have revealed that physical exercise programs help to improve balance in older adults who are at risk for falls. These researchers further assert that planned nutritional strategies contribute to induce positive health changes such as improved performance and reduced risk for falls in geriatric patients.

In a similar study, Durbin, Kharrazi and Mielenz (2016) support the use of social support, physical exercise, and dietary supplements in promoting health maintenance to geriatric patients. Since health maintenance solutions for geriatric falls are supported by evidence-based research, clinicians can utilize these ideas to make appropriate healthcare decisions for their elderly patients (Kristensen, Nymann and Konradsen, 2015).

The number of elderly adults who are being diagnosed with diabetes in the society today is on the rise. The major challenge faced by clinicians is defining the therapy goals for geriatric patients due to the existence of limited data about the aging process and drug response of this population (Kazerle, Shalev, and Barski, 2014).

Considering the complexities that surround the health status of geriatric patients, clinicians are charged with the responsibility of choosing a treatment plan that will maximize glycemic control, while at the same time avoiding exposing their patients to increased risks. Due to variations in physiological functions between adults and geriatric patients, the treatment approach for geriatric patients differs significantly from that of an adult (Graveande and Richardson, 2016). 

Treatment of geriatric patients involves the use of medication as well as other interventions such as nutritional strategies and psycho-social support (Graveande and Richardson, 2016). This paper will focus on pharmacological or drug treatment alone. The best medication that should be used to treat geriatric diabetic patients includes; metformin, sulfonylureas, meglitinides, thiazolidinediones, alpha-glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors, and sodium glucose co-transporters two inhibitors.

These medications are taken orally at highly controlled doses. Geriatric diabetes patients can also be treated using injectable therapies such as GLP-1 analogs, pramlintide, and insulin. Although similar medications can be used to treat diabetes in adults, the drug dosage differs significantly between the two populations due to variations in pharmacokinetic parameters. In this respect, the drug dosage given to geriatric patients are relatively lower than those administered to adults. The goal of delivering lower doses to geriatric patients as compared to adults is the need to maximize chances of glycemic control, without exposing the elderly adults to additional risks (Kazerle, Shalev, and Barski, 2014).

My learning progress in the course directly correlates to the stages in Benner’s Novice to Expert Theory. Benner’s Novice to Expert Theory assumes that a learner experiences a progressive form of knowledge acquisition that involves five stages namely; novice, advanced beginner, competent, proficient, and expert stages of skill acquisition (Josephsen, 2014). Since I began the course, I have successfully gone through the first stage of Benner’s theory known as novice stage.

When I started the course as a novice, I had no background experience, and I had difficulty differentiating between relevant and irrelevant aspects. Even now, I still take my time to understand course requirements and their significance in shaping my roles as a clinician. After familiarizing myself with a few course concepts, I will move to the second stage of advanced beginner.

At this stage, I will rely on rules provided by my instructor to perform every individual task. Furthermore, I will ask more experienced students to help me integrate practical knowledge and to set priorities for the course (Bowen and Prentice, 2016).

After learning course concepts for two years, I will progress to the competent stage of skill acquisition. Here, I will easily compare situations and make judgments on that scenario that require immediate attention. Additionally, I will integrate devised rules with those learned in the classroom to help solve complex matters. From the competent stage, I will move to proficient stage characterized by critical thinking and individual decision making (Bowen and Prentice, 2016).

While at proficient stage of skill acquisition, I will be able to easily see changes that take place in every situation and implement appropriate responses to promote success. It is at this stage where I will view the course as a whole rather than regarding its small components like I currently do. Later on, I will progress to expert stage of skill acquisition. Here, I will be able to grasp every situation more accurately than now.

Additionally, I will no longer rely on rules and guidelines to make appropriate decisions on how to tackle issues related to the course. Moreover, I will operate from a deep understanding of every situation and make judgments that will generate positive outcomes (Josephsen, 2014).

In conclusion, as a clinician, I have an obligation to observe ethical, legal, and regulatory responsibilities during documentation, coding, and billing. Also, I must acknowledge the importance of evidence-based research by making clinical decisions based on facts obtained from empirical studies. A good example of a health situation in which I can effectively utilize evidence-based research is when designing a health promotion program specific to geriatric falls.

In this case, evidence-based practice will help me to deliver the most appropriate care for the patient and his or her family. Considering the little volume of knowledge that I have gathered as a novice, I believe that my learning progress in the course effectively correlates to the stages of Benner’s Novice to Expert Theory.

References

Benoit, M., Bergeron, J. & Bertrand, G. (2016). Decision-making tool: Telepractice and digital records management in the health and human relations sectors. Quebec: Conseil Interprofessionnel du Quebec.

Bowen, K. & Prentice, D. (2016). Are Benner’s expert nurses near extinction? Nursing Philosophy, 7(2): 144-148. Doi.10.111/nup.12114.

Burton, A., Cavalheri, V. & Hill, K. (2015). The effectiveness of exercise programs to reduce falls in order people with dementia living in the community: A systematic review and meta-analysis. Clinical Interventions in Aging, 10: 421-434.doi:10.2147/CIA.S71691.

Deloitte. (2016). International review: Secondary use of health and social care data and applicable legislation. Author: Deloitte & Touche Oy, Group of Companies.

Durbin, L., Kharrazi, R. & Mielenz, T. J. (2016). Social support and older adult fall. Injury Epidemiology, 3(1):4.doi:10.1186/s40621-016-0070-y

Grave and, J. & Richardson, J. (2016). Identifying non-pharmacological risk factors for falling in older adults with type 2 diabetes mellitus: A systematic review. Disability and Rehabilitation, 39(15): 1459-1465.doi:10.1080/09638288.2016.119974.

JoAnn, M. (2017). Call to action: How to implement evidence-based nursing practice. Nursing, 47(4):36-43.

Josephsen, J. (2014). Critically reflective theory: A proposal for nursing education. Advances in Nursing, 2014: 360-594. Doi:10.1155/2014/594360.

Kazerle, L., Shalev, L. & Barski, L. (2014). Treating the elderly diabetic patient: Special considerations. Diabetes Metabolic Syndromes and Obesity, 7: 391-400.

Kristensen, N., Nymann, C. & Konradsen, H. (2015). Implementing research results in clinical practice: The experience of healthcare professionals. BMC Health Services Research, 16:48.doi:10.1186/s12913-016-1292-y

Mazur, K., Wilczynski, K. & Szewieczek, J. (2016). Geriatric falls in the context of a hospital fall prevention program: Delirium, low body mass index, and other risk factors. Clinical Interventions in Aging, 11:1253-1261.doi:10.2147/CIA.S115755.

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The Parietal Lobe

The Parietal Lobe
The Parietal Lobe

The Parietal Lobe

Question 1

The parietal lobe is located at the top region near the back of the brain. There are two parietal lobes – left and right parietal lobe. This part of the cerebral cortex is involved in vision, speech, sensation and interaction with other regions to connect sensory input from external environment and interpretation of the stimuli. Parietal lobe stroke occurs when the blood vessel supplying blood to this region ruptures or gets blocked.

This interferes with sensation of the entire opposite sides.  This is because motor system of the brain is mainly found in the frontal lobes (Knoefel, 2011). It starts with promoter regions for coordination of complex movements to the primary motor cortex where output is transmitted into the spinal cord leading to contraction and movement of the muscles.

The primary motor cortex located on the left side of the brain is responsible for the movement and muscle contractions in the right side of a person’s body and the primary motor cortex on the right controls movement of the left side. This explains why patient with right parietal stroke gets return of voluntary movement in the left hand (Migliaccio et al., 2014).

Question 2

Fronto parietal stroke affects the frontal and parietal lobes part of the brain. A right fronto-parietal stroke patient with better movement in the left hand side is also likely to may not necessarily have better attention of the side. This is because the frontal lobe is responsible for solving skills, emotions, and selective attention behavior. On the other hand, the parietal lobes control sensations such as touch and pressure.

Therefore, the indication of stroke will depend on the region of the brain involved. Stroke on the right hemisphere cerebrum affects left side whereas stroke in the left hemisphere affects the right side.  In addition, injury in the left lobe disrupts the patient understanding of the written and spoken word (Knoefel, 2011).

Question 3:

Visual motor integration refers to a person’s ability to perceive visual information, process it and move the motor system accordingly.  The idea that the front ends of visual system is responsible for breaking down stimulus for down into their constituent’s parts such as pattern, shape, motion, color and to glue the feature in the parietal lobe neuron.

Therefore, patients with right front parietal stroke make it challenging to grasp coordination. Visual- motor integration involves three processes; a) visual stimulus analysis, b) fine-motor control and c) conceptualization. Deficit in any of the three processes influence the final outcome. For instance, if fine motor control and visual analysis are within the normal range, then the challenge lies in the conceptualization (Johansson, 2012).

Question 4:

It can be challenging to farm with Parkinson’s disease because of tremors and rigidity that makes it difficult to hold hand tools and increases the likelihood of accidental injuries to self and others. In addition, the increased diminishing balance can increase risk for secondary injuries due to fall, slip or trip.

In addition, the medications used to treat the disease are associated with light headedness, confusion, insomnia and dizziness can dramatically reduce the patient’s energy. Therefore, these are the safety risks to consider when supporting the patient engage in his chosen hobby (Santos-García & de la Fuente-Fernández, 2013).

Question 5

Parkinson disease is a neurodegenerative disease described by non motor and motor symptoms that negatively impact the patient’s quality of life.  Most of PD patients are stigmatized because of the visible motor and non motor symptoms. The symptoms of this disease are difficult to hide and are perceived as unscrupulous by the public. This includes observable traits such as gait difficulties, tremor and drooling. These symptoms disrupt the autonomous integration into the society due to their exterior conditions. In addition, the deteriorated self esteem evokes feelings of embarrassment and shame which results into isolation (Santos-García & de la Fuente-Fernández, 2013).

In addition, stigma and seclusion is not only associated with the observable signs and symptoms but also due to progressive loss of functionality. This factor further contributes to bad self image, self efficacy and autonomy. In fact when interviewed about their life history, most of the patients explain symptoms as the key issue for seclusion and low self esteem due to increased physical dependence.

Stigma also arises from awkwardness and inability to do activities that require simple motor actions. This reduction to functionality results into increased social disengagement associated to stigmatization. Stigmatization may also occur due to hindrances to communication.  PD patients may be mislabeled for instance as drunkards. In addition, the delayed thinking and difficulty to convey their opinions easily can make them feel frustrated and isolated. The difficultness to decipher PD patient’s mute expressions makes them feel alienated and disconnected from others (Maffoni et al., 2017).

References

Johansson, B. B. (2012). Multisensory Stimulation in Stroke Rehabilitation. Frontiers in Human Neuroscience, 6, 60. http://doi.org/10.3389/fnhum.2012.00060

Knoefel, J. E. (2011). Clinical neurology of aging. Oxford University Press.

Maffoni, M.,  Giardini, A.,  Pierobon, A., Ferrazzoli, D., and Frazzitta, G.  (2017). “Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies,” Parkinson’s Disease, Article ID 7203259, doi:10.1155/2017/7203259

Migliaccio, R., Bouhali, F., Rastelli, F., Ferrieux, S., Arbizu, C., Vincent, S., … & Bartolomeo, P. (2014). Damage to the medial motor system in stroke patients with motor neglect. Frontiers in human neuroscience, 8, 408.

Santos-García, D., & de la Fuente-Fernández, R. (2013). Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. Journal of the neurological sciences, 332(1), 136-140.

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MENTAL HEALTH CARE

Mental health care
Mental health care

Mental health care

DIFFERENCE BETWEEN HISTORICAL AND CONTEMPORARY MENTAL HEALTH CARE

  1. INTRODUCTION

Mental health care practice began several years ago when relatively simple approaches to care were still being utilized. Like any other form of health care, mental health care can be evaluated based on a range of theories and models which have extensively been used to inform mental health nursing practice. This paper discusses the difference between historical and contemporary mental health care as it applies to nursing models and the nursing process.

This paper has described in details, the concepts of “nursing process” and “nursing model” and how they have evolved since conception. Moreover, this paper uses a case study to describe how the nursing process and a nursing model have been applied in nursing care provision for a patient who is suffering from a sexually transmitted infection characterized by depression.

  1. CONTEMPORARY AND HISTORICAL MENTAL HEALTH CARE

2.1 The Nursing Process and how it has Evolved since Conception

The principles of nursing process largely dominate mental health care practice in today’s nursing and health industry. The term “nursing process” is defined as the application of a scientific approach to care provision that involves strict adherence to distinct steps which are aimed at generating positive health outcomes for patients (Perez-Rivas, Martin-Iqlesias, Pacheco del Cerro, Arenas, Lopez and Lagos, 2016, p. 43).

According to Perez-Rivas et. al., (2016, p. 43), for a nursing process to be considered effective, the health care practitioner must complete all the documented steps because information gained from one step results into the success of subsequent steps. Approaching mental health care based on the principles of “nursing process” helps to develop critical thinking skills of nurses, which eventually translates into improved problem-solving and positive health outcomes for mentally-ill patients (Perez-Rivas et. al., 2016, p. 44).

Nursing process and its application in mental health care has greatly evolved from when it was introduced up to date. Traditionally, the nursing process extensively emphasized on health care assessment, implementation of intervention, and planning as the only phases involved in mental health care delivery. In those days, the process did not recognize the significant role played by cognitive processes in influencing decision making during care (Zamanzadeh et. al., 2015, p. 411).

However, as nurses continued to utilize the historical principles of the nursing process into practice, increasingly advanced nursing processes were integrated and this has greatly improved the overall image of the nursing process. For instance, the advanced nursing process currently integrates diagnostic reasoning that facilitates decision making which was absent in the traditional nursing process.

Through continued nursing research and practice, nursing professionals have contributed greatly to the evolution of the nursing process by identifying the need to incorporate health outcomes identification and planning into the nursing process. To date, health care professionals who handle mental health cases view the nursing process as an advanced form or practice that involves five steps: “assessment, diagnosis, outcome identification and planning, intervention implementation, and evaluation (Zamanzadeh et. al., 2015, p. 412).

2.2 How the Nursing Process was First Developed and How it is used in Contemporary Nursing

            The nursing process that is used in contemporary nursing differs significantly from the one used in traditional nursing as it applies to mental health care. This is attributed to the changes that have been made on the “nursing process” since it was developed (Perez-Rivas et. al., 2016, p. 44).  Nursing was first viewed as a process rather than a distinct activity in 1955 by Lydia Hall from United Kingdom.

Although many professionals in the nursing field were not sure as to whether Hall’s views were right, a few of them dwelled extensively on the topic and they began to refer to nursing as a process. Examples of authors who supported Hull in describing nursing as a process include Johnson, Orlando, and Wiedenbach and their opinions on the nursing process are available in their publications of 1959, 1961, and 1963 respectively.

By then, only three steps were used to define the nursing process and they include, “assessment, planning, and evaluation (Zamanzadeh et. al., 2015, p. 411).” These three steps provided the basis of the nursing process that traditional nurses used to deliver mental health care to patients.

            Later on in 1967, an additional step described as implementation of intervention was added to the nursing process by Walsh and Yura. It is not until 1973 when the American Nurses Association (ANA) felt in necessary to incorporate diagnosis into the nursing process. During the final revision and publication of the ANA standards in 1991, another step known as identification of outcome was integrated into the nursing process.

The step was made part of the planning phase and this resulted into the generation of a nursing process that comprised of five steps namely; “assessment, diagnosis, outcome identification and planning, intervention implementation, and evaluation (Zamanzadeh et. al., 2015, p. 412).” The development of the nursing process has progressed through a number of steps which have been modified across years to generate the process that is currently used in contemporary nursing to provide care for mentally-ill patients.

Based on the nursing process, contemporary nurses frequently assess, diagnose, identity outcomes, implement interventions, and finally evaluate the effectiveness of interventions whenever they are delivering mental health care to patients.

2.3 The Nursing Model and How they Have Evolved Since Conception

            Nursing models play a very important role in nursing practice in the sense that, they largely influence decision making processes by nurses concerning the most appropriate ways through which patients should be handled. A nursing model is defined as a framework of nursing concepts that act as a foundation for nursing care and that describe how given health care practices should be performed (Murphy, Williams and Pridmore, 2010, p. 23).  

Nursing models have been developed to help direct nurses on the best approaches they should take to improve patient outcomes and to explain why certain approaches as relevant. Different nursing models exist and their goal is to assist nurses to achieve various nursing components based on the nature of a mental health issue they are handling at any given time (Springer and Casey-Lockyer, 2016, p. 647).

            Nursing models have significantly evolved since their conception due to constant changes in patients’ needs and due to rapid technological advancements in the contemporary world which tend to change approaches to care. Nursing models were first developed in the United States way back in 1960s (Murphy, Williams and Pridmore, 2010, p. 23). In 1960, the United States was characterized by a number of cultural, technological and social transformations which influenced nursing professionals to make changes that were aimed at improving nursing practice.

For this reason, traditional nursing models were developed based on their effectiveness in meeting basic medical goals. For instance, the “medical model” provided a foundation only for the management of physical health problems. Nurses in the United Kingdom began to apply nursing models into practice in 1970s (Murphy, Williams and Pridmore, 2010, p. 24).

Since then, significant transformations in the world have helped nurses to build a body of knowledge that has been used to develop modern nursing models. Nursing models which are used in contemporary nursing to deliver mental health care have been developed to guide nurses on how they can handle patients with a wide variety of health problems as opposed to traditional models (Springer and Casey-Lockyer, 2016, p. 660).

2.4 Total Patient Care: A Historical Nursing Model

            An example of a historical nursing model that is rarely used by today’s nurses is Total Patient Care which is also known as Private Duty Nurses. Total Patient Care is a nursing model that conceptualizes that, for nurses to deliver quality patient care, they must have a small number of patients that they can effectively handle at any given time. The nurse should then work in collaboration with other registered nurses to ensure that the patients being attended to receive maximum care.  

Total Patient Care model guided traditional nurses to work with small groups of mentally-ill patients that they could effectively handle at any given time. Although Total Patient Care can still be used to guide clinical decisions in today’s health care settings, today’s health care organizations rarely utilize this model to deliver mental health care (Mary and Sandra, 2004, p. 291).

2.5 Watson’s Theory of Caring: A Contemporary Nursing Model

            Through his theory of caring, Jean Watson greatly influences clinical decision making processes by today’s nurses, especially those who deliver care to patients with mental health problems. This contemporary nursing theory conceptualizes that there are four major factors that determine positive patient outcome during care delivery. These factors include the personality of the care giver, the patient’s health status, the environment in which care is delivered, and the nursing process (Ozan, Okumus and Aytekin, 2015, p. 26).

These factors influenced Watson to assume that the most effective form of care is that which is delivered interpersonally. In addition, the nurse should take time to understand specific health problem that a patient is suffering from. Again, it is the responsibility of the nurse to create caring environment for his or her patient. Furthermore, nursing lies at the center of caring and intended health outcomes will only be achieved if the right nursing processes are followed. Watson’s theory of caring is widely used in nursing practice today (Ozan, Okumus and Aytekin, 2015, p. 25).

  1. SERVICE USER’S HISTORY

            A service user whom I have cared for in the past is a female patient aged 16 years and who suspected that she was suffering from a sexually transmitted infection and was therefore in need of medical care. I had to take historical data before I could identify the best component of the nursing process to use in order to confirm presence or absence of a sexually transmitted infection.

My patient was an orphan who stayed with her uncle at the time of visit. At the time of visit, she was feeling depressed and psychologically disturbed because of her health condition. In addition, she was part of a group of commercial sex workers in the city despite her young age, and she uses money earned from the business to earn a living. She had also been in an intimate relation with different partners without protection.

Her uncle used to beat her up every time he was at home and therefore, she feared staying at home. The patient had not taken any medication prior to visiting the health care facility. I applied the nursing process to deliver the most appropriate nursing care for the patient.

When I was handling my patient, I greatly relied on the nursing process that is majorly used in contemporary nursing. By following the five steps of the nursing process, contemporary nurses are able to provide quality care that addresses specific patients’ needs. During assessment phase, the contemporary nurse collects, verifies, organizes, interprets, and documents patients’ health data that will be used to accomplish the subsequent steps.

After collecting relevant data, the contemporary nurse ensues to diagnosis phase where he or she analyzes the collected data to make a clinical judgment which is aimed at identifying a specific health problem that the patient is suffering from (Perez-Rivas et. al., 2016, p. 44).

Once a specific health problem is identified, the contemporary nurse proceeds to the third phase where he or she identifies the most appropriate health outcomes that the patient should be assisted to achieve. It is in this phase where the nurse documents a plan of how the patient can be helped to achieve the proposed outcomes. In the fourth phase, the contemporary nurse implements the right intervention as documented in the plan (Zamanzadeh et. al., 2015, p. 416).

The nurse then proceeds to the fifth phase where he or she evaluates the effectiveness of the implemented intervention in generating the proposed health outcomes for the patient. In case the proposed health outcomes are not realized following intervention implementation, the nurse is compelled to change the intervention until the intended results are obtained (Perez-Rivas et. al., 2016, p. 44). 

            A component of the nursing process that I used to exercise care for the patient was taken from the Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE) model described above, considering the fact that it is the one that is widely used in contemporary nursing.  I decided to use Diagnosis component of the ADPIE to maximize nursing care for my patient.  

By choosing diagnosis component, I wanted to bring together all the historical data that I had gathered into meaningful information. Specifically, when conducting diagnosis on the patient, I used the data that I had already collected to make clinical judgment about my patient and the family. This enabled me to understand that risk factors that exposed by patient to acquiring sexually transmitted infections.

Furthermore, I was able to predict possible responses that she could receive from family members if she approached them with her health problem. Generally, diagnosis provided me with the basis for selecting the most appropriate nursing intervention that could generate positive health outcomes for my patient.

            The type of diagnosis that I conducted on the patient was possible nursing diagnosis. A possible nursing diagnosis is conducted when a patient’s problem requires additional analysis for the presence or absence of a health problem to be confirmed (Perez-Rivas et. al., 2016, p. 44). In the case that I was handling, it was not yet confirmed that the patient was suffering from sexually transmitted infections. The client was worried that she might have acquired sexually transmitted infections owing to her sexual behaviours in the recent past.      Such thoughts had severe impact on her mental health. Data obtained from this diagnosis helped me to confirm presence of a sexually transmitted infection (Zamanzadeh et. al., 2015, p. 416).

            Diagnosis was a very important component of ADPIE for my patient because it acted as a link to the other aspects of the nursing process namely; planning, implementation, and evaluation. The diagnosis was the second phase of the nursing process that was performed after collecting data in the assessment phase. Information gathered during diagnosis phase was extremely useful in the subsequent steps because I utilized it to identify the best health outcomes for my patient and to select a nursing intervention that could generate those outcomes for my patients. Diagnosis was very important in the overall nursing process because it helped me to come up with the right interventions that were intended to generate improved health outcomes for the patient (Zamanzadeh et. al., 2015, p. 416).  

When I was providing nursing care to my patient, I paid greatest attention to Watson’s Theory of Caring mode. I utilized the four major factors that determine positive patient outcome during care delivery as described in Watson’s theory of caring. Specifically, I strived to; build strong interpersonal relationship with the client, establish specific health problem the patient was suffering prove, create an environment suitable for nursing care, and to adhere to all steps of the nursing process (Ozan, Okumus and Aytekin, 2015, p. 25).

  1. CONCLUSION

Historical and contemporary mental health care differ significantly due to evolutions in nursing theories and models which have taken place over the years. For instance, while traditional mental health care was delivered using a nursing process that only involved three steps, delivery of contemporary mental care utilizes a nursing process with five steps.

Additionally, while traditional mental health care was based on historical nursing models, today’s mental health care is guided by contemporary nursing models such as Watson’s theory of caring model. The evolutions of the nursing process and the developments of nursing models have brought about significant improvements in health care delivery particularly in mental health care.

From this case study, I have learnt the importance of implementing contemporary nursing processes and nursing models in care delivery. I will utilize this knowledge to improve the quality of mental health care that I will deliver in future. As a student nurse, I will take my time to evaluate and understand changes in nursing models and components of the nursing process as they apply to mental health care.

References

Mary, T. & Sandra, L. 2004, “Traditional models of care delivery: What have we learned?” Journal of Nursing Administration, vol. 34, issue 6, pp 291-297.

Murphy, N., Williams, A. & Pridmore, J. A. 2010, “Nursing models and contemporary nursing 1: The development, uses and limitations,” Nursing Times, vol. 1, issue 106, p. 23-24.

Ozan, Y., Okumus, H., & Aytekin, A. 2015, “Implementation of Watson’s theory of human caring: A case study,” International Journal of Caring Sciences, vol. 8, issue 1, pp. 25-35.

Perez-Rivas, F., Martin-Iqlesias, S., Pacheco del Cerro, K., Arenas, C., Lopez, M. & Lagos, M. B. 2016 “Effectiveness of nursing process use in primary care,” International Journal of Nursing Knowledge, vol. 27, no. 1, pp. 43-47.

Springer, J. & Casey-Lockyer, M. 2016, “Evolution of a nursing model for identifying client needs in a disaster shelter: A case study with the American Red Cross,” Nursing Clinics of North America, vol. 15, no. 4, pp. 647-662.

Zamanzadeh, V., Valizadeh, L., Tabrizi, F., Behshid, M. & Lotfi, M. 2015 “Challenges associated with the implementation of the nursing process: A systematic review,” Irarian Journal of Midewifery Research, vol. 20, no. 4, pp. 411-419.

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