Interprofessional Working As Central To Healthcare Management Nursing Essay

Interprofessional Working As Central To Healthcare Management Nursing Essay Fast-Track Discharge is a service available to in-patients who wish to leave hospital at the end of their lives and to die in a place of their choosing (REF). In practice, this requires the use of Fast-Track Pathway Tool for NHS Continuing Healthcare (July 2009) which aids healthcare practioners in ensuring support for individuals with a rapidly deteriorating condition entering the terminal phase in their preferred place of care (REF). This process is designed to bypass potential delays associated with the completion of the full NHS continuing healthcare eligibility process; meaning responsibility for care packages lies with the PCT in order to move the individual to their preferred place in a timely fashion (REF). This innovation has been introduced to combat the issue that the majority of people who would choose to die at home ultimately end their lives in hospital (Gomes Higginson, 2006) despite the UK having one of the worlds most developed palliative care systems (Economist Intelligence Unit, 2010). The Fast-Track Discharge aims to reduce the incidence of hospital deaths by speeding up the discharge process, facilitated by the Department of Health (DoH) End-of-Life strategy that includes ten markers to measure implementation and effectiveness (REF); for example, ensuring that individuals end-of-life care preferences and choices are well documented, communicated and where possible, achieved (DoH 2010). Furthermore, the strategy makes recommendations to better meet patient needs by improving community services, improved cross-agency communication, and improved communication skills of the healthcare worker to better enable delivery of end-of-life through collaborative efforts by PCTs and spe cialist NHS providers (RCN/Royal College of General Practitioners 2011). Partnership working and quality of care has become a central focus for the NHS following the NHS Next Stage Review High Quality Care for All (Darzi, Date?), that has identified the need to personalise services for individuals through the provisions of information and choice. However, the current economic climate of austerity has seen the NHS identify  £15-20bn of efficiency savings that must be achieved by year end 2013/2014 as a result of increased pressure on the NHS budget from the growing healthcare demands of an ageing population with higher patient expectations (DoH, 2010). This is being achieved through four themes shaping healthcare policy in an environment of austerity; quality, innovation, productivity, and prevention QIPP; a regional and national programme supporting clinical teams and NHS organisations to improve quality care whilst making efficiency savings that can be reinvested into NHS services (REF). QIPP is engaging large numbers of NHS staff to help address qua lity and productivity challenges at local and regional levels through tools and programmes developed by national QIPP workstreams, to ensure success implementation (REF). The dynamic nature of the healthcare environment and the need to successfully deliver efficiency savings whilst enhancing patient care, particularly in relation to the Fast-Track Discharge, has highlighted the importance of effective communication and successful motivation by those in management and leadership roles to achieving this (REF). Leadership and management are by no means two distinct and separate roles, and in fact the level of overlap between the two means they often form part of the same role, with many leadership or management roles involving a combination of both i.e. there is continual adjustment of the direction (leadership) and controlling resources that pursue that direction (management) (REF). Essentially, leadership articulates a new vision or direction for a group whilst management facilitates the realisation of this vision through effective control of people/resources according to established values or principles (REF). Scouller (2011) quantifies this by suggesting that management involves the effective utilisation of resources to achieve goals that have been formulated by the change, inspiration and enthusiasm necessary for leadership. However Marquis and Huston (2012) warn against viewing these as two separate functions performed in two distinct roles, asserting instead that leadership is a function of management. Nonetheless Finkleman (2006) contends in healthcare settings it is possible to observe many nurses who fill roles of leadership without being in formal management positions, and arguably there exists managers who are not effective leaders; suggesting then that the harmonisation of management and leadership falls to individuals to be able to successfully integrate the need for change and inspiration with the ability to control and utilise. The qualities and abilities required for managers/leaders to effectively implement the necessary vision and drive with organisations have been the focus of models and styles of leadership that have their foundation in theoretical approaches to leadership and have impacted the management and delivery of healthcare (Finkleman, 2006). Perhaps the most prescriptive of theories pertaining to management/leadership is the trait-based leadership model that emerged from Carlyles (DATE) Great Man Theory; it is based on the integrated patterns of personal characteristics, following the assumption that individuals possessing certain qualities and traits are better disposed to leadership roles (Zaccaro, Kemp Bader, 2004). There is a strong emphasis on values and beliefs, personality, confidence, the need for acceptance or achievement and emotional, mental and physical attributes and the theory contends that people are born with specific traits, some of which are strongly aligned with good leader ship (Eysenck, 1992). However Tulsian Pandey (2006) have reiterated the argument raised by Spencer (1680) regarding this assumption; that the belief that people demonstrate successful leadership abilities independently of their environmental situations and influences is flawed. However this approach to identifying what makes a good leader is inherently appealing in so much as it fits with the notion that leaders are gifted individuals that can do extraordinary things; which individuals can use as a measure of their own personal leadership attributes (Jung Sosik, 2006). That notwithstanding critiques of the theory express concern about the over-simplified approach to leadership (Conger Kanugo, 1998), contending that traits are a poor predictor of behaviour, primarily because a high score on an assessment of a particular trait does not necessarily equate to consistent displays of that trait in varying situations (Boeree, 2006). This contention is particularly applicable when considering leadership in nursing environments; the dynamic nature of said environment is largely unpredictable, potentially leading to individuals integral to these environments to react to this capriciousness and behave in ways that are strongly indicative of consistent traits (REF). However from these traits, it may be possible to patterns of behaviour in individual leaders. The behavioural view of leadership, whilst acknowledging the traits of leaders, places emphasis on the learned patterns behaviour that leaders acquire (REF); Weber (1905) identified two types of leaders bureaucratic and charismatic. The highly structured and procedural approach of the bureaucratic leader contrasts with the energy-enthusing enthusiasm of the charismatic leader approach. From this developed the democratic leadership style, which assumes that individuals are motivated by internal drives and impulses with a proactive desire to undertake and complete tasks (Sullivan Garland, 2010). Arguably, such an approach to leadership is suited to the automony and individual management required for extended periods of group working (Marquis Huston, 2009). However, critiques of theory propound that without clearly defined roles or in a time-constrained environment this approach to leadership has the potential to lead to communication failures and incompletion of projects (REF), high lighting the integral role that communication and motivation play in the context of the effectively delivery of the Fast-Track Discharge innovation. Communication, defined by Boddy (2008) as the reaching of a common understanding through the exchange of information in the form of written or spoken words, symbols or actions, impacts all levels of management activities and incorporates all key stakeholders including; clients, colleagues, superiors and subordinates (Marquis and Huston, 2012). The process of communication is a complex two-way complementary process used to convey a message between two or more individuals, with sender and receiver roles that should be used in such a way that benefits patient care and reaches identified outcomes (Finkleman, 2006). Considering the potential implications of ineffective or inadequate communication on patient care and the implementation of initiatives, an understanding of the communication process for healthcare providers is of paramount importance (Marquis and Huston, 2012). This process, at its most basic level, involves the initiation of communication from the sender by trying to transfer ideas, facts or information to the party who receives the message, the receiver; the message is coded by the sender using words, actions or expressions which represent a tangible expression of the senders ideas through a chosen communication channel (face-to-face, electronic communication, written words). This message is then decoded by the receiver and reconstructed to resemble the original message (Boddy, 2008). However, Finkleman (2006) asserts that perception of a message is fundamental to the communication process and effective communication dictates that the receiver must be capable of perceiving the senders message correctly; failure to do so will result in ineffectual communication or messages being misconstrued (University of Rhode Island, 2010). Furthermore, Marquis Huston (2012) have suggested that directions of communication (upwards, downwards, diagonal, lateral) also impacts of the way the message is decoded by the receiver; contributing to directives, facilitation of tasks, negotiation, problem-solving and discussion according to which direction of communication is used (Sullivan Garland, 2010). In the context of the Fast-Track Discharge initiative, downward and diagonal communication are likely to be most salient, owing to the need for senior management to effectively impart the initiative throughout the organisation and the requirement for nursing practictioners to communicate with external agencies in order to effectively deliver said policy (Nursing Midwifery Council, 2010). However, these are not the only consideration for the effective implementation of the Fast-Track Discharge initiative; the choice of communication model has the potential to impact on the sending and receiving, and integrity of information. Models of communication are visual, simplified representations of complex relationships in the communication process (West Turner, 2010). The earliest of these models, the linear model developed by Shannon and Weaver (1949), frames communication as a one-way process of transmitting a message to a destination, from the sender to the receiver through a channel (see appendix 1) and gives consideration to the potential for message distortion in the process communication noise (University of Rhode Island, 2010). Critics of this model suggest that the definable beginning and end of communication presumed by the theory is incorrect and does not take account of interuptions (Anderson Ross, 2002). Furthermore, there is an assumption of the passivity of listeners and that communication can only occur when speaking that has not been borne out in reality (West Turner, 2010). These issues are addressed in the interactional model (Schramm, 1954), that highlights the bi-directional nature of communication; from sender to receiver and receiver to sender; suggesting an ongoing rather than linear process that is characterised primarily by feedback or response to the message in the form of assessment of the communication. However although this model addresses some of the shortcoming of the linear approach, critics have suggested that the interactional model still neglects to consider the impact of non-verbal messages sent with verbal messages and maintains the one-dimensional view of senders and receivers propounded by the linear model (West Turner). Conversely, the transactional model highlights the notion that sending and receiving messages is simultaneous and mutual and both senders and receivers are responsible for the effect of and effectiveness of communication, building a shared perception of the message being communicated and acknowledging the necessity of both verbal and non-verbal behaviours as an inherent element in the communication process (West Turner, 2010) Clearly then, effective communication is of paramount importance in the conveying, delivering and receiving of messages and is therefore central to the effective implementation of the Fast-Track Discharge initiative. The most appropriate model of communication to ensure the successful delivery of the initiative is the transactional model, allowing for the building of shared perceptions regarding the initiative that have the potential to converge to form a shared vision (Torrington et al, 2005). Such a model does not fall prey to the overly-simplified approaches to communication propounded by the linear and interactional models such as neglecting to consider the symbiotic nature of human communication and the issues caused by not giving due to consideration to the influence of external distortions; whilst giving appropriate weight to the impact of non-verbal communication on sender/receiver perception of the message and how noise levels alter this message (West Turner, 2010). Semantic noise is a particularly pertinent issue; the highly technical nature of frontline healthcare, in this case delivered by nurses to terminally ill patients, invariably results in the use of jargon and technical language to communicate with colleagues (Devlin, 2009). The British Medical Association contends that the use of jargon and technical language when dealing with wider stakeholders, as is central to this initiative, has the potential to cause confusion for both staff and patients and feedback collated from patients surveys by the BMA has revealed a significant negative emotional impact on patients and their families as a result of ineffectual communication methods (Triggle, 2009). The interdependent, cross-agency relationships that are necessary for the effective delivery of the initiative means that frontline care providers have to communicate information to individuals in a diverse range of agencies that are not familiar with the use of department or speciality-specifi c language (REF). The use of unfamiliar or technical language has the potential to alter the receivers perception of the message, which may lead to mistakes or delays in the delivery of the initiative for a particular patient (Triggle, 2009) Whilst styles of leadership and the qualities and skills of leaders is of paramount importance in the effective implenatation of the fast-track discharge programme, the issue of interproffessional working and team building needs to be considered in conjunction with these skills (sounds clumsy!). It is crucial that intergrated models of health and social care are effectively implemented in a timely manner that is cost efficient, innovative whilst using resources wisely (CIPW DATE). Team working enables the professions to solve complex health problems that cannot be adequately dealt with by one profession alone. (WHO 1999: 135). A team can be described as a group of people with complementary skills who are committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. (Carrier Kendall 1995), implying a willingness to share ideas and knowledge for a common goal. Various models of team working exist to allow recognition of basic concepts. Identifying team roles may be useful in identify peoples strengths and weaknesses in the workplace. This information can be used to: Build productive working relationships Select and develop high-performing teams Raise self-awareness and personal effectivenessBuild mutual trust and understanding(REF). Belbin identifies 9 roles (Appendix) within a team and suggests that balance is the key to an effective team that requires at least one of each role to ensure a strong team. Allowable weaknesses of each role are also recognised allowing for management of these perceived weaknesses (Belbin 1981). However it can be argued that not all teams will be made of 9 people each carrying an identified role and that some people may have one or more strength in a preferred role (Brooks, 2009). B. Tuckman (1965) proposed an alternative view to addressing group dynamics, suggesting that groups move through 5 stages of development. Firstly, leader-led information and resource gathering (Forming). Conflicts may develop with tasks being resisted (Storming), and then conflicts settled with a developing team group cooperation with new standards set (Norming). At this point teamwork is achieved and solutions are found and implemented (Performing). On completion of task the group disperses (Adjourning) (Cole, 2004). This suggests then that effectiveness as an outcome is achieved over a period of time as the group develops an understanding of the task, what is required to complete the task and an awareness of the skills and knowledge of the individuals making up the group (REF). These models focus on the behaviour within groups, however inter-professional working requires intergroup working and collaboration between these groups is vital in the delivery of good quality healthcare. Following a three year study of multi-professional working Miller et al (2001) suggested three main types of interprofessional working; Integrated team working whereby the teams served the same population of patients leading to a joint approach to care planning and evaluation of care. However it was noted that this approach worked most well when caring for a group of patients who were medically stable (Hewison 2004). Fragmented working describes a group of professionals making decisions within their own profession groups but with sharing of information often resulting in a superficial understanding of roles and boundaries and a lack of consensus around decision making. A type of interproffessional working incorporating both of these models has been described as core and periphery w orking whereby a predominantly integrated core group works alongside a more peripheral fragmented group. Glendinning et al (2002) argue that whilst integrated style of working has benefitis for the patient the circumstances to achieve this in its purest form are not often in place and as a result this disclocation of the core group from the periphery can result in a lack of communication and a poor understanding of the role of others. These various approaches to interprofessional working can enable practitioners to plan and design the best type of care and to clarify how they are organised. The fast-track discharge programme involves health care professionals from both health and social care sectors and is supported by a Fast-track Discharge End of Life Pathway (DoH 2008). An integrated style of interprofessional working is required to co-ordinate all elements of the care pathway. With nurses being the key provider and co-ordinator for patients in hospital reaching the end of theirs the responsibility falls to them to link and communicate across the health and social care teams (RCN 2011) whilst working in partnership with and as an advocate for the patient and their family/carers. This requires the nurse to ensure that all team members contribute to the care planning process and, with consent (NMC 2008), circulate relevant information to key co-ordinators. A MDT meeting with the key nurse, consultant/Registrar, O Ts/Pts, Discharge Liaison Nurse, Palliative Care Nurse, Pharmacist, and Social Services representative is appropriate to share information, ensure that all team members are aware of the patients wishes and the plan to discharge. It may be most appropriate for the Palliative Care Nurse to liaise with the patients GP and this needs to be decided upon. All decisions need to be clearly documented and regularly updated and shared with relevant professionals. Poor communicaton and fragmented working across professions is the main barrier to this innovation being successful. Organisational cultures refers to the values and behaviours that contribute to the social and psychological environment of an organsition, including the expectations, experiences and philosphosies and is based on shared attitudes and beliefs. (Schein 210).

First Draft of Fundamentals of Macroeconomics Paper Essay

There are a lot issues that actually affect our economy, such acts as gross domestic product, nominal GDP, real GDP, inflation rate, unemployment rate, and as well as interest rates. These areas actually has massive power regarding the way we purchase groceries, if there will be a large amounts of layoffs to workers, and decrease in taxes. Gross Domestic Product is defined as the market value of services and goods that are made in the country in one year. This is an indication of the normal living situation in a country. On the contrary, real GDP is a nation’s total output of goods and services adjusted for price changes. Nominal GDP is the gross domestic product without inflation adjustments. Unemployment rate is a fraction of the whole workforce who are unemployed and looking for work. Inflation rate is the amount increase by percentage that products & services increase on an annual basis. Interest rate is the amount charged, expressed as a percentage of principal, by a lend er to a borrower for the use of assets. These factors are relevant to our lives and how we manager the money we have. Purchasing food sounds like an easy thing to do but if you are limited on money, it can be very stressful. The price of food affects the government. Products are produced and sold within our country; this affects GDP, real GDP, and nominal GDP. This is precisely relevant to buyers spending and during periods of recession, buyers ease up on spending and decide to save. Once consumers venture into savings mode, all business will be effected because production is down and this could cause layoffs. Purchasing food affects homes due to the fact that a lot of people have a hard time trying to provide for their families and when the cost of goods constantly goes up but wages don’t this makes it really difficult to live. Massive layoffs affect people’s standard of living and that is what the GDPÂ  is centered around. Having to many layoffs can have a dramatic effect on the unemployment status which c auses the economy to have a higher unemployment rate which causes salaries to go down so what their spending is down. Massive layoffs has a vicious cycle and globally in 2012, 200 million people were without employment and this shows the slowdown in employment growth, which means companies are were not hiring and people were not spending like they use to. Massive layoffs affect the economy dramatically because it has a huge impact on consumer spending which in my opinion makes the world go around. If no one is buying then production is down and that’s how layoffs happen, and this affects households, businesses, and the government. Tax decreases can stimulate economic growth because if people are paying less in taxes, they have more money to spend. It has been proven over the years that tax decreases generate economic growth and federal revenue will always rise. On a personal note, I sometimes spend more during tax season because I usually get back a good return because I qualify for various tax breaks. These affect my household because I have more disposable income. Tax decreases can help a business if their taxes are decreased the organization will payout less and have more income. As we compare GDP, nominal GDP, real GDP, unemployment rates, inflation, and interest rates, it is obvious that all of these factors affect us every day. They show how we spend our money and these factors give indications of recession. Buying groceries, layoffs, and tax decreases are all a reflection of these factors. Daily acts, such as, buying groceries has huge impact on our economy because it is directly related to consumer spending, which is a driving force. Massive layoffs affect our households, business, and government because this causes consumer spending to go down. Tax decreases on the other hand has a positive influence on all six factors. Plus it will benefit your household, business, and the government. References Colander, D.C. (2010). Macroeconomics (8th ed.). Boston, MA: McGraw-Hill/Irwin http://www.forbes.com

My favorite hero Netaji Subhaschandra Bose Essay

Great heroes are honoured in every country. There are many such heroes in every country. People have great liking for this hero or that. In our country many great heroes were born in the past. They were great patriots. They sacrificed their lives for the freedom of their mother land. We may mention, for instance, the name of Rana Pratap. He was a great national hero. He sacrificed everything for the freedom of his State. In the present age also many great heroes were born in India. They sacrificed their lives for their country’s freedom. We remember their names with love and respect. My favourite national hero Among the great heroes of modern India, the name of Netaji Subhaschandra comes uppermost in my mind. I like him best/He is my favourite national hero. His life is a great ideal to us. It inspires every Indian with ardent patriotism. Why he is my favourite national hero Very few Indians can be compared with Netaji Subhas. He was born in a rich and aristocratic Bengalee family in Orissa. He became a member of the Indian Civil Service. That was probably the highest ambition of most of the Indian students during the British rule in India. But Netaji Subhas was not satisfied with this. He did not like the life of luxury and pleasure. He chose the difficult path of serving his motherland. He took the vow of freeing his beloved motherland from the bondage of foreign rule. He resigned his imperial sevice. He did not care for rank and wealth. He joined the movement of the Indian National Congress under Deshbandhu Chittaranjan. He reaped the fruit of his service to the motherland. He struggled hard to free India from the British rule. And for this he had to suffer much all through his life. He was sent to prison. He was externed. Then he was interned in his own home. But no hardship could daunt his spirit. He followed his ideal with wonderful zeal. He did what he thought to be right. In this respect he did not yield even to Gandhiji. Perhaps we cannot mention any other eminent leader who had the courage to oppose Gandhiji. But Netaji did it because he had the courage of conviction. He felt that in certain respects he was right and Gandhiji was wrong and he had the courage to say this. His courage won the admiration of all. He became the President of the Indian National Congress. But he had to resign Presidentship for his fault of opposing Gandhiji. He preferred this. Still he would not sacrifice his firm faith in his policy of fighting for the freedom of his beloved motherland. During the last great War, he left India in disguise and went to Germany and Japan. He hoped to free India with the help of those countries. He had a wonderful power of organization. This had been noticed all through his life. He raised an army and called it the Indian National Army. It is briefly known as LN. A. With this army he fought against the powerful British Government at Imphal in Manipur. But owing to many adverse circumstances, his attempt was not successful. But his noble example inspired all freedom-loving people and particularly the young men of India. This LN. A. and’Jai Hind’ which was their way of greeting, will make his name ever memorable in the history of India. The members of I. N. A. alled him Netaji and since then he has been known as Netaji Subhas. After his failure, he left for Japan in an aeroplane. It is said that he met his death from the crashing of that aeroplane. But many Indians still believe that he is not dead. If he is alive, we do not know where he is now. Conclusion The life of Netaji Subhaschandra is a bright example of wonderful patriotism, indomitable spirit, undaunted courage of conviction, miraculous power of organization and loftiness of character. All these virtues appeal to me most, and hence I regard him as my favourite national hero.

Dissolve Styrofoam or Polystyrene in Acetone

Dissolving Styrofoam or another polystyrene product in acetone is a spectacular demonstration of the solubility of this plastic in an organic solvent. It also illustrates just how much air is in the Styrofoam. All you need to do is to pour a bit of acetone into a bowl, and place Styrofoam beads, packing peanuts, chunks of foam, or even a Styrofoam cup in the container. The Styrofoam will dissolve in the acetone much like sugar dissolves in  hot water. Since Styrofoam is mostly air, you may be surprised by how much (or, in the end, how little) foam will dissolve in the acetone. A cup of acetone is enough to dissolve an entire bean bags worth of styrofoam beads. How It Works Styrofoam is made of polystyrene foam. When the polystyrene dissolves in the acetone, the air in the foam is released. This makes it look like youre dissolving a massive quantity of material into a small volume of liquid. You can see a less-dramatic version of the same effect by dissolving other polystyrene items in acetone. Common polystyrene products include disposable razors, plastic yogurt containers, plastic mailers, and CD jewel cases. The plastic dissolves in just about any organic solvent, not just acetone. Acetone is found in some nail polish removers. If you cant find this product, you could dissolve styrofoam in gasoline just as easily. Its best to do this project outdoors because acetone, gasoline, and other organic solvents tend  to be toxic when inhaled.