Research Topics: Community Nursing

COMMUNITY NURSING

How the individuals risk of disease such as TB (tuberculosis) might differ from the risk posed by the same disease for the population at large.               Tuberculosis is a contagious infection caused by an airborne bacterium, Mycobacterium tuberculosis. It usually affects the lungs, although it can attack most any organ in the body. Tuberculosis has been a serious public health problem for a long time. There were more cases among older people because they have likely to have acquired the infection as the body’s immune system weakens with age, dormant bacteria become reactivated. Tuberculosis may transmit to a person depend on the boy’s immune system, an individual may get infected with the bacteria if an individual possess a strong body immune system, prolong exposure on the bacteria, immune system is compromised having cancer, HIV, poor nutrition, substance abuse, inadequate hygiene which is susceptible to the bacteria. Individuals having no BCG scar is in risk of developing the bacteria. Although both the individual and the population is in risk of having the disease, the same mode of transmission and how TB spread into the body but they are differ in  terms of treatment as with the individual its causes either we went to a certain places and encountered a person whom has a tuberculosis, the treatment is within the person alone being affected.  While in terms with the population at large who were being affected, it will involve the whole community in treating the disease, the carrier or the host should be mainly targeted in order not to spread the disease. Doing the case control study on the certain population. In the community, if one person is carrying the bacteria, the community may get the chance to be infected especially in those areas that are crowded, poorly ventilated, homeless shelters, tenement houses, and squatter’s area as compare to an individual who is at risk of having tuberculosis. It may affect also on the individuals who are uneducated in which they don’t have a knowledge regarding the transmission of the disease. Since tuberculosis is very contagious an individual must be treated with its basic treatments. As with this making up with the lifestyle habits, stop smoking, and stop alcohol consumption at the turie of their diagnosis. With the community, people may tend to discriminate and make avoidance on the certain community, people who have tuberculosis and which they’re community is high incidence in TB they tend to be avoided. It may have an effect on the social interaction lead to disturbance, occupational changes on individual’s side as well. To assess the feasibility and cost effectiveness of community based tuberculosis care, operational research is needed. Tuberculosis really give an impact on ones life, on the community. It should really need to comply those entire regimen treatment courses to stop the spread of the bacteria. To sum up everything, individual risk is that tendency he/ she might infect other people to have tuberculosis in which it may lead to a community problem. And as the community that has a high incidence of tuberculosis, as a result it may lead to social disturbance. More preventive measures in a community it needs a lot of appropriate actions to reduce the number of cases in tuberculosis. First thing first target those individual who have TB .   Reference: De Cock KM. (1996). Tuberculosis control in resource-poor settings with high            rates of HIV infection. Am J Public Health. New York. Bonuck, K.A. et al. (1993). The Journal of Law, Medicine & Ethics. Blackwell           Publishing. Vol. 21 p. 317-323.   Powell KE, Farer LS. (1980). The rising age of the tuberculosis patient: a sign of            success and failure. Washington DC. Vanham G, Edmonds KE, Qing L, et al. (1996).  Generalized immune activation            in pulmonary tuberculosis: co-activation with HIV infection. Clin Exp            Immunol;103:30–34 Watt C.J, et al. (2005).Evolution of tuberculosis control and prospects for            reducing tuberculosis incidence, prevalence and deaths globally. Elsevier. Credit:ivythesis.typepad.com

COMMUNITY NURSING

How the individuals risk of disease such as TB (tuberculosis) might differ from the risk posed by the same disease for the population a...

Levels of Prevention in Community Nursing

The three levels of prevention in the community settings are; primary prevention, secondary prevention and tertiary prevention. With these three levels of prevention it helps the individual, the people and the community to attain better and good health. First the primary prevention, which focus mainly on health education,  health promotion primary. This activity is concerned in preventing the specific illness or disease. The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services (2d edition, 1996), give on the definition of primary prevention as to prevent the individuals in the onset of a targeted condition. Examples of primary prevention we have , giving active and passive immunization, teaching the client, body weight, maintaining the diet.   Primary prevention is the most cost effective form of health care. Its target is the community as a whole.  Second, we have the secondary prevention, in which the activity is focus in treating the disease, promoting early detection and screening. It also called as the health maintenance phase. The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services (2d edition, 1996), they describe secondary prevention as those persons who have already develop risk factors, it identifies and treat asymptomatic patient or those who have preclinical disease but the condition is not clinically apparent. Focusing on early case finding, screening is one of the examples of secondary prevention, other examples are breast self exam, newborn screening and genetic counseling. Its target is that population who are at risk. Secondary prevention reduce the severity of diseases, decrease the duration of illness, through early diagnosis thus it may give a prompt intervention. Through case finding, it also have an impact in minimizing the sufferings of the people, thus maximize well being.  Lastly, the tertiary prevention that deals in rehabilitating phase,  leading towards recovery. It refers to prevention initiatives, as with this level of prevention, it made to restore to highest function, to have an optimal reconstitution, thus have a support adaptation to risk.   How might primary intervention be addressed in a community experiencing increasing level of family violence?             Our awareness in our community about violence doesn’t seem to enhance our ability to work on methodical screening and prevention. Even though medical professionals seems not to conduct such search or screening in the family practice, but there were some that which questioning about the relationship of the family is being question, like home visits. Observation is one tool to assess the relationship of the family but this cannot guarantee that this way we could easily detect. Some providers or researcher may seems to find it difficult to screen out, because there were also some barriers to screening, we have time, skills, resources, comfort and fear on the part of clinicians. In some case clinicians also have contribute to the lack of screening. There were some health care teams who are not dedicated to their work and find them to work on other field, still other clinicians , a group of small who are dedicated to help the families who have problems in terms of violence, abusing and etc. In this primary prevention, this is important to address knowing the activity of this prevention is to avoid and stop any occurrence that might develop. Home visit programs, in which we can assess the family, the child and the mothers relationship, but as I said earlier that this is not tool to evaluate easily. In the school, we can also assess, and do interventions to know and determine violent behaviors, because teachers knows status of their pupil, absentees, bruises and others which a teacher may also can have answer on that. Aside from that, having from school based program , we can detect and implement some counseling program. This is to decrease the adolescent behavioral problems.  It is hard to detect this kind of problem, as clinician may find it difficult, so as with the nurse, and other, it needs merely, great investigation also in this part.   By making the community improve, healthy and well being, primary prevention should be always implemented. As primary prevention is taking an action in which it builds resilience, thus preventing a situation or problem before they arrive or occur. Primary prevention is also essential in the efforts to ameliorate family violence. The primary prevention is important but it doesn’t just lies in the suffering in which can be avoided, however sufficient treatment resources can be allocated because it is unlikely, though to match the magnitude of the problem. In a community setting, in order to avoid occurrence of family violence, we have what we called health teaching to the community, counseling, educating the people and with therapeutic efforts. Not just as a nurse we evaluate the disease or other health condition but speaking with prevention, we are focusing and helping the people, giving primary prevention to the community as a whole. The role of a nurse has a great part in providing the health teaching, as a nurse we are not just educator but as well as a counselor, a leader. As this level of prevention, it is a public health term, in which focusing on prevention against violence is one of the purposes in this. Thus it builds long-term solutions. As a health provider we must first think why is this happening, or why is that people are facing with that problem? There are risk factors which can be individual, or environmental. Knowing first its causes and roots helps the provider to answer those question and that may implement health teaching and do counseling to the community, especially the family. For prevention approaches, focusing on protective factors that build on the positives, than seeking simply to fix the negatives.   Explain why a comprehensive health program should address all three levels of prevention. Dealing with health, it is necessary to apply all these three levels of prevention. The health program provides this level of prevention to help the individual, family and community to attain good health, free from any diseases. Not just the department of health can get benefit on it program but as well as the people, the individual, family and community. Uniting each other and helping to be free from any disease. In any health settings, hospitals, clinics, health centers and even in the home, these three levels of prevention is greatly addressed. With this three levels of prevention, were talking about, health maintenance, health promotion, health education then by early detection and screening we greatly reduce the number of diseases. Having accomplished the two levels then restoring the health. In health program the three levels of prevention should merely addressed as because it cannot be avoided, it is part of their assessment. Their activities are mostly on the levels of prevention it is their duty and responsibility to do health teaching, giving immunization, do screening and mostly covered in all activities of levels of prevention. Primary prevention it’s aimed is no high risk people. Getting avoided on no high risk people.   The department of health used this primary prevention because it is least costly and eventually it is effective. On the secondary prevention, as the health program addressed the levels of prevention because it search and look for a change, a change in which it could bring to a behavior to avoid some ill and sickness occur. This covered on the people who are affected, individuals, families and community. Although it is difficult to accomplish, but it is more costly. Then the tertiary prevention same as secondary it seeks to behavior but it is focused on to treat the ill effects which mainly caused by the behavior of the individual. This prevention focus also in the individual who is at risk and who develop ill effects. The provider and the practitioner find it difficult to achieve success but more costly, as these both change the behavior thus treating illness.     Is addressing a health concern at this level of prevention cost effective? Explain. For me, it would be cost effective to be addressed the health concern on the three levels of prevention because with this, we might bale to assess one’s needs and problem, and by that we could also determine other factors that contribute to the problem. In any setting, this levels of prevention is always present, it cannot be avoided or just neglected by the health care providers, because this three preventions is  important tool for them to help the individual, family and community and as well as for their own purpose, so that they may easily recognize and could implement a help to the client. This three prevention is very important. This three levels of prevention is very cost effective , first the primary prevention, it is cost effective because your preventing any disease or illness that might occur or develop, could one afford not to have this , if ever he/she neglect this like having immunization he will take the risk, and he could have develop a lot of diseases to manifest, thus leading to problem that way may secondary prevention be implemented or applied. So as caring for your own health, why take this level of prevention, if you’re really care for your health then an individual must do and have this. Although the secondary and tertiary is difficult to achieve its success but it is more costly.       Reference: Adler, L.L & Denmark, F.L. (1995). Violence and the Prevention of Violence.               Praeger Publishers. Westport, CT Kubisch, A.C. et al. (1998), ‘Evaluating community initiatives: a progress report’               in K. Full bright-Anderson, A.C. Kubisch & J.P. Connell (eds), New              Approaches to Evaluating Community Initiatives: Volume 2: Theory,              Measurement, and Analysis, Roundtable on Comprehensive Commuity              Initiatives for Children and Families, The Aspen Institute, Washington DC U.S. Preventative Services Task Force (1996) Guide to clinical preventative               services (2d edition) Baltimore: Williams & Wilkins. Credit:ivythesis.typepad.com

Levels of Prevention in Community Nursing

The three levels of prevention in the community settings are; primary prevention, secondary prevention and tertiary prevention. Wit...

SELLING HERBAL MEDICINE IN THE UNITED KINGDOM

Introduction    Herbology is a Chinese traditional medicine of treating illness and promoting well-being using herbs, animal parts and other natural supplements.  The practice necessitates these ingredients to balance their interaction affirming to Yin Yang which existed in Confucianism.  It is said to deal with the root of disease and obtain body harmony.  However, even though benefits are assured by its millennia old usage in which Mainland China deemed it as part of the healthcare system, knowledge and consultation about herbal medicines are necessary.  Also, initial acquaintance may not equate to optimal benefits as the body needs adaptation.  Side-effects are likely when used with other medication simultaneously (UK Department of Health Homepage).  For the part of the user, cooperation with the practitioner is a must where discipline and dedication to be healed are integral to herbal medication.  It usually accompanied by acupuncture and custom–made prescriptions for better results.              In Hong Kong, every district sells herbal medicine.  On the other hand, only the United Kingdom’s cancer-inflicted niche is the significant segment that uses in what west called alternative or complementary form of medicine (UK Department of Health Homepage).  Although these two countries regulates the use of herbal medicine because of its empirical indications of adverse effects, English consumption to them is in the restrictive infancy wherein the segment mostly dealt with herbal medication are chronic diseases or those that are too costly to treat with modern methods.  In this respect, a Chinese merchant who would like to be successful to sell licensed herbal medicine could face cultural and social barriers that require deeper strategy aside from UK government’s approval of its herbal imports.   The Cultural and Social Significance             Perhaps, the most significant dividing force between the two countries is their extreme roles in herbal medicine.  Ninety percent of the Hong Kong population is Chinese while at the same level UK counterpart is populated with whites (UK National Statistics).  China is where the practice is developed and evolved while western countries are limited in exposure and practical experience and it is in introductory stage.  Another, Hong Kong housed most ancestor worshipers extracted from the teachings of Confucius while UK is 70% Christian (UK National Statistics).  As a result, the belief and benefits of Yin Yang concept basic to herbal mixture could not be fully realized and institutionalized by western counterpart.               The monogamy and one child policy rule in Mainland China can post greater influence of the family to children.  Divorce rates are high while second marriages are discouraged with the right of the legal wife to property of the mistresses.  These factors tend to stimulate family cohesion.  On the other hand, UK family is headed by 70% married couple (UK National Statistics), almost fifty percent of them do not have children and at least 50% of them do not have children living at their homes.  These statistics could be indicative that both countries exhibit monogamy and small family size.  However, UK children impliedly characterize more independence from Chinese and this could impact their choice behavior.             Urban Chinese societies are stratified between economic and political perspectives.  This undermines the UK’s prominent social division in terms of occupational status (UK National Statistics).  Thus, the identification process of ability to distribute resources and opportunities are more complex in Urban China than UK.  The latter showed significant positive relationship between the economic statuses of parents in relation to their children’s mental capability.  Higher income earners also lived longer, have advantageous condition of employment, likely to have personal computers and have more slack time to do other things.  On the other hand, there is limited information to Chinese elite class and social class in general as adjustments to its society in the process.                  Recommendation to Herbologist Merchant             When doing business, he could divert the attention of English prospects from the religious concepts of herbal medicine into an essential health concept.  This means that adaptation to the English religion is needed.  Diversion of religious perspective of Yin Yang could be upheld by minimizing the use of such term when talking or advertising to prospects.  The latter may feel cultural imperialism on the move that could adversely affect purchase.  He could use general terms such as strong and weak ingredients as an option.  However, such alternative could demise the healing power of the practice.  Healing through herbal medicine necessitates harmony and it could not be attained if dishonesty lurks in the communication process.                Therefore, adaptation does not strictly require the practitioner to deemphasize the origin of herbal medicine which is China.  There should only be a greater emphasis to concentrate advertising to the health aspects of the product not in its inherent Yin Yang concepts.  The product specifications should be written comprehensively in the package which should include cautions, benefits and other educational facts.  Leaflets about herbal medicine can also be helpful accompanied by seminar for closer customer communication.              Diversity marketing, the process of customizing marketing programs to a specific market segment, could be tapped to cater the economic class stratification of UK.  A more sophisticated and well-package product should be distributed to the upper class, the relative reverse could be distributed to the lower class and the middle features can be allotted to the working class.  As a strategy, it can be more realistic to generate income if the merchant will initially focus on the middle and lower class as they are characterized with cost-cutting while most of their income is allocated to food and education.              Herbal medicine could be characterized by high involvement in buying behavior and significant differences between other forms of mainstream Western medicine.  As a result, the merchant can fight in terms of cheaper price and non-toxic characteristic of herbal medicines.  It can initially gain market in cases of simple viral- or bacterium- based sickness like colds and flu.  It could be advertised as natural forms of medicine that simple disease could not only be treated in the short-run but continuous consumption can lead to long-term benefits.  In doing this, marketing should highlight not only the breakthrough accomplishments, but more importantly, educate the consumers about the risks and researches.  By emphasizing its cost-and-benefit features, it can be differentiated with other modern medicines as non-biased and customer-friendly alternative.              The small size of English family connotes great influence in the consumer behavior of children.  However, it is not typical for English family to stay in their parents’ house which can limit the mobility and content of information about the product.  As a result, the merchant should identify opinion leaders like the health department that can certify its claims about the product and that it can compete with the modern medicines.  As an alternative opinion leader are fitness instructor associations and personalities that can be effective medium to entice the market to try the product.  The role of these opinion leaders is to situate the status of the product to awareness set to be able to qualify to successive sets in which consumer decision making will undergo like consideration set, choice set and the final decision.  The number of products as the stages are reached becomes smaller due to elimination process.             As the product is new, at best peculiar, to the English customers, it is likely that the five-stage model of consumer buying process will be applied to herbal medicine.  In triggering the need for customers to arrive at recognizing a problem,  herbal medicine’s cost-advantages and being natural medicine could be compared to the modern medicine that are mostly characterized by a commercial prices and toxic characteristics that are left in the body.  Second, it is time to select the best information source for an active information searcher which is experiential source.  Although this is the core determinant for a consumer to test effectiveness in sensitive healthcare aspect, there is a need for a strong approval from a medical practitioner who is known and widely-acknowledge to affect this product challenge.              In the third process, after the actual experience with the product, the merchant should understand what attributes and in what level customers develop product beliefs.  In this way, he can adjust advertising or promotional mix he initially conducted.  The merchant, in addition, should remind that the body needs adaptation to herbal medicine to obtain results.  Fourth and fifth stage which is purchase decision and post purchase behavior will largely depend in the first three stages and how the merchant adapted to the needs of the customers.  Due to this fact, retention of customers requires the merchant to be a licensed medical practitioner himself, at best, a member of medical association in order for customers to feel safe in dealing with such first three stages.              Finally, the merchant needs a lot of researches to do in a pluralistic society of United Kingdom and its adherence to modern form of medicine.  It should be satisfied with slow and gradual piling of demand and prevent too much advertising as it can develop to large number of people frustrated of the results due to unguided intake and accompanying change of habits.  A small number of initial participants could join the testing stages and completion of the first three stages of the buying process that the small merchant’s company can handle.  When it is already established and familiar to the preferences and establish a learning curve from mistakes, it can be more aggressive in marketing and mass-distribution of its products.         Credit:ivythesis.typepad.com

SELLING HERBAL MEDICINE IN THE UNITED KINGDOM

Introduction Herbology is a Chinese traditional medicine of treating illness and promoting well-being using herbs, animal parts...

Nursing Practice

The paper discusses the issue on why nurses do not use more research in their practice. Nursing should be a research-based due to its technicalities and that research should underpin nursing practice, nursing education and management. Research is important to be integrated in nursing practices to improve the quality of nursing care.             Despite of the importance of research in nursing, and the widely accepted research and recent findings, nurses do not use more research in their practice. Nurses tend to base their practice on traditions and cultural issues, organizational factors, individual resistance to implementation and problems with the research itself are the four general issues that prevent nurses from using research in practice.             There are some health organizations that are not characterized by a strong research culture and the organization appears to undervalue its importance. When the entire organization itself does not promote awareness and use of research, then nurses within the organization follow that practice and ignore the use of research in their practices. Also, in a health environment, nurses tend to be more inclined with traditions rather than on new ways of doing things that are based on research.             In addition, there is a wide physical and philosophical gap between research and practice. Much research is conducted in universities away from the practice setting and many researchers are able to assume only minimal clinical commitment. This statement is observably true. In universities, nursing students follow theories based on research but in hospitals, nurses usually follow what more senior nurses do which is usually based on traditions and experience thus improvement in nursing care tend to be slow.             Long-standing organizational structure is also one of the underlying reasons why nurses fail to integrate research on their practice. First, implementation of new ideas based on research should be supported by the managers of a health organization and most managers failed to do so. Multiprofessional practice is also a factor. It can be observe that it is difficult for nurses to change practices involving other medical professionals (Funk et al, 1995) such as physicians, surgeons and others. For example, if anaesthetic or surgical instructions indicate an all-night fast prior to surgery and nurses know that a six- hour fast would be more appropriate, it is extremely difficult to adopt the correct policy. Moreover, some nurses personally resist the use of research in their practice due to personal beliefs. Some individuals needed confirmation from a research before they practice the research themselves while some have different belief from a research study that is why they can not put the research on their practices. In addition to that, nurses can only make decisions about the relevance of research findings in practice if they are able to analyze critically the raw material. Most nurses neither have the skills to search for the literature nor to interpret critically a research. The practice of not putting research into practice can be changed by educating the nurses from the universities up to the sites of practice so that they can have enough skills to interpret research and put it into practice. Also, most health organization should be aware of this issue so that they can implement change within the organization. This issue is more of an organizational issue. Nurses are only a part of an organization and they can integrate research on their practices only up to a certain extent.   Credit:ivythesis.typepad.com

Nursing Practice

The paper discusses the issue on why nurses do not use more research in their practice. Nursing should be a research-based due...

Problems and Proposed Alternatives for Faith Community Hospital

Problems Defined             Faith Community Hospital is an institution of devoted and well-coordinated team of healthcare professionals, who are capable of providing the quality health services to the community. As stated by its mission statement, “With the foundation and commitment of our spiritual heritage and values, our mission is to promote the health and well-being of the people in the communities we serve through a comprehensive continuum of services provided in collaboration with the partners who share the same vision and values”. However, from the current situation of the hospital, it appears that its major problems are rooted from this mission statement. Specifically, the institution may have an established mission, yet the people operating within it do not seem to have a universal interpretation for this mission.               There had been reported incidents for instance, wherein the provision of healthcare services by the staff is influenced by individual directives. While there are patients who decline to take some medical services, there are hospital staffs as well who refuse to provide certain healthcare services to the patients. There are staffs who care too much for the patients’ well-being, whereas other staff will prioritize the institution’s welfare among others. This problem is greatly attributed to individual religious beliefs or moral principles. It is then ironic that despite the inclusion of the collaboration concept in the institution’s mission statement, there are obvious signs that staff in general does not really put this into practice.             Aside from the disjointed interpretation of the hospital’s mission statement, the lack of clear communication channels among the different staff units also contributes to the problem. Healthcare staff appears to operate and decide on their own, including sensitive issues. With individual interpretation of the institution’s healthcare standards, the hospital is really likely to encounter problems like legal charges. Unfortunately, the problem of the hospital on uncoordinated healthcare efforts is a partial contributor to the institution’s now growing concern on increasing expenses. If some healthcare staff provides unauthorized services for free or if they allow payments in installments, this will directly affect the hospital’s overall gains. The report analysis on the hospital’s accounts revealed that the number of patients is not the factor that causes this problem. Thus, if the number of patients will not increase, the institution will have to make major cost reductions on its fixed costs. Though a non-profit organization, this problem should be taken seriously considering that the hospital needs the finances for its facilities and workers.               From this definition of the problem, the primary concern is the lack of clear understanding of the hospital’s mission statement among the staff, specifically, lack of collaboration. This then resulted to two other major problems: the lack of clear communication lines between healthcare teams and the increasing hospital expenses. Alternatives that will be implemented should then directly address these major institutional issues.   Proposed Alternatives and Rationale Understanding the Mission Statement             A mission statement is not only developed by organizations; it is imperative that people who will work with the mission clearly comprehends its meaning and proper application so as to prevent conflicts. For this purpose, a general gathering to be participated by the hospital staff must be conducted. The objective of this general gathering is to discuss the values indicated in the mission statement. This will then foster the establishment of a single professional goal among the staff. It should be stressed that while individual differences are respected by the institution, having a common goal as well as universal healthcare standards will help the institution in providing quality services. Moreover, this will make decision-making effective and less complicated. Practicing a single mission statement will also enable the use of standard operations resulting to less errors and cost control.   Promotion of teamwork             The importance of developing effective communication and interpersonal skill among healthcare teams has been emphasized through a number of theories. Communication may be defined as the transmission of meaning and information from one person to another (Donatelle & Davis, 1998). While the transmission itself may appear to be a simple task, the interpretation of the message being relayed through communication poses a challenge, particularly on the establishment of human relations. In general, communication becomes effective when both parties involved are honest and open to share information and have the ability to decipher the meaning of their messages. Effective communication must always be practiced as it is significant to individual health as well as for the creation of positive relationships. Specifically, the ability to communicate directly affects an individual’s stress levels, self-esteem and relationship quality (Donatelle & Davis, 1998). This is then the skill that must be practiced in Faith Community Hospital in support for its mission statement.   Communication within a group or inter-professional team goes beyond the concepts of effective speaking or listening, or what is commonly considered as linear communication. It is an interactive model which deals with feedback and reciprocal exchanges. According to surveys focusing on areas of improvement among corporations, communication is usually ranked first as an important element within the organization (Harris, 1993). Specifically, communication is recognized as an important aspect of an organization as it keeps employees well-informed and open to communication channels. Moreover, organizational communication enables the employees to comply with company standards, leading to efficiency and accuracy.   The hospital should then designate communication lines within the staffs’ units; in particular it should be made clear to whom they should report or inquire. They should also be instructed as to how they should interact with members of other hospital departments (e.g. physicians and nurses). This in turn can be done through the organization of relevant workshops or seminars for the staff members. Having an established communication in the hospital plays several purposes. For one thing, this could ensure the application of the collaboration principle in the mission statement. With teamwork, the quality of healthcare given to patients will naturally improve as well. As mentioned, control in operations is an important factor that should be observed in the institution.   Practicing effective communication can then ensure that staff members follow the set hospital standards rather than deciding on personal motivations. In general, the case of the Faith Community Hospital should apply the concept of the Dynamic Social Impact Theory (DSIT). In this theory, it has been explained that in spite of the differences inherent among people as well the influences that significantly affect the social spaces, people should learn how to adapt and become flexible through open communication (Latane et al., 1996).   Cost Control             The cited alternatives have certain capabilities of controlling the hospital costs. Nonetheless, a direct measure must be enforced. For this issue, a dual-alternative may be appropriate; this means that two supporting activities for cost control can be implemented. Specifically, this can be done by minimal cost-reduction and increased customer satisfaction. Forcing a drastic 15% fixed cost reduction for a break even is too big and may not be possible for the hospital staff to support. It is perhaps best to start on a lower reduction of cost (e.g. 5%) to increase the possibility of goal achievement. Monthly changes in expense levels should be monitored; this will help in assessing whether further reduction is still necessary. The staff members on the other hand, will support this alternative through conserving the use of major utilities and managing supply inventories.               While the first alternative is focused on reducing cost, increasing the level of customer satisfaction on the other hand is geared on profit generation. If more and more patients are satisfied with the services the company provides, the number of patients is likely to increase. This will then help the hospital in preventing further cost reductions as well as major company losses. In order to improve the services of the hospital for increased customer satisfaction, the staff could adapt a certain healthcare model. In particular, the staff members may apply the discrimination model. In the discrimination model, clinical supervisors are necessary and should perform three supervisory roles. These include the teacher, counselor and consultant roles. As teachers, clinical supervisors can share their knowledge or experience to the supervisee through lectures or instructions. By means of addressing the problems of the supervisee, clinical supervisors can then act as counselors. During co-therapy activities, the provision of assistance to the supervisee serves as the supervisor’s consulting responsibility (Leddick, 1994).               In order to save valuable resources (since the institution aims to reduce major costs), it is recommended that potential leaders in the department units are given the appropriate training to become effective clinical supervisors. This training will then focus on teaching the clinical supervisors how to motivate their staff, settle conflicts, answer inquiries, make decisions, teach the patients and the staff as well as address personal issues. These learnings will then be relayed to the staff through mentoring approach. This alternative actually supports the aim of collaboration as it promotes the establishment of clear and common healthcare standards. These standards will then enhance the ability of the staff in delivering health services. In turn, this could increase the satisfaction of the patients and lead to customer loyalty. The satisfaction of the patients can also become an effective marketing channel, specifically through referral. With these two cost control alternatives, the institution could avoid extreme cost reduction efforts, gain a certain level of profitability, obtain loyal patients and practice quality healthcare service delivery.   Implementation             In order to implement the cited alternatives, trainings, workshops, seminars and similar activities should take place. Moreover, printed booklets that would facilitate the discussion of the hospital’s mission statement, the conduction of the effective communication and clinical supervisory trainings should also be provided. Speakers who would discuss these factors should also be informed in advance; seminar organizers should also decide how and when these activities should be conducted. For the cost reduction alternatives, it is important that the staffs are given prior information regarding the hospital’s concerns on its growing expenses. This information should explain the current cost issues, the problems that could arise if this will not be resolved and the ways how this matter can be addressed. A general meeting among individual staff can be conducted for this purpose. Assigned clinical supervisors will then be responsible for ensuring that cost reduction measures are observed in their respective units. This monitoring responsibility will be done along with the enforcement of quality healthcare delivery among the staff.               In order to evaluate the effects of these alternatives, regular reports from the clinical supervisors will be submitted to the management. Every month, the institution should see to it that the board meets to discuss the developments brought about by the alternatives applied. For the cost reduction issue, the expertise of a financial analyst should be employed to facilitate the discussion as to how further reductions should be made; progress made by the institution through its cost-reduction efforts should also be supported by clear financial reports. In conclusion, the problems in Faith Community Hospital are characterized by unclear mission interpretation, ineffective communication and increasing expenses. In order to resolve them, trainings and seminars that will clarify the values of the mission statement, promote the utilization of effective communication skill, conserve resources and increase quality of healthcare services should be done. Regular monitoring of the alternatives’ effects to the institution should be done to maintain positive outcomes and address other relevant issues.   References: Donatelle, R.J., & Davis, L.G. (1998). Access to Health. Boston: Allyn and Bacon.   Harris, T.E. (1993). Applied Organizational Communication: Perspectives, Principles, and Pragmatics. London: Lawrence Erlbaum Associates.   Latane, B. et al. (1996). Dynamic Social Impact: Robust predictions from Simple Theory. In: Hegselmann, R., Mueller, U. and Troitzsch, K.G. (eds). Modelling and Simulation in the Social Sciences from the Philosophy of Science Point of View (pp. 387-310). Dordrecht, Netherlands: Kluwer Theory and Decision Library.   Leddick, G.R. (1994). Models of Clinical Supervision. Greensboro NC: ERIC Clearinghouse on Counseling and Student Services. (ERIC Document Reproduction Service No. ED 372340). Credit:ivythesis.typepad.com

Problems and Proposed Alternatives for Faith Community Hospital

Problems Defined Faith Community Hospital is an institution of devoted and well-coordinated team of healthcare professional...

How should a Community Health Nurse Address a Client about Family Finances?

Community health nursing means giving health care to the public or community in settings such as state health departments, visiting nurse services, community or neighborhood health centers, day care centers, and hospices (Kovner et al, 2001). Community health nursing bring health care to the communities, especially impoverished areas without the option to seek costly medical help. This implies that majority of the patients treated by community health nurses have difficulties in paying for medical bills and medicine. This further implies that there is a need to support these people in managing and taking control their finances and learning about health care opportunities. The community health nurse is in the best position to provide this support because he or she has the capacity to foresee and approximate the expected health care cost and the knowledge to suggest financial support services. Supporting patients to manage their finances involves two aspects, which are actual and preventive support. Actual financial support refers to the process of providing information to the patient about the expected medical expenses, upon the patient’s inquiry and when the community nurse deems it appropriate to volunteer the information. The community nurse has to be receptive to determine whether the patient is open to discussions about his or her financial standing or if the patient prefers to deal with it on his or her own or with the help of other people. In this case, the community nurse may recommend people such as the local social worker who can provide information support or recommend the patient for available medical welfare services.             Apart from providing information, the community nurse should also elicit information to be able to evaluate the financial status of the patient to provide the necessary financial information and other forms of support. There are two ways of gathering information, which are formal and informal determination of financial need. Formal determination of need pertains to the filling up of medical forms by the patient including questions about the patient’s financial needs. However, this is problematic because most of the time patients are only made to sign forms at the beginning of the medical treatment when they may not have a complete view of their medical expenses in the long run. Again, offering information at this stage is crucial to the patient’s decision making. There are informal ways of determining patient’s financial needs through direct conversations, patient advocacy and indirect need triggers. Direct conversations cover the exchange of information on the financial cost of medical treatment and the financial condition of the patient in an engaging conversation so that building a fiduciary relationship with the patient is necessary. Indirect need triggers showing financial need are perceived by the community nurse through statements by the patient such as canceling or being late to medical sessions due to lack of transportation or the need to work despite the medical condition. Patient advocacy involves the proactive action of community nurses to inform the patient about support groups and recommend or contact the group for the patient. (Gould, 2005) Preventive support refers to the information dissemination drive that may be given by community nurses to apprise households and individuals about the medical cost of certain unhealthy habits such as excessive intake of junk food, smoking and drinking to prevent people from incurring the higher cost of health care treatment. References   Gould, J., Peng, I., Cameron, C., Bowes, P., Chauvette, L., Fitzgerald, B., et al. (2005). Cancer Professionals’ Views on the Financial Issues of Lower-Income Women       with Breast Cancer The Generating Dialogue with Cancer Health Professionals  Advisory Committee. Ontario, Canada: Ontario Breast Cancer Community         Research Initiative.   Kovner, C. & Harrington, C. (2001). ‘Counting Nurses: What is Community     Health-Public Health Nursing?’. American Journal of Nursing, 101(1): 59-60.     Credit:ivythesis.typepad.com

How should a Community Health Nurse Address a Client about Family Finances?

Community health nursing means giving health care to the public or community in settings such as state health departments, visiting nurse...

The importance of Communication in Collaborative Practice for Nursing Teams

(I) Abstract               This paper will be discussing the various issues surrounding the public sector nursing organization. The aim of the paper is to be able to determine how these issues affect the performance of nursing teams. In addition, this paper will be focusing on issues that involve collaboration practices. The presence or absence of effective teamwork will be investigated in relation to collaborative practice theories. In the end, the paper will be making recommendations on how to resolve the issues. The major aim of the paper is to be able to encourage teamwork within public sector nursing teams so that they will be able to provide the best possible services to their patients.      (II) Introduction               Providing medical care to numerous patients on a daily basis is a complex task that requires close coordination between all of the parties involved. This suggests that team is indispensable in the medical profession. The presence of an effective teamwork among medical practitioners can lead to the delivery of high quality as well as safe care of patients (Leonard, Graham & Bonacum, 2004). The close coordination among medical practitioners will allow them to monitor the conditions of their patients in such a way that relevant and important information will be relied. In turn, this allows them to administer the appropriate treatment to them, thus eliminating some margins for error.               According to Leonard, Graham & Bonacum (2004), due to the inherent limitations of human performance margins for error are present. However, this is intolerable in the medical profession since the main objective of every medical practitioner is to uphold the right to life of all his or her patients. Earlier, it was expressed that one of the effects of close coordination is the ability of medical practitioners to relay relevant and vital information to other members of the team on time. This implies that one of the issues that are crucial in encouraging effective teamwork is fostering effective communication.               However, in order to attain effective attain effective communication among members of a team, it is important that other aspects that affects team performance must be assessed. For example, effective communication is dependent on the situation and the personality of the individuals within the team. This means that in order for the issues of communication to be resolved, problems such as the roles and responsibilities of the individuals within the team must be clearly defined. In turn, this will lead to the analysis and resolution of conflicts within the team.               This paper will be presenting an incident that affected the collaboration of the individual members of a nursing team. In order to understand the underlying problems that resulted from the incident. The understanding of the problems will help in the formulation of the necessary action plan needed to resolve the problem. In order analyze the incident related literature will also be presented. This literature will provide the theoretical platform to launch the discussion of the incident in relation to the collaboration.               In addition, issues such as definition of effects of leadership styles and effects of motivation will also be crucial the task of fostering effective communication within teams. The familiarity with the mentioned issues that affect teams within the medical profession, nursing in particular, will allow the paper to make recommendations in the end. These recommendations are aimed at improving the over-all performance of the group.   Even though, individual contributions to the team are valuable, it will not be used as the basis of evaluating the performance of a group. It should be taken into account that the failure of one is the failure of all and the success of an individual will be seen as the success of the whole team. This will be the predominant frame of mind in the length of this paper.   (III) The Incident That Challenges Collaboration   The incident that will be presented in this section of the paper will illustrate how miscommunication between members of a nursing can jeopardize their performance as medical professional. In addition, the incident will also show how the presence of communication problems can put the life of the patient in danger. The incident to be presented will not be mentioning any manes. Rather, it will only provide the details of the incident itself.               A patient was rushed to the emergency room of the hospital. The patient is a 55 year old male with a new atrial fibrillation. Due to this, the attending nurse placed him under diltiazem drip for rate control.  He was then transferred to the cardiac care unit and upon arrival, it was observed that the patient was hypotensive. In order to address the problem, a saline bolus was ordered.  At that moment, the nurse attending to the man told her co-worker to get the saline bolus. As the attending nurse’s co-worker went to get the saline bolus, she went on to check other patients.               Upon her return to the bedside of the man, she saw that an intravenous bag was already in place on the IV pole. The immediate though that crossed the attending nurse’s mind was that her co-worker had already returned with the saline bolus and administered it to the patient. With the belief that the patient needed a rapid infusion of saline, she opened the IV up.               Immediately after the attending nurse opened up the IV, her co-worker entered the room with the 500cc saline bolus. When the attending nurse saw her co-worker enter the room with the saline bolus, she quickly realized that she administered an IV bolus of diltiazem, which is more than 300mg. Because of the mistake, the patient suffered a severe case of bradycardia. This required the placement of a temporary transvenous pacemaker. In addition, a calcium infusion was also deemed necessary. Fortunately, the mistake did not cost that life of the patient and there were also no permanent harm done.               The incident presented above showed that the miscommunication, worse, the lack of communication could result to the inefficiency of the nurses. If the attending nurse verified the contents of the IV bag before opening the IV up, then the patient would have gone through the whole ordeal.  This incident also suggests that the level of collaboration among the members of the nursing team is not enough to improve their performance and deliver the best possible service to the patients.                      In addition, the failure of the attending nurse to verify the contents of the IV bag and the failure to communicate with her co-worker affected her decision-making. The information that she based her decision on were assumption and were not really based on any information gathered. Due to the inadequacy and inappropriateness of the information, the attending nurse arrived at a decision that was not the best or even not suitable in the case of the patient.   (IV) Roles of Communication in Collaboration Practice               The incident presented above implies that high levels of cooperation or collaboration among the members of a nursing team is important in order to function effectively. It also suggests that collaboration helps in decision-making process of the nursing team regarding the action that needs to be taken to help the patients under their care.               Collaboration is defining that work in partnership and cooperate together. It is a process that interdependent professionals working together to achieve the goal of towards patients’ care needs (Rodriguez et al., 2005). The term collaboration is simply defined as people working together.  However, the simple definition of the term is not a reflection of its underlying conditions.  Collaboration is a communicative approach that can be used in decision-making. This implies that collaboration is associated of the complex web of social learning theory.  It is stated in the social learning theory that people tend to resist change naturally (Duffy, 2003). In addition, they have the notion that their opinions are the only possible and correct ones.  This line of thinking is the kind that collaboration attempts to overcome.               According to Friedman (1987), collaboration is able to do this by connecting formal with practical knowledge through face-to-face dialogues between contending adversaries. This also means that theoretical knowledge is being transformed to informal, practical wisdom. In the process of collaborating, parties involved are discouraged to be seen as adversaries. Instead, they are being regard as participants in the process. The process attempts to formulate or suggest terms that are accepted by all the participants. It is also encouraged that civic dialogues are used in conveying the opinions of the participants. During the process of finding the middle ground, local knowledge, discourses and discussions are being fostered (Friedman, 1987).                It is important the every member of the group be considered as participants. This is the case since they are all stakeholders in the performance of the team (Avery, 2001). This implies that they have the right to be informed and take part in the decision process of the team. This being the case, allowing all members of the team to take part in the decision making process can result to the formulation of suggestion of alternative solutions for the problems. It is also the case that various experiences can be shared to draw lessons from as well as perceive the outcome of the decision based on varying circumstances.                  The presence of more participants implies that the decision was based on a consensus of the participants. If the participants voice out their opinions during the process, there are better chances that the decision will be the fusion of the viewpoints of the participants (Myrna Associates, 2005). This will also allow the body to glimpse the underlying factor that affects the over all performance and manner of conduct of their members – personality.  Through the discussions that will transpires in the process, each participant will be able to get to know each team member and in the process will be able to deal with the tendencies of each participant.                  According to Selin and Chavez (1995), collaboration is effective in reaching decisions that will enable the team to solve their problems that would otherwise have been difficult to resolve in the individual level. In addition, it is believed that collaboration cultivates democratic proceedings and civic discourse. This is achieved through the cooperation that involves the widest possible number of participants and by establishing non-economic values in the process of decision-making (Dryzek, 1990).             (IV) Essential Elements of Communication in Collaborative Practice   Earlier, the incident illustrated that the lack of communication among members of a nursing team can result to actions that will jeopardize the performance of the team and the welfare of the patients. Because of the chaotic nature of hospitals, since many patients need attention all at the same time, confusion is also lurking. This means that nurses must be able to think clearly in front of all the things that they need to do and all of the patients they need to attend to. The case presented above showed that attending nurse failed to communicate with her co-worker to verify the contents of the IV bag and this resulted to administering the wrong dosage to the patient. This part of the paper will be discussing the importance of communication among members of the team.               As mentioned earlier, effective communication is seen as the key towards that improvement of the over-all performance of nursing teams. However, it has also been mentioned that the task of implementing effective communication among members of a team is a tedious one since it requires sub-issues to be resolved first. This sub-issues pertains to the factors that affects the communication among members of the nursing team. Examples of these sub-issues include conflict within teams and leadership styles among others. This section of the paper will be discussing the main problem along with the sub-issues. This will pave the way for making the connection between the sub-issues and the main problem. The discussions in this section will be basis of the recommendations that will be presented in the latter part of the paper.         Communication within the Team   Failure to communicate is one of the leading causes of unintentional harm to patients (Smetzer, 2001).  Given the complexity of care that most patients need and the number of people that needs to administer care, it is important that each member of the team be able to assess the situation based on the findings of other members’ of the team. This way the patients’ condition will be better evaluated. Although, historically the medical care given to patients are have been structured based on individual expertise.   Due to this, the presence of effective communication is only assumed. In reality, there is a lack of formal training to begin with. Medical practitioners were not taught to develop and exercise team qualities as a means of delivering high quality service to patients. In addition, once practice begins there is no actual assessment being performed to determine the impacts of team qualities in the performance of the individual and the entire medical team as well.   Based on the study conducted by McLain (2004), there is distortion in the communication process within medical teams. He attributed this to both the physicians and the nurses. In relation to collaborative practice, McLain believes that there are three elements that contribute to the success of the said practice.   1.                           Readiness to go beyond the fundamental exchange of information during interactions between nurses and physicians. 2.                           Readiness and capability to dispute the distortions as well as the assumptions made regarding the relationships within the team. 3.                           The presence of a belief system that is based on self-reflection.   In lieu of this, Blancett and Flarey (1995) suggested a framework that can be used to develop the relationship among professionals in the healthcare industry.  The framework is founded on the organizations formal structures. These structures include policies, reporting relationships, committee structures and procedures. Furthermore, it is stated that the framework suggested by Blancett and Flarey encompasses the expectations and personal values of the individual. This is the case since the members of the team have aligned themselves with the vision of the organization in order to attain their objectives.   The framework is also based on the perceived role of communication in improving the performance of the team. The table below will be summarizing four levels of the framework starting from the reactive to the high performance team. Through the presentation of the framework, the development of the team into an effective group of medical practitioners can be observed. It is also the case that through the presentation of the steps towards achieving an effective communication among the members of the team will be revealed.       Professional Communication Define as both verbal and non-verbal contacts that delineate relationships     Reactive -          communication is forced -          it travels from the top ranks to the bottom -          there are no recognized expectations for communication on a personal level     Responsive -          the focus of communication is the development of conflict management skills -          the culture of giving and receiving feedback is fostered -          build interpersonal relationships in order to foster cooperation among members of the team -          expectations in the professional communication and interpersonal level are similar to the that of the organization   Proactive -          open dialogue among and between all levels is present -          this fosters a positive professional communication   High Performance Team -          there is synergetic relationship that lows in all levels of the team       Roles and Responsibilities within Teams   It is inevitable that every team has designated or recognized team leaders. This power may be vested through formal and informal means. One example of formal designation is through rank filing, where head nurses are the duly designated leaders of the teams. However, it is the case that nursing teams are further divided into unit or a shift team; the role of the head has changed dramatically. Instead of being the over all coordinator, the head nurse is now seen as a consultant and management educator of the smaller nursing teams (Stevens-Barnum & Kerfoot, 1995).   Clear delineation of the roles and responsibilities among the members of the team will help in avoiding overlapping of jurisdiction. In addition, it will also ensure that everybody within the group knows his/her task. Task distribution is very important since it allows members to finish a task faster and no one member of the team will be burden by the responsibility of handling one task alone. Drawing the line on where one’s responsibility ends and the other’s begin is crucial in ensuring the effective handling of roles within the team. It is a matter of conserving resources as well as ensuring the smart use of valuable time.   Conflict within Teams   Failure to communicate properly also results to the surfacing of conflict among members of the group. One common type of conflict cause is miscommunication. Earlier, it has been stated that providing medical care to patients is a complex task that requires the knowledge of various medical professionals with different specializations. This specialization can also be causes of differences in views in the practice.  In addition, it is a fact that every individual has different personality that will not automatically jive with the personalities of the other team members.   The effects of personal values and personality its self can take a toll on the performance of the team. This happens when the values and belief system of an individual is not aligned with the objectives of the organization. This will cause certain lapses in judge during the performance of his/her duty as a medical worker. However, there is also a common ground where the personal and the organizational can meet. Finding this common ground is main role of conflict resolution. Once conflicts have been resolved, the team can move in one synchronized motion, towards the attainment of the organization’s goal (Gleason, 1997).           (V) How to resolute Communication Problems in Collaborative Practice               The discussion made above is not isolated or not applicable in textbooks alone. Issues within nursing teams in relation to collaboration usually erupt.  It is fact that the task that nurses need to carry out is complex and rigorous. After long hours of running here and there to tend to the needs of a number of patients, it is inevitable that nurses experience a certain degree of fatigue and stress that can affect the way they interact with the rest of the nursing team. In turn, this change in interaction behavior can result to issues.               Interactions among members pf a nursing team is closely related to collaboration. Therefore, it can be stated that some problems that affects interactions will also affect collaboration within the nursing team. For example, communication is carried out through interactions. If members of the nursing team have problems interacting with each other, it is also the case that they have problems interacting with each other.               However, as presented in the previous section of this paper there are many more reasons why failure to communicate within nursing teams become present. These various stimulants of collaboration problems also results to different collaboration problems.   According to Rice (2000), collaboration problems may take the form of dominance of one member over the other, lack of consideration of the skills as well as the roles of the others members, the feeling of autonomy brought about by professional education and territorial issues. However, this list will not be complete without the mention of communication barriers. This proves that communication plays a very important role within nursing teams. However, it is also the case the communication is lacking among members of nursing teams.   The lack of communication results in errors. There are two ways of understanding how and why errors happen. The first way is through the person approach.  According to Reason (2000), the person approach focuses or blames the individual’s failures including carelessness or forgetfulness. On the other hand , there is the approach which focuses on systems and the manner in which they contribute to errors (Reason, 2000).    In a study carried out by the Agency for Healthcare Research and Quality, they found out that error within the healthcare industry for a number of reason. On top of the list is the lack of effective communication not just within nursing teams but in all levels of healthcare workers. This is followed by the insufficient information flow from one team member to the other or from one level to the other.  Also included in the list is the lack of appropriate procedures and policies that will serve as the guide of healthcare workers.   Since the lack of communication is one of the major causes of inefficiency among and between nursing teams, it is very important that the source of the problem be addressed. Early resolution of the problem can lead to improved performance of the teams. This means that patients will be able to experience the kind of healthcare that they needs and deserve.  However, in order for the action plan to work effectively, it must be noted that the actions must be directed towards the source of the problem. Superficially, resolving the problem will only result to more complications in the future.  This means that nursing teams must address the lack of effective communication within the nursing teams if they want to address the cause of the other issues within the team.   The next section of this paper will be discussing the recommended actions that nursing teams can use in order to resolve the issue of lack of effective communication, verbal, non-verbal and written.  The recommendations posted below are based on the earlier discussion of the framework as suggested by Blancett and Flarey as well as other related literature.   (VI) Recommendations               Communication among members of a team, especially in a nursing team, is crucial in delivering the best possible service to the people. This is the reason why it is important that every nursing team foster a culture of effective communication. It is being recognized that there is uneven development. There are those who are relatively underdeveloped compared to the rest. However, it is the task of the advance units to help others. This should be the kind of thinking present in every nursing team. Each member must recognize the importance of one another to the team. It is through this recognition that each member will extend a helping hand to others. It is through this that each member will open up to others and start communicating effectively.               In addition, all members of nursing teams must be able to identify and report errors immediately. After all, these errors cannot be deal with if they are not recognized. It is also important to recognize and report errors because every member of the team can learn from the mistakes committed. They will be able to draw from experience the next time they are faced with the same dilemma.               Change should not be rushed. As presented in the framework above, there are four stages. There is no need to immediately jump form stage one to stage three. It is important the before going top the stage, lessons learned will be used to fix previous mistakes. Personalities have been molded for very long time, that is why there is a need to recognize that it cannot be changed overnight. It is important that every member of the team be able to make guided realization. It is the role of leaders to guide their members. However, it is up to the members to make the changes in their perception. The main concern for all is the time it will take to realize the changes that needs to take place. This is where the support of the rest of the teams comes into play. Everyone have each others’ back always.   Credit:ivythesis.typepad.com

The importance of Communication in Collaborative Practice for Nursing Teams

(I) Abstract This paper will be discussing the various issues surrounding the public sector nursing organization. The ai...