Analysis of Quality Improvement Initiative

Analysis of Quality Improvement Initiative With reference to the practice development literature, critically discuss the principles informing a quality improvement initiative in your area of practice as a Community Registered General Nurse Introduction The purpose of this assignment is to critically analyse a quality improvement initiative, namely the updating of care plans and other documentation within the student’s area of practice, which is Community Nursing. The chosen initiative has occurred within the framework of practice development. The concept of practice development originates from the 1980s when Nursing Development Units (NDUs) were established with the aim of advancing the profession of nursing in order to benefit both patient care and the profession (Bassett and McSherry 2002). Practice development is becoming a part of every Trust’s strategy, being seen as an essential requirement for modernising health care. A key component of practice development is the integration of research- based evidence into practice. Another key element of practice development is Total Quality Management (TQM), a process that involves quality assessment, quality improvement and quality assurance (Blackie and Appleby 1998).Clinical governance is a system whereby health care providers are accountable for the provision of quality services (McSherry et al 2002). Magnet hospitals provide an example of centres of excellence that actively demonstrate high standards of care (UK healthcare 2007). Practice development also involves increased interprofessional working and the empowerment of patients and clients, thus embracing the concept of consumerism (Chin 2003). Consumerism within healthcare refers to its recipients having more informed expectations about healthcare provision and being able to articulate these (Gough P 2002). In Ireland the Commission on Nursing (1998) recognised that increasingly, people are being cared for in the community as opposed to other settings and accordingly made recommendations for the development of public health nursing with more emphasis to be placed on health promotion and prevention, thus paving the way for practice development within community nursing. Inevitably practice development involves change. Within healthcare there have been several areas of reform, which have been influenced by social, economic and political factors (Brooks and Brown 2002). As a result health care services need to be responsive to the need for change. Theoretical overview This section will further examine the relationships between practice development, quality issues and change theory, with particular emphasis on the implementation of change. Practice development is a continuous process of improvement that works towards the transformation of care. It is a process that requires management, in order to advance its progress, which needs to be done in a systematic and rigorous way (Titchen and Higgs 2001a). In some areas facilitators have been appointed with the specific remit of advancing practice development; elsewhere practice development units have been established (Bournemouth University 2007a). Practice development is said to dovetail with clinical governance standards (Bournemouth University 2007b) and is linked to quality issues in the following ways: by empowering healthcare professionals, patients/ clients and carers; by promoting a client- centred approach towards delivery of care; by promoting interprofessional communication and collaboration; by working towards clinical governance; by facilitating the selection, recruitment and retention of quality staff; by influencing organisation strategy in line with National Policy and by drawing upon the knowledge and skill of identified experts. An essential element for the delivery of quality care is evidence- based practice (Parsley and Corrigan 1999). As highlighted within the introduction, an important element of practice development is ensuring that practice is informed by research. Strategies for introducing research into nursing practice include the creation of nurse researcher posts; encouraging nurses to access continuing development opportunities that will enhance their research skills, promoting research- mindedness as well as research activity; making research findings accessible to practitioners; forging stronger links between educational institutions and clinical practice areas and setting- up journal clubs. Because of the developing nature of the discipline, community nurses are often involved in research activity whether as participants or researchers (Lawton et al 2000). However there is evidence to indicate that not all nurses are actively basing their practice on research findings; some are neither researc h active nor research- minded, so there is developmental work needed in this area (Banning 2005). As previously identified within the introduction, it is inevitable that practice development involves the need for change.(Titchen and Higgs 2001b). The change strategies framework by Bennis (1976) provides a useful model for understanding and challenging the different assumptions we have about what effectively brings about change. The framework includes three strategies for bringing about change which are based on different assumptions about human behaviour, and which involve three distinctly different approaches. The first strategy (rational- empirical), is based on the supposition that ‘knowledge is power’. Within this strategy it is assumed that an individual will change in response to receiving reliable and valid information. For example, if a manager in a healthcare setting wishes to initiate change, this strategy would involve giving information to the healthcare practitioners involved, that includes valid reasons for making changes to their practice. The reality is that people are often resistant to change and may adopt certain strategies in an attempt to avoid change. For example, they might adopt Freudian mental defence mechanisms, which are (in this case) maladaptive coping strategies used to circumvent evidence that change is necessary. These include denial, intellectualisation (which i nvolves citing contradictory evidence), or rationalisation, among others (Lupton 1995). Resorting to these defences can undermine the power of knowledge and evidence, however valid and reliable it is. The second strategy (power- coercive) involves the use of legislation and policy change in order to enforce health- related change. Within this strategy, a manager would use power, authority and/ or disciplinary procedures to bring about changes in practice. Inevitably there are some legislative and policy changes that inform practice, so there will be times when this strategy is used. The first two strategies adopt a ‘top- down’ approach whereas the third strategy (normative- re-educative) is based on the assumption that an individual is more likely to change if they have had involvement in bringing about the change; if they feel empowered. According to Wheeler and Grice (2000), this last approach is critical if the enthusiasm and cooperation of those affected by the change process is to be gained. This is the approach that the student aimed to use when putting her chosen change initiative into practice, which is analysed within the next section. Practice Development initiative The chosen initiative was to update care plans and other documentation. As nurses we are accountable through our documentation; there could be legal consequences to what we write (Richmond and Whiteley 1999). Care plans and other nursing documentation are essential communication tools. The language used therefore, should be clear and unambiguous, and avoid the use of abbreviations. A well- written care plan should provide all the information that a nurse needs to provide comprehensive care to a patient. A care plan should not just be a ‘paper exercise’ but an integral part of nursing activity. The need for this change initiative was identified by staff, patients and management. This was a promising start as the drivers for the change came from everybody who would be affected by it. As the last section proposed, change is more likely to be taken on board if all involved have been included within the decision- making process. It was found that the existing care plans were insufficient for use with a client- group who have increasingly complex needs. Care plans are based on nursing models, which are derived from nursing theory. Nursing theory is a knowledge base that has been developed specifically for nursing. Practice development and research contributes towards the continued development of nursing theory. A nursing model is a conceptual framework; a blueprint for nursing practice. The appropriateness of nursing documentation contributes towards closing the theory- practice gap. We should therefore review our nursing documentation at regular intervals and strive for excellence in relation to these tools. The model of choice for the revised care plans was Orem’s Self- Care Model which is based on the belief that the individual has a need for self- care actions, and that nursing can assist in meeting that need. This model is widely used in all areas of nursing. Orem suggests that a person needs nursing care when the person has a health- related self- care deficit. She has defined three nursing/ care systems based on the premise that the nursing/ care system depends on the self- care needs and abilities of the clients: wholly compensatory the nurse gives total care to meet all needs; partly compensatoryboth the nurse and the client perform care measures; supportive- educative the client can carry out self- care activities but requires assistance (Taylor et al 1997). The emphasis on self- care within this model was the rationale for choosing this model for use within a community setting where frequently the nurse works in partnership with the patient and their informal carers and facilitates the reduction of their dependence on her, as the ability of the patient to be self- caring increases. With most if not all, change processes there are factors that can be harnessed to drive change, and there are factors which impede or restrain, change. A model which can be used to identify driving and restraining factors is forcefield analysis (Martin and Whiteley 2003). This enables us to identify and work with, both the negative and positive forces. In relation to the change initiative i.e. updating care plans and other documentation, the driving forces were identified as: the commitment of most staff; strong leadership and a generally agreed need for an increased customer focus. The restraining forces were identified as: resistance from a small number of staff; lack of time to devote to the project and the need for education and training in the effective and consistent use of care plans. It was essential that the tools to be developed met with recognised quality standards and guidelines; therefore the developmental work was informed by the Irish Health Services Accreditation Board (2007). The Board is concerned with quality and safety issues across the health care system in Ireland. The values which underpin its work; patient- centredness; integrity and accountability; excellence, innovation and partnership provided us with an excellent framework upon which to base the development of the new care plans. The change initiative could also be described as a benchmarking project (Pickering and Thompson 2003). Benchmarking involves: the sharing of best practice; user involvement; a user- focused approach; the use of an evidence- based approach and the use of stepping stones to work towards the benchmark (NHS Modernisation Agency 2001). As far as possible the initiative was designed to meet these criteria. Drawing upon the principles of the forcefield analysis outcomes, the guidance provided by the Irish Health Services Accreditation Board and the benchmarking criteria, the project was designed as follows: A working group was set up to represent the views and input of all who would be affected by the change which included user representation. It was hoped that if those affected by the change were involved in the development of the initiative from the start, then they would be more committed towards it. Staff who showed an initial resistance tended to become more enthusiastic about the project once they became involved in the initiative. Time issues were addressed by delegating aspects of the work to different people, which was coordinated by a project manager. By breaking the task down into manageable parts, these became the ‘stepping stones’ of this benchmark project and helped to promote involvement from different people. Assistance from the Education Institution with which we are associated was mobilised in order to provide the essential theoretical input and to provide some education and training regarding the principles of care planning, which addressed one of the identified restraining forces. Care plans from other areas were also scrutinised (with permission) in the spirit of sharing best practice (derived from the benchmarking criteria), in order to gain new ideas that might help to inform our work. Once the new documentation had been developed, it was piloted to test its effectiveness. A patient survey (Graves 2002) was conducted to gather their views about the newly- developed documentation. The final version of the new care plan and other documentation was produced and introduced to all staff with some training sessions to support this new initiative. The use of the new documentation will be monitored and its effectiveness will be regularly evaluated. Conclusion and Recommendations Practice development is about continually improving our practice, which should be evidence- based. We should increasingly work in partnership with patients/ clients and their informal carers. Practice development has implications for change. With any change there are both driving and restraining forces, and those affected by change may be resistant towards it. Change therefore, needs to be managed. We can draw on change theory to inform the management of change. A learning outcome from the change initiative described above is that people are more likely to be responsive to change if they are involved in all stage of the change process. Other important aspects of the change process were the sharing of knowledge, the integration of theory and practice with input from academics and working in partnership with those ultimately affected by the change initiative i.e. the patients/ clients and their informal carers. References Banning M. Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers views. Journal of Clinical Nursing. 14(4) 2005. 411-417 Bassett and McSherry Practice Development in the Clinical Setting: A Guide to ImplementationNelson Thornes 2002. p. 11-12. Blackie C and Appleby F. Community Health Care Nursing. Elsevier Health Sciences. 1998 p. Bournemouth University. Institute of health and Community Studies. Practice Development Unit: What is a PDU? http://www.bournemouth.ac.uk/ihcs/pduwhat.html. Accessed: 20th January 2007. Brooks, I. Brown, R. The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service. Journal of Advanced Nursing, 38 (4) 2002 341 – 352. Chin H. Practice Development: A Framework Toward Modernizing Health Care in the United States and the United Kingdom and a Means Toward Building International Communities of Learning and Practice. Home Health Care Management Practice, 2003 15 (5), 423-428 Commission on Nursing. Report of the Commoission on Nursing: A blueprint fro the future. Stationery Office. 1998. p. 8. Gough P. Churchill Livingstones Guide to Professional Healthcare. Elsevier Health Sciences. 2002. p. 36. Graves P. Quantifying Quality in Primary Care. Radcliffe Publishing. 2002. p. 246 Irish Health Services Accreditation Board. Mission, Vision and Values. http://www.ihsab.ie/mission_statement.html Accessed: 20th January 2007. Lawton S Cantrell J and Harris J. District Nursing.: Providing Care in a Supportive Context. Elsevire Health Sciences. 2000. p. 109. Lupton D. The Imperative of Health: public health and the regulated body. Sage Publications. 1995. p. 111. Martin and Whiteley. Leading Change in Health and Social Care. Routledge. 2003. pp. 160-162 NHS Modernisation Agency. Essence of Care: patient- focused benchmarks for clinical governance. 2001. Department of Health. Parsley K and Corrigan P. Quality Improvement in Health Care: putting evidence into practice Nelson Thornes. 1999. p. 2. Pickering S and Thompson J. Clinical Governance and Best Value: Meeting the Modernisation Agenda. Elsevier Health Sciences. 2003. p. 164. Richmond J and Whiteley R Nursing Documentation: writing what we do. Ausmed publications. 1999. pp. 2,3. Taylor C. Lillis C and LeMone P Fundamentals of Nursing: The Art and Science of Nursing Care Stanley Thornes and Lippincott 1997 Titchen A and Higgs J. Professional Practice in Health, Education and the Creative Arts. Blackwell publishing. 2001. pp. 186-7 UK Healthcare. Magnet Status Fact sheet. http://ukhealthcare.uky.edu/publications/healthfocus/fact_sheets/magnetfst.htm . Accessed: 20th January 2007. Wheeler N and Grice D. Management in Health Care. Nelson Thornes. 2000. p. 136.

Genetically Modified Foods Should Be Promoted Essay

Thank you members of the FDA for letting me speak today regarding the morality of genetically modified foods. Different bioengineering, better known as genetically modified, methods have been prevalent in modern society for almost half a century. It has allowed scientists to transfer genes that would have never been able to interbreed in nature but with the help from scientists, can breed as naturally (Harvard Law). The technology that describes this is known as biotechnology. When somebody is asked what are they afraid of, a common response might be, â€Å"I’m deathly afraid of spiders† or â€Å"I’m afraid of heights. I can’t look off the edge†. The response that is never heard is the unknown and I believe that â€Å"the unknown† is something that many people are afraid of. The unknown is simply a scary thing because it is impossible to tell the future. People say that cell phones may cause cancer, but in reality, this will not be known for decades and people surely will not stop talking on them. GMF’s scare people because they don’t know what the future holds. The future holds an agricultural revolution that could never have been predicted and will open many doors that were thought to not have existed. The United States federal government should promote the purchasing of genetically modified foods by the public that can be done by educating the public with the benefits of genetically modified foods In a poll done by ABC regarding the skepticism of genetically modified foods, 52% of people believed them to be dangerous and 13% were unsure about them (Poll). The public should not be so confused regarding the safety of the food that they eat on a daily basis. The majority of all cultivated food has been genetically modified in some way by the time of its production (Harvard Law). This means that the public eats genetically modified food every single day without knowing it. If the public was to be better informed about GM foods then they would support them. The public really does not know so much about the technology surrounding bioengineered food. Biotechnology can be defined as the genetic manipulation of organisms for a common goal, in this case, food. Genetic engineers have successfully been able to introduce methods to be able to combine genes of species by selecting certain genetic material from each organism. This results in a new organism that contains traits of both preceding organism (Harvard Law). A solution to the unawareness of the United States’ public would be to advertise the benefits of genetically modified food. If the public were more educated on the topic of genetically modified foods they would support it because the advantages outweigh the disadvantages. The government needs to introduce a series of advertisements regarding GM foods. Every man and woman in this country has the ability to vote for who they want, say what they want, write what they want. Although not written in the constitution, all people are also given the right to eat what they want. Whether cheap, expensive, healthy, or unhealthy, we are all given the choice to make those decisions for ourselves. In a poll done by ABC news asking if people would be more inclined to buy genetically modified food, 57% said they’d be more likely to purchase untouched food (Poll). If the federal government were able to make the public more aware of the advantages of genetically modified foods people would be more inclined to buy them and support the industry. As of now, the public chooses non-GM foods over GM foods. They need to be introduced to the positive aspects of bioengineering. If the federal government wants to revolutionize the agricultural industry, consumers need to be in favor of GM foods. If more than half of the consumers said they’d be less likely to purchase GM foods then how can food companies put GM foods on the shelves of super markets knowing that not enough will be sold? Little does the public know, but about 60-70% of processed foods do contain genetically modified ingredients (Web MD). The FDA states that there is no new safety concerns introduced into the food (Harvard Law). The FDA’s purpose is to deem food safe or dangerous and whether or not the public should be eating it. The FDA constantly argues that there are no safety risks when eating GM Foods. The public needs to trust them on this topic just like they do with all other foods. As previously stated, most people are scared of the unknown, and in order to make this industry a well working one, consumers need to be in favor of genetically modified food. Genetically modified food is safe. People are eating GM food at every meal and there have been no outbreaks of any diseases related to the introduction of GM food. Genetically modified food is the future. In developed countries, crop yield was increased by 6% and in undeveloped countries; crop yield was increased by 29% (Wikipedia). A very well known example of a genetically modified food is golden rice. It was introduced to the world as a solution to the extremity of morbidity from lack of vitamin A, iodine, iron, and zinc. The lack of these fundamental dietary components is the root cause of disease worldwide. Golden rice offers a solution that contains these lacking components. Many things can be made possible in the future with an increase in support for genetically modified food. If scientists were able to create a gene that could be put into all cultivated crops that would allow them to grow throughout the winter, they could end world hunger. World hunger being solved would mean one of the utmost impossible puzzles has been solved. The two things that most people would likely to fix in this world are world peace and an end to hunger worldwide. No this government can’t solve world peace. Yes this government and others do produce enough food to feed the every human on this planet. However, if enough cheaply grown crops were produced throughout the whole year, governments will be more inclined to try to feed the world. With climate change being a really evident effect from global warming, it is nearly impossible to predict what Mother Nature holds in store for mankind. With the technology available, the United States’ government must issue out more patents for scientists to increase and continue the research surrounding GM foods to make them the food of this world. The government should and would only issue out more patents to scientists if the United States’ consumers would buy GM food and support the industry. This is the sole reason that this federal government needs to make aware the public, of the advantages from GM foods.

Are Schools Promoting Sex by Teaching It in Schools? Essay

Are Schools Promoting Sex by Teaching it in School? | | | | Teen pregnancy have risen sky high, STD’s are spreading faster than the speed of light, and sexting id done more often as a factor of knowing about sex. Sex is the attraction drawing one individual sexually toward another leading to sexual intercourse. Schools promote teen sex to their students by teaching sex in class. Although, sex is a part of the curriculum and is supposed to be taught to students, it’s being taught at the wrong time in life. Because sex education is being taught at a young, schools are promoting teen sex and negative behaviors. Teen sex is promoted in schools and in classes’ every day because it is a part of the learning curriculum that is supposed to be taught in grade school, but at what age is it appropriate to teach students? Schools are teaching elementary school students about sex in the fourth and fifth grade to be exact( Brown, 2006). One parent says: â€Å"For elementary school students, the school is a happy place to play with friends. Topics like sex and relationships have yet to enter their minds† (Mustaza, 2010). This makes it seem like teachers, more or less, want their students to know about sex, which should not be taught to elementary school students because children’s minds at this point and time frame are not fully developed or mature enough to know about sex. For middle school students, sex being taught only gets their minds wondering. It pops questions in their heads about the things they don’t know about sex and maybe what they want to know. Kids are taught to death about all the bad things that can happen to them if they have sex† ( Bobkowski, 2009). They’ve said: â€Å"We’ve heard about sexually transmitted infections, we know you can get pregnant, but we want to know about the pleasures of sex and healthy relationships† ( George 2009). Teaching sex in schools progresses the mind to wonder about sex. If sex is going to be taught in schools, it should be taught in an informational way that doesn’t leave students with minds to pose questions or sex shouldn’t be taught at all to elementary school students. Some teens live what they learn and others lead by example, but they all have a primary source of why they live to do what they do. Teachers today may be just a couple of years older than many high school students and could be an idol. A young teacher teaching about sex may be more effective to students rather that their fifty-three year old, grey haired teacher teaching them this. The word from the younger teacher is going to be like words from the wise. But are these words the wise, wise enough? Students at the teenage level may need someone to fall back on or depend on and it may be that young teacher. Amirul, 14 years old: â€Å"At first the thought of learning about sex was a bore, but when we had coach Allen (22) I was all ready to learn everyday†( George, 2009). Students are more motivated to learn about sex now that they have a younger person in their life teaching the subject. This only makes the subject easier to the student s to learn, but harder to the teachers to teach them without getting the wires all worked up on students. But , Alan Harris said, the more educated someone is the more likely they are to make responsible and informed choice for their behaviors. Sex education given by teachers at school is the most relabel way to give kids the right information about sex. In schools sex education information is give by professional and has be proven by many reports all over the country and world. The first formal attempts at sex education were introduced by a Dr. Arnold a schoolmaster at a public school. Dr. Arnold used the Bible to make the schoolboys fell guilt and scared of sex and masturbation. The nineteenth-century scare tactics books of Dr. Arnold were nothing like the sex book used by the sex educations teachers of today(Greaves.pg. 171). Some parents don’t approve of their children learning about sex in schools, but some do. For the parents that approve, how are the teachers teaching the students? Some schools, whether it is public or private, teach the students about sexual contact and conduct in separate classes. That’s right, some schools have separate teachings; they have the students’ parents sign a consent saying that they may teach sexual education in school and then separate the males from females and teach them about sex. It sounds like a positive but in actual reality, in the long run it’s a negative according to Gandy: â€Å"Classrooms separated by gender offers different resources, different teaching methods, and other factors that create unequal living environment† (Gandy, Piechura-Couture, N. P). Meaning that, the students that are separated may learn a little bit more or a little bit different that what is on the standard list. Male may learn more about the females and how to arouse then and females may stay close minded to what males have in store or vice versa. Teaching boys and girls at separate times only make them worry and wonder more about sex. Teaching a girl about her body and teaching a boy about his body makes the students ponder about the other gender. What teachers are teaching the students about sex are another negative effect. As well as teaching the students about their body parts and how they work and what they do. Jansen, a local shop owner, holds sex workshops for all teens (Geogre, 2009). In her workshops, Jansen urges teens to ask about anything and everything. From masturbation, gender identity, and same-sex feelings to sex toys (which they keep on hand in case the subject comes up), why people like oral sex, and why should that particular act go both ways and she will answer the question as honest as possible(George, 2009). Holding these workshops are not the best way to break the ice about questions, it only gives them more conformation to keep asking these kinds of questions to eventually figure out what they mean or how they operate and participate in the act of having sex. Teens should approach their parents with questions like these rather than a stranger. Sex should not be taught in school or outside of school either. Six year olds should learn how to spell their names, fourth and fifth graders should prepare to shift from one class to eight, and high school students should focus on getting a job or going to college; real world situations instead of sex. Teaching sex in the curriculum throws off all attention to anything else in life that students should pay more attention.

TEEN PREGNANCY PREVENTION Essay - 1918 Words

Teen pregnancy has become an epidemic in the United States alone. The United States has the highest rate of teen pregnancy and sexually transmitted infections (STIs) in the industrialized world. Each year, one out of three teenage girls becomes pregnant. Although teen pregnancy rates have dropped from 61.8 births per 1,000 in 1991 to 41.7 births per 1,000 in 2003, pregnancy rates in the U.S. still are declining at slower rates than those in other developed nations (Block et al., 2005. para, 1). These sobering statistics are the basis of an ongoing battle: the fight for abstinence-only versus comprehensive sex education. Although proponents of both types of sex education aim to reduce teenage pregnancy and STIs, their approaches vary†¦show more content†¦Debates have been ongoing on what type of program is the most effective, which programs are too explicit, and what curriculum should be included in these programs. There have been several programs that have been developed to educate our adolescents on teen pregnancy and prevention. Prog rams have been implemented in schools, government funding has been provided for prevention programs, and television shows have focused on the struggles of becoming a teen parent. Teen prevention programs focus on teen pregnancy prevention, but contain different curriculum to educate adolescent. Some programs focus on abstinence-only, sexual behavior, parent-adolescent communication, contraceptive use, the outcome of becoming a teen parent, and there are some more precise programs that focus on long term outcomes with adolescents that start at early as the age of ten years old all the way up to high school. Abstinence-only programs have been the main front for the debate when it comes to prevention programs. Leslie M. 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