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The Influence of Leadership Styles on Employee Satisfaction and Productivity

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Abstract

This study sought to identify the types of leadership styles exhibited by management, the impact of leadership styles on employee satisfaction, productivity and staff perception of leadership styles. The study will adopted a descriptive survey of non-experimental research design to investigate the influence of leadership style on employee satisfaction and productivity. The study will rely on simple random and purposive sampling techniques in selecting a total of 120 respondents for the study.

The study will also expose that leaders who exhibited democratic (participative), people-oriented or transformational leadership characteristics for that matter, enhanced staff productivity. Leadership is a process influence between leaders and subordinates where a leader attempts to influence the behavior of subordinates to achieve the organizational goals. Organizational success in achieving its goals and objectives depends on the leaders of the organization and their leadership styles. By adopting the appropriate leadership styles, leaders can affect employee job satisfaction, commitment and productivity.

Background to the study

In recent times, organizations are going through dramatic changes, including flatter and looser structures, downsizing, and horizontal approaches to information flow. On the one hand, these changes are due to rapid technological developments, global competition and changing nature of the workforce. On the other hand, these organizational transformations and innovations are triggered by interventions such as total quality management and business process re- engineering.

Leadership is regarded as a critical factor in the initiation and implementation of the transformations in the organizations. In the past, leaders were identified, selected and installed based on the trait approach. The trait theory argues that leaders have certain personalities, social and physical characteristics, known as traits, which influence whether the person acts as a leader. Proponents of this view assert that qualities such as intelligence, knowledge and expertise, dominance, self-confidence, high energy, tolerance for stress, integrity and maturity were inborn.

The approach thus, rests on the assumption that some people were born to lead due to the presence of these qualities in them while others are not. This approach has witnessed a lot of criticisms from researchers and practitioners as a result of certain inconsistencies associated with it.

Effective leadership and employee job satisfaction are two factors that have been regarded as fundamental for organizational success. A capable leader provides direction for the organization and lead followers towards achieving desired goals. In similar vein, employees with high job satisfaction are likely to exert more effort in their assigned tasks and pursue organizational interests. An organization that fosters high employee job satisfaction is also more capable of retaining and attracting employees with the skills that it needs (Mosadegh Rad & Yarmohammadian, 2006).

Several studies have also examined the relationship between the two factors and concurred that leadership has significant impacts on job satisfaction and organisational commitment (William & Hazer, 1986). High job satisfaction enhances employees’ psychological and physical wellbeing (Ilardi, Leone, Kansser, & Ryan, 1983) and positively affects employee performance (Vroom, 1964).

According to Mosadegh Rad and Yarmohammadian (2006), employee job satisfaction refers to the attitude of employees towards their jobs and the organization which employs them. In particular, leaders within organizations can adopt appropriate leadership styles to affect employee job satisfaction, commitment and productivity.

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Previous studies have examined the relationship between employee job satisfaction and leadership behavior in various settings such as healthcare, military, education and business organizations (Chen & Silversthorne, 2005). Consistent with this, the present study intends to examine the relationship between leadership styles, job satisfaction and in the public sector. Two types of leadership styles will be examined, namely, transactional and transformational leadership.

General Objective

The overall aim of the study is to investigate the influence of leadership style on employee satisfaction and productivity.

Specific objectives:

1. To determine the relationship between aspects of transactional leadership such as contingent reward, active management by exception and passive management by exception with job satisfaction among employees.

Research Questions

What is the relationship between aspects of transformational leadership such as idealized influence, intellectual stimulation, individual consideration and inspirational motivation with job satisfaction among employees?
What is the relationship between aspects of transformational leadership such as idealized influence, intellectual stimulation, individual consideration and inspirational motivation with job satisfaction among employees?
What is the type of leadership styles that exists in the chosen organization?
What is the impact of leadership styles on staff productivity?
What is the impact of leadership styles on employee satisfaction?

Significance of the study

The research will be of great value to firms that need to improve staff productivity and employee satisfaction The research will also be of benefit to the research community in by suggesting areas that scholars can venture into. Thus it will act as a background research for future studies.

Research methodology

This section will provide the process of collecting the, outline the research design and the population and sample of the study. Study parameters such as the study setting, the type of data to be collected, the time of conducting the study and the limitations of the study will discussed as well.

Research Design

This study is quantitative in nature and descriptive research will be used incorporating the case study design in the study. A case study is concerned with investigating a given phenomenon in great detail. The main reason behind using this design is to establish the extent to which the variables under study influence of leadership styles on employee satisfaction, productivity and staff perception of leadership styles.

The study will adopted descriptive survey for the data collection in order to answer the research questions because the researchers did not control factors that might influence the behavior and performance of subjects under study thereby reporting the outcome as they are (Smith, 1975).This study adopted qualitative method to assess the effects of leadership styles on staff productivity and employee satisfaction.

Target population

The target population will involve the total number of all units from in the organization. This study will be conducted among the various units of the institution where selected heads and other members of staff of were sampled to obtain in-depth data on how leadership style affected staff productivity and employee satisfaction.

Sample Size Determination

The target population will indicate above as 515 and a sample of 120 will be drawn for the study. The research will considered this sample size as a representation of the total population. Nwana (1992) suggests that if the population is a few hundred, a 40% or more sample size will do, if several hundred a 20% or more sample size will be suitable, if a few thousands a 10% sample size will do. Based on this criterion, 23.3% of 515 will equal to 120 and hence the sample size drawn for the study.

Procedure for Data Collection

The research will begin the study with a visit to all the various units and departments and also interacted with a number of staff. With this, the researcher will get to know members of staff well and better understood the institution and its structures. The objectives of the study will be made known to the respondents and also assured them of treating their information with utmost confidentiality. Assurances from a researcher to respondents of confidentiality of information being sought will make the interviewees more relaxed and open in their responses.

Data Presentation and Analysis

Computer data analyses software such as the Statistical Package for Social Sciences (SPSS version 17) and other relevant software such as Microsoft Excel were the main tools employed to analyze. The justification for the choice of these programs was that, these techniques facilitated word processing and data analysis very easy and accurate.

REFERENCES

Adair, J. (1973) Action-Centred Leadership. New York,: McGraw-Hill.

Archer, F. K., Adentwi, K. I.and Sam, F. K. (2008) Educational Management and School Administration: Ebens Press.

Bass, B.M.and Avolio, B.J. (1994) Improving organizational effectiveness through transformational leadership. Thousand Oaks, CA: Sage Publications.

Blake,R.R and mouton, J.S (1964) Managerial Grid. Houston, Texas: Gulf Publishing.

Bryman, A. (1992).Charisma and leadership in organizations. London: Sage.

Burns, J. M. (1978) Leadership. New York: Harper and Row.

Fieldler, F.E.(1967) A Theory of Leadership Effectiveness. New York: McGraw Hill.

Foster, R., & Young, J. (2004). Leadership: Current themes from the educational literature. The CAP Journal (12)3, 29-30.

Heifetz, R. and Laurie D. (1997) „The work of leadership‟, Harvard Business Review, Jan.-Feb., pp. 124- 34.

Hersey, P.and Blanchard, K.H. (1988). Management of organizational Behaviour: Utilizing Human Reources, 5th edn. Englewood Cliffs, NJ: Prentice Hall International.

Hooper, A. and Potter, J. (1997) The Business of Leadership. Aldershot: Ashgate Publishing Company.

House, R. (1976) „A 1976 theory of charismatic leadership‟, in J.Hunt and L. Larson (eds)

Howell, J.M., & Avolio, B.J.(1989). Transformational versus transactional leadership: How they impact innovation, risk-taking, organization structure and performance. Paper presented at the National Meeting of the Academy of Management, Washington, DC.

Kilpatrick, S. And Locke, E. (1991) „Leadership: Do Traits Matter?‟ Academy of Management Executive Vol. 5 , No. 2, pp. 48-60.

Lewin,K., LIippit, R. and White, R. K. (1939). Patterns of aggressive behavior in experimentally created social climates. Journal of Social Psychology, 10, 271-301.

Müller, R., and Turner, J. R.(2005). Cultural differences in project owner-manager communication. In D. P. Slevin, D.

Yammarino, F.J. and Dubinsky, A.J. (1994). Transformational leadership theory: using levels of analysis to determisne boundary conditions. Personnel Psychology, 47 (4), p. 787.

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Preventing Heart Disease in Women by Promoting Awareness

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Preventing Heart Disease in Women by Promoting Awareness through Evidence-Based Practice

In investigating the impact of promotion awareness on preventing heart disease in women, the following PICOT question will be used to guide the research:

In women with cardiovascular diseases (P), does health promotions using evidence-based strategies to achieve optimal health of the heart (I), as compared to women receiving standard cardiovascular care (C) show better improvement in the cardiovascular disease (O) within six months? (T).

Using terms in the PICOT statement was not effective in finding useful studies. Most of the studies found by using such terms addressed broader concepts or did not relate all the ideas that the PICOT question needed to address. Some of them talked about one aspect of cardiovascular diseases alone without giving any hint about women, outcomes or interventions made towards controlling the condition.

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MESH terms such as cardiovascular, women, health promotion and others limited the number of studies that were listed on the databases compared to when those terms were not used. Therefore, this is an implication that the utilization of the MESH terms delimited the search as it filtered out some of the search results that did not have most components of the PICOT question.

Most of the research findings were not relevant to the study. To improve the relevance of the of the materials obtained, I applied limiters such as age, studies, EBP, women, years so as to only have articles that had a direct link to the various components of the Picot statement. The use of limiters was helpful because most of the items obtained in this case gave relevant information about aspects of the study. Reviewing this articles provided adequate information on the association between evidence-based practice in health promotion and improvement of cardiovascular diseases in women.

The study used for the study on preventing heart disease in women the following databases: AHRQ, guidelines.gov, joannabriggslibrary.org, EBCO, PubMed, and Ovid to gather evidence. All of them provided valid pieces of evidence. The study provided level I evidence as most of the articles were systematic reviews of randomized control trials.

References

Joanna Briggs Institute. Joanna Briggs Institute reviewers’ manual 2014 edition. Adelaide: JBI; 2014. Retrieved from http://joannabriggs.org/assets/docs/sumari/reviewersmanual-2014.pdf.

US Department of Health and Human Services. (2014). Guide to clinical preventive services. US Preventive Services Task Force. 3rd ed. Washington (DC): US Government Printing Office. Retrieved from https://www.google.com/search?q=http%3A%2F%2Fwww.ahrq.gov%2F&ie=utf-8&oe=utf-8&client=firefox-b.

Vandvik, P. O., Lincoff, A. M., Gore, J. M., Gutterman, D. D., Sonnenberg, F. A., Alonso-Coello, P., … & Spencer, F. A. (2012). Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 141(2_suppl), e637S-e668S. Retrieved from https://www.guideline.gov/summaries/summary/35273?.

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The Impact of Brexit on the UK and the EU’s financial regulation

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The Impact of Brexit on the UK and the EU’s financial regulation

Introduction

The 1999 EU regulatory initiatives were meant to ensure that there were maximum financial markets activities among member countries. The regulations were also meant to contribute to the removal of existing legal barriers in the financial sector among EU members. The cross-border financial market initiative benefitted the UK and contributed to an increase in trade in the sector. However, Brexit’s move on 23rd June 2016 might have resulted in an end to the many of the financial conveniences that the UK enjoyed (Grant Thorton, 2016).

According to Wellink (2009: 13), and World Bank (2013: 15), regulatory arbitrage is one of the greatest disadvantages that can emerge from an exit of a country from a Union with existing guidelines and policies. According to Wen (2016), there is a possibility of businesses undercutting each other if the current financial market is deregulated. Brexit might contribute to deregulation of the UK’s financial sector, therefore contributing to undercutting of some firms through unscrupulous dealers. Some of the firms that have their headquarters in the region might initiate planning on moving to other regions that they consider favourable; especially those within the European Union coverage.

Institutions in the global financial market will be affected to great lengths as a result of Brexit. Institutions that are directly related to the UK or the European Union might have to “revise” the location of their headquarters or location of their subsidiaries. The adjustments are necessary for the firms to survive in the market. Brexit has a major impact on financial firms because the sector is strictly regulated, and might contribute to challenges especially for UK firms.

Impact and challenge of Brexit on the UK’s financial sector regulation

According to Claessens and Kodres (2014: 78), regulation of the financial sector contributes to securing of firms so that the shareholders’ wealth is maximized. The UK financial institutions will have to meet the requirements of strict regulations which emanate from Brussels. Before Brexit, the UK might have had an upper hand in negotiating for strict financial regulations such as their refusal on the imposition of tax bonuses. However, the EU might want to use them (UK) as an example of the disadvantages that countries are bound to face when they exist the EU.

The regulatory arbitrage for the UK might have complex consequences since some of the financial sector regulations for the UK and EU are different. The UK might have more strict rules in comparison to those that are issued by the EU. The EU might have less stringent rules based on the need to accommodate many different members who have different backgrounds.

The UK has been part of the EU for over forty years, and most of its financial sector laws are based on policies in the EU regulations. Therefore, Brexit could contribute to instability of the UK banking system since most of the financial regulations that have been in use, have not been enshrined in the UK law for the forty years that the country has been a member of the EU. The effects from pass porting will determine the future of the financial sector for the UK. It is not all gloom for the UK’s financial sector after Brexit since the country will attain independence to make its own decisions in the sector.

Any loopholes that might be used by firms for arbitrage purposes should be identified and sealed so as to minimize any chances of illegal activities. Banker bonus cap has been raised as one of the areas that the bank of England and the European Parliament discussed as possibly contributing to financial regulation arbitrage. 

There will be immediate need of business continuous amidst the new and old regulations, or lack of clarity in the regulations that should be applied. Existing international financial firms that are located in the UK will have to make decisions on the viability of their current location. If the firms decide on a new location within the EU, they will have to make assessments on the suitability of a location that will contribute to a high level of business.

The short duration of confusion might lead to loss of business for some international firms. Financial firms in the UK will also have to ensure that they follow the MIFD II rules that will be established in 2018. The UK’s economy will be negatively impacted by a move of the financial firms that will want to relocate especially from London. Most of the international firms owned by EU member countries might want to relocate to other capital cities within the EU in order to make maximum gains.

The UK owned financial firms that have been conducting business in the EU will face higher costs and double rules if they will continue trading within the EU (Ashurst, 2016: 4). The low costs and EU financial regulation rules will no longer be accessible to those firms. Companies in the UK will also face stringent measures as required by the European Commission and the UK in the acquisition of partners from the EU.

The regulatory authorities in the UK are likely to increase the sector’s interest rates so as to make up on the deficit from being charged high rates through trade involving the EU. Clients will consider financial firms in the UK as being less stable as compared to those in the EU. Therefore, the clients might ask for higher returns on their investment based on the higher level of risk.

Financial firms will in turn have to invest in projects that have a high return, but take a long duration to give the expected profit on the investment made. The regulation of the financial sector institutions and supervision is largely national, even if the country is a member of a larger body (Omarova, 2010: 665: International Monetary Fund, 2009).

Evaluation of UK and EU’s financial regulation

The EU is quite strict on “bailing out” of companies since it results in the depression of the economy. Funds that could have been injected into projects contributing to the development of the economy, or boosting the economy are put into several companies that might not have a major positive impact on the economy (Heath, 2013: 32). Bailing out of companies by the government might contribute to lowering of ethical standards in companies.

The companies would know that the government would bail them out in the event that they collapsed. UK based financial companies are bound to face strict regulation especially since clients are likely to demand higher returns based on the higher level of risk. The EU is viewed as contributing to stability among its member states, and therefore making transactions that they engage in safer and more likely to give the planned return.

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The consequence arbitrage that has resulted from Brexit is highly influenced by non-financial effects of the initiative. The UK is no longer being considered as a major stakeholder in the making of foreign policies that might be required in times of conflict. Therefore, the UK has less bargaining power if it requires making deals with other countries. It is critical for a country to have a high bargaining power so as to negotiate trade and profitable financial agreements for its institutions (Weil, Fung, Graham, and Fagotta, 2006: 68).

The consequence arbitrage is the exit of major international financial institutions from London to other European Union capital centres. International financial organizations such as banks have already operated in the European Union and in the EU for decades. The move will contribute to the undoing of many years work, since the UK government has made numerous deals to bring the firms into the country (Ashurst, 2016: 4). Governments usually have to spend reasonable resources and adjust their regulations so as to be attractive to investors from foreign organizations.

Many other countries usually compete for the foreign firms. Therefore, countries have to ensure that their package offers are as friendly as possible. Furthermore, a financial Maginot line is necessary to deal with any eventualities that might arise such as collapsing of hedge funds. A hedge fund with a large volume of deposits could collapse and contribute to the collapse of banks in the region. The collapse or discovery of missing funds in a hedge fund could be triggered by sudden national financial moves such as the one triggered by Brexit.

Clearing houses might also contribute to negative consequences in the financial sector. According to Wen (2016: 9), clearing houses deals defaulting by a few traders can contribute to the system’s collapse. The collapse would result from the system’s insolvency. The central banks in different nations oversee the financial systems of those countries. However, there is no institution to oversee the central banks of different countries.

In the event of a collapse of the central banks of the countries involved in Brexit, there would be a collapse of all other financial institutions in involved nations. Financial regulatory organizations are focused on maintaining the regulations in place, especially because of the hefty fines that have been put in place. Therefore, in the event that the central bank was collapsing, it might take time for signs to be recognized by the financial firms that are the major focus of regulation.

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4.0 Conclusion

If it would not make the UK appear inconsistent, I would recommend a return to the European Union. However, since the decision and necessary steps have already been taken, the UK has to make do with its current situation. The UK has to establish clear guidelines in its financial sector since it has mostly used those in the European Union for about forty years. The opportunity should be utilized in coming up with financial sector regulations that will promote growth and have a competitive edge over countries in the European Union.

The regulatory authorities in the UK are likely to increase the sector’s interest rates so as to make up on the deficit from being charged high rates through trade involving the EU. However, the UK will have to come up with clear financial policies so as to mitigate the occurrence of a crisis. In the past, there has been severe and a high level of frequency of financial crisis that have occurred across the globe. The regulation and supervising of firms in the financial sector of a country is largely a national responsibility.

Both regulation and consequence arbitrage results are likely to be experienced by countries in the UK due to its exit from the European Union. There are international banks that have been situated in the UK for a long duration. These firms might have to relocate to other geographical locations in the EU so that they can continue enjoying the same regulations that they are used, especially if their parent firms are located in Europe (Ashurst, 2016: 6).

The geographical move would result in loss of revenue and employment for many UK nationals. Financial firms in the UK would be motivated to move because they would be expected to comply with a double regulation of the financial sector in EU, and that of the UK. Clearing houses could also contribute to a major collapse of the financial sector as a consequence of a failure of payment by a few dealers especially if they trade in high volumes. The solution to the possible loopholes that might occur is strict regulation of the financial sector for both the UK and EU.

Bibliography

Ashurst, 2016, Brexit: potential impact on the UK’s banking industry. Ashurst.

Claessens, S. and Kodres, L. 2014, The Regulatory Responses to the Global Financial Crisis: Some Uncomfortable Questions, IMF Working paper.

Grant Thorton, 2016, The impact of ‘Brexit’ on the financial services sector, http://www.grantthornton.co.uk/globalassets/1.-member-firms/united-kingdom/pdf/Brexit-impact-financial-services.pdf

Hopkin P, 2013, Risk management. London: Kogan Page.

Heath, R., 2013, “Why Are the G-20 Data Gaps Initiative and the SDDS Plus Relevant for Financial Stability Analysis?” IMF Working Paper 13/6 (Washington: International Monetary Fund).

International Monetary Fund, 2009, “Restarting Securitization Markets: Policy Proposals and Pitfalls,” Chapter 2 in the Global Financial Stability Report (Washington: International Monetary Fund).

Omarova, Saule T., 2010, “Rethinking the Future of Self-Regulation in the Financial Industry,” Brooklyn Journal of International Law, 35, (3): 665.

Weil, D., Fung, A., Graham, M., and Fagotta, E. 2006, “The Effectiveness of Regulatory Disclosure Policies,” Journal of Policy Analysis and Management, Vol. 25, No. 1, pp. 155-81.

Wellink, A.H.E.M, 2009, “The Future of Supervision,” Speech given at a FSI High Level Seminar, Cape Town, South Africa, January 29, at http://www.dnb.nl/en/news/newsand-archive/speeches-2009/dnb212415.jsp

Wen, J. 2016, some gaps in the financial Regulatory system. Class Notes.

World Bank, 2013, Global Financial Development Report, Rethinking the Role of the State in Finance, (Washington: World Bank).

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Mixed Method Approach: Research Design

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Mixed Method Approach Research Designs

Every work involves the use of specific tool or apparatus that enhances the attainment of the desired objectives. Similarly, in research, there are diverse methods that can be applied to collect data and come up with scientific reality or information about the social reality. In some instances, research work will need to apply combined techniques or more than one technique to increase the chances of getting more reliable information.

One of the prominent research techniques is the use of the Mixed Method Research, (MMR). Mixed method approach, also referred to as the multi-methodology, involves the application of both the quantitative and qualitative techniques in a single study. The application of both techniques can either be concurrent or sequential. The mixed method approach is likely to give a wider dimension of approach to research when applied in psychology-based study.

The current paper describes the mixed method research as an integration of both quantitative and qualitative methods. In addition, the paper explains the type of questions best explained by the mixed method approach. The paper also elaborates the strength and limitation of mixed method approach. Finally, there is the rationale for and against the utility of mixed methods in psychology.

According to Johnson & Onwuegbuzie (2004), the mixed method approach can be used to bridge the rift between quantitative and qualitative techniques. Both techniques though viewed as different, may have closer similarities. For example, both techniques aim to gather empirical evidence or data to address the questions posed. Mixed method approach is therefore an integrated approach that erases the limitations posed by the single method and can be used to answer a question posed on the social phenomenon (Johnson & Onwuegbuzie, 2004).

The mixed method approach technique usually uses both quantitative and qualitative techniques in order to create a greater validity that can be derived through the use of varied techniques of data collection. In the mixed method research technique, both the qualitative and quantitative data are collected. Afterwards, the data are mixed together to produce more comprehensive and integrated results regarding the social reality.

The mixed method technique can therefore be viewed as the bringing together of the qualitative and quantitative techniques (Creswell, 2014). Consequently, the mixed method technique can be explained as a convergence of results arising from both the qualitative and the quantitative results. This can be illustrated by the diagram below.

RESULTS

The data collected from both the qualitative and quantitative techniques are then connected together to form integrated research results.

Lastly, the information that is got from the result of carrying out both techniques is then embedded together and used to explain the social phenomenon that was under enquiry.

Any research study usually aims to answer a specific question or identify a gap that has been identified. When applying the mixed method of approach, one question is usually developed and then extended into quantitative and qualitative sub-questions. Once the enquiry has been undertaken, different perspectives of research are got and can therefore be used to explain the social phenomena under the study (Collins & O’cathain, 2009). The questions that are raised and are to be investigated can be answered from a number of perspectives.

In a concurrent mixed study method, both the quantitative and qualitative studies are carried out together and results emanating from the study combined. In a sequential study approach, the qualitative method for instance can be carried out first while the quantitative technique will be used to test a named hypothesis arising from the study so as to enhance generalization of the facts (Burkholder, Cox, & Crawford, 2016).

One of the advantages of using the mixed method approach is that the researcher can be able to use narratives, words and pictures to be able to explain reality or factual data in social phenomena (Creswell, 2014). For instance, Psychological facts can better be understood when a combination of these concepts will be used to aid in the explanation of the social reality.

From another insightful perspective, the researcher has an ample platform that allows him/her to be able to generate and at the same time test any grounded theory (Burkholder, Cox, & Crawford, 2016). Since the researcher will not be confined to particular tenets of the single method of research, he/she can be able to tackle broader and complete varieties of questions.

This allows the researcher to explore fully and comprehensively the case that he/she is studying to come up with conclusive information on what he/she is studying. In the mixed method approach, therefore, there is the concept of complementarily. Additionally, the mixed method allows the researcher to be able to add insightful facts and methods that can be ignored when a single research technique is applied in carrying out research work especially in psychology.

On the other hand, the mixed method can be considered to be more time-consuming and expensive. From another perspective, a lot of researchers may also find it difficult to handle any conflicting ideas or results arising from the study that uses the mixed method research technique. Furthermore, there are some researchers who may hold methodological predilections, which may make them lean on one method at the expense of the other. In such cases, the researcher may fail to understand the mixed methods as a complete integration of both the qualitative and quantitative methods.

Psychology-based researches require intensive implementation of research techniques that come up with viable results that fully explain a specific social phenomenon. For example, when the mixed method is used in finding out psychological concepts in the social world, the researcher is likely to come up with stronger evidence that will be derived from the convergence and collaboration of ideas from both the qualitative and quantitative techniques, applied together.

When both methods have been applied, the researcher can come up with a complete knowledge that can be effective in explaining and informing psychological practices and theories (Edmonds & Kennedy, 2012). From another insightful perspective, when the mixed method approach is used to investigate a psychological concept, overlapping, though diverse ideas about a social phenomenon can be derived.

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When undertaking a psychological study, the mixed method can enhance complimentarily between the quantitative and qualitative techniques. For instance, the results that can be derived from one method can be verified using the other. For example, the qualitative study can be used to come up with a psychological concept in the social world. Quantitative study can afterwards be undertaken to verify the facts through coming up with a hypothesis following the survey undertaken from the qualitative study (Mertens, 2014). Consequently, when qualitative technique is used as a platform to carry out a survey study, quantitative technique can be used to verify the facts.

Contrarily, the mixed method approach can pose difficulties to the researcher especially where he/she will be required to apply two or more approaches concurrently to study a psychological concept on a certain population. The researcher will be required to go an extra mile to understand how to apply both methods and how to mix them appropriately.

In conclusion, a single method used in carrying out research can produce a variety of weaknesses. The mixed method approach can be used to compensate for the weaknesses that can be prevalent in every single technique. For instance, the use of both the qualitative and quantitative techniques yields results that give a comprehensive outlook about the social phenomenon under enquiry.

References

Burkholder, G. J., Cox, K. A., & Crawford, L. M. (2016).The scholar-practitioner’s guide to research design. Baltimore, MD: Laureate Publishing.

Collins, K. & O’cathain, A. (2009). Introduction: Ten points about mixed methods
research to be considered by the novice researcher. International Journal of Multiple Research Approaches, 3(1), 2-7. http://dx.doi.org/10.5172/mra.455.3.1.2

Creswell, J. (2014). Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks, California: SAGE Publications.

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

Edmonds, W. A., & Kennedy, T. D. (2012). An applied reference guide to research designs: Quantitative, qualitative, and mixed methods. Sage Publications.

Johnson, R. & Onwuegbuzie, A. (2004). Mixed Methods Research: A Research Paradigm Whose Time Has Come. Educational Researcher, 33(7), 14-26. http://dx.doi.org/10.3102/0013189×033007014

Mertens, D. M. (2014). Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative, and mixed methods. Sage publications.

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Measles (Rubeola): Research Paper

Measles (Rubeola)

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Abstract

Forty years after the licensing of an effective vaccine, measles continues to cause severe complications and death in children in the world. The most common complications from measles include pneumonia and encephalitis. Measles also remain a leading cause for blindness in the world. However, there has been some remarkable progress in the global measles program. In the past one decade, annual reports on measles have decreased by 77% that is from 146 per million populations to 33 cases per million people.

This is attributable to the wide coverage of safe and inexpensive vaccine. Nevertheless, there have been many incidences of measles outbreak in developed and developing countries. This is attributable to poor implementation of vaccination programs in developed and developing nations. This results to infection of 40 million people and results in 1 million deaths in the world.

Due to the highly infectious of the disease, a population immunity of 95% is needed in order to disrupt the transmission, but only a small fraction of the population gets vaccinated. In this regards, this paper explores the pathogen, the disease signs and symptoms, its transmission and preventive measures available. The paper will also explore the mechanism of measles vaccination in improving human immunogenicity.
Glossary

CDC: Centers for Disease Control and Prevention

CD8+: cluster of differentiation 8

CD4+: cluster of differentiation 4

CD46: cluster of differentiation 46

CD150: signaling lymphocyte activation molecule

CNS: Central Nervous System

EEG: electroencephalogram

pH: acidity or basicity of a substances

MV: Measles virus

SLAM+: Signaling lymphocytic activation molecule

SSPE: Subacute Sclerosing Panencephalitis

WHO: World Health Organization

Background

Measles is a viral disease that was first described by Rhazes- a Persian Physician in the 10^th century. The incubation period and lifelong immunity after an infection was described by Peter Panum in 1846. The virus was isolated in 1954 in monkey and human kidney tissue by Enders and Peebles. The first measles vaccine was given license in the USA in 1963. Prior to the development if vaccine, the disease was nearly universal in early life stages, but most of the children would develop immune by the time they are 15 years.

Although it is significantly managed in the USA, measles is still one of the major fatal diseases in the world. According to the World Health Organization (WHO), the disease causes 40 million infections with 1 million deaths globally in 2013. Measles is clinically manifested with cough, running nose, maculopapular rash, Koplik’s spots, low grade fever, and lymphadenopathy. In some cases, measles could lead to the infection of the respiratory tract or other organs including the skin, Kidney, bladder and viscera (Koehlmoos, Uddin, & Sarma, 2011).

Measles Virus

Measles is caused by a virus. This virus is known as Morbillivirus measles virus. It belongs to the family paramyxoviridae, order Mononegavirales and the genus Morbillivirus. The virus diameter is120-250 nm, and consists of single stranded RNA. The species is a close relative of canine distemper viruses and rinderpest.

There are two membranes that enclose the virus proteins. The membranes are responsible for the pathogenesis. The F (fusion) protein main role is to cause fusion of the virus to the host, haemolysis, viral infiltration; and Hemagglutinin (H protein) that causes the integration of the measles virus into the host cells. However, recent studies have reported changes in the H glycoprotein of the virus. Measles virus is inactivated by heat, acidic pH, trypsin and ether. Outside its host, the virus has a short life span which is normally less than 2 hours (Walsh, 2011).

The measles virus genome encodes 8 proteins, 6 structural proteins and 2 are responsible for viral entry. These are the Hemagglutin (H) as well as the measles virus fusion (F) protein. These proteins are the components of the viral envelope that together they mediate integration of the virus into the cells in the upper respiratory tract. The H protein targets the cellular receptors of the CD46 and CD150. This protein is is associated with the lifelong immunity that follows after recovery of the infection. This is attributable to the cell-mediated memory that causes the creation of neutralising antibodies that target the H protein of the measles virus (Walsh, 2011).

The measles virus life cycle starts with virus adsorption to host’s cell membranes surface using the H protein. The virus CD46 molecule is the cellular receptor. The virus then enters to the host cells where it uncoats. This is followed with RNA polymerase transcription of the Virus genome into the host mRNA. This is followed by the assembly of helical nucleocapsid occurs before the virus are released by budding. The mRNA synthesis, translation process and replication processes are as shown below (Walsh, 2011);

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Pathogenesis measles virus

The virus transmission is through droplet or airborne route. The nasopharynx is the primary infection site of the virus is the nasopharynx respiratory epithelium. The virus enters through the upper region of the respiratory system but the infection is not localized one specific site. The viral replication takes place in the epithelium of the respiratory system, and the replicated virons moves to lymphatic tissue.

Replication continues again in the lymph nodes and is from the lymphatic system that the virus spreads to the other different organs including the gastrointestinal tract, skin, and kidney. The virus replication takes places in the endothelial cells and epithelial cells of each of the aforementioned system. The virus has broad range of tissue tropism after it has accessed the epithelium (Walsh, 2011).

In each system, the virus replicates and sends it to the new virions which target the new host cells. The primary viremia is 2-3 days. After invasion, the virus replicates takes place in the respiratory epithelium and in lymph nodes as mentioned above. Following this replication, the second viremia takes place which is usually 5-7 days after initiation of the infection, which could lead to the infection of the respiratory tract or other organs including the skin, Kidney, bladder and viscera. The rash in measles and the Koplik’s spots arise from delayed hypersensitivity reaction (Walsh, 2011).

The pathogenicity of the virus takes place through in various distinct stages. The prodrome stage is the first stage. This stage is characterised by non-specific clinical manifestations such as fever, coryza, cough and conjunctivitis. However, addition signs and symptoms can be manifested during this prodrome stage. Small white spots can appear on the mucus membrane around the eye or sometimes along the parotid duct of the mouth. The spots are called the Koplik spots and precede the onset of skin rash. The Koplik spots are considered as diagnostic indicators, but are not present in all infections and also requires experienced healthcare provider to recognise them (Hanvoravongchai et al., 2011).

The onset of skin rash marks the end of prodrome. The rash is distinctive in that it is maculopapular and erythematous. The rash is attributable to immune reaction to endothelium and which occurs due to infiltration of mononuclear cells. The rash starts from the face and outspreads down to the trunk and lower extremities. The rash often lasts 3-4 days and dries up following a similar pattern. When the rash fades away, indicates that the viral clearance has begun. For uncomplicated incidences of measles, full recovery begins as soon as the skin rash begins to disappear (Guerrant, Walker, & Weller, 2006).

The third stage takes many forms and will occur where immunosuppression occurs and results to complications. When the patient is infected with measles virus, it induces immune response that is intense, which makes the host to be immunologically compromised. The reduction in CD4+ T helper cells, incapacitation of clonal activation of cell mediated and humoral immunity and reduction of CD8+ cytotoxic cells follows the viral clearance.

In addition, the antigen presenting capability is reduced due to maturation of then dendritic cells. The immunosuppression greatly affects the aspects of innate and adaptive immunity, and since the immunosuppression can last for sometime, the patient state of viral clearance makes them to become increasingly vulnerable. The immunosuppression can result to increased bacterial and viral infection. The most common type of infections is diarrhoea and pneumonia, which are responsible for increased paediatric mortality and morbidity associated with measles (Hanvoravongchai et al., 2011).

Measles virus has been isolated from the bronchial lymph nodes mononuclear cells and in tonsils in the first few days after infection Other studies have demonstrated massive infection in the lymph node, thymus and spleen. This suggests that it is possible that the virus primary target is the epithelial cells of the respiratory system and normally follow the SLAM + and CD46- independent pathway including the monocytes and lymphocytes.

The rash is occurs when T-cell reacts to the MV-infection in the capillary vessels. This is supported by the fact that the skin rash is absent from children with T-cell immunodeficiency. The mechanism that underlies the severe lymphonepia and immunosuppression is not well understood. However, the massive destruction of SLAM+ cells could cause the immunosuppression (Fields et al. 2013).

Acute measles panencephalitis normally involves the central nervous system (CNS). Transient EEG detects the brain abnormalities in 50% of the patient. It is difficult to isolate the measles virus from the patient’s brain. Therefore, the CNS damage arises from autoimmune reaction. The Subacute measles encephalitis occurs in patients with a history of severe immune disorder.

Therefore, the infections are not accompanied by production of antibodies. In SSPE, the virus gains entry to the CNS during the secondary viraemia. This causes a low grade infection that is persistent. It is not yet established if the lesions are due to immunopathological mechanisms or through viral replication (Walsh, 2011).

The human body immune system has a capacity to fight the measles viruses. The immune systems is carried out by specialized cells, each cell is designed to fight the disease. The microbe’s macrophages recognize the microbes through microbe’s specific antigen. The antigens trigger the lymph nodes to produce lymphocytes that are of two types- the T cells and B cells.

These cells are programmed by exposure to microbe’s antigen. The T cells function as defensive cells and offensive cells. The offensive cells work by attacking using chemotaxis. The defensive cells are the cytotoxic T cells also known as killer cells which usually identify the cells that are harbouring the microbes and release chemicals which destroy infected cells (Walsh, 2011).

The T helper cells help in activation of the T killer cells. The T helper cells works together with the B cells, which help secrete antibodies. The Antibody (Ab) that fights measles is produced and circulates in the blood system. The antibodies produced match the Ag sites for measles viral coat. The Abs then binds to the antigen in a specific matter. The Ab-Ag complexes have two effects.

First, the complex distorts the coat protein by attaching on its receptors. Secondly, the complexes have powerful chemical attractants of the white blood cells, which destroy the virus through phagocytosis. After viral clearance, the B cells and T cells are transformed into memory cells. These then quickly divide further into plasma cells making reserve antibody. In case of re-exposure to the measles virus, the immune system recognizes them and stops the infection. Through immunization, the live attenuated measles virus is injected in a person’s body.

The body responds by forming measles specific Abs through a process that mimics the actual infection of the virus. The viruses introduced are usually weakened and therefore cannot cause a disease, but it leads to formation of Memory cells. Thus, if the vaccinated persons get confronted with the real virus in the future, the body already have adequate quantity of anti-measles Abs, thus no infection results (Walsh, 2011).

Summary of an article

Eden and colleagues investigated the impact of novel microneedle measles vaccine in primates. The study hypothesised that use of microneedle patch will improve vaccination rates. The microneedle patches is a dry formulation of vaccines, which occurs in solid needles which dissolves upon application of the patch of microneedle puncture into the primate’s skin. The advantages of these patches are that they provide the opportunity of minimally-trained person to give the vaccination as there are no requirements for reconstitution. In addition, no single-dose presentation and avoids use of sharp waste, facilitates mass vaccination (Edens et al., 2015).

The microneedle vaccination systems are effective in delivering of vaccines. They have been effectively used in cotton rats, where the findings indicated that equal neutralizing antibody titers as those in cotton rats that had vaccination in subcutaneous injection. However, in this article, the animal model used is the rhesus macaques.

In this study, one group received live attenuated vaccine using microneedle patch and the other group using the subcutaneous injection. The serum samples collected were tested for presence antibodies, and the presence of IgM in day 14 after vaccination. The presence of IgM by day 14 is an indicator that the animal had generated immune response following immunization (Edens et al., 2015).

As shown in the Fig 1. , the neutralizing antibodies were detected at day 21 after vaccination, which accelerated and peek on day 28 in both groups. There was no statistical difference on the peak of titers and times to peak between the two groups. In subcutaneous injection and microneedle patch, the animals reached a titer higher than 120mlU/mL- which is normally considered as protective level in humans (Edens et al., 2015).

On matters concerning safety of microneedle patch vaccine, no side effects were observed. However, upon the removal of the patch, faint erythema was observed but there was no evidence of wound infection or bleeding. The faint puncture disappeared 2-3 days post vaccination and no swelling or discharge was observed. In addition, no reactogenicity or discomfort was observed.

This technique should be used in clinical practice as thermostability of the microneedle patches is considerably better as compared to the currently measles vaccine that are formulated and refrigerated during transport. Most of the vaccines denatures due to cold-chain failures (Edens et al., 2015).

Environmental factors that contribute to the re-emergence of measles and its impact in the society

The measles outbreaks have been hopscotching across the USA. It has not yet been confirmed on what exactly triggered the Disney linked measles outbreak, but the CDC officials have associated it with the overseas tourists who visit Disneyland Park. This is supported by the findings of genetic finger prints which was identical to B3 measles virus that had caused the massive measles outbreak in the Philippines. With the low vaccine coverage rate, the disease spread rapidly across the states. Medical professionals were quick to point to possibilities of anti-vaccine movement (Edens et al., 2015).

Research points out other contributing factors from public health measures such as lack of access to quality health care. For instance, surveys indicate that only 50% of pre-school aged children have been vaccinated against measles. Disparities in vaccination are observed in African American and Hispanic community. The vaccines for children program is for uninsured and medical eligible children.

The vaccine is give at no additional cost. However, still not every child gets immunized (Walsh, 2011). This is because some parents rejects vaccinations and another fraction may delay the child from getting immunization. This trend has increased in the recent past, which has resulted in unvaccinated communities. This poses a public health risk and barriers in achieving significant benchmarks for immunization coverage.

There are increased concerns that measles outbreaks have been reoccurring in areas that are least expected and in some cases in persons who have received vaccines in the past. This raises concerns on whether there is vaccine dilemma, or if the current vaccine must be insufficient and lacks adequate protective levels that will ensure that will enhance the circulation of measles specific neutralizing antibodies (Poland & Jacobson, 2012).

Measles have severe impact to the society. For instance, high measles fatality ratios have been reported in both developed and developing countries. In the developed countries, less than one in 1000 children diagnosed with measles dies. In developed country, measles is the leading cause of mortality in refugee camps. The risk of death depends on patient’s age, vitamin A deficiency, and malnutrition.

Most of the mortality is attributable to a number of measles complications such as encephalitis and pneumonia. The economic cost of the disease cannot be overlooked. CDC estimates that approximately $ 4,091-$ 10, 228 is used to contain each case of measles per day. The additional economic costs include the weighty costs of work absenteeism and children missing schools. These estimates indicates that the outbreak have a hefty price tag (Benjamin, 2014).

The resurgence of measles and most infectious disease globally reflects a quick fix mentality. There is poor development planning in infectious disease endemic regions, lack of institutional inertia and political determination. The re-emergence of infectious disease is inevitable because of high environmental and developmental change which results in increased population growth. There is much that can be done to reverse the current trend.

However, this will require meshing the economic and social developmental programmes with the natural resource and environmental programmes in order to establish strategic interventions that will reinvigorated the virus ecology and advancement of scientific measures. This will facilitate the strengthening of applied and basic research on the interaction of a pathogen, host and environment; which in turn will result in the development of vaccines, diagnostic procedures and new therapies required to detect and control the disease (Benjamin, 2014).

References

Benjamin Johns, D. (2014). Measles Eradication versus Measles Control: An Economic Analysis. J Vaccines Vaccin, 05(06). Retrieved from http://dx.doi.org/10.4172/2157-7560.s3-002

Edens, C., Collins, M., Goodson, J., Rota, P., & Prausnitz, M. (2015). A microneedle patch containing measles vaccine is immunogenic in non-human primates. Vaccine, 33(37), 4712-4718. Retrieved from http://dx.doi.org/10.1016/j.vaccine.2015.02.074

Fields, R., Dabbagh, A., Jain, M., & Sagar, K. (2013). Moving forward with strengthening routine immunization delivery as part of measles and rubella elimination activities. Vaccine, 31, B115-B121. Retrieved from http://dx.doi.org/10.1016/j.vaccine.2012.11.094

Guerrant, R., Walker, D., & Weller, P. (2006). Tropical infectious diseases. Philadelphia: Churchill Livingstone.

Hanvoravongchai, P., Mounier-Jack, S., Oliveira Cruz, V., Balabanova, D., Biellik, R., & Kitaw, Y. et al. (2011). Impact of Measles Elimination Activities on Immunization Services and Health Systems: Findings From Six Countries. Journal Of Infectious Diseases, 204(Supplement 1), S82-S89. Retrieved from http://dx.doi.org/10.1093/infdis/jir091

Koehlmoos, T., Uddin, J., & Sarma, H. (2011). Impact of Measles Eradication Activities on Routine Immunization Services and Health Systems in Bangladesh. Journal Of Infectious Diseases, 204(Supplement 1), S90-S97. Retrieved from http://dx.doi.org/10.1093/infdis/jir086

Poland, G. & Jacobson, R. (2012). The re-emergence of measles in developed countries: Time to develop the next-generation measles vaccines?. Vaccine, 30(2), 103-104. Retrieved from http://dx.doi.org/10.1016/j.vaccine.2011.11.085

Walsh, R. (2011). Measles Part 1: The Virus, the Disease, and the Dynamics. Retrieved from http://www.infectionlandscapes.org/2011/07/measles-part-1-virus-disease-and.html

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Reducing nursing alarm fatigue

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Reducing nursing alarm fatigue

Introduction

In the healthcare setting, clinical alarm fatigue management failure is often as a result of nursing mistakes relating to complexity of the system. Telemetry technicians as well as nurses are occasionally affected by clinical alarm fatigue which hinders their capability to respond to the clinical alerts in the monitors (Sowan et al, 2015). Often, these practitioners are inundated with a significant number of visual and audio alerts which makes them ignore or fail to see the pertinent clinical alarm.

According to a qualitative research done by Dressler et al (2014), fatigue alarms rate from about 187 alarms per day in a single bed, 88.8% of which are false positives. This high rate has been a nuisance and a distraction in the healthcare setting as they can lead to increased number of mistakes in patient care. They are also a cause of panic and stress to patients who may be trying to rest as well as recover from illnesses and surgeries. Therefore reducing nursing alarm fatigue is much needed in the healthcare setting.

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Problem statement

The rate at which false alarm fatigue go off has remained to be a huge problem for telemetry technicians and nurses in charge of monitoring alarm signals in the telemetry room. These nurses and technicians are faced by a barrage of alarms and alerts during their shifts which makes them ignore the alerts at times. As a result, these practitioners may ignore a true positive alarm that needs immediate action leading to detrimental safety complications on the patient (Sowan et al, 2016).

Purpose of this study

The main aim for this study is to investigate whether healthcare organizations can minimize the amount of fatigue alerts in the telemetry rooms by applying the Plan Do Study Act (PDSA) method. Failure to respond to true actionable alarms has led to serious patient injuries and even deaths in the healthcare setting (Christensen, Dodds, Sauer, & Watts, 2018).

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Significance of the study

This research is important because it informs the healthcare practitioners on how to minimize the severity of non-actionable alerts that nurses and other clinicians face during their shifts. Reducing the number of false positive alarms will create an environment that can improve the practitioner’s awareness of the alarms thus decreasing alarm fatigue (Cho, Kim, Lee, & Cho, 2016)

Research Questions (PICO)

How does an organization’s infrastructure, culture, technology, and practices influence a strong alarm management plan?

How can the elimination of false alarms such as premature ventricular contraction (PVC) and low amplitude GCG complexes lower the number of non-actionable alerts in the telemetry room?

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Key words

Alarm fatigue, false positive alarms, premature ventricular contraction, and telemetry room

Methods

This qualitative research investigates how the healthcare system can minimize the number of alerts that cause fatigue among nurses as well as telemetry technicians to enhance patient safety. This paper uses peer reviewed papers from credible sources retrieved from databases such as PubMed, CINAHL, MEDLINE/EBSCO, Proquest, and HEALTH SOURCE/NURSING/ACADEMIC EBSCO.

The key terms that were used in this research includes clinical alarms, alarm fatigue, and physiologic monitor alarms. The timeline for this research was publications that dated from 2012 to 2019. The inclusion criteria for this research study included qualitative and quantitative studies that discussed how to reduce false positives in the telemetry room. A total of 46 research articles were reviewed though only 10 were used as the rest were duplicates or did not include detailed information.

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Reducing nursing alarm fatigue

Results

Srinivasa et al. (2017) and De Vaux et al. (2017) carried out quality improvement projects using the PDSA methodology in an effort of minimizing the severity of false alarms that nurses and technicians are exposed to in a single shift by revisiting the alarm alert typology. While De Vaux et al. (2017) used direct observations based on the alarm codes to develop concepts, Srinivasa et al. (2017) captured data using electronic software tools to capture data.

The two research studies investigated the PVC alarms and asserted that these alarms go off when physiologic monitor peaks irregularities in cardiac rhythms. During the beginning of physiological monitoring, most healthcare practitioners treated PVCs using various interventions or medications. However, recent research shows that cardiac irregularities are basically benign and are not treated.

Nonetheless, even after this discovery the PVCs alarms were not removed from the physiologic monitoring system. These two researchers concluded that PVC alarms should be removed from the physiologic monitoring system to reduce alarm fatigue among the practitioners.

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In their research, Walsh-Irwin and Jurgens (2015) also investigated how the healthcare system can reduce false alarms by adopting better cultures and patient care systems. These researchers carried a research that involved monitoring physiologic alarms before interventions and after the application of certain physiologic monitor leads following improved skin preparation.

Walsh-Irwin and Jurgens (2015) analyzed the collected data before and after the skin care intervention in an effort of determining whether the number of alarms reduced or accelerated. The statistical data that was collected in this research showed that proper skin preparation results to a reduced number of false positive alarms. The healthcare system should therefore adopt cultures that ensure proper skin preparation in patients to reduce the number of false alarms in the telemetry room.

Paine et al. (2016) also carried out a quasi-experimental research to investigate how healthcare organizations can reduce the number of false positive alarms among patients. This research examined topics such as the relationship between nurse response time and alarms exposure, non-actionable and actionable alarm propositions, and important interventions that help in the reduction of false alarms frequency.

This research established that the actionable alarms raged between <1% and 36% across many healthcare organizations in the United States. This research also found that there is a considerable correlation between alert exposures and the time that nurses take to respond to the alarm.

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In another experiment, Pelter, Fidler, and Hu (2016) investigated the probable impacts of a low-amplitude QRA complexes on asystole alarms that are false positives. Low-amplitude QRS complexes occur when limb complexes lead to less than 5-10 millimeters in the precordial leads. This qualitative study involved 82 patients who were observed in a period of 31 days.

The research suggested that there was no significant statistical data to having a false positive asystole alarm when a 12-lead ECG measured QRS complexes that were low amplitude. This experiment demonstrated that the low amplitude QRS complex alarm can be eliminate from the physiologic monitor.

Discussion

The themes that are evident in the above research studies provide insight to the healthcare’s struggles to apply PSDA methods that can manage alarm alerts. The studies establish that most alarms are not actionable and are a source of disruption and fatigue among nurse and therefore there should be active efforts to minimize the number of false positive alarms because they result to alarm desensitization and important alerts can be ignored as a result (Model for Improvement, 2018).

The research studies also establish that modifying alarms to ensure that only actionable physiological changes are recorded is a good of reducing alarm fatigue. Pelter, Fidler, and Hu (2016) clearly show that interventions are also a safe way of reducing the number of non-actionable alarms.

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Conclusion

In essence, alarm fatigue is a huge problem that puts patients in grave danger and a practitioner can ignore an actionable alarm thinking that it is a false positive. As such, adopting a PSDA methodology to reduce the number of false alarms will enhance the opportunities for practitioners to respond to the actionable alarms as well as reduce alarm fatigue. The healthcare organizations should create an environment that provides meaningful information to telemetry room monitors.

Reducing nursing alarm fatigue

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References

Cho, O. M., Kim, H., Lee, Y. W., & Cho, I. (2016). Clinical alarms in intensive care units: Perceived obstacles of alarm management and alarm fatigue in nurses. Healthcare informatics research, 22(1), 46-53.

Christensen, M., Dodds, A., Sauer, J., & Watts, N. (2018). Alarm setting for the critically ill patient: a descriptive pilot survey of nurses’ perceptions of current practice in an Australian regional critical care unit. Intensive and Critical Care Nursing, 30(4), 204-210.

De Vaux, L., Cooper, D., Knudson, K., Gasperini, M., Rodgerson, K., & Funk, M. (2017). Reduction of nonactionable alarms in medical intensive care. Biomedical Instrumentation & Technology, 51(s2), 58-61.

Dressler, R., Dryer, M. M., Coletti, C., Mahoney, D., & Doorey, A. J. (2014). Altering overuse of cardiac telemetry in non–intensive care unit settings by hardwiring the use of American Heart Association guidelines. JAMA internal medicine, 174(11), 1852-1854.

Model for Improvement: Plan-Do-Study-Act (PDSA) Cycles. (2018). Retrieved April 29, 2018, from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChang es.aspx

Paine, C. W., Goel, V. V., Ely, E., Stave, C. D., Stemler, S., Zander, M., & Bonafide, C. P. (2016). Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency. Journal of Hospital Medicine, 11(2), 136-144.

Pelter, M. M., Fidler, R., & Hu, X. (2016). Research: Association of low-amplitude QRSs with false-positive asystole alarms. Biomedical Instrumentation & Technology, 50(5), 329- 335. Srinivasa, E., Mankoo, J., & Kerr, C. (2017). An evidence‐based approach to reducing cardiac telemetry alarm fatigue. Worldviews on Evidence‐Based Nursing, 14(4), 265-273.

Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), 134- 139.

Sowan, A. K., Gomez, T. M., Tarriela, A. F., & Reed, C. C. (2016). Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: a pilot project. JMIR human factors, 3(1), e1.

Sowan, A. K., Tarriela, A. F., Gomez, T. M., Reed, C. C., & Rapp, K. M. (2015). Nurses’ perceptions and practices toward clinical alarms in a transplant cardiac intensive care unit: Exploring key issues leading to alarm fatigue. JMIR human factors, 2(1), e3.

Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), 134- 139.

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VOLUNTEERS IN NFP AND NGOS

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VOLUNTEERS IN NFP AND NGOS

The Victorian equal employment opportunity law stipulates volunteers’ rights. The law states that, volunteers in not for profit and non-governmental organizations should have equal protection against harassment and damages as the other paid employees. Volunteers are important recourses for NGOs and NFP organizations. Most of these charitable organizations are run and managed by volunteers (Taylor, 2011).

They offer their services free of charge to the organizations that deliver charitable programs to disadvantaged countries and communities. They have no interest in financial compensation. Most of them derive personal satisfaction from offering their services free of charge to charitable organizations. The importance of volunteers is attached to their contribution towards achieving an organization’s mission and objectives. According to Ralph (2006), qualified volunteers should be retained through motivation. They can be encouraged by training incentives and rewards.

CHARACTERISTICS OF VOLUNTEERS IN NFP AND NGOS

Volunteers are very important resources for NFP and NGO’s. They are expected to deliver their services like the other employees. They are not entitled to any payment by the organization. There services are considered to be of good faith and charitable (Farmer & Fredor 1999). The fact that they are not entitled to monetary compensation, does not oblige inefficiency and lack of commitment. They work voluntarily, they cannot be forced to work, they can stop their services any time and the organization can dismiss them any time.

Volunteers should be willing to learn and train in order to acquire the necessary skills and qualification required in the organization. Choudhory (2010) found out that, most of them have different professional backgrounds that may not correspond to the nature of the organizations work. They should be flexible to acquire appropriate skills and experiences that are necessary through training.

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Taylor (2001) states that, volunteers do not have tenure of employment and when unproductive they are dismissed by the organization. The organizations objectives should be achieved through volunteers who should be willing and are committed to provide their services to the respective organization. They should be flexible in delivering their duties, some organizations work in risky and hardship areas, these calls for volunteer resilience and endurance.

Volunteers should be productive, efficient and motivated in carrying out their duties. Transparency and accountability is an important aspect in volunteering, they should be able deliver their services in a diligent and honest manner (Boraas, 2003).

Agreements between the volunteers and the organizations are not legally binding. The organization is not obligated to act in accordance to the volunteers’ specifications and the volunteers have no legal obligations with the organization. However, some organizations provide insurance cover for the volunteers, such covers shield against work related injuries and liabilities. In an occurrence of losses or damages, such organizations are liable to cover for the respective damages.

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According to Vitner & Yodfat (2008), organizations may award volunteers minimal payments as incentives but the organization is free from obligations. They can be entitled for allowances, rewards and should be reimbursed for their out of pocket expenses. They can also receive non monetary benefits like free air tickets and free access to services provided by the organization. Volunteers are entitled to work in good working conditions and in safe environments like the other paid employees. The equal opportunity Act protects their rights.

These charitable organizations have their responsibilities to fulfill. Qualified volunteers with proper skills, experiences and interests should be recruited so as to reduce turnover rates. The organization should provide proper training and orientation to volunteers. Proper induction facilitation should be enhanced so as to enable volunteers to work towards achieving organizational objectives.

RECRUITMENT OF VOLUNTEERS IN NFP AND NGOS

Non for Profit and Non governmental Organizations have significant intentions of attracting and recruiting qualified volunteers. In order to establish long- term productivity and relationship between the volunteers and the organization, volunteers should have appropriate skills, interests and qualities that correspond with the objectives and mission of the organization.

Attracting and recruiting volunteers with these characteristics, ensures good performance, such volunteers have high chances of being retained. Once qualified volunteers have been recruited, it is important to specify and delegate duties, responsibilities, expectations and tasks between the organization and the volunteers.

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Recruitment of volunteers depend on the organizations specifications regarding skills and competences. Background checks are also considered during recruitment. Background checks vary in accordance with the nature of the work the volunteer will be entitled. Volunteers working with children, elderly and disabled individuals should have distinct background check. The nature of the organization should correspond with the background checks.

It was established by Bruney (1999) that during recruitment, a written agreement is not necessary. However an agreement stipulating the roles and responsibilities is initiated between the organization and the volunteers. These will help to resolve any disputes concerning obligations between the volunteer and the organization. An organization should not take anyone as a volunteer if it believes he is incompetent and cannot perform the required tasks.

A volunteer may take action against the organization if he is discriminated in respect to personal characteristics. The Victorian Equal opportunity and Human rights commission stipulate laws that protect the volunteers against discrimination.

TRAINING VOLUNTEERS IN NFP AND NGOS

Training of volunteers is very important in ensuring efficiency and effectiveness in service delivery. Most volunteers do not have a background of professionalism in their assigned line of duties. Training is necessary towards achieving important organizational objectives. The aims of training volunteers include; maintaining long term motivation and orientation of duties and responsibilities to the volunteers. Volunteers are equipped with tools, experiences and exposure in their line of duty, further more leadership lessons and skills are facilitated through training (Courtney 2001).

Training volunteers is an aspect of supporting, attracting, rewarding and retaining volunteers. It enhances improvement in performance and quality in service delivery. Volunteers from different backgrounds with diverse needs and duties are catered for through training and proper orientation. Companies that train their volunteers attract potential volunteers; this is because motivation is provided through training and careers development. An organization that trains its volunteers is committed to supports its volunteer’s welfare and needs for career development.

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According to Johnson (2007), volunteer training involves either formal or informal training. The training is administered through out the volunteers’ lifecycle. Informal training involves induction programs while formal training involves college training for a specific period of time. Organizations train their volunteers according to their specific needs. Important aspects to be included in training include, determining the training needs, establishing the training objectives, designing, implementing and evaluating the training program.

DESIGNING A TRAINING PROGRAM FOR VOLUNTEERS IN NFP AND NGOS

A training program should be designed according to the organizations’ needs. Important aspects to be considered when designing training program include, determining the type of training to be administered, identifying the facilitators, determining the content of the program, sourcing for the appropriate materials and determining the setting through which the training will be facilitated. Settings for training may include, on job training, classroom or in the field training (Zullo, 2011).

Individual volunteer needs should be considered when designing training programs. Suitable training should be administered to different groups of people. Younger and older volunteers should be trained differently according to their needs and duties. Volunteer’s diverse cultural settings should also be considered (Nagbhushanam & Sridhar, 2010).

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Implementation of the training is the most important stage of volunteer training. The training contents should be appropriate and to be delivered effectively. Facilitation and coordination of the training is very important because it determines the outcome of the program. The success or failure of the program will be determined by carrying out an evaluation on the effectiveness of the program.

Evaluation questionnaires are usually used to collect feedback from the program participants. Criticisms, suggestions and proposals are obtained from the evaluation. According to Thomas (2007), criticisms from the participants can be used for continuous improvement in future trainings. A strategy can be formulated from the strengths and weaknesses established from the program.

It was observed by Allhyari (2000) that, evaluation should be carried out to determine if the volunteer target competency was achieved. It is very important in determining the effectiveness and reliability of the program. Volunteer training should be an on-going process. Volunteer’s skills and competencies should be frequently updated to suit the rising needs of the organization. Through training volunteers will be able to achieve career development and leadership skills.

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MOTIVATION AND RETENTION OF VOLUNTEERS IN NFP AND NGOS

Not for Profit and Non-governmental organizations should develop strategies that will enable them retain and motivate their volunteers. The success of such organizations highly depends on the workforce which majorly constitutes the volunteers. Many NFP and NGO’s have experienced a significant percentage in losing volunteers. This emerging trend has necessitated the need for motivation, so as to retain volunteers. Elshaug & Metzer (2001) established that, most volunteers serve briefly in their respective organizations.

Such organizations fail to provide sufficient motivation to retain the volunteers. Recent studies show that older volunteers most likely serve longer than younger volunteers. The younger volunteers have 20% lower retention rates than adult volunteers. The retention rate in adults is high up to 69.9%.

Various organizations employ different motivation strategies. It has been established that proper recruitment and motivation strategies leads to successful strategies for retention. Retention is affected by barriers and factors which discourage or encourage volunteers. Major barriers that discourage volunteers include risky and costly nature of their work, lack of appropriate skills and experience, insufficient time, poor working conditions, poor reward systems and lack of personal and career development (Odenheirmer, 2011).

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Volunteer retention can be achieved through various strategies. Frequent training is a strategy that motivates volunteers. Their personal and career development needs are enhanced through training. Another strategy to ensure volunteer retention relates to attraction and recruitment strategies, the recruitment process directly relates to retention. Recruiting interested and qualified volunteers improves the retention rates. Other important factors that contribute to volunteer retention include proper skills experience and qualifications, improved reward system, flexibility, recognition, leadership roles and career development.

Low volunteer retention is a vital problem that such organizations face. High rates of volunteer turnover affect the capabilities of these organizations in service delivery. In order for these organizations to achieve their missions and goals volunteer retention must be achieved. Proper working relationships should be enhanced between the volunteers and the organization (Ralph, 2006).

VOLUNTEERS IN NFP AND NGOS: VOLUNTEERING AND ITS BENEFITS

Vitner & Yodfat (2008) argued that, despite the current trend of low volunteer retention rates, enormous benefits can be derived from volunteering. Individuals are able to acquire more skills and career development through volunteering. One of the greatest benefits of volunteering is the impact it creates on the community. Charitable services and activities offered by NFP and NGO’s are aimed at improving the status of the community. Most of these organizations’ activities address social and development needs in the community. The disadvantaged countries and poor nations are the major targets of these organizations.

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Volunteers are able to expand their social skills, make friends and create networks through wide interactions with the communities. Some individuals derive personal fulfillment and satisfaction through community service. These individuals attach themselves to the society and are determined to impact positively on the society. Such individuals desire to give back and may commit their own resources to improve the community. Recognition and appreciation in the community provides personal satisfaction (Zullo, 2011).

Career development is enhanced through volunteering. Individuals are able to acquire important work place skills such as problem solving skills, teamwork, project management and task management through voluntary exposures. Individuals with these qualities have high employability rates and a competitive advantage in career development. Professional experience is acquired through volunteering. Such experiences are useful in acquiring long-term professional career. Furthermore, volunteering may lead to a well paying job in similar organizations.

VOLUNTEERS IN NFP AND NGOS: BARRIERS TO VOLUNTEERING

Recent studies show that voluntary services have declined drastically. The perception that volunteering is charitable and has no monetary benefits has prevented individuals from volunteering their services in charitable organizations. The most significant barrier against volunteering is lack of time. Individuals who could be willing to volunteer are committed in their families or in other activities (Boraas, 2003). The notion that volunteering requires a long-term commitment is another challenge. However, most individuals dismiss voluntary work because it has no monetary benefits.

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Economic conditions and needs have severely affected voluntary work. Voluntary work has no monetary benefits yet economic conditions are worsening. There is high demand for money, which dictates the preference for individuals to work in paying institutions. The impact of economic changes has forced employees to multi-task with various employers. Such employees hardly find time to volunteer in charitable organizations.

Voluntary work is associated with lots of risks and costs. Some organizations work in hardship and risky areas. Volunteers are exposed to risks of injury, death, financial loss or legal action. These risks discourage potential volunteers from joining charitable organizations. Thomas (2007) observed that, technological advancement has impacted on voluntary work. Potential young volunteers spend most of their time operating gadgets. They prefer to try out new things and very entrepreneurial. The young generation lack commitment in voluntary work because it is very involving and have no substantial benefits.

Odenheirmer (2011) suggest that, charitable organizations should implement strategies to reduce the barriers to volunteering. Organizations should reimburse volunteers out of pocket expenses and should be able to provide incentives such as transport allowances among other incentives. Allocating roles according to individual’s preferences and interests is another strategy.

Adequate training and support should be provided to volunteers as well as their needs should be considered. In the case of organizations administering charity in risky areas, insurance covers should be secured for volunteers. The covers will shield against any losses and damages that may arise due to the nature of the work.

Charitable organizations should initiate programs that will facilitate successful volunteers to be absorbed in to long-term career opportunities. This strategy is very effective in attracting and retaining volunteers. They will be able to gain professional experience in their line of careers giving them competitive advantage as compared to the other potential recruits.

This strategy addresses their long- term objective of professionalism and career development. Organizations that implement these strategies are advantaged in volunteer retention. When volunteers are motivated and satisfied, the retention rates will be high (Courtney, 2001).

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In conclusion, volunteers are very important resources in the community. They constitute the major work force in charitable organizations. The fact that they are not entitled to any monetary benefits does not authorize any neglect, mishandling, harassment and frustrations on the volunteers. Organizations should adopt appropriate attraction and recruitment strategies in order to draw many volunteers. Proper motivation and retention strategies should be employed to reduce volunteer turnover rates.

REFERENCES

Allahyari, R. A. (2000). Visions of charity: Volunteer workers and moral community. Berkeley, CA: University of California Press.

Boraas, S. (2003). Volunteerism in the United States. Monthly Labor Review, 126(8), 3-21

Brudney, J. L. (1999). The effective use of volunteers: Best practices for the public sector. Law and Contemporary Problems, 62(4), 219.

Choudhury, E. (2010). Attracting and managing volunteers in local government. The Journal of Management Development, 29(6), 592-603. doi: http://dx.doi.org/10.1108/02621711011046558

Courtney, R. (2001). Strategic management for voluntary nonprofit organizations. New York: Routledge.

Elshaug, C., & Metzer, J. (2001). Personality attributes of volunteers and paid workers engaged in similar occupational tasks. The Journal of Social Psychology, 141(6), 752-63. Retrieved from http://search.proquest.com/docview/199837239?accountid=45049;

Farmer, S.M., & Fedor, D.B. (1999). Volunteer participation and withdrawal. Nonprofit Management and Leadership, 9(4), 349-368.

Johnson, J. A. (2007). Getting and staying involved: What motivates volunteers in a non-profit organization? Capella University). ProQuest Dissertations and Theses, , 111-n/a. Retrieved from http://search.proquest.com/docview/304720694?accountid=45049;

Nagabhushanam, M., & Sridhar, M. (2010). Voluntary Organizations – Growth, Trends and Challenges. Vilakshan: The XIMB Journal of Management, 7(2), 143-166.

Odenheimer, M. (2011). Integrating Volunteers In- to Long-Term Sustainable Development. Journal Of Jewish Communal Service, 87(1/2), 81-87.

Ralph, C. (2006) “Recognising current competencies of volunteers in emergency service organisations”, Journal of Workplace Learning, Vol. 18 Iss: 7/8, pp.451 – 463

Taylor, A. (2011). Volunteers are a neglected resource. Third Sector, (672), 18-18. Retrieved from http://search.proquest.com/docview/887547857?accountid=45049;

Thomas, C., Newell, J. N., Baral, S. C., & Byanjankar, L. (2007). The contribution of volunteers to a successful community-orientated tuberculosis treatment centre in an urban setting in nepal. Journal of Health Organization and Management, 21(6), 554-72. doi: http://dx.doi.org/10.1108/14777260710834346

Vitner, G., Shalom, V., & Yodfat, A. (2008). Training volunteers for the elderly in israel. Industrial and Commercial Training, 40(4), 216-225. doi: http://dx.doi.org/10.1108/00197850810876271

Zullo, R. (2011). Labor unions and charity. Industrial & Labor Relations Review, 64(4), 699-711.

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