Research Topics: Nursing Management And Shortage

HIP JOINT REPLACEMENT CASE STUDY

HIP JOINT REPLACEMENT CASE STUDY               This paper will focus on Mrs. ’s hip joint replacement, the main physical processes and the structures involved, the key biopsychological factors that may influence the patient’s experience of this problem and how consideration of these factors that may influence the management and outcome of the case. The hip is a ball and socket joint. The ball is the femoral head, which forms three-fourths of a sphere. The socket is the acetabulum, which is not a true hemisphere, but rather forms a horseshoe-shaped joint surface with a depression in the middle called the fossa. The transverse acetabular ligament connects the bony portions to complete the rim of the socket. The ligamentum teres arises from the confluence of the acetabular fossa, and the transverse ligament then inserts into a small depression in the femoral head. This structure provides the head with blood flow early in development, but it is not essential for blood flow in adults. The ligamentum teres does appear to provide some stability for the hip, especially in the flexed/abducted/externally rotated position or with hyperabduction. The anterior rim of the acetabulum has a small depression called the psoas notch; the iliopsoas muscle tendon is located extracapsularly in this area. The iliopsoas attaches to the lesser trochanter of the femur and functions as the primary flexor of the hip. A series of ligaments connects the acetabulum to the femoral neck; collectively, this structure is called the hip capsule ( 2005). The hip joint allows the leg an amazingly wide range of motion. Luckily, the joint itself is relatively simple, mechanically-a ball-and-socket arrangement in which the rounded upper end of the femur moves inside the acetabulum, a socket in the pelvis. In the operation, the worn or diseased end of the femur is replaced with a new ball part, and the worn and damaged parts of the acetabulum are removed and replaced with a concave bearing cup to match the ball. The artificial ball and socket have surfaces that glide against each other in a way that mimics the natural joint ( 2006).             The standard hip replacement involves making a large incision down the side of the upper thigh, cutting through muscle and exposing the hip joint. The head of the femur (thigh bone) is then removed with a saw and replaced by a prosthesis, which is driven into the thigh bone and cemented in place. The operation causes extensive pain, bruising and swelling and requires one to two weeks in hospital. Like any surgery, hip joint replacement carries certain life-threatening risks, such as infection, blood clots and complications from anesthesia. Other complications include nerve damage, dislocation of breakage after surgery, and wearing out or loosening of the joint over time (2004). After the operation, there can be wound infection and worse, infection of the hip replacement. These may require prolonged antibiotics and possible removal of the implants             Patient factors include age, gender, race, and living arrangement. These factors are either nonmalleable traits or pre-existing states that each patient possesses before joint replacement surgery. Clinical factors include comorbidities and preoperative physical status indicators (eg, total lymphocyte count [TLC], hematocrit). Body mass index (BMI), an indicator of total body fat, also is a relevant clinical indicator because joint stress can be caused by an increased BMI. Treatment factors include surgical factors, such as length of time in surgery and type of anesthesia, and postoperative factors, such as type and amount of postoperative analgesia and postoperative complications ( 2004).             After the hip replacement surgery, it is expected that the care of the patient can become complex as a result of physiological changes that may occur. Another thing is that, the patient now has an artificial hip in him and this is something that the client has to get used to.             To assess the patient’s condition after the hip replacement surgery, the nurse should apply critical thinking while relying on information from the preoperative nursing assessment, knowledge regarding the surgical procedure performed, and the events that occurred after surgery (2004). The information that the nurse gathered from the client will help the nurse to detect any change and make decisions about patient’s care. A variation from the patient’s normal signs may indicate the onset of surgically related complications (2004). The health care professional like the nurse should thoroughly document the assessment, including vital signs, level of consciousness, comfort level, pain, range of motion or mobility among other things. The initial findings are a baseline for comparing changes before and after the surgery. The nurse also has the responsibility of explaining to the patient and his/her family the purpose of post-operative procedures or equipment and the status of the patient.             Two acute needs of the patient after total hip replacement surgery are pain and mobility. The physiology of these two are altered after surgery. The pain after undergoing hip replacement surgery is intense but is still somewhat manageable (2003). It is imperative that the nurse and other health care professionals set the stage for the relationship that allows for open communication about pain. Simple measures such as sitting when talking to patients about pain lets patients know that the nurse has the time and the interest to assess the pain felt by the patient (2004). The kind of pain that the patient experiences after surgery is acute pain which everyone experiences some level of during one’s lifetime. It is actually protective and has an identifiable cause, in this case, the surgery itself was the cause of the pain. This kind of pain has limited tissue damage and emotional response. Since acute pain is expected to be healed and the cause can be identified, healthcare teams are usually willing to treat the acute pain experienced by the client. Nurses should be aware that unrelieved acute pain can progress to chronic pain (2004). Assessment of the patient’s mobility enables the nurse to determine the client’s coordination and balance while walking, bending, and doing usual movements with the knee. The assessment of mobility has three components: range of motion, gait, and exercise (2004). Assessing the range of motion is used to determine the degree of damage or injury to the joint or it could be from recovery. The nurse should ask questions about joint stiffness, swelling, pain, limited movement, and unequal movement. Assessing the client’s gait or the manner and style in walking allows the healthcare professional like the nurse to draw conclusions about balance and posture (2004). Other than that, malignant hypothermia could occur and is a potentially lethal condition that can occur in patients who underwent hip replacement surgery and received general anesthesia. This should be suspected when there is unexpected tachycardia and tachypnea, jaw muscle rigidity, body rigidity of limbs, abdomen and chest, or hyperkalemia (2004).             Patients who have temperature elevations should be assessed and nursing interventions should be planned for a possible infectious process. Postoperative interventions of deep breathing and coughing, early ambulation, and aseptic care of the surgical wound of the hip will decrease the patient’s risk of postoperative infections.             The patient may be recommended to rest, the use of hip supports, the use of walking aids such as canes and walkers. Physical therapy and appropriate exercises may also be suggested. Occasionally, steroid injections into the hip may decrease pain and inflammation. A variety of drugs for arthritis exists. These range from painkillers aspirin and acetaminophen to NSAIDs (nonsteroidal anti-inflammatory drugs) such as diclofenac, meloxicam, piroxicam, mefenamic acid, ibuprofen, to the latest COX-2 inhibitors (rofecoxib and celecoxib).             Patients whose pain level is reported as tolerable should to be more active and willing to engage in physical therapy. With emphasis being placed on providing quality care while striving for cost-effectiveness, such adverse outcomes need to be targeted for prevention from all possible angles (1999). Approximately six weeks after surgery, comfortable hip motion usually is regained, and strength training can begin. Low impact exercises, such as walking, swimming, and biking, are well-tolerated and can be performed up to five or six times per week. Optimally, strength training is performed three times per week and includes using a leg press machine and doing hamstring curls and squats and lunges. The therapist should instruct the patient to be careful during isolated hip movements with resistance on the ankle because these movements can generate high hip joint loads. Strength training should be varied for maximal gains, alternating between low resistance/high repetition and high resistance/low repetition workouts ( 2005) Hip replacement surgery is a safe and cost-effective treatment for persistent hip pain and disability, and increasing numbers of patients like Mrs.  are seeking it in order to minimize or eliminate pain and difficulty in moving the hip joint. After surgery, health care professionals and the family of the patient still have many important factors to assess in order to make sure that the patient is doing well after the surgery. Health care professionals and families should continue assessing the patient until the critical factors are on a less intensive basis.   Annotated Reference 1.          and  Fundamentals of Nursing sixth edition, published in 2004 by , is a textbook for nursing students which prepares the nursing student’s of today for the challenges of tomorrow. This was a revised copy from the previous editions and contains new chapters, new ideas and new issues. This textbook is designed for beginning students in all types of professional nursing programs as well as for other health care or non-health care professionals who are doing research on nursing and other health aspects. The textbook also has a comprehensive coverage providing fundamental concepts, skills, and techniques of nursing practice and a firm foundation for more advanced areas of study.             The book also provides a contemporary approach to nursing practice, discussing the entire scope of primary, acute, and restorative care. Nursing concepts like concept maps which visually demonstrate the relationship between multiple nursing diagnoses for associated medical diagnoses, nursing skills and nursing care plans, contemporary nursing issues such as emerging practice issues and nursing shortage, and the increased focus on research and evidence-based practice in skills and care plans to influence and guide clinical decision making are just a few of the many contents of this book. 2.         Review of Medical Physiology 20th edition, published in 2001, is designed to provide a concise summary of mammalian and, particularly, of human physiology that students of the medical profession and others can use by itself or can supplement with other readings in current texts, monographs, and reviews. Pertinent aspects of general and comparative physiology are also included in this textbook. Summaries of relevant anatomic considerations are found in every section of the book, but it is with warning that the author mentions that this book is written primarily for those who have some knowledge of anatomy, chemistry, and biochemistry. Examples from clinical medicine were given where pertinent to illustrate physiologic points.             Review of Medical Physiology also includes a self-study section to help students review for examinations and also has an appendix that contains general references, a discussion of statistical methods, a glossary of abbreviations, acronyms, and symbols commonly used in physiology, and several other useful tables. In this 20th edition, as previous editions, the entire book has been thoroughly revised, with a view to eliminating errors, incorporating suggestions of readers, updating concepts, and discarding material that is no longer considered relevant. In a way, the book has been kept as up-to-date and accurate as possible. 3.         and  10th edition of the Textbook of Medical Physiology was published in 2000. The first edition of this book was written around 50 years ago by Dr.  alone. In this 10th revision, Dr.  joined as coauthor and helped in the revisions needed for the textbook. Both the authors thoroughly revised the textbook throughout in order to improve clarity of the concepts and to include new physiological principles where necessary. The goal of this textbook is to present new and more recent physiologic principles in the terminology of molecular and physical science rather than merely as a series of separate unexplained phenomena. The field of physiology and medicine as a whole is continually evolving and changing, therefore certain concepts may not be true or useful in the present. Another goal of this text is to be as accurate as possible. Suggestions and critiques from many physiologists, students, and clinicians throughout the world have been sought and then used for checking factual accuracy as well as balance in the text.  The sources referenced in the textbook have been chosen primarily for their presentation of physiologic principles and for the quality of their own references. 4.         article in the AORN Journal is about predictors in joint arthroplasty patients. This particular article was published in the May 1, 2004 issue. The AORN Journal, available in printed and online editions, is an award-winning source of perioperative nursing information. It is published monthly and provides articles on clinical management and research topics; updates on clinical issues, perioperative pharmacology, operating room nursing law and legislation; and features such as book reviews, practical innovations, Board reports, conference reports, and home study programs.             In this particular article, focus is given to elderly arthroplasty patients. The study explored the effect of patient, clinical, and treatment factors on length of stay (LOS), discharge disposition, and total acute care hospital charges for older adults undergoing elective total hip arthroplasty or total knee arthroplasty. A causative retrospective design was used, and data analysis included descriptive statistics, multiple regression, and logistic regression. The results of the study showed significant differences in predictor variables between patients who were discharged to home and those who were discharged to another facility. Only postoperative complications contributed significantly to LOS. Total surgical time and postoperative complications contributed significantly to hospital charges. 4.         This next article is also from the AORN Journal. This articled is about arthroscopic hip surgery and is written by  and published on December 1, 2005. Arthroscopic hip surgery has become an accepted surgical procedure with well-defined indications and expected outcomes, primarily because of recent advances in surgical in surgical instrumentation and techniques. Hip arthroscopy is said to be performed as a same-day procedure using a fracture table to apply distraction to the hip joint. The article “Arthroscopic hip surgery” is the basis for this AORN Journal independent study. The article also provided a short background on the anatomy and function of the hip joint, as well as the major health concerns and diseases that affect the hip joint. Diagnostic testing (like Physical examination of abnormal gait, tenderness, hip range of motion, muscle flexibility, and baseline neurovascular status) and surgical indications regarding hip replacement are also included in the article. Credit:ivythesis.typepad.com

HIP JOINT REPLACEMENT CASE STUDY

HIP JOINT REPLACEMENT CASE STUDY This paper will focus on Mrs. ’s hip joint replacement, the main physical processes and t...

Improving the service quality to the residents of GreenLife Old People’s Home

Proposal for Improving  the Staff Care Quality to the Old People     Submitted to the General Manager of GreenLife Old People’s Home   31 January, 2007/1/30   Introduction Background GreenLife Old People’s Home is providing the nursing care service for the aged since 2004. Mainly provide a safe and dignified service for elder people, including the personal care that we help with mobility, bathing, showering, getting up in the morning and starting the day, meal preparation and serving and going to bed at night, also accompany the older person transport to hospital and take  prescriptions when they are sick. Sometimes we organize outings, for example, visiting relatives or just to have a ride out into the countryside or to the seaside. Statement of Problem The clients and their family members complained about our staff care is not adequate that leads to negligence of attention to our clients. Feeding and bathing times are delayed frequently. Injury occurred several weeks ago when one of the old people failed down in the washroom, it was discovered until the next day morning. To prevent the similar problem happened again, an immediate action should be taken that we have to realize and correct the problem we oversight.   Objective This proposal offers a realistic and effective solution to remedy solutions for the improvement of our service. We first identify the actual defects of our daily operation in aged care service, and then we show the ways how to reduce inefficiency and eliminate complaints of our operating procedures.   Sources My data come from the interviews with our clients and their family members; internal meetings with our care workers; guidelines for old care from government social welfare department and my own observation for these three years.   Causes Complaints specifically about our staff care: <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 150%"> The care workers seems very busy everyday, the old people need to wait for a long time when they call for assistance. And they also complained that some workers are rude in attitude </li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 150%"> Some of the new care workers said it was inadequate time to finish their task, it seems they are inexperience of the nursing care service. </li> We are facing the recruitment problem in the sector, younger people were being given little incentive to work in the care industry. Increasing number of our clients recently leads to inadequate time for care workers to carry out their job and communicate with the clients, let alone to recognize the different needs of each individual. The inexperience staffs and high turnover rate also caused the inefficiency of our service.   Needs This is a serious problem that would cause our patrons away. We can help restore our company creditability and recover the faith to our clients if we could continue to provide not only satisfying service, but also a quality service to our clients.   Proposed Plan Staff Reinforcement Training.  Regular training will be given to workers to ensure and remind their skills and understanding necessary to meet the standard of nursing care service referring the guidelines providing  by the social welfare department. Training offers not only the technical skills of service, but also the caring attitude towards the aged, let the old people have the sense of belongings and caring from others. Mature and experienced workers are preferred. Care workers should be carefully recruited and placed. We are looking for who experienced in aged care, and able to recognize the old people’s needs. Caring and patience is the first priority we placed. Such staffs are well-trained and high in efficiency, they are deserved to receive a higher wages and company welfare.  More workers should be hired to meet the increasing clients recently. Select a ‘key worker’. We will select a ‘key worker’ to responsible for training and supervising the care workers to ensure that they have the essential skills and understanding necessary to meet the clients’ needs. The ‘Key Worker’ will help in communication and management of the team, it  enables the efficiency and quality of our service. Arrange recreational activities. Recreational activities, for examples, going for picnic in countryside or one-day traveling programme should be held to enhance relationship with the clients, their family members and our staffs. To rebuild a good communication channels and trust between each others.  Personnel Inexperience staffs who would be layoff would create low in staff morale. The old people may hard to adapt if changes of the workers who is serving them. Changes in human resources is suggested to be progressively. In addition, the success of this plan is relying to the implementation of our new format. We should review the progress by staff monthly meeting. Conclusion and Recommendation To restore the confident to our profession in aged care service, the proposed plan shows the recommended steps pointed to our existing problem that we are growing in size, but shortage of manpower is resulted to oversight our mission that we aimed to provide the professional nursing care service to the old people. Our immediate response to remedy the situation would create a positive image to the clients and their family members. Caring service is a matter of interpersonal relationship that our staffs are the most important part of our assets, we should pay more attention to provide quality service that the old people could enjoy the rest of their life. Credit:ivythesis.typepad.com

Improving the service quality to the residents of GreenLife Old People’s Home

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Strategic Management Case study for Wimm-Bill-Dann

PART A – Strategic Management Case Study for Wimm-Bill-Dann   Introduction             Wimm-Bill-Dann Foods is one of the largest dairy food manufacturers in Europe. It was founded in 1992, and since then, it produces a wide variety of branded products, including dairy food, such as milk, butter, cream, sour-milk products, cheese, yoghurts, and pudding; juices and beverages, such as juice concentrates, juice-based drinks, and berry-juices; bottled mineral water, baby food products, and products for nursing mothers. Its headquarters is located in Moscow, with 36 other production sites in 26 cities in Russia. Its popular brands include “J7”, “Agousha”, “Jolly Milkman”, “Favourite Garden”, “100% Gold Premium”, and “House in a Village”. Currently, it sells its products to independent wholesalers and distributors, SME’s, supermarket chains, groceries, and restaurants (‘’ 2007; ‘’ 2007).             Since 1999, to answer to the shortage of cattle, the company has been an advocate of the Milk Rivers program, leading to a significant increase of sales and production from 26% to 45% between the year 2000 and 2004. As its competitive advantage, it employs a strategy of producing dairy products in the region where they are consumed, thus, contributing to its strong production base in the Russian regions. Currently, it has over 18,000 employees in its production, having significant roles in keeping the mission of the company. This mission involves helping the entire family live healthier through offering their nutritious and delicious products (‘’ 2007).    Strategy Position of WBD             The macro environment of any organization includes external factors, such as the economy, demographics, culture, politics, natural resources, and technology ( and  1999). These factors must be determined, as they largely and significantly contribute to the success and the problems being faced by the organization, and thus, responsible in Will-Bill-Dann’s (WBD) strategic position or competitive advantage in the market. In terms of its external or macro environment, WBD excelled by taking advantage of its economy, demographics, technology, and natural resources. Despite the effects of the Asian Economic Crisis in Russia and its difficult adjustment in the change of its market system, WBD took advantage of the fact that Russia has one of the biggest market in the world in terms of the food market, specifically in the dairy and juice markets. The reforms and collapse in the Russian economy reduced the imports of juices, thus, giving a chance for WBD to take over the juice market in the country. The economy of the country somehow restricted the production and manufacture of products of the company. However, because of its strategic position in terms of its natural resources, the company was able to surpass the crisis. The company also strategically positioned its manufacturing plants where sources for dairy products, such milk and cheese can be bountifully obtained, giving the company its advantage over its foreign competitors. In this regard, the company had been able to position its production facilities in such a way that it would be able to obtain bountiful raw materials for its production. In this regard, the company had been successful in both utilizing its natural resources, with the support of its manpower, creativity, resourcefulness, and technology. Such success would not have been observed without its technology, employing innovative product development, distribution, quality, packaging and marketing (. 2005) all at the same time. The efficiency, creativity, and resourcefulness of the company had been their primary tools for going through the economic crisis affecting Russia, along with the intense competition from other foreign dairy and juice manufacturers. In analysis of WBD’s competitive positioning that affects the ability of the organization, the five-force model of competitive positioning can be used. The use of this model enables realization and analysis that all the five forces listed in Porter’s model have significant effects on the overall performance of WBD in its industry. It also enables the analysis of the overall capability of an organization to respond to the different crises that may come their way, which would affect their operations and productions. One of the forces is competitive rivalry, which pertains to the ranges of products being offered by WBD and its differentiation over the products of its competitors. In this regard, WBD has a significant competitive position over its competitors, as it offers a very wide range of products that are not offered by other dairy and juice manufacturers. Second factor is new market entrants, which refers to the geographical factors that affect the production and distribution of dairy and juice products of WBD. This involves offering the products to other geographical locations, which the company was able to succeed from, as it was able to strategically place its manufacturing plants to areas that would not only enable it to obtain bountiful raw materials, but reach its consumers as well. Product and technology development allows WBD to maintain its products at low prices, based on the trends in the economy and market. This factor is the most significant aspect in any organization in this generation, given the important role technology plays. Organizations that do not take advantage of the capabilities of technology need to rely heavily on costly human resources to fulfill the same functions (cited in ‘’ n.d.). Supplier power pertains to the reputation and quality of the products, and the relationship that exists between the company and its customers, while buyer power refers to the powerful choice, cost, and demand of the consumers on the products of WBD ( 1998). From this analysis, it can be perceived that the competitive advantage of WBD in the market is determined by the effective and efficient interplay of such factors.             The influence and support of major stakeholders also determined the competitive positioning of WBD. Major stakeholders include its internal and external stakeholders, performance measurement techniques, financial, innovative, business, and customer perspectives, and its competencies, capabilities, and resources. These stakeholders of the organization refers to the fact that individuals have some ‘stake’ in the organization, as they are engaged in some kind of exchange relationship with the organization, whether it be for capital, information, or resources. The expectations of stakeholders vary significantly according to their relationship to the firm, and thus it is important for strategic leaders to understand what each requires in exchange for their investment (‘’ n.d.). The company would not have been able to meet the demands of the customers during that time without the support, organization, discipline, and expertise of both its internal and external stakeholders. In this regard, labor, skills, hardwork, time, and effort have been the key characteristics exhibited by the employees, staffs, and suppliers of the company, thus, enabling them to effectively and efficiently meet the increasing demand of the public. In addition, the competitive positioning or advantage of the company lies on the fact that it has able to healthily and actively participate in competition brought about by Western companies by producing new product lines and by changing its corporate structure. Thus, in this regard, the internal factors can be deemed a successful means in terms of the continuously changing external environment of the organization.   Diversification and Acquisition in WBD             The aim of the organization to further diversify its line of products resulted from the objective of WBD to formalize its management structure, thus, effectively focusing on strategic management and giving control of production facilities to managers and directors of the company. It has been reported that product diversification is defined as the production of several different commodities by a firm, in different physical commodities, and the production and sale of the same commodity at different times of the year ( 1976). It is typically more expensive, as it involves an advantage based on distinctive product attributes that would offer benefits that others do not (. 2003). In this regard, it can be assumed that product diversification for WBD may present financial and resources problems, given the only recovering economy of Russia during this time. However, in the case of WBD, it can be perceived that significant increase in profits were being enjoyed by the company, thus, having adequate resources to support a wide range of product diversification. In support of this, it has been emphasized that signs of improvement appear widespread and optimism has returned ( and  2000).                 Another significant event in the history of WBD is the potential acquisition of  in 2003 due to the significant increase of ’s share in the stocks of WBD and the continuous exploration of WBD’s stakeholders of mergers with the company. It has been reported that acquisitions and buyouts can introduce untold opportunity for growth, cost savings, and competitive advantage, which can be achieved through alliance of people, processes and information within the newly combined organizations (‘: ’ 2005). However, for this particular situation, the buyout intention and negotiations have been deemed to produce negative results instead of positive ones. With reference to the economy of Russia, it has been written that dynamic growth has been observed in all economic and industrial sectors during this time ( 2005), thus, indicating that buyouts from foreign companies might not be needed. In this regard, the internal processes of the organization, including its management must be particularly and significantly modified in order to maintain and sustain the productivity and operations of WBD.   Strategic Options of WBD             One of its open opportunities is improvement using advanced technologies in terms of its operations and production processes. In today’s dynamic and fast-paced changes in terms of technology and information, information systems can be used to support specific functions and operations in the organization, given limited resources, and security vulnerabilities that endanger the essential information-based functions needed to be addressed (. 2003). In relation to the use of information systems is the update and modification of its IT processes and equipments, to guarantee that its computer systems will function properly (. 1998), thus promoting innovation. Specifically, it can improve its logistics, which would improve business linkages throughout an organization. In this regard, flexibility in terms production can be reached.             WBD can also engage in extensive Research and Development in order to find ways in further improving their products. The company can provide modifications and alterations on their existing products, such as providing new flavors and coming with new packaging and gimmicks. This would also help the company target new markets in the future. In this regard, product development would be a valuable strategic option for the company, rather than further product diversification. It has been reported that companies nowadays are placing on new products as a source of new sales and profits ( and 1995).             Another strategic option for WBD is expansion, which would allow the company to speed up its production and entertain new ideas for the improvement of its products. However, expansion is a double-edged sword, which can both present advantages and disadvantages to the company. Although expansion would enable WBD to attain more efficiency in terms of production and increase productivity and creativity, it would also enable the company to increase costs, conflicts, and other problems. One of these problems is the limited resources that the company might have. Resources needed by the company include human, financial and physical resources. The amount of money or the budget of the company serves to be its financial resources, thus, the company must be able to allocate its budget effectively in order to push through with the expansion. Aside from human and financial resources, physical resources are also needed, and include the premises, such as heating, lighting, cleaning, security, and structural alterations ( 2004). In line with the company’s expansion, problems with resources can be solved through financial help from other companies through sponsorships, or through additional income-generating programs such as contests and promos. Based on the profit and sales of the company at present, WBD has attained a strong sales growth in all segments, with net sales up to 40.5% to US,147.8 million (‘’ 2007). With such profits and sales, the further expansion of the company with the support of its resources can be effectively and efficiently achieved.             Improvement of the management in WBD is also its strategic option, as it aims to provide the whole organization and its members with the chance to grow and develop as individuals and as a group. Improvement in the management involves the implementation and use of good leadership and motivational styles, such as job enrichment and job rotation programs. To be able to achieve superior success and efficiency in the organization, a recommendation for WBD would be to employ Total Quality Management or TQM, which is a description of the culture, attitude, and organization of a company that strives to provide customers with products and services that satisfy their needs, through requiring quality in all aspects of the operation of the company, with the process being done right the first time and defects and wastes eliminated from operations ( 2007). In addition, it also refers to employee interventions and techniques used to improve quality, and many are a basic business strategy to provide goods and services that completely satisfy the customers by utilizing the employees’ talents while providing a positive financial return to the shareholders (cited in  and  1995). Such improvements can be done through focusing on work processes, variability, systematic gathering of data in the problem-solving cycle, and continuous learning and improvement in the organization ( and  1995). With the support of the managerial grid theory of leadership, the company would be able to offer a better ground for using leadership styles, and develop team management. With the support of Maslow’s Hierarchy of Needs theory, the employees of the organization would become more empowered and motivated, as the company recognizes all their human needs, beyond those of physical and economic well-being.                Last strategic option for WBD is the improvement of its distribution channels and promotion strategies in order to effectively reach its target markets. The exchange of good products and services between consumers and producers is mediated by the use of media, advertising and promotion, and sales service ( 1999). WBD can enhance its use of different types of media, such as the Internet, radio, television, and print ads to introduce their products and attract potential consumers. In turn, the consumers also use these types of media to interact with their service providers concerning their rendered products. In this type of business, the use of a variety of means in the company’s aim to strategically reach the customer is one effective way in order to generate and increase sales, and establish the company’s reputation in its target market. These can be done through advertising, publicity, or personal selling. In addition, the company can also employ direct marketing and franchising, which may include selling the product and offering commissions through networking. This would also allow the company to engage in globalization, which is a major trend in the world economy and has great impacts on the environment of most organizations (. 2006). In this regard, WBD would be able to foster effective communication with its customers, and in turn achieve higher sales and profits in the process.             References Credit:ivythesis.typepad.com

Strategic Management Case study for Wimm-Bill-Dann

PART A – Strategic Management Case Study for Wimm-Bill-Dann Introduction Wimm-Bill-Dann Foods is one of the largest dair...

CLINICAL REFLECTION

Clinical Reflection               This reflection will discuss my interaction with a mental health patient in the community and the reaction I experienced upon meeting any mentally ill patients for the first time. Through consideration of the theoretical perspectives and my own view points I will explain my feelings and attempt to interpret my reactions. I will suggest how my future behavior will be different as a result of this experience and my understanding of it. We live in a time when mental health has been increasingly failing for many individuals. Many situations that are reflected in our societies today re increasingly convincing me, helping me to come to realize that mental health nurses matter, are essential healthcare providers, and will continue to be needed in the future. Mental health nurses are in the right position to grow in the understanding of mental health and to better identify the constructs and care practices that promote, strengthen, and protect the mental health of individuals and families. Mental health can be a very challenging area to work in and as an experienced student nurse, I have a great admiration for the skills and commitment registered mental health nurses give. There are many qualities that a registered mental health nurse must possess. Personally, I feel that I have already developed some of these qualities given the time and experience that I have spent in the mental health field. To illustrate my capabilities, I will outline in the succeeding paragraphs the qualities that I have developed as well as the situations where I have applied them. Mental and behavioral disorders are understood as clinically significant conditions characterized by alterations in thinking, mood or behavior, and associated with personal distress and/or impaired functioning. Mental and behavioral disorders are not just variations within the range of “normal” but are clearly abnormal or pathological phenomena. In order to be categorized as disorders, such abnormalities must be sustained or recurring, and they must result in some personal distress or impaired functioning in one or more areas of life. Mental and behavioral disorders are also characterized by specific symptoms and signs, and usually follow a more or less predictable natural course, unless interventions are made. Not all human distress is mental disorder; unless all the essential criteria for a particular disorder are satisfied, such distress is not a mental disorder. Similarly, culturally determined normal variations in thinking and behaving are not mental disorders ( 1996). These are aspects that must be considered when dealing with mental health patients. While I was on my practice placement at a mental health clinic, I have experienced a lot of things and I have also learned many valuable lessons from those experiences. Being with the vulnerable population is an experience unlike any other I have come across. I had to make a lot of adjustments. As a student, my knowledge about behaviors of patients with mental problems is limited only to the books. And that also goes true for my knowledge on how to handle them, especially in unexpected situations. In my diary I have described my experiences during my student practice where I have learned a lot. On my first day, I was assigned to take care of a male mental health patient and assist his needs. The next day, I was also assigned to another patient who is completely different from this one that I have previously handled. My third day patient is a 21 year old female with psychosis. She permitted me for an observation and I came inside and observed the interview and oral medication. On that same day, we visited a schizophrenic patient. This patient was very depressed. Schizophrenia is found all over the world. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness. However, some people are not greatly helped by available treatments or may prematurely discontinue treatment because of unpleasant side effects or other reasons. Even when treatment is effective, persisting consequences of the illness — lost opportunities, stigma, residual symptoms, and medication side effects — may be very troubling. My job as a mental health nurse while taking care of the mental patients involve more than just giving them anti-depressant medications. What I was trying to achieve while I was the mental health nurse taking care of the mental health patients is to support them and relieve their feelings of hopelessness. I also wanted to show them that I care for them as a person and that everyone loves them and have time for them. I have learned that for a patient to fully heal, you have to also touch their hearts. I acted the way I did with my patients because they were obviously very depressed. I did not feel that I could just simply them her while they were in this state. I felt a need to help them develop positive attitudes for the future. I listened to everything they would want to say to me because I believe that it would help them minimize and overcome the depression that they felt from their situation. To reach out and encourage them was just one of the most natural things for me to do. The need to remove the considerable barriers to health promotion for people who have mental health problems has long been recognized. In Australia there is commitment to community care and recognition of the importance of providing services that place the user central to service delivery. Whilst wide variations in the patterns of collaboration can be found between the health organizations and local government, it is possible to begin to identify key principles that underpin the delivery of coordinated services to the user that enhance quality of life irrespective of the particular structure through which they are delivered (2001). Partnership is a fundamental theme in current government initiatives and is seen not only as the way to modernize statutory services but also as a catalyst to challenge the existing cultural mores within which our society operates. Within this, partnership is about developing and acknowledging our collective responsibility for the health and well-being of the community to which we belong ( 2001). Service users played a big part in determining how the partnership was set up. Brent is one of the few authorities nationwide to have a fully integrated learning disability service. There are many personal factors which influenced the way I took care of the mental health patients. I believe that being able to listen and the application of touch are important skills in a nurse, as well as showing that you care for the patient. I also believe in my mental health patients as a person. Although I know that some of them are severely depressed, I also know that as the days went by, some of them are fighting hard to overcome it. Many people have stigma against mental health illness. There is a lot of information regarding stigma in mental illness and the effect it has on health care workers’ attitudes towards their patients. Viewing stigma as a public health issue points to the ways in which stigma harms people with mental illness. Three are particularly notable: label avoidance, blocked life goals, and self stigma. The public health approach to decreasing mental illness stigma largely relies on education programs dominated by the medical or disease model. Education is defined broadly in terms of any strategic format (that is, classrooms, public service announcements, magazine articles) that seeks to decrease stigma by informing the public about mental illness. One example is the National Alliance for the Mentally Ill’s (NAMI) “Mental Illness is a Brain Disease” campaign, in which the organization distributed posters, buttons, and literature that provided information about the biological basis of serious mental illness. On a global scale, the World Psychiatric Association (WPA) is sponsoring its Open the Doors Global Program against stigma and discrimination focusing on schizophrenia. Now in its eighth year, the WPA information program educates the public about mental disease and corresponding treatment. The public health approach may have some value in reducing label avoidance and limited impact on aspects of blocked opportunities and self-stigma. However, in other ways it may exacerbate stigma-related problems. What might we learn from other perspectives on stigma that will diminish its impact? When not discussing health disorders, generic ideas of stigma are typically defined as social injustice; this general definition rests on the idea of discredited difference (2001). Prejudice of any sort rests on human differences. Although the vast majority of human differences are irrelevant to prejudice–handedness, eye color, foot size–history shows some differences such as skin color and sexual orientation are salient and often paired with negative attributes. There is also the problem of unequal treatment of mental health patients. The causes of this unequal treatment arise in part from deep-seated convictions, if not biases. Foremost is the belief that mental health and disorder are poorly defined. While few would argue today that mental illness is a myth, or maintain that mental illness is whatever psychiatrists treat, nonetheless there is a bewildering diversity of views about mental illness, ranging from biological accounts to social determinism. The nature of mental illness is often conceived as a dichotomy between mind and body, an unfortunate dualism that tends to minimize the physical suffering and disability associated with mental illness. Oddly enough, even within the mental health field there are those who wish to distinguish biological from nonbiological mental disorders and give priority to the former ( 1992). I have learned that mental health nurses should focus on the wider needs of the patient, using their skills to improve physical well-being through better assessment and health promotion activities, and by providing more psychological therapies. Mental health nursing is at the heart of modern healthcare. Through the development of new roles, such as prescribing, and new skills in areas such as physical wellbeing, mental health nurses are at the forefront of changes in how services provide for the needs of people with mental health problems. All mental health professionals are having to rethink the part they will play in the services of the future. This report sets out an optimistic and ambitious vision of a confident and responsive nursing profession. Mental health nursing should take a holistic approach, seeing services users as whole people and taking into account their physical, psychological, social and spiritual needs. This means that mental health nurses need to widen their skills to improve promotion activities and provide more evidence-based psychological therapies. Mental health nurses need training, supervision and managerial support. From my research, I have learned that Integrated care, an emerging trend, offers much promise to clients and all healthcare workers (2001). Integrated care is the increased collaboration of mental health professionals within primary care settings. More specifically, integrated care is most effective when services are provided via co-location, that is, when mental health counselors work in the same offices with primary care physicians. In this type of integrated arrangement, primary care physicians and mental health professionals consult regularly throughout the day about clients’ needs and will, in some situations, see a client together to help determine the most appropriate treatment plan. For example, in one large health maintenance organization, primary care physicians and psychologists share offices. Consequently, the professionals are successfully identifying 90% of the primary care clients who need mental health services, and of those clients, 85 % are receiving treatment (2002). Reasons for this success include the collaboration between the two healthcare providers and more importantly, clients’ following through with treatment, perhaps because primary care physicians can introduce clients to the mental health professionals on staff, instead of referring them to outside agencies ( 1990).             I have also reflected that the quality of mental health care or of health care for that matter also rests on other aspects. Quality of patient care is threatened by the acute shortage of nursing staff and at times a less than optimum mix of skills and experienced staff. The consequences are felt by patients or their families as well as nurses and have implications for clinical responsibilities and vulnerability to litigation. Due to this experience I have gained insight and will adapt my attitude and action when encountering patients with mental illness in the future. What I felt about the experience with the mental health patients is a mixture of feelings. I was very supportive with them and with their families. I wanted them to really overcome their situations if it is possible and I want them to feel that they are still loved. Some of the patients are still so young and have so much to live for. Sometimes I would feel helpless when I couldn’t make them calm down or I couldn’t stop them from crying or simply couldn’t stop them from doing weird behaviors.   Overall, I feel better and grateful for the experience I had with the mental health patients. It brings me joy that somehow I was able to foster hope in them and in the process helped them through daily living and even get well. I will use the knowledge I have gained from this experience to apply to future situations and hopefully help other persons with mental problems.                         Credit:ivythesis.typepad.com

CLINICAL REFLECTION

Clinical Reflection This reflection will discuss my interaction with a mental health patient in the community and the react...

Quality and Clinical Governance

QUALITY AND CLINICAL GOVERNANCE   Contents   Abstract          ………………………………………………………………………….1 Introduction   …………………………………………………………………………..2 Analysis         …………………………………………………………………………..4 Plan                …………………………………………………………………………..5 Change         …………………………………………………………………………..10 Conclusion   …………………………………………………………………………..12     Abstract             There is an increasing incidence of medication errors in our area of practice. This is due to incompetent staff and management. This is unavoidable yet it is important that health care organizations should focus on how to completely eliminate or decrease this incidence. Thus a plan is made up to further educate health care professionals within the organization regarding the correct administration of specific medications. Additionally, management has to adopt new techniques that will contribute to the decrease in medication errors. This change has to be completely supported by all health care staff and management in the health care organization so that there will be effective change that will take place. Introduction The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. In my place of employment, there are increasing medication errors happening in my hospital which may due to many possible causes. But as we know that patient safety and quality care is very important. The blame is placed on aspects of manpower (labor), management, money (finances), and materials. It is time to seriously rethink, redesign, redevelop and reinvigorate the way governance is practiced in my current place of employment. There is a need for better quality and care governance. Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For healthcare professionals, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care ( 2002). Medication errors that occur in many healthcare organizations mirror the increasing problem worldwide of deterioration of health care. The deterioration of healthcare work and its environment is a major problem of concern to the healthcare leaders or managers. A healthy work environment is necessary to bring about quality healthcare service to the population. An unhealthy work environment would create a devastating impact not only to the healthcare professionals and the clients but most importantly on the effectiveness of the entire healthcare system.             The possible root causes for this apparent deterioration of healthcare work are outlined in the succeeding sentences. (1) Healthcare professionals are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Healthcare professionals, especially in the case of nurses are assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved. Many medical-surgical nurses experience difficulty when calculating drug dosages. One study revealed that 56% of nurses could not calculate medication dosages to a 90% proficiency rate. In addition, nurses made significantly more errors in calculating intravenous drug dosages as compared to oral, intramuscular, or subcutaneous drug dosages (2004). The nurse should double-check the six rights of safe medication administration and know the desired action and side effects ( 2004). If the medication has an antidote, it must be available during administration. When administering potent medications, the nurse must assess vital signs before, during, and after infusion. The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for healthcare leaders and the staff as well. For example, when each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – doctors, clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished.   Analysis   Strengths (internal) Weaknesses (internal) Competent staff Good clinical facilities Lack of education and qualifications of some staff Opportunities (external) Threats (external) Health authority support Staff support Shortage of qualified staff               The SWOT analysis table shows that although the hospital is equipped with the most advanced materials and funded with more than enough financial resources, there is still an increase in medical errors resulting to unsafe practice. Hong Kong’s healthcare profession is challenged by the shortage of healthcare professionals. This presents a threat to many areas of health care practice. Not only that, this is a threat to patient care. It seems that there is also an apparent poor quality of management and leadership in this case resulting to the poor quality of service. Management is necessary to make labor and capital productive and requires converting economic principles into rules of behavior that can be clearly communicated to employees, bosses, clients, and other partners. Management in health care is not simple. In management it is people, not things that have to be managed, and because decisions must be made under uncertainty, based on expectations, without ever really knowing the entire facts one would like to have, it makes it all the more complicated. Applying the four key components of clinical governance to the problem is helpful. The activities involved in clinical effectiveness will include finding out what is the best known practice a specific medication administration, appraising the available evidence, changing the practice by educating the health care staff, and confirming through monitoring or clinical audit that actual practice is consistent with best practice. The human resources component of the clinical governance framework would aim to ensure that the health care staff has the right education, adequate training and development, skills and competencies to provide quality care to patients which include the proper medication administration. The expected outcome of the recommendations should be a decrease in the incidence of medication errors.   Plan             Coming up with recommendations and implementing them at the place of employment is the most logical thing to do. An improvement for the increase in medication errors is expected as health authorities and the staff supports the programs that are designed for improvement of health care services and quality of patient care. Improvements are geared towards the management and individual health care staff. To improve quality, organizations have to apply ‘Total Quality Management’ (TQM) to their organizations to help them plan their efforts. The promise of superior performance through continuous quality improvement has attracted a wide spectrum of business to TQM, with applications reported in many domains including healthcare ( 2002). Total Quality Management or TQM is defined as an integrative management philosophy aimed at continuously improving the performance of products, processes and services to achieve and surpass customer or patients expectations (2001). Actually, it was a management approach originally developed for improving manufacturing. However, it has recently shown its significance in service industries like healthcare services for improving the quality of service and satisfaction which has resulted in increased competitive advantage ( 2001). One of the service industries for example that have already joined the TQM bandwagon is the clinical healthcare sector. The surveyed clinical healthcare sector already applied the principles of TQM in their operations. They have shifted from efficiency to quality in order to attain the needs of their patients. But the implementation of TQM is not as “easy as one two three”.             There are some advantages that clinical healthcare services sector guided by the principles of TQM. Basically, the Total Quality Management philosophy of management within clinical healthcare services sector is customer-oriented. All members of a total quality management (control) organization strive to systematically manage the improvement of the organization through the ongoing participation of all staff in problem solving efforts across functional and hierarchical boundaries.  TQM incorporates the concepts of product quality, process control, quality assurance, and quality improvement. Consequently, it is the control of all transformation processes of an organization to better satisfy customer needs in the most economical way. Total quality management is based on internal or self-control, which is embedded in each unit of the work system (technology and people). Pushing problem solving and decision-making down in the organization allows people who do the work to both measure and take corrective action in order to deliver a service that meets the needs of their patients. Healthcare providers are able to make the most of their participation in the quality movement because of the learning provided by the various patients training sessions, especially when these are relevant and highly accessible. As this survey revealed, most surveyed healthcare industries were doing a relatively good job in making sure that their healthcare staff were all keeping on improving their skills and knowledge through relevant and accessible training activities. However, the time needed to attend to these trainings seemed to be a problem for most healthcare workers. The feasibility and sustainability of these quality management movements were also sometimes being doubted by the healthcare workers. With these things under consideration, the government must be able to find ways to make these quality management movements even more advantageous and beneficial so workers and staff can do their jobs effectively. The leadership training program in the health institution should be an innovative, team-based approach to learning which supports the institution’s mission of providing responsive and cost-effective services by developing a highly skilled work force. Additionally, the program should to support the organizational values. Its dual focus on process improvement and team development enables health staff to learn in an outcome-driven environment, where they can directly apply learned skills to improve a specific process. Moreover, leadership training interventions help cross-functional work teams analyze existing processes, identify possible improvements, implement changes, and evaluate results. Sometimes, situations call for a time to shift the responsibility for leadership away from management and toward the employees. One way to do this is to allow each of the employees to run a weekly staff meeting–its structure, delineation of responsibilities to others and follow-up. Placing future leaders into management development roles is probably the most important benefit that management has to offer the people (2002). In addition, management should keep an eye out for other ways to give the employees more responsibility to test their leadership skills. Respect and recognition are two proven ways to retain employees. The dramatic increase in the number of new medications, including biotechnology products, makes it difficult to keep current on their proper use, and can overwhelm the best intentions of all health care practitioners, including nurses. Administration of the wrong drug is the most common error that occurs. Factors that contribute to wrong drug error include similar labeling and packaging of products, medications with very similar names and storage of these similar products together. In addition, poor communication is a common cause of administering the wrong drug.             To administer medication safely to patients, certain cognitive skills are essential. The nurse accepts full responsibility and accountability for all actions that are taken; this includes the administration of medications, whether it is intravenous, oral, or something else. When a nurse administers an intravenous medication to a patient, the nurse accepts the responsibility that the medication or the nursing actions in administering it will not harm the patient in any way. The nurse does not assume that the medication that is ordered for the patient is the correct medication or the correct dose.             The nurse or any health care professional could be held accountable for administering an ordered intravenous medication that is knowingly inappropriate for the patient. Because of this, the nurse should be familiar with the therapeutic effect, usual dosage, laboratory interferences, and side effects of all medications that are administered (2004). Demonstrating accountability and acting responsibly in professional practice means that the nurse acknowledges when errors in professional practice occur. Most of the errors that are made by nurses are medication errors (2004), and this includes intravenous medication administration. Once all the health care staff are thoroughly educated and properly equipped with the knowledge of the recommended practice regarding medication administration, their performance has to be monitored every now and then. They will be assessed on how they administer medications and evaluated if there is a change on how they perform it. It is not enough that after the initial educating sessions they will then be left to do the procedure. Monitoring has to be done in order to ensure that there is a demonstration of safe and proper practice of care.             The period of monitoring would be the longer period in my recommended strategy. This would include assessing how each health care professional performs medication administration and also observations on the incidence of patients’ reactions to administration. To effectively carry out all of these, strategic planning has to be developed. Strategic planning is crucial in the management of healthcare organizations, even when the characteristics of the healthcare systems vary (2003).             The health care professional is the essential link in the prevention of medication errors. Unfortunately, many medication errors are never identified. When an error occurs, it should be acknowledged immediately and reported to the appropriate hospital personnel. This is necessary since measures to counteract the effects of the error may be necessary.   Change There is no right way of effective change. According to  (1996), there is “No Best way to manage change”. An organizational change comes in different shapes, sizes and forms. Thus it is difficult to establish an accurate picture of a successful change management ( 1996). However, According to (2002) there are three main components for organizational change that collectively lead to improve organizations performance: (1) creating a shared mindset; (2) building competencies and capabilities; and (3) changing organizational culture.             Moreover, change must be effectively managed to enable the competitive position of the organization to be refocused. At this instance, change becomes a fundamental need not an option (2002).  Nevertheless, organizational change requires a clear vision of the clinical healthcare sector’s new strategy and the shared values needed to make it work by managing it from the top down. Leadership by example is combined with organizational adaptations and changes e.g. systems, structure etc. Changes in medical care and management needed to be a representation of all affected by the healthcare. This would mean that an experts approach might not be as successful as a case conference approach which would involve physicians, mental health professionals (clinical and organizational psychologists, specialty and organizational psychiatrists), social workers, church leaders, family members, and family support system members. Although the process might seem unwieldy, the reality was that differing ways of knowing and differing world views would expand the options and capacities needed to craft strategies that fostered harmony, bonding, trusting, and honoring of the client and the healthcare system (2002).   Conclusion Medication errors can be a source of significant morbidity and mortality in the health care setting. Thus in our health care setting, this problem is not being taken lightly. Providing care to a patient is a complex health care technology and patients are at risk of experiencing adverse events such as medication errors. Increasingly, human error theory is used to investigate adverse events such as these. In our health care area, medication errors could be largely attributed to lack of knowledge, skills, and education of the health care staff; and an incompetent management. A plan is therefore proposed to rectify this problem. It is important that medication errors be monitored so that similar incidents can be prevented in the future. Problems associated with devices that lead to medication errors should also be reported to health care authorities.   Credit:ivythesis.typepad.com

Quality and Clinical Governance

QUALITY AND CLINICAL GOVERNANCE Contents Abstract ………………………………………………………………………….1 Introduction …………………………………………………………...