T.D. enjoys caring for the children and young people in the schools where she works, but sometimes she is faced with tough situations such as suspected child abuse and neglect, teen pregnancy, and alcohol and drug use among teenagers. She works hard to ensure that the children in her schools receive the best care possible.
Question for the case
1. Several third graders reports having received no breakfast at home for more than a week. T.D. is exercising Advocacy for the students under her care. What type of actions she might be doing to exercise advocacy for the students?
Answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:
1. Moral distress is a frequent situation where health care providers should face. Give an explanation of and a discussion of a personal event in which you encountered moral hardship in your line of work.
Talk about what you’ve learned about your own communication advantages and disadvantages. Determine whether circumstances would make it challenging for you to begin or end a therapeutic relationship.
Talk about the moral implications of health promotion.
Submission Instructions:
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
Planning is the key to successful completion of this course and program-related objectives. The Individual Success Plan (ISP) assignment requires early collaboration with the course faculty and your course preceptor. Students must establish a plan for successful completion of
The required 50 community direct clinical practice experience hours, 50 leadership direct clinical practice hours, and 25 indirect clinical experience hours.
Completion of work associated with program competencies.
Work associated with completion of the student’s capstone project change proposal.
Students will use the “Individual Success Plan” to develop an individual plan for completing practice hours and course objectives. As a part of this process, students will identify the number of hours set aside to meet course goals.
Student expectations and instructions for completing the ISP document are provided in the “NRS-493 Individual Success Plan” resource, located in the topic Resources and in the assignment instructions.
The “Individual Success Plan” is a clinical document that is necessary to meet clinical requirements for this course. Therefore, the form should be submitted with the preceptor’s hand-written signature. A typed electronic signature will not be accepted.
Students should apply concepts from prior courses to critically examine and improve their current practice. Students are expected to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.
After the ISP has been developed by the student and approved by the course faculty, students will initiate a preconference with the faculty and preceptor to review the ISP.
PART 1- Module 1 Discussion- Unethical Practice of Marketers
Name and describe one unethical practice of marketers. Why do marketers engage in unethical conduct? Does this hurt society? Why or why not?
SUBMISSION INSTRUCTIONS: Your initial post should be at least 200 words, formatted and cited in current APA style with support from at least 2 academic sources.
PART 2- Module 1 ASSIGNMENT 1- Marketing’s Effects on Society
Considering the society, we live in today, is marketing good or bad for our society? Discuss your opinion on this topic.
Be sure to also define Marketing and explain the role it plays in business strategy overall.
In addition, find two articles: one that supports your argument and one that does not.
SUBMISSION INSTRUCTIONS:
· The paper is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.
· The paper is to be 2 pages in length double-spaced, current APA style, excluding the title, and references page.
· Incorporate a minimum of 2 current references (published within last five years) scholarly journal articles or journals and magazines (Wall Street Journal or the New York Times; Wikipedia will not be accepted) within your work.
· You must include a web link or URL so that I can access the articles online.
· Use the Library E-research link BELOW to an external site to find these articles.
· LINK- https://www.stu.edu/library/
PART 3- Module 1 ASSIGNMENT 2- Strategy Mapping
Strategic planning is the way you, as an organization leader, can articulate your vision for the future and your goals and objectives.
1. Assess the needs within your organization (COMMUNITY RESOURCES AGENCY)
2. Strategy – develop a strategy to meet the needs of your organization
3. Strategic Objectives – create three (3) strategic objectives detailing how you will achieve the strategy
4. Strategy Mapping – show the cause-and-effect chain of the implementation of your strategy
SUBMISSION INSTRUCTIONS:
Using an online tool located at https://creately.com/guides/what-is-a-strategy-map/
Describe where the physician practice and the hospital fall on the continuum of patient care.
Analyze how providers at each location try to return their patients to their highest level of functioning.
Explain how a physician practice communicates with the hospital to foster high-quality, efficient, and effective patient care.
Analyze three peer-reviewed articles that each discuss one of the topics above.
Description or summary presents the what of the article, but analysis will pursue the question of so what?
Why do these ideas matter and/or how are these ideas connected?
What are the potential gaps or questions that remain?
Organize your paper with the following headings:
Title Page.
Agenda.
Introduction.
Professional introduction (1 paragraph).
You have license to be creative as you imagine the background you would bring to a position like this one.
Agenda (bullet points).
Preview the main goals of the lunch-and-learn.
Refer to some of the scholarly sources you will summarize.
Continuum of Care.
Describe where the physician practice and the hospital fall on the continuum of patient care.
Analyze a peer-reviewed article that discusses where the physician practice and the hospital fall on the continuum of patient care.
Care Quality.
Describe how a physicians practice maximizes patient care quality to return them to the highest level of function, addressing quality standards such as:
Maximizing value-based reimbursement.
Positive patient experience.
Maintaining operational efficiency.
Analyze a peer-reviewed article that discusses how a physicians practice maximizes patient care quality to return them to the highest level of function.
• Operational Strategy. o Describe the communication between the hospital system and medical practices to provide effective, efficient, and high-quality care. o Examine a peer-reviewed publication that examines how hospital systems and medical practices interact to promote effective, efficient, and high-quality treatment. • Concluding. o Summarize the key points of your lunchtime lecture. o Make judgments based on data from at least two of the articles you summarized. o Provide concrete examples to illustrate how these concepts can be applied in real-world situations.
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Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalised elderly patients: a systematic review protocol
Amos Wung Buh,1 Hassan Mahmoud,2 Wenjun Chen ,3,4 Matthew D F McInnes,2,5,6 Dean A Fergusson 6
To cite: Wung Buh A, Mahmoud H, Chen W, et al. Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalised elderly patients: a systematic review protocol. BMJ Open 2021;11:e043042. doi:10.1136/ bmjopen-2020-043042
► Prepublication history and additional material for this paper is available online. To view these files, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjopen- 2020- 043042).
AWB and HM contributed equally.
AWB and HM are joint first authors.
Received 23 November 2020 Revised 08 February 2021 Accepted 17 February 2021
For numbered affiliations see end of article.
Correspondence to Wenjun Chen; wchen140@ uottawa. ca
ABSTRACT Introduction Pressure ulcers are serious and potentially life- threatening problems across all age groups and across all medical specialties and care settings. The hospitalised elderly population is the most common group to develop pressure ulcers. This study aims to systematically review studies implementing pressure ulcer prevention strategies recommended in the Pressure Ulcer Prevention Practice Guidelines for the prevention of pressure ulcers among hospitalised elderly patients globally. Methods and analysis A systematic review of all studies that have assessed the use of pressure ulcer prevention strategies in hospital settings among hospitalised elderly patients shall be conducted. A comprehensive search of all published articles in Medline Ovid, Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, Cochrane library, Scopus and Web of Science will be done using terms such as pressure ulcers, prevention strategies, elderly patients and hospital. Studies will be screened for eligibility through title, abstract and full text by two independent reviewers. Study quality and risk of bias will be assessed using the Joanna Briggs Institute for Meta- Analysis of Statistics Assessment and Review Instrument. If sufficient data are available, a meta- analysis will be conducted to synthesise the effect size reported as OR with 95% CIs using both fixed and random effect models. I2 statistics and visual inspection of the forest plots will be used to assess heterogeneity and identify the potential sources of heterogeneity. Publication bias will be assessed by visual inspections of funnel plots and Egger’s test. Ethics and dissemination No formal ethical approval or consent is required as no primary data will be collected. We aim to publish the research findings in a peer- reviewed scientific journal to promote knowledge transfer, as well as in conferences, seminars, congresses or symposia in a traditional manner. PROSPERO registration number CRD42019129088.
BACKGROUND Pressure ulcers (PU) also known as pressure injuries are areas of localised damage to the skin and/or underlying structures due to
pressure and/or friction and shear.1 They are serious and potentially life- threatening problems across all age groups from the very young to the very old and across all medical specialties and care settings.2 It has been documented that hospital admissions due to PU are 75% higher than admissions for any other medical conditions and that, the conse- quences of PU development in hospitalised patients are particularly serious.2 Patients with hospital admission PU are three times more likely to be discharged to long- term care facilities and mortality of these patients is twice that of patients without hospital admis- sion PU.3 The cost of treatment of PU is 2.5 times than its prevention, and PU increases the length of stay in the hospital from 4 to
Strengths and limitations of this study
► This is a systematic review and meta- analysis of randomised controlled trials.
► This review will be the first to synthesise the ev- idence regarding the effectiveness of guidelines used in pressure ulcer prevention for elderly pa- tients in hospitals and offer the highest level of evidence for informed decisions on use of Pressure Ulcer Prevention Practice Guidelines (PUPPG) in prevention pressure ulcers in the elderly patients in hospital.
► There may be heterogeneity of interventions used on eligible studies and incomplete information reported about the interventions in the literature which could limit our ability to statistically compare the effective- ness of interventions.
► The main limitation of this review might be scarcity of randomised controlled trials on the use of PUPPG for preventing pressure ulcers in elderly patients, publication bias and methodological quality of grey literature that shall be found.
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30 days, decreases quality of life, and increases pain, morbidity and mortality.4
On international level, hospital- acquired PUs (some- times called decubitus ulcers) are very common.5 Although many of these cases are preventable, their point prevalence in Canadian hospitals for example is measured to be 25.1%.6 Unfortunately, the high rates of such condi- tion are associated with subsequent high burden on the healthcare system and the national economy considering the high cost of their management, and the frequent occurrence of associated significant morbidity and mortality.5 According to the Ontario Case Costing Initia- tive database in 2013 using the European Pressure Ulcer Advisory Panel (EPUAP) staging system, it was estimated that the cost of management of stage II ulcer is up to US$40 000 and can reach more than double this price for managing a single case of stage IV ulcer.7 A good example of the burden that PU add to the national economy was measured in USA; it was estimated that hospital acquired PUs increase the financial expenses on healthcare systems between US$6 and US$15 billion annually.8
The National Pressure Ulcer Advisory Panel (NPUAP), the EPUAP and the Pan Pacific Pressure Injury Alliance (PPPIA)9 have defined PU as a ‘lesion or a trauma to the skin and/or underlying tissue usually over a bony promi- nence and is the result of undiminished pressure, or pres- sure combination with shear, friction and moisture’. It is a degenerative progress attributable to biological tissues (skin and underlying tissues) being exposed to pressure and shearing forces. The pressure constrains the proper blood circulation and causes cell death, tissue necrosis and the development of ulcers.9 While the quality of PU prevention and treatment has increased considerably over the past years, PUs remains a global concern because of its frequency of occurrence and negative consequences for patients and families as well as for the healthcare system.10 Incidence of PUs for hospitalised patients ranges from 9% to 18%, among which the elderly popu- lation appears to be the most common group to develop the ulcers.11 At the same time, many elderly patients are more vulnerable to be ‘stuck’ at a certain stage of PU for a long period of time and sometimes for the remainder of their lives.12 This may result in longer length of hospital stay, heavier burdens for the healthcare system and family members, worst quality of life for elderly patients, which may also influence their mental health such as emotional stability.13 14
NPUAP, EPUAP and PPPIA9 developed the Pressure Ulcer Prevention Practice Guideline (PUPPG), which involves a range of evidence- based recommendations for PUs prevention that could be applied by healthcare profes- sionals globally. Frequently used PU prevention strategies recommended in this guideline includes PU risk assess- ment, regular repositioning, prevention management plan, appropriate use of support surfaces and protection, continence management, patient education, skin protec- tion, nutritional assessment and adequate nutrition.15 It also includes some recommendations specifically for
elderly people—‘protect aged skin from skin injury asso- ciated with pressure and shear forces’, taking into consid- eration that an aged person’s skin is vulnerable.15
A number of studies have been conducted on the implementation of PU prevention strategies among hospitalised patients. One cluster randomised trial conducted in Canada revealed that multidisciplinary PU prevention groups are more cost effective than usual care and yields no significant improvement in the treatment of PUs.16 Despite the existence of the guidelines on the prevention of PU, their effective utilisation in preventing PUs among hospitalised elderly patients varies in settings and countries. Also, although a number of studies have assessed strategies used in preventing PUs, there appears to be little or no information on systematic reviews that have assessed the effectiveness of guidelines used in PU prevention for elderly patients in hospitals. This study, therefore, aims to systematically review studies imple- menting PU prevention strategies recommended in the PUPPG for the prevention of PUs among hospitalised elderly patients globally.
OBJECTIVE The objective of this review is to assess the effectiveness of each of the strategies included in the PUPPG guide- line in reducing the incidence and prevalence of hospital acquired PUs in hospitalised elderly patients in compar- ison to no strategy (usual practice), or other strategies. The review question is: what is the effectiveness of imple- menting each of the PU prevention strategies included in the PUPPG in decreasing the incidence and prevalence of PUs among hospitalised elderly patients compared with no strategies (basic usual care) or different preven- tion strategies?
METHODS Study design This will be a systematic review and meta- analysis of published and unpublished studies that have assessed the use of PU prevention strategies in hospital settings among hospitalised elderly patients. The systematic review protocol has been developed and reported following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) criteria (see online supple- mental appendix 1).17
Inclusion criteria Population included This systematic review will focus on studies that involved all vitally stable (not admitted in the intensive care unit) bed ridden hospitalised patients aged 60 or above.
Interventions All studies that assessed the effect of PU preventive strat- egies found in the PUPPG, that were implemented on vitally stable bed ridden hospitalised patients aged 60 and
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above with an aim to decrease the occurrence of PUs, will be included in this review. Interventions will be limited to use of risk assessment, skin assessment, skin care, nutri- tion, position and repositioning, education and training, and medical devices care.
Comparator Interventions will be compared with other strategies to identify the most effective among them and/or will also be compared with no interventions (regular basic management).
Outcomes In this study, the primary outcome will be directly related to the incidence of the disease among elderly hospitalised patients (incidence shall be considered as the propor- tion of hospitalised patients who developed PUs while in hospital). Included studies must measure study duration related incidence of the disease and/or its point preva- lence and /or stage of PU (severity) as a measure of the effectiveness of the preventive strategies.
Types of studies We will focus only on Quantitative studies—experimental and quasi- experimental studies. These might include randomised and non- randomised controlled trials in addition to comparative and before- and- after studies.
Language Only studies written in English will be included in this systematic review.
SEARCH STRATEGY We will use a three- step strategy to find published and unpublished studies on PUs and their management. First, we will conduct an initial search through the Medline Ovid database using an analysis of text words found in the title and abstract, and the index terms used to describe the article. Second, we will use identified keywords and index terms to search for studies in identified databases. Finally, we will use the reference list of selected studies from the first and second searches to look for additional studies not found in the databases. For this study, we will consider only studies either published or unpublished in English.
The databases that shall be searched for this review will include Medline Ovid, Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, Cochrane library, Scopus and Web of Science. See online supple- mental appendix 2 for the example searching strategy and results in Medline (Ovid). All these databases will provide published studies. To find unpublished studies on our topic, we will use Google, Grey Literature reports and the Centers for Disease Control and Prevention.
The keywords we will use for our initial searches in Medline Ovid will include ‘pressure ulcers’, ‘pressure sore’, ‘bed sore’, ‘pressure injuries’, ‘prevention strate- gies’, ‘elderly patients’ and ‘hospital’.
Study screening and selection The titles, abstracts and full text of studies selected for this study will be reviewed by two independent researchers to identify studies that potentially meet the inclusion criteria outlined above. The Covidence software will be used for title, abstract and full- text screening. After importing references and inclusion/exclusion criteria into the Covi- dence software, two independent reviewers will screen titles of included studies according to the eligible criteria. Conflicts between those two reviewers will be resolved through discussion with a third reviewer. The same proce- dures shall be used for abstract screening. Following the abstract screening, full texts of these potentially eligible studies will be retrieved and independently assessed for eligibility by two reviewers. Any disagreement between the two reviewers over the eligibility of a particular study will also be resolved through discussion with the third reviewer. The process of study selection will be reported using the PRISMA flow diagram.17
Assessment of methodological quality Two independent reviewers will be used to assess the methodological validity of the quantitative papers that will be selected for retrieval prior to their inclusion in the review using standard critical appraisal tools from the Joanna Briggs Institute for Meta- Analysis of Statistics Assessment and Review Instrument (see online supple- mental appendix 3). All disagreement between the two reviewers shall be settled through discussions.
Data extraction After screening and selecting studies, key information from those studies will be extracted into an excel sheet for further analysis. We shall use a data extraction tool adapted from the standardised data extraction tool from the Joanna Briggs Institute Meta- Analysis of Statistics Assessment and Review Instrument (JBI- MAStARI). Considering the infor- mation, we will need for the data synthesis of our study, we shall use the JBI- MAStARI to develop a data extraction tool specifically for quantitative research data extraction (see online supplemental appendix 4). The tool will be used to extract: (1) Study characteristics of reviewed papers, such as authors, year of publication, journal; (2) Methods of the study, including study design (randomised control trial (RCT), quasi- RCT, longitudinal, retrospective), research purpose and/or questions; (3) participant characteristics, country where the study took place, setting, population, sample size, age, sex, ethnicity, socioeconomic status and/ or education level; (4) PU prevention strategies used in experimental group and control group (if applicable), (5) outcome measures and results and (6) conclusions of reviewed papers and any comments from reviewers. Two reviewers will independently perform data extraction. Authors of reviewed papers will be contacted in case of any missing details about their studies.
Data synthesis A meta‐analysis of outcomes combining various studies included in the review shall be done. We will assess
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statistical heterogeneity with I2, which will indicate the percentage of the total variation across studies: 0%–40% low heterogeneity, 30%–60% moderate heterogeneity, 50%–90% may represent substantial heterogeneity and 75%–100% is considerable heterogeneity. If there is a substantial amount of heterogeneity (75%), then sources of heterogeneity will be examined through subgroup and sensitivity analyses. We will also use χ2 test to test the heterogeneity and consider p<0.05 as statistically signifi- cant. A fixed‐effects model will be selected for significant homogeneous studies; otherwise we will apply a random‐ effects model. All outcomes will be summarised using ORs and 95% CI. An OR <1 will represent a lower rate of outcome among the group of patients who were treated following the guidelines. Publication bias will be assessed by visual inspections of funnel plots and Egger’s test.
We will also provide a narrative synthesis of the find- ings from the included studies. The narrative synthesis shall be structured by describing the studies according to the type of intervention used. This will include the three categories of interventions recommend in the PUPPG guideline9: 1. Prevention of PUs, including risk factors and risk as-
sessment, skin and tissue assessment, preventive skin care and emerging therapies for prevention of PUs.
2. Interventions for prevention and treatment of PUs, such as nutrition in PU prevention and treatment, re- positioning and early mobilisation, repositioning to prevent and treat PUs, support surface and medical device- related PUs.
3. Treatment of PUs, for example, assessment of PUs and monitoring of healing, pain assessment and treatment, wound care, assessment and treatment of infection and biofilms, wound dressings for treatment of PUs and surgery for PUs. Results will be presented in tables, figures and graphs, followed by discussion. Publication bias will be assessed in all analyses synthe- sising 10 or more studies to ensure adequate power in the analysis.18 For investigation of the effect of small studies and publication bias, data from included stud- ies will be entered into a funnel plot asymmetry test if we have at least 10 studies in the meta- analysis. Egger’s statistical test will be implemented using STATA/SE V.13 (StataCorp). The quality of supporting evidence will be assessed by the Grades of Recommendation, Assessment, Development and Evaluation.19
Patient and public involvement No patient involved.
Ethics and dissemination This review will only use published literature and will not recruit participants. Therefore, no formal ethical approval or consent is necessary. It is anticipated that this systematic review will provide a detailed summary of the evidence of the effectiveness of the PUPPG in preventing the occurrence of PUs among elderly patients in hospital. It is also expected that the study will provide
recommendations on the best PU preventive strategies applicable in healthcare settings. We aim to publish the research findings in a peer- reviewed scientific journal to promote knowledge transfer, as well as in various media, such as: conferences, seminars, congresses or symposia in a traditional manner.
Author affiliations 1Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada 2School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada 3School of Nursing, University of Ottawa, Ottawa, Ontario, Canada 4Xiangya School of Nursing, Central South University, Changsha, Hunan, China 5Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada 6Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Acknowledgements The authors would like to thank Lindsey Sikora (librarian) for counselling in developing the searching strategies.
Contributors AWB, HM and WC contributed to the conception of the research question and writing of the protocol. HM, AWB, WC, MDFM and DAF contributed to the development of search strategies, eligibility criteria and methodology for data synthesis. HM, AWB, WC, MDFM and DAF contributed to drafting of the protocol and provided approval for the final version of this protocol. HM, AWB and WC will work in duplicate to screen the titles and abstracts of all the materials obtained using the search strategy to exclude the articles that do not meet the eligibility criteria. HM, AWB and WC will evaluate the potentially eligible studies with the full text and further exclude studies with documentation of the reason for exclusion. All authors will contribute to the bias assessment strategy and data extraction criteria. HM, AWB and WC will independently extract data from the included studies. HM, AWB and WC will analyse the data and draft the manuscript. All authors will read, provide feedback and approve the final manuscript.
Funding This work was supported by Hunan Provincial Key Laboratory of Nursing, grant number (2017TP1004), Hunan Provincial Science and Technology Department, China.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer- reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
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3 Cano A, Anglade D, Stamp H, et al. Improving outcomes by implementing a pressure ulcer prevention program (PUPP): going beyond the basics. Healthcare 2015;3:574–85.
4 Dalvand S, Ebadi A, Gheshlagh RG, Ghanei Gheshlagh R. Nurses’ knowledge on pressure injury prevention: a systematic review and meta- analysis based on the pressure ulcer knowledge assessment tool. Clin Cosmet Investig Dermatol 2018;11:613–20.
5 Sullivan N, Schoelles KM. Preventing in- facility pressure ulcers as a patient safety strategy: a systematic review. Ann Intern Med 2013;158:410–6.
6 Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy Wound Manage 2004;50:36–8.
7 Chan B, Ieraci L, Mitsakakis N, et al. Net costs of hospital- acquired and pre- admission pus among older people hospitalised in Ontario. J Wound Care 2013;22:341–6.
8 Markova A, Mostow EN. Us skin disease assessment: ulcer and wound care. Dermatol Clin 2012;30:ix:107–11.
10 Chaboyer W, Bucknall T, Gillespie B, et al. Adherence to evidence- based pressure injury prevention guidelines in routine clinical practice: a longitudinal study. Int Wound J 2017;14:1290–8.
11 Bredesen IM, Bjøro K, Gunningberg L, et al. The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross- sectional study. Int J Nurs Stud 2015;52:149–56.
12 Garcia AD, Thomas DR. Assessment and management of chronic pressure ulcers in the elderly. Med Clin North Am 2006;90:925–44.
13 Chiari P, Forni C, Guberti M, et al. Predictive factors for pressure ulcers in an older adult population hospitalized for hip fractures: a prognostic cohort study. PLoS One 2017;12:e0169909.
14 WHO. Mental health of older adults [Internet], 2017. Available: https://www. who. int/ news- room/ fact- sheets/ detail/ mental- health- of- older- adults [Accessed 01 Mar 2019].
15 Latimer S, Chaboyer W, Gillespie B. Pressure injury prevention strategies in acute medical inpatients: an observational study. Contemp Nurse 2016;52:326–40.
16 Stern A, Mitsakakis N, Paulden M, et al. Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care. BMC Health Serv Res 2014;14:83.
17 BMJ. Preferred reporting items for systematic review and meta- analysis protocols (PRISMA- P) 2015: elaboration and explanation | The BMJ [Internet]. Available: https:// www- bmj- com. proxy. bib. uottawa. ca/ content/ 349/ bmj. g7647 [Accessed 20 Jul 2020].
18 Cochrane. Cochrane Handbook for systematic reviews of interventions. Available: /handbook/current [Accessed 20 Jul 2020].
19 Guyatt GH, Oxman AD, Vist GE, et al. Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6.
Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalised elderly patients: a systematic review protocol
Introduction Diversity is the practice including and involving individuals from different ethnicity, gender and sexual orientation (Godfrey et al., 2020). In Iraq, there is a mixture of cultures due to different individuals from different cultural backgrounds, languages and religion. The population comprise of Arabs, Kurdish, Christians and Yessed practicing different cultural beliefs and living together (Matthews et al., 2020). This study will help individuals to support each other’s beliefs and ideas for peaceful contribution to the country in spite of their differences. The guiding research question is “what are the long-term impacts of cultural diversity?” the research question will help us provide a response by the end of the study. I believe diversity has aided the people of Iraq to experience co-existence and multiculturalism.
As diversity goes beyond just ethnic groups, it includes facets of sexuality and gender and social groups. The Iraq population comprises of the primarily four major groups inclusive of Arabs as the majority, Kurds, Turkmen, Chado Assyrians and the minority ethnic groups such as Shabak and Yezidis. These particular groups bring a mixture of cultures and languages in the country. Also, the country has a number of religions practiced in the country which include the Islam religion which is practiced by majority of citizens, Christianity, Yezidism, Zoroastrianism, Mandaeism Judaism and Hinduism (Matthews et al., 2020). All these religions are accepted through the right to religion. The Islamic religion uses sacred text known as the Quran which has divine messages and celebrates observances like the Ramadhan which is the fasting season. The Christians on the other hand use the bible as the sacred book and celebrate festive like Easter which is the Lenten season (Alfahham, 2020). Also, other minority religions have their own holidays and religious cultures indicated in sacred books.
Studies show that Iraq has introduced an institute for study of religious diversity aimed at changing the country’s discourse towards religious minorities. The institute in the middle east was established by Masarat which is a Bagdad non-profitable organization focusing of the minorities. The curricula is a sequence of textbooks inclusive of non-Muslim faith to help Muslim students have diversity of other religions. The institutes main agenda is to bring better understanding of different faiths and influence the Muslim clergymen to abandon religious prejudices concerning religious diversity to help end radicalism and hatred speeches in Iraq (Matthews et al., 2020).
After overthrow of Saddam Hussein rule, more than fifteen thousand pieces of artifacts were stolen from the national museum. With the retrieval of many of the artifacts, they were stored in different museums in the country. Example of these museums include the national museum of Iraq, Baghdad Museum, museum of natural history, Kurdish textile museum, and Mosul Museum (Hussein & Khalid, 2018). These museums preserve different cultural artifacts from different races. The Assyrian empire culture is well represented through statues, Kurdish weaving and a multilingual library to help people understand various cultures. The museums in Iraq play a major role in cultural diversity as they help display artistic objects to preserve, interpret and provide cultural education to individuals.
Some of the artists in Iraq compose music that show historic roots and ancient traditions. There are different songs from different cultures reflecting on traditions and the culture of the nation. Music is performed in different languages and it is recognized as an important part of the country’s culture. Art and literature have thrived in the country for a long period. The nation even produced the greatest Arab poets, architectural designers and painters. The Gallery Ancient Near East exhibits more than a thousand pieces of art work including drawings from different cultures from the ancient Iraq. These works of art and literature show diversity of cultures. This research adds to current literature of the multicultural Iraq. (Hussein & Khalid, 2018).
Research
The research topic entails the long-term impacts of cultural diversity. I believe diversity inspires creativity and innovations in organizations in the nation. Different cultures influence individuals differently in the way they see the world. A variety of opinions together with wide range personal and professional understanding may offer new perspectives and motivate other people in workplaces. Study has shown that diversity has helped breed creativity and bring exciting ways of problem solving (Hlepas, 2013). A recent study from Forbes, a successful organization highlighted that, the best way for development of new ideas is through diverse and inclusive taskforce. Above all diversity attracts talent in organizations enabling them to offer broad services helping the nation in business. Through multiculturalism, members of the society become open-minded to other cultural groups dispelling stereotypes which help them promote peace. Cultural diversity helps citizens of avoid conflicts and make a nation a better and interesting place to live in. different cultures have different beliefs and diversity helps individuals understand other people’s culture ensuring people share alternate ways to do things. When peace is spread, then the members of the society can enlighten each other on insights in religion, food, literature and history. Through cultural diversity, there is promotion of peace and understanding in different cultures among diverse individuals (Matthews et al., 2020). Visit writing assignment help for more information. Finally, in a setting where there is peace and understanding, an individual has the chance for personal growth. Diversity is a way of exploring inner interests aiding and individual live outside the comfort zone. Through understanding of different cultures, one gains knowledge and develops sense of personal growth. Embracing different cultures brings opportunities to explore new languages and traditions gaining valuable insights which may help one determine opportunities for individual growth. in general, cultural diversity inspires creativity, productivity and enables us gain knowledge and insights of other cultures to better cooperation among different kinds of people (Godfrey et al., 2020). Conclusion Many countries have a population inclusive of different race of individuals from different corners of the world. Iraq as one of these countries has a diverse population practicing different religions, speaking in different languages and practicing different cultures. The study of cultural diversity may help an individual gain insight and understanding about different cultures to ensure dispel of stereotypes for peaceful relations with others. The question that remains is, would a country be peaceful, innovative and productive practicing monoculturalism despite comprising a mixed population? Some challenges associated with cultural diversity include idea implementation problems. With different experiences, different individuals may propose different ideas bringing forward too many opinions which can compromise the ability to stick to the best options. Also, some individuals may feel that their ideas are not taken into consideration. There may arise misunderstandings professionally in workplaces for example conflict on working days or hours. Other challenges include challenges like language barriers, social tension, dysfunctional adaptation of behaviors and civic disconnection (Hussein, & Khalid, 2018). References Godfrey, M., Kim, J., Eluère, M., & Eys, M. (2020). Diversity in cultural diversity research: A scoping review. International Review of Sport and Exercise Psychology, 13(1), 128-146. https://onlyprofessors.com/tag/writing-assignment-help/ Matthews, R., Rasheed, Q. H., Palmero Fernández, M., Fobbe, S., Nováček, K., Mohammed-Amin, R., … & Richardson, A. (2020). Heritage and cultural healing: Iraq in a post-Daesh era. International Journal of Heritage Studies, 26(2), 120-141. https://247essayhelp.com/tag/writing-assignment-help/ Hlepas, N. (2013). Cultural diversity and national performance. Athens, Greece: International Centre for Black Sea Studies (ICBSS). https://www.academia.edu/download/32885718/Hlepas_Cultural_Diversity_deo24_dp_series_7.pdf Alfahham, M. B. M. (2020). Review on Sects and Religions in History of Iraq. International Journal of Islamic Business & Management, 4(1), 1-9. http://cribfb.com/journal/index.php/ijibm/article/download/503/685 Hussein, A. A., & Khalid, R. M. (2018). Issues in the protection of cultural heritage in Iraq. International Journal of Asian Social Science, 8(7), 396-405. https://archive.aessweb.com/index.php/5007/article/download/3004/4604 Verkuyten, M., & Yogeeswaran, K. (2020). Cultural diversity and its implications for intergroup relations. Current opinion in psychology, 32, 1-5
Everything that social workers do is an intervention; therefore, social workers develop treatment plans so that they can outline the purpose of treatment, assist in giving the client direction in the treatment process, allow the social worker to collaborate with the client, and help social workers and clients mark progress toward goals. Depending on where you work as a social worker, your funding source may be dependent upon your treatment plan.
In this Assignment, you develop a treatment plan for a client. In real practice, you should never create a treatment plan without conducting a more thorough assessment and then collaborating with the client to mutually agree on goals and steps to implement the plan. For the purpose of this Assignment, however, you explain how you might go about this process.
To Prepare
Watch the video case study found in the Learning Resources.
Then, consult the Learning Resources and/or go to the Walden Library to find information related to interventions for this type of client or problem.
Use this information to help develop an individual or family treatment plan for the identified client (Amy, Mrs. Bargas, or Bargas family) with whom you have chosen to work from the case study.
For help with this assignment, refer back to the Library recommendations in Week 3.
Helpful tip: Try other keywords including:
treatment programs
intervention
Try using the AND and OR connectors. For example:
drug addiction OR drug abuse OR substance abuse OR drug use
senior citizen OR older people OR elderly OR aging
intervention AND alcoholism
Learn more about AND, OR, and NOT (Boolean operators) in the guide below.
Guide: Keyword Searching: Boolean
By Day 7
Write a generalist treatment plan that includes all of the following:
Identify the client.
Describe the problems that need to be addressed.
Explain how you would work with the client to identify and prioritize problems.
Identify the related needs based on the identified problems.
Describe how you would utilize client strengths when selecting a strategy for intervention.
Identify at least two treatment plan goals.
Create at least one measurable objective to meet each goal.
Explain the specific action steps to achieve objectives.
Describe what information is important to document in a treatment plan, and explain why.
Southside Community Services: Mrs. Bargas Case History
Program Transcript
[MUSIC PLAYING]
LINDA FORTE: Hi, Mrs. Bargas, I’m Linda Forte, the social worker assigned to
your case. It’s nice to meet you. So what brings you in, today?
MRS. BARGAS: Well– I’ve been out of work about 3 months. And 2 weeks ago,
my husband had a stroke. He’s still in the hospital. So it’s been– a lot, all at once.
And the money– I don’t know how going to pay the bills, or the rent. We cannot
lose our home. We have five children.
LINDA FORTE: Has this been hard on them? It sounds like you’ve been going
through a lot since losing your job and your husband being in the hospital. I can
understand how you can feel stressed and concerned.
MRS. BARGAS: My daughter Amy– she’s my oldest– she’s been having the
hardest time. She’s cutting classes at school and she’s failing two of her courses.
LINDA FORTE: So how did you hear about our agency and how can I help?
MRS. BARGAS: Well, my pastor said that you could help me find a job and
maybe help with the rent money. And maybe Amy could– speak to somebody.
LINDA FORTE: OK. Has your daughter, Amy, has she ever expressed any
interest in hoping to speak to somebody about her problems?
MRS. BARGAS: Maybe. I don’t know. I haven’t really mentioned it to her. But my
pastor thinks it’s a good idea.
LINDA FORTE: Has Amy ever spoken to the social worker at her school, before?
MRS. BARGAS: No, I don’t think so.
LINDA FORTE: OK. That’s fine. We can definitely talk about getting Amy some
help. But first, why don’t we talk a little bit about work experience. What kind of
job are you hoping to find?
MRS. BARGAS: Well, before I married my husband, I worked as a nanny.
LINDA FORTE: OK. So why don’t we talk a little bit more about that, about who
you worked for, and what kind of job duties you had.
MRS. BARGAS: Well, I was much younger when I was a nanny. Let me see, it
was– more than 12 years ago. But I don’t think I could do that work, now. Maybe
Southside Community Services: Mrs. Bargas Case History
Reply to classmate’s discussion (answers to your peer of 150 words) each reply needs citation and reference independently. Turnitin less 15%.
Classmate 1 post:
The United States has a growing demand for highly skilled and specialized nurses. An aging population, a growth in chronic illnesses, and an increasing emphasis on preventative care drive this demand. Nurses must be able to grow their careers and practice to their full ability to meet this demand. Unfortunately, various barriers prevent nurses from doing so, one of the most significant being policy. Nurses must be able to ensure policy change for advanced practice registered nurses to solve labor shortages in remote places. The Affordable Care Act (ACA) is one strategy to accomplish this. The Affordable Care Act gives financial incentives to nurses.
Nurses can advocate for policy changes in a variety of ways. One approach is to educate decision-makers on the value of advanced practice registered nurses (APRNs). APRNs play a crucial role in providing high-quality care, and policymakers must recognize their value to the healthcare system (Hassmiller, 2022). Another option for nurses to lobby for policy change is to speak out about the importance of APRNs having access to the resources they require to be successful. It includes education and training, as well as adequate remuneration. Nurses can also endeavor to educate the public about the value of APRNs and the need for legislative reform (van Wijk et al., 2022). This objective can be accomplished through social media, community outreach, and other forms of public interaction.
The Affordable Care Act (ACA) has many provisions aimed at addressing rural labour shortages. One section authorizes the establishment of Community Health Centers (CHCs), which will offer primary care services in underprivileged communities. CHCs can help attract and maintain rural health care practitioners by offering debt repayment assistance and other financial incentives. Another ACA provision created the National Health Service Corps (NHSC), which offers medical practitioners scholarships and loan repayment aid if they agree to serve in underprivileged communities. The NHSC also provides loan repayment help to providers who commit to work for at least two years in underserved areas. The Affordable Care Act (ACA) offers financial incentives for medical care providers (Zhang et al., 2020). Increasing the number of graduates from medical institutions, attracting foreign-trained physicians, and implementing contemporary technology are some initiatives to equip the physician workforce to cater to the rising healthcare demand.
The current demand in the United States for highly competent and specialized nurses can only be met if legislative adjustments are adopted to allow nurses to reach their full potential. One technique used to do this is the Affordable Care Act. Financial incentives are provided to healthcare providers under the Affordable Care Act (ACA), which also forms Community Health Centers (CHCs) that might assist attract and retaining rural healthcare practitioners. Nurses may help bring about the policy reforms needed to solve the nursing crisis by educating decision-makers and the general public about the significance of advanced practice registered nurses and the need for legislative reform.
References
Hassmiller, S. B. (2022). How Nurses Can Help to Create a Better Post-Pandemic World. Policy, Politics, & Nursing Practice, 23(1), 3–4. https://doi.org/10.1177/15271544221075201
van Wijk, M., Lalleman, P. C. B., Cummings, G. G., & Engel, J. (2022). Public Opinion Leadership in Nursing Practice: A Rogerian Concept Analysis. Policy, Politics, & Nursing Practice, 23(1), 67–79. https://doi.org/10.1177/15271544211071099
Zhang, X., Lin, D., Pforsich, H., & Lin, V. W. (2020). Physician workforce in the United States of America: forecasting nationwide shortages. Human Resources for Health, 18(1). https://doi.org/10.1186/s12960-020-0448-3
Classmate 2 post:
How should nurses assure policy change for advanced practice registered nurses? What role does the Affordable Care Act (ACA) play in addressing workforce shortages in rural communities?
Nurses participate in policymaking as healthcare professionals, which is critical for improving service, protecting patient safety, increasing healthcare outcomes, and facilitating access to excellent health care. Advanced registered nurses are particularly suited to play a significant role in healthcare policy formation. Advanced registered nurses have an impact on health policy at several levels, particularly organizational, regional, and national levels. They use their leadership abilities to drive shifts in policy at both levels. Advanced registered nurses impact policy at these levels by introducing advocacy skills to the management and advocating collaborative governance mechanisms in their organization (Arabi et al., 2014). They may, for example, lobby fellow caregivers to optimize staffing numbers, emphasize professional growth, and guarantee an appropriate provision of safety gear. Through these channels, nurses encourage a safe working environment in order to safeguard both patients and staff from injuries and other hazards.
By taking on leadership roles in healthcare and addressing policy issues with state authorities, registered nurses may influence policy. This may be achieved through enrolling in formal political education programs, participating in local government organizations and councils, or even campaigning for local office. Additionally For example, by engaging in lobbying and using their voting privileges. Specialized training Registered nurses may also do this by joining organizations for professionals, many of which include lobbyists who can raise concerns about nursing with authority or political figures (BARZEGAR SAFARI et al., 2020). They may also become members of state nursing organizations, in which they can fight for unrestricted practice rights, or join state nursing associations, where they have the chance to promote professional autonomy (BARZEGAR SAFARI et al., 2020). Nurses may also promote policy change by campaigning for elected office; if elected, they will have the ability to directly address concerns with the Legislature or the Presidency.
The Affordable Care Act is a critical component in the effort to alleviate labor force shortages. This is made easier by the availability of financial support to support rural communities in attracting and retaining clinical staff and also by the creation of a national office of rural healthcare reform to aid in coordinating and improving medical coverage in remote regions (Kominski et al., 2017). Both of these measures are aimed at making it easier for rural residents to receive medical treatment. It is possible that the ACA can help alleviate the nursing labor shortage by investing in education and training initiatives that will assist in the expansion of the proportion of healthcare practitioners working in rural regions (Kominski et al., 2017). This is accomplished by providing financial aid to remote healthcare professionals in order to assist them in the recruitment and retention of staff members. The Affordable Care Act (ACA) contributes to an increase in the number of nurses actively working in the field, which in turn helps alleviate any labor shortages that may exist in the field.
References
Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research, 19(3), 315–322.
BARZEGAR SAFARI, M., BAHADORI, M., & ALIMOHAMMADZADEH, K. (2020). The Related Factors of Nurses’ Participation and Perceived Benefits and Barriers in Health Policy Making. Journal of Nursing Research, Publish Ahead of Print. https://doi.org/10.1097/jnr.0000000000000385
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual Review of Public Health, 38(1), 489–505. https://doi.org/10.1146/annurev-publhealth-031816-044555
Company mergers are very busy and challenging times for corporate leadership. The role that HR plays during a merger is often complex and far reaching. In this assignment, you write an executive brief that considers aspects of how an HR department might prioritize and operate to support the union of two companies.
Preparation
How to Brief an Executive
There is no single correct way to brief an executive or other stakeholder. The final deliverable is your choice, but effective briefs have common elements; they should be clear, concise, relevant, well-structured, and provide decision-making information. Here are a couple of resources you may use to get started:
Imagine that Anchor Hospital, a 250-bed medical center, is merging with the similar-sized Saint Mary’s Hospital to better serve the needs of their metropolitan community. An administrative board has been formed to guide all aspects of the merger. They have asked all departments to submit an executive brief that states their roles, intended model of operations, and initial steps to build interdepartmental relationships.
The board’s primary concern for HR is how it will manage the merging of the workforces into a single, cohesive, and effective team. They want to understand HR’s primary role, guiding principles, and application of current practice. Specifically, they want your vision for the following:
A merger-related current best practice or trend that is being successfully employed by HR departments.
HR’s primary role in assimilating the workforces for the two hospitals.
The HR management model to be followed.
How to foster relationships between HR and department managers.
Instructions
Write a 3–4-page executive brief that address the following merger-related items:
Recommend a relevant HR trend or practice that would be useful to consider as part of this merger. Justify your recommendation.
Analyze HR’s primary role(s) as a strategic corporate partner in merging the workforces of the organizations.
Recommend an HRM model that would effectively steer the joining of each organization’s employees into a single, cohesive workforce. Justify your recommendation.
Recommend two initial steps that HR should initiate to develop an effective relationship between HR and management. Justify your recommendation.
Additional Requirements
Resources: Use four sources to support your writing. Choose sources that are credible, relevant, and appropriate. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the library or review library guides
