Benefits of Evidence Based Healthcare Practice

Benefits of Evidence Based Healthcare Practice Evidence based practice refers to clinical practices that include best available scientific evidence (Levin and Feldman, 2006) based from expert opinion, clinical guidelines and findings from researches, combined with good clinician judgement and client’s preferences (Kim and Mallory, 2011) on issues relating to healthcare. The whole essence is to ensure the best care for patients and to be able to explain why certain clinical interventions are applied. This piece of work will briefly outline the importance of evidence based practice before analysing four pieces of evidence in the care of a stroke patient, Omar Banerjee, and its usefulness other users. Oman et al (2003) states that evidence based practice started to be appreciated and recommended by the National Health Services (NHS) in the UK in the early 1990s. The reason was to have effective and less costly interventions while providing high quality healthcare system. The intervention should be based on best available evidence and provided in the best interest of the patient such as Omar in this analysis. In addition, when a particular intervention is used on a client, evidence is required to back up that particular action (Kim and Mallory, 2011). In the UK this support can come from the NICE guidelines, Care Quality Commission and the codes and practices of professional bodies like Nursing and Midwifery Council. Evidence based practice ensures accountability. Aveyard and Sharp (2013) noted that professional health carers who belong to various professional organisations are expected to comply with their standards, codes and policies. This will be enabling them to justify their actions if required to do so. The first analysis of Omar’s condition is based on Cross (2008)’s evidence on stroke care. This evidence was obtained from the UWE blackboard website. I have chosen this article because it has statistical information helpful to Omar and his carers. It identifies important areas of his care needs and why stroke research should continue to be an on-going process. Sander (2013) defined stroke as a disease caused by the disturbance of the flow of blood in blood vessels in the brain which could have been necessitated by a bursting blood vessel or blood clot. Omar’s stroke was caused by a blood clot in the brain. Stroke has become a big problem and the second main cause of death and disability in developed economies after heart related diseases (Cross, 2008). Sander (2013) emphasises out that stroke is affecting about 150, 000 people in the UK yearly. However, the article reports a decline in deaths because of improvements in stroke care, management and awareness. More resources have been put towards short to long term care of stroke patients such as admission to acute stroke units and to rehabilitation areas (Cross, 2008). The report says this evidence, among others, is being used to develop new stroke treatments and guidelines in the UK. NICE (2008) which provides tools and quick reference guide to stroke related cases could have emerged as a result of this. These developments may give hope to Omar and his distressed family. The article cited two evidence of good practice from two hospitals. It is reported that the stroke management team at Aintree University Hospitals NHS Foundation Trust assess stroke patients on admission to the AE, take brain scans and admit relevant patients to a stroke unit within 24 hours. The other evidence is from Salford Royal NHS Foundation Trust where patients have brain scans, swallow screens and initial dose of aspirin given to relevant patients. These practices are recommended by NICE (2008) guidelines and may reduce further risks to patients. Omar received these interventions. This shows the strength of this article to Omar’s case and how early intervention may result in positive outcome. Although the article stressed the need for nurses to continuously monitor patients during the early stages of stroke on certain variables, it did not provide guidelines to back up the checks. Locally agreed hospital policies suggested may not meet NICE standards. Despite the improvements noted in the research, caution should be taken when making decisions based on the findings. These are 2008 findings and a lot has happened since then. Omar may be interested in hearing recent studies such as that of Sander (2013) who points out that in addition to the swallow screen stroke patients should further be screened for malnutrition using Malnutrition Universal screening Tool (MUST) in line with the NICE (2008) guidelines. The second analysis of Omar’s care is based on a qualitative study of Tutton et al (2012) on ten staff and ten patients’ views on the concept of hope on a British stroke unit. The evidence was obtained from EBSCO via CINAHL database and UWE library section. I chose this evidence because CINAHL is considered as one the good sources of evidence (Levin and Feldman, 2006) and the concept may be useful to Omar to learn other patients’ experiences in a similar hospital setting. The aim and key search terms in the article relate well to Omar’s case. Hope is defined as getting better from illness and being able to do things as before (Tutton et al, 2011). This was echoed by some of the patients in the study. An in depth analysis of key terms and the codes used in qualitative study (Aveyard and Sharp, 2013) may help carers to understand how it feel to have a stroke. Omar and his family may share the same thoughts as they are finding it hard to come to terms with sudden change of things in their family. Despite taking long time on data collection and variations in stroke severity Omar may be encouraged to learn that some patients took less than a week in hospital. This result is echoed by Arnaert et al (2006) in a similar study based on ten patients in Canada. They reported that some clients were hoping for a quick recovery and self-healing. The article is good evidence as it stated what is already known about this topic and nursing implications. These aspects are echoed by Arnaert et al (2006) but Tutton et al (2011) further identify what the paper has added such as the multidisciplinary team involvement in caring for stroke patients to make hope a realistic thing. Although the article mentioned that consent was obtained from both participants, there are still some ethical issues in the article. Some of patients’ names are mentioned in the article. This is confidential information and Omar may find himself in a similar situation. Furthermore, relatives and carers of patients were not interviewed in the study. It may be necessary to hear their views as well especially after learning from Preeti how she was struggling to come to terms with Omar’s condition. Her understanding of hope would improve our knowledge on this aspect. It is generally accepted that qualitative evidence is ranked second from the bottom in the hierarch of evidence (Polit and Beck, 2012) and uses a small sample size for the purpose of in-depth analysis of topic under consideration (Aveyard and Sharp, 2013). Although a large sample size may be costly and time consuming, caution must be taken when making inferences on large population size like 150, 000 patients mentioned earlier. A third analysis of Omar’s care considers service audit and evaluation evidence from Sentinel Stroke National Audit Programme (SSNAP) (2013). It is a national audit on stroke patients admitted to hospital in the first three months of 2013. The research looks at the processes of care at early stages of stroke (72 hours) from hospital arrival. I have chosen this evidence because SSNAP is a nationally recognised organisation and works with other organisations in stroke related cases. Its recent results obtainable through Google, SSNAP Audit Report (2012) and Royal College of Physicians links have strong implications on Omar’s condition. SSNAP (2013) results show the importance of using guidelines in any intervention involving stroke cases. There is strong evidence in the article that stroke patients were immediately taken for brain scans and admitted to the stroke units, as in the case of Omar, upon arriving hospital. This is in line with NICE (2008) guidelines. Most of the trusts were able to meet this standard. However, it is worrying to learn that there is a lower chance of having scan during the weekend and night times, the time of the week when Omar experienced the stroke. NICE (2012) guidelines stipulate that people who have had TIA should have first dose aspirin upon initial assessment. Although Omar received one, the outcome in the report is not very pleasing. It is clear from the research that this standard was not met by all trust as there are huge variations. The research was only focused on 72 hours upon hospital arrival. It may benefit the public and give confidence to Omar if the care he received from the ambulance crew were up to standards. NICE (2012) guidelines require people suspected to have had stroke to be screened using a FAST tool. There are no statistics regarding this in the article as the research excluded time before hospital arrival and the rehabilitation. This information may enlighten the public the importance of early intervention in stroke care. This evidence is not peer reviewed and the way data was collected is of concern. Because the SSNAP is a single source of data nationally (Paley et al, 2013) and an online web-tool was used to gather information one may wonder whether variations in results may appear if a different organisation undertakes the same research. Caution should be applied when interpreting this data. The audit results stress the importance of early intervention by multidisciplinary stroke team in the care of stroke patients. However, there are some areas that require attention if the all standards are to be fully met. The final analysis of Omar’s care is based on quantitative study by Beavan et al (2010) on whether looped nasogastric tube (NGT) feeding improves nutritional delivery to acute stoke patients with dysphagia. The evidence was obtained from UWE blackboard website. I chose this evidence because the intervention, tube feeding, helps to resolve Omar’s swallowing difficulties and improve nutritional needs. The research helps in answering questions on whether there are other alternatives and any effects associated with the intervention. The research was necessitated by the poor nutrition on patients on admission to hospital and the dislodgement associated with adhesive nasal stickers. Findings from the research reported more benefits in using the loop system than the other method. Some of the benefits include fewer checks for NGT position, less supplementary feeds required, more volume of fluids and feeds and less dislodgement of NGTs. This is vital information to Omar as it highlights why the intervention is used. However, the costs were seen to be high for the two week period. It is important to explain to Omar that studies of this nature are useful and commonly used in clinical interventions. It is a view shared by many authors like Polit and Beck (2012) and Aveyard and Sharp (2013). They rank randomised controlled trials as second best on the hierarch of evidence after systematic reviews and meta-analysis. There are some ethical issues regarding the funding for the research. Procare Ltd supplied the loops. The researchers stressed that it was not involved in any logistics or interpretation of the results, but one may wonder why the loops were sold at a bulk price. Could this have resulted in a discount? If the answer is yes then it is likely that the costs could be higher than the reported one. In addition, the aspect of tolerability was mainly based on the views of nurses and family members. Although it is understandable that most of the patients were having communication problems, the number of patients unable to communicate is alarming to the extent that caution is required when using this evidence. The study was done some years ago and the results published in 2010. A number of changes may have happened since then. Omar will be susceptible on why using such an old piece of evidence. Recent research results may be easier to convince Omar and his family than old results. To sum up, stroke is a major disease affecting many people and causing disabilities among survivors. Any nursing intervention will require evidence to back up. Four sources of evidence have been analysed in relation to Omar, a stroke patient. The strengths and weaknesses associated with each of this evidence will enable any intervention in Omar’s care to be made in rationale way and to his best interest. WORDS: 2 089 Reference Aveyard, H. and Sharp, P. (2013) A Beginner’s Guide to Evidence-Based Practice in Health and Social Care, 2nd ed. Berkshire: Open University Press. Kim, M. and Mallory, C. (2011) Statistics for Evidence-Based Practice in Nursing, Burlington: Jones and Bartlett Learning. Oman, K.S., Krugman, M.E. and Fink, R. M. (2003) Nursing Research Secrets, Philadelphia, Pennsylvania: Hanley and Belfus. Pilot, D. F. and Beck, C.T. (2012) Nursing Research: Generating and Assessing Evidence for Nursing Practice, 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams Wilkins. Levin, R. F. and Feldman, H. R. (2006) Teaching Evidence-Based Practice in Nursing: A Guide for Academic and Clinical Settings, New York: Springer Publishing Company. Arnaert, A., Filteau, N. and Sourial, R. (2006) Stroke Patients in the Acute Care Phase: Role of Hope in Self-healing [online]. 20 (3), pp137-146. [Accessed 14 November 2013] Beavan, J., Conroy, S.P., Harwood, R., Gladman, J.R.F., Leonardi-Bee, J., Sach, T., Bowling, T., Sunman, W. and Gaynor, C. (2010) Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial. Available from: https://blackboard.uwe.ac.uk/bbcswebdav/pid-3425495-dt-content-rid-4569416_2/courses/UZWSN3-15-1_13oct_gl_feb14_1/Tube%20feeding%20after%20stroke%20RCT.pdf [Accessed on 19 November 2013] Cross, S. (2008) Stroke care: a nursing perspective. Nursing Standard. 22 (23), pp 47-56. Available from: https://blackboard.uwe.ac.uk/bbcswebdav/pid-3473085-dt-content-rid-4709333_2/xid-4709333-2 [Accessed on 29 October 2013] National Institute for Health and Clinical Excellence (NICE) (2008) Audit support (NICE clinical guideline 68 – Stroke) Available from: https://blackboard.uwe.ac.uk/bbcwebdav/pid-3461610-dt-content-rid-4659555_2/xid-4659555_2 [Accessed 12 November 2013] NICE (2008) Understanding NICE guidance: Early assessment and treatment of people who have had a stroke or transient ischaemic attack (TIA) Available from: www.nice.org.uk/nicemedia/pdf/cg68publicinfo.pdf [Accessed on 01 December 2013] Paley, L., Campbell, J., Hoffman, A. and Rudd, (2013) Sentinel Stroke National Audit Programme (SSNAP): Clinical audit first pilot public report, National results. Available from: www.rcplondon.ac.uk/sites/default/files/ssnap_pilot_national_report_january_-_march_2013_admissions_with_appendices_.pdf [Accessed on 11 December 2013] Pale, L., Campbell, J., Hoffman, A. and Rudd, (2013) Sentinel Stroke National Audit Programme (SSNAP): Clinical audit first pilot public report, National results. Available from: www.rcplondon.ac.uk/sites/default/files/ssnap_pilot_national_report_january_-_march_2013_admissions_with_appendices_.pdf [Accessed on 11 December 2013] Sander, R. (2013) Prevention and treatment of acute ischaemic stroke. Nursing Older People [online]. 25 (8), pp 34-38. [Accessed on 4 December 2013]. Sentinel Stroke National Audit Programme (SSNAP) (2012) Acute organisational audit report: Public Report for England, Wales and Northern Ireland. Available from: http://www.rcplondon.ac.uk/sites/default/files/ssnap_acute_organisational_audit_-_public_report_2012_0.pdf [Accessed 12 November 2013] Tutton, E., Seers, K., Langstaff, D. and Westwood, M. (2011) Staff and patient views of the concept of hope on a stroke unit: a qualitative study [online]. 68 (9), pp 2061-2069. [Accessed 14 November 2013] 1

Change Proposal Essay

Kudler Fine Foods is an exclusive neighborhood food store with outstanding local and trade in prices. The company has locations found in La Jolla, Encinitas, the San Diego metropolitan area, and also Del Mar. These stores entail of about approximately 7,980 square feet of merchandising space in the best sophisticated shopping locations. Kudler’s’ assortment consist of the luxury cheeses, pastry goods, wines, meats, garden-fresh goods, condiments and seafood. By declaring the most important details of the establishment’s existence, the reader of this paper will become familiar with the reason for this style of organizational structure, lateral and vertical collaboration, the phases of the collaboration process, and the key stakeholders and the collaborative interactions among them in order to reach a victory. Primary reasons for the business existence Kathy Kudler had a vision and made it a reality. Her experience in marketing gave her a leg up in the industry and the ability to market her vision. With her mission statement in place she and her staff provide exceptional service to customers and the community. â€Å"Our selections, coupled with our experienced, helpful and knowledgeable staff, merge to offer each customer a delightful and pleasing shopping outing†. If its quality you seek, then quality is what she and her staff delivers. Special orders are also welcome. If not for her desire to make shopping the simplest and most pleasurable to customers Kudler’s would not belong have become a reality. In organization collaboration consist of employees working together to accomplish shared goals. We all should know of the saying â€Å"Two heads is better than one,† this statement is indeed true. As workers in the bakery progress into the Christmas season, we have seen some changes that need to be made. Collaboration with our staff has allowed us to open the door and make the necessary changes needed. Changes needing attention are as follows * Waste * Safety * Customer care As manager, staff and I have held meetings, brainstormed and visualized where as a team we would like to see the company and the department in the future. Changes need to be made as far as waste; we are wasting too much product. Safety, we have a great record we would like to maintain. Customer satisfaction is at an all-time high but we would like to see our customers referring us new business. Changing the way Kudler focuses on waste, safety, and customer care. Managing this change comes with some adjustment and re-alignment of a few processes. We want to continue operating at optimum levels or performance to bring our customers the highest quality of service along with our superior products in the bakery. Focusing on waste, we waste approximately 4 thousand dollars a quarter in day olds and charge offs. That equates to $1600.00 a month in lost revenue. Team members need to be properly trained in order accuracy. By doing so we have proposed a training lead to shadow each employee and engage them to ask questions and repeat orders back to customers. Also we propose to offer day olds at a discounted rate, and once items have reached near expiration dates we like to donate to the local food banks and churches for a quarterly write off. This proposal suggests we will bring down the number per quarter and see more profits, allowing us to provide higher wages to our team members. Safety is a major focus in our department; we are at a 0% for accidents and pride ourselves in taking all safety precautions. Management proposes to hold weekly training meetings relevant to the industry and department per OSHA guidelines. All staff members must attend mandatory meetings on a weekly basis. We will schedule these meetings so all members will not have to attend during their personal time. Customer satisfaction is at an all-time high as we mentioned earlier, however we would like to accelerate our service to a higher level. Beginning the New Year we planned to begin handing out CSSS; customer service satisfaction surveys. At the end of each week we will compile the data and suggestions to see where we are lacking in service. The four dimensions of change management are strategy and vision, resources, systems and organizational culture. First, the strategy and vision that I have for the implementation is to inform each team member of the bakery of the new processes, and the expectation. This process will be introduced in phases. The resources that will be needed for this change be clear knowledge and a handbook approved by OSHA and upper management. If employees need an adjustment period to learn new processes and procedures we will allow an open forum to ensure all staff members’ success. I would use the Project Management approach in managing this change by supervising both the implementation of the CSSS, and its results. Close monitoring in conjunction with the safety and waste programs set forth. Prior to incorporating this change, I will advise my team in the bakery to inform me and show me daily reports on waste and customer satisfaction vs. complaints. I will then work directly with the staff to implement all necessary changes within the department. From initial planning, to installation to daily monitoring and follow up, I will keep both my managers, and my supervisors informed of the progress and results of the change. Necessary corrections will be implemented as we grow and change as a team. My expected return on investment is not only going to be looked at by cash savings, but also savings in overages in labor, time spent by employees in which their focus is not on Kudler Fine Foods related business, and employee morale. The cash savings will be productivity based. The more time that my bakery employees spend on customer related business, the more productive they will be. By incorporating the CSSS, safety and new waste projects; this will ensure that each and every member of the bakery will be focused and attentive to bakery and customer satisfaction. As the other members of the bakery see their effort and drive are being met by their fellow employees, this will increase their desire to keep pushing towards our department and personal goals. Once each employee’s realizes that everyone is doing their part, it will add to their sense of team accomplishment. I am very confident that this change that I am suggesting will increase both monetary returns, but also increased individual and departmental morale. Kudler Fine Foods has an impeccable reputation for superior service and customer care. By implementing such processes we plan to uphold the company mission and values is our number one priority. Utilizing teamwork and engaging our employees to embrace change is our goal as a company and as managers. We want to see our staff and company succeed and thrive. By implementing such change we offer more growth and stability for our company to expand and our staff to grow within our family. Reference https://ecampus.phoenix.edu/secure/aapd/cist/vop/Business/Kudler2/internet/about.asp Kudler Fine Foods. (2012). About Kudler. Retrieved from http://Kudlerfinefoods.info Functional Area Relationship, Jennifer Hoff UoP

Why Almost Everything Youve Learned About Sample Essay Writing Topics Is Wrong and What You Should Know

Why Almost Everything You've Learned About Sample Essay Writing Topics Is Wrong and What You Should Know The Sample Essay Writing Topics Game Whether you're in school or in college or pursuing a phd some or the other kind of essay is needed by the institution you're enrolled with. It's advisable if you're unable to compose your high school papers, get assistance from somebody who has experience in writing quality papers. Our high school papers writing services are offered by very qualified writers that are university graduates from several academic disciplines. They are available at very affordable rates. Definitions of Sample Essay Writing Topics There's, obviously, a limit on the range of pages even our finest writers can produce with a pressing deadline, but generally, we figure out how to satisfy all the clients seeking urgent assistance. Finally though remember that great writing doesn't happen by accident. In other words, an outline is a concise review of your work, which highlights its major points. For instance, the written document may give a fully reasoned argument about a certain path of action given lots of facts that you identified in the Candidate Brief'. Ideas can likewise be obtained from various sources of information that can be found. Any documents containing confidential info or that were written with the aid of others are no-gos. After which, you'll find it less difficult for you to start. If You Read Nothing Else Today, Read This Report on Sample Essay Writing Topics Do not seem through the topics before you opt for. Obviously, you may pick any other topic. Each topic is broken up into subtopics that you should prepare. Deciding upon a topic is a critical issue that partly estimates final success of the job. 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Among the various kinds of essay, there's a definition essay that could appear to be among the most simple assignments. The right manner is to be adopted to choose the essays. Creative essays should have a topic. High school essays are structured very similarly whatever the topic and decent essay structure will allow you to compose a very clear essay that flows from 1 paragraph to the next. The main reason for this is that these very topics should be adhered as in regard to provide the meaning. Get really clear regarding the impression you wish to makemaybe even jot down a couple of words. The essays cannot be selected any way until there may be made no sort of the informative measures. The key point to remember is these expository essays are based on facts in contrast to the writer's beliefs or feelings.

What Is Economics

Economics is the study of the production, distribution, and consumption of wealth in human society, but this perspective is only one among many different definitions. Economics is also the study of people (as consumers) making choices about which products and goods to buy. Indiana University says that economics is a social science that studies human behavior. It has a unique method for analyzing and predicting individual behavior as well as the effects of institutions such as firms and governments, clubs, and even religions. Definition of Economics: The Study of Resource Use Economics is the study of choices. Though some believe that economics  is driven purely by money or capital, the choice is much more expansive. If the study of economics is the study of how people choose to use their resources, analysts must also consider all of their possible resources, of which money is but one. In practice, resources can encompass everything from time to knowledge and property to tools. As such, economics helps  illustrate how people interact within the market to realize their diverse goals.   Beyond defining what these resources are, the concept of scarcity is also an important consideration. These resources—no matter how broad the category—are limited, which is the source of tension in the choices people and society make: Their decisions are a result of the constant tug of war between unlimited wants and desires and limited resources. Many people break down the study of economics into two broad categories: microeconomics and macroeconomics. Microeconomics The Dictionary of Economics  defines microeconomics as the study of economics at the level of individual consumers, groups of consumers, or firms, Microeconomics is the analysis of the decisions made by individuals and groups, the factors that affect those decisions, and how those decisions affect others. Microeconomics deals with economic decisions made at a low, or micro, level. From this  standpoint, microeconomics is sometimes considered the starting point for the study of macroeconomics, as the former takes a more bottom-up approach to analyze and understand the economy. The prefix micro- means small, and, not surprisingly, microeconomics is the study of small economic units. The field of microeconomics is concerned with: Consumer decision making and utility maximizationFirm production and profit maximizationIndividual market equilibriumEffects of government regulation on individual marketsExternalities and other market side effects Microeconomics concerns itself with the behavior of individual markets, such as the markets for oranges, cable television, or skilled workers, as opposed to overall markets for produce, electronics, or the entire workforce. Microeconomics is essential for local governance, business, personal finance, specific stock investment research, and individual market predictions for venture capitalists. Macroeconomics In contrast to microeconomics, macroeconomics considers similar questions but at a larger scale. The study of macroeconomics  deals with the sum total of the decisions made by individuals in a society or nation such as, How does a change in interest rates influence national savings? It looks at the way nations allocate resources such as labor, land, and capital. Macroeconomics can be thought of as the big-picture version of economics. Rather than analyzing individual markets, macroeconomics focuses on aggregate production and consumption in an economy. Topics that macroeconomists study include: Effects of general taxes, such as income and sales taxes, on output and pricesCauses of economic upswings and downturnsEffects of monetary and fiscal policy on economic healthEffects of and process for determining  interest ratesCauses for the pace of economic growth To study economics at this level, researchers must be able to combine different goods and services produced in a way that reflects their relative contributions to aggregate output. This is generally done using the concept of the  gross domestic product, where goods and services are weighted by their market prices. What Economists Do Economists do many things, such as: Conduct researchMonitor economic trendsCollect and analyze dataStudy, develop, or apply economic theory Economists hold positions in business, government, and academia. An economists  focus may be on a particular topic, like inflation or interest rates, or her approach might be broader. Using their understanding of economic relationships, economists might be employed to advise businesses, nonprofits, labor unions, or government agencies.  Many economists are involved in the practical application of economic policy, which could include a focus on several areas from finance to labor or energy to health care. Some economists are primarily theoreticians and may spend a majority of their days deep in mathematical models to develop new economic theories and discover new economic relationships. Others may devote their time equally to research and teaching, holding a position as a professor to mentor the next generation of economists and economic thinkers.