Top Guide of Online Coursework Writing Service

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Dwight D. Eisenhower - Biography

Annotated Bibliography On The Domestic Cat - 1682 Words

Cat From Wikipedia, the free encyclopedia This article is about the cat species that is commonly kept as a pet. For the cat family, see Felidae. For other uses, see Cat (disambiguation) and Cats (disambiguation). For technical reasons, Cat #1 redirects here. For that album, see Cat 1 (album). Domestic cat[1] Cat poster 1.jpg Various types of domestic cat Conservation status Domesticated Scientific classification e Kingdom: Animalia Phylum: Chordata Class: Mammalia Order: Carnivora Suborder: Feliformia Family: Felidae Genus: Felis Species: F. silvestris Subspecies: F. s. catus Trinomial name Felis silvestris catus Linnaeus, 1758[2] Synonyms Felis catus (original combination)[3] Felis catus domestica (invalid junior synonym)[4] The†¦show more content†¦Cats have been known to extirpate a bird species within specific regions and may have contributed to the extinction of isolated island populations.[10] Cats are thought to be primarily responsible for the extinction of 33 species of birds, and the presence of feral and free-ranging cats makes some otherwise suitable locations unsuitable for attempted species reintroduction.[11] Since cats were venerated in ancient Egypt, they were commonly believed to have been domesticated there,[12] but there may have been instances of domestication as early as the Neolithic from around 9,500 years ago (7,500 BC).[13] A genetic study in 2007[14] concluded that all domestic cats are descended from Near Eastern wildcats, having diverged around 8,000 BC in the Middle East.[12][15] A 2016 study found that leopard cats were undergoing domestication independently in China around 5,500 BC, though this line of partially domesticated cats leaves no trace in the domesticated populations of today.[16][17] A 2017 study confirmed that domestic cats are descendants of those first domesticated by farmers in the Near East around 9,000 years ago.[18][19] As of aShow MoreRelatedMacro Economic Analysis of Coca Cola4039 Words   |  17 PagesCoca-Cola has maximized the benefits to strengthen the brand portfolio. This could help the gain of market share position and avoid the left behind with the competitors. However, as Coca-Cola is an innovator and market leader of the beverage market, Copy Cat may follow Coca-Cola to product the new innovation product and spread the profit generate. Defensive Strategic Market Defensive strategic marketing plan was used to protect high market share position and it is useful to help the short-run profit performanceRead MoreChildrens Literature13219 Words   |  53 Pages[ancient Rome; 50 BCE to 500 CE] 31 The Middle Ages [500 to 1500 CE] 31 The European Renaissance [1500-1650 CE] 32 The 17th Century 34 The 18th and Early 19th Centuries 35 The Victorians: The Golden Age 36 Twentieth Century: Widening Worlds 38 9. Bibliography 38 1. Introduction In 1817 Robert Bloomfield, author of The History of Little Davy’s New Hat, wrote: ‘The longer I live †¦ the more I am convinced of the importance of children’s books.’ That similar statements are still being made two hundredRead MoreQuality Improvement328284 Words   |  1314 Pagesthe field. It is available at www.wiley.com/college/montgomery. Student Resource Manual The text contains answers to most of the odd-numbered exercises. A Student Resource Manual is available from John Wiley Sons that presents comprehensive annotated solutions to these same odd-numbered problems. This is an excellent study aid that many text users will find extremely helpful. The Student Resource Manual may be ordered in a set with the text or purchased separately. Contact your local Wiley representativeRead MoreLibrary Management204752 Words   |  820 Pagesachieved. Strategic Planning—Thinking and Doing    99 envirOnment—the aSSeSSment What Do You Think? â€Å"Would you tell me, please, which way I ought to go from here?† asked Alice. â€Å"That depends a good deal on where you want to get to,† said the Cat. —Alice in Wonderland How can an organization get from where it is now to where it would like to be? What steps must be taken to accomplish that goal? One primary benefit of strategic planning is that it serves as a necessary self-analysis or self-study

Same Sex Marriages Effect On Society - 1685 Words

Abstract Objective: This report discusses same-sex marriages effect on society. Informative Research: On June 25, 2015 the United States Supreme Court ruled the constitutional right to gay marriage. The ruling made the United States the 20th country in the world to approve gay marriage. The first country to make the legalization was the Netherlands in 2001. Massachusetts paved way for allowing gay marriage in the United States in 2004 and was followed thereafter by all but 13 states by February of 2015. Canada is another country allowing gay marriage. Canada made the decision on July 20, 2005. Many Canadian leaders support gay marriage over civil unions. Results: As a result of gay marriage, different parts of society took different viewpoints. Conservatives disagree with the decision while liberals agree. The effect on society however is viewed by the acceptance, adolescents transitioning, and political issues. Conclusions: By further understanding gay marriage and how aspects of society react to it, members of society and society itself reap the benefit of gay marriage. Key words: Gay marriage, same-sex marriage, supreme court, society, acceptance, adolescents Word count: 182 Table of Contents Society And Same-Sex Marriage Introduction Significance On June 25, 2015 the United States (US) Supreme Court (SC) ruled the constitutional right to same-sex marriage (SSM) in a 5-4 decision. The decision affected the lesbian, gay, bisexual, and transgender (LGBT) communityShow MoreRelatedSame Sex Marriage Has A Positive Effect On Society Essay1482 Words   |  6 PagesSame-sex unions have existed in various forms throughout history. These have ranged from informal and unsanctioned to highly ritualized unions, which included marriage, in places such as Greece, Egypt, and Mesopotamia. In recent years, there has been a push in first world countries to acknowledge and legally accept gay unions and allow them the option of marriage. The modern LGBT+ rights movement started with the Stonewall riots in 1969. The goal was originally just acknowledgement and social acceptanceRead MoreGay Marriage Essay1744 Words   |  7 Pages 02/02/2012 Legalizing same-sex marriage has been a debate going on for quite some time. The recognition of such marriages is a civil rights, political, social, moral, and religious issue in many nations. Since 2001, ten countries have begun allowing same-sex couples to marry nationwide. In the United States the federal government does not recognize same-sex marriage, but such marriages are recognized by some individual states. Proposition 8 in NovemberRead MoreThe Legalization Of Gay Marriage1749 Words   |  7 PagesThe Legalization of Gay Marriage: A Step to Equality Imagine a world where heterosexuals are the minority. Straight people would be the ones fighting for the same rights as homosexuals. Same-sex marriages would be average and normal, while straight marriages would be frowned upon and considered unholy in the eyes of religion. Heterosexuals would be denied service at restaurants because of their sexuality, they would be called derogatory names while holding their partner’s hand and most importantlyRead MoreThe Laws Of Our Society980 Words   |  4 Pages The laws of our society at its best do not depict equality to every substantial entity that graces the land of the United States of America. The turmoil that is documented and/or reported that flourish our different media outlets, struggles in people day to day lives, or the great strain against indivisibility or a simple liberty or justice for all. Everyone will not always agree if ever. Some may choose to be belligerent with their voice—where others may bid for peace. Perhaps is it greener onRead MoreShould Marriage for Same Sex Couples be Legal in United States?1220 Words   |  5 PagesMarriage as generally define is the union between one man and one woman. However a recent debate over same-sex marriage has stirred a nationwide debate reverberating in the halls of Congress, at the White House, in dozens of state courtrooms and legislatures, and is also becoming a speech-making topic for election campaigns at both the national and state levels. As the debate for this contr oversial topic rages on, the American religious community view on the topic remains deeply divided over theRead MoreThe Legalization Of Gay Marriage1411 Words   |  6 Pagesgay marriages is one of the most controversial issues throughout particularly in modern life. This paper, based on secondary research, arguing for legalizing same-sex marriage through specific analysis of its positive influences. In particular, there are two main benefits regarding society as well as economy. The finds of the research indicate that gays or lesbians are completely an important part of society. Therefore, they must have the rights to live and marry legally as other opposite-sex couplesRead MoreThe Debate Over Same Sex Marriage1682 Words   |  7 PagesThe largely debated topic of same-sex relationships have been on the forefront of all U.S. citizen’s minds, including and more specifically of those in the branches of legislature. More states today have begun passing laws that accept and re cognize marriage for this population. This minority group, in some opinions, has been at a disadvantage when it comes to marriage equality. Previous studies have explored this great debate in the United States beginning in the 1970s. The Minnesota Post publishedRead MoreSame Sex Marriage1185 Words   |  5 PagesMarriage is a coming together for better or for worse, hopefully enduring, and intimate to the degree of being sacred. It is an association that promotes a way of life, not causes; a harmony in living, not political faiths; a bilateral loyalty, not commercial or social projects.† (U.S. Supreme Court). Marriage has been defined as a religious legal commitment between a man and woman, as well as an expression of love. Homosexuals have not been allowed to partake in these commitments and the risingRead MoreSame Sex Marriage Should Be Legal Essay1348 Words   |  6 PagesMarriage is a commitment between two people who love each other and have chosen to spend the rest o f their lives together, this is a pretty standard view of marriage. How that commitment looks from culture to culture can be very different. In the United States, today, marriage is viewed as a commitment of love and loyalty. Legally it is a binding contract between two people giving them the benefits of marriage i.e. tax benefits and legal decision making benefits. The big controversy facing theRead MoreSame Sex Marriage Should Be Legal1182 Words   |  5 PagesProfessor Margot Bowlby 22 February 2017 Same Sex Marriage Our society today is greatly influenced through controversial issues over same-sex marriage in America, leaving many stumped and concerned about the ongoing conflict. For some time now, it has been an expanding problem to legalize same sex marriage. A vast majority of the population believe that marriage should be between two genders due to it’s being biblical. The opposition upon same-sex marriage has led to the misconception of civil rights

The Cons Of Standardized Testing - 1555 Words

The Standardized Testing System, instituted in the public school system, has been used as a guideline in assessing a student’s comprehension of the subjects taught in the classroom and for measuring a teacher’s aptitude of relating the subject material to the students (Fletcher). Florida has instituted a new Bill SB-736 that will now no longer grant teacher’s tenure, and will use the scores from the FCAT to decide whether a teacher will keep their job. While originally created to help the school system, standardized testing has been shown to have many problems, and even to cause harm to students, teachers, and schools. The standardized testing system must be severely revamped, as well as the way the scores affect the schools the students†¦show more content†¦I have equally high expectations for all of the students in my charge. If a teaching strategy fails to work for a student in my room, I will find an alternative method. After all, I want each student to succeed, no matter what kind of effort I must put forth† (Brennan). This quote epitomizes to me that the teacher will play a heavy part in a student’s success, and this does not always translate over into the test scores. Another situation to factor in is a student who has come from a bad teaching environment and has little education. There is a teaching method called TPR that teaches the students using a system that does not test, but does. This method will have students physically do exercises that involve math problems, Spanish words, etc as a method of learning. This teaching is very effective for those who have learning difficulties, yet how can students who learn in this manner be expected to take the same test as those without these learning disabilities (Nelson). A teacher may help this student in many ways, however the student may have lower scores due to the deficiency of knowledge they possess. The teacher will then be punished for having this student score poorly when in fact they have done nothing but help this student. SB 736 does offer a reward for teachers who are teaching at at-risk schools,Show MoreRelatedThe Cons of Standardized Testing1005 Words   |  5 Pages Throughout high school and college we will go through a vast amount of testing but why? Testing is used to show a person’s amount of knowledge on a particular subject. Usually it’s for one specific subject and not a majority of them, standardized tests administered in schools today include all testable subjects as in English, Math, Science, Writing, and Reading. However, before we can all take the next step and begin our college careers, we have to take one of two tests, the ACT or the SATRead MorePros And Cons Of Standardized Testing801 Words   |  4 Pagescontroversial topic Since Middle School, I was not opposed to standardized testing. I thought of it as a way of testing us of what we have learned. Although, after reading some articles about standardized testing I am re-thinking the pros and cons. From personal experience, I thought of it as a challenge to pass them. But now that reminisce about it, I noticed some of the cons of standardized testing. I remember having a week or two dedicated for testing, and in case of students failing they had to take timeRead MorePros And Cons Of Standardized Testing1400 Words   |  6 PagesEven though there are many downsides to standardized testing there are still viable reasons why they are still being used today. One of the main reasons includes the easy and quick access of testing students. Standardized testing allows schools to quickly access a large amount of students at one time. This is also one of the cheapest ways to tests such a large crowd due to machinery that grades which results in low tests costs f or students. These tests also help by setting a national curriculum forRead MorePros And Cons Of Standardized Testing1025 Words   |  5 PagesWhat are standardized tests? Standardized tests are exams that are administered, scored, and interpreted in the same way for all students. Now there are many pros and cons of standardized testing however, I believe that public and private schools should just abolish standardized testing all together. These tests determine a student’s academic performance and each student is given the same test with the same questions and answers. These tests are designed to measure the students learning capabilitiesRead MoreThe Pros and Cons of Standardized Testing1050 Words   |  5 Pageseducational world is standardized tests. All fifty states have their own standards following the common core curriculum. There are many positives and negatives that go with the standardized tests. A standardized test is any type of â€Å"examination thats administ ered and scored in a predetermined, standard manner† (Popham, 1999). These standardized tests are either aptitude tests or achievement tests. Schools use achievement tests to compare students. There are pros to standardized examinations as toolsRead MorePros and Cons of Standardized Testing583 Words   |  2 PagesStandardized testing has its pros and cons I do not believe in it but I will give you proof for and against the testing. We will cover some the history and where the testing came from and why we do it. I will talk a little bit of how I feel about testing and how much we should focus on how the students do on the test. I have interviewed a few teachers that I had when I went to school and some personal friends that are teachers now and how it effects how they teach. Most historians trace the beginningRead MoreThe Pros and Cons of Standardized Testing Essay674 Words   |  3 PagesStandardized testing is a down fall to many students but also an opportunity for many others. Standardized testing has its pros and its cons. It can be the make it or break it factor into getting into colleges you are hoping to attend or the scholarships you want to earn. Some people may have their opinions about the test, whether they hate it or not but the fact is that it’s here to stay. What exactly is standardized testing you may ask, it is a test which measures the knowledge among differentRead MoreThe Pros And Cons Of Standardized Testing1295 Words   |  6 Pages many colleges have begun to make standardized testing optional. Skeptics of standardized tests claim that higher test scores are not always an accurate indicator of intelligence but rather are more closely associated with socio-economic status (Milligan 2015). In 2013, Ithaca College made the decision to go completely test optional. Thomas Rochen, the President of Ithaca, explained that many students refrain from applying to schools that require testing if they are poor test takers or didRead MoreThe Pros And Cons Of Standardized Testing1302 Words   |  6 Pages Standardized Testing is a regulation of rigorous dialogue and debate. Both sides of this subject impose arguments based upon moral and financial justifications, and span from the local to national level of legislation. The policy of standardized testing as a means to identify schools who are lacking in successful educational processes neither harm school districts through unequal distribution of power, nor negatively affect students’ learning; rather, it benefits students, faculty, and districtsRead MoreThe Pros And Cons Of Standardized Testing794 Words   |  4 Pageswhy school testing should happen more frequently and why parents and teachers should be less fearful of standardized tests. For educators and parents, testing means standardized testing: a tool wielded by politicians and administrators to terrify children and teachers. W hen cognitive psychologists hear the word testing, they think immediately of the testing effect — one of the best learning strategies. In this quote, the authors make a separation between testing and standardized testing. They bring

Infection Prevention and Control Level

Question: Discuss about theInfection Prevention and Control Level. Answer: Introduction: This essay aims to analyze critically a qualitative and a quantitative research literature for supporting research development. The method of research critique will be utilized for analyzing the different components of the two articles and determining their significance in the research field. At first, the analysis of the two research articles will be done followed by a critical analysis. The essay will first define research critique and will make the readers understand regarding the research findings. For analyzing every section of a literature, an appropriate framework is needed (Parahoo, 2014).A summary will be provided after critically analyzing the two articles. Subsequently, this essay will critique a compulsory section of this article along with the other three sections for evaluating the findings of the research. The reviewing of the other parts includes introduction, literature review and discussion. The essay will critique the two research articles by considering the framew ork of research. Research Critique A research critique is concerned with the evaluation of content of the research papers. It involves the identification of problem, finding out specific questions, studying the theoretical and analytical approaches of the study and evaluating the findings along with the significance. The summary of a research critique involves the personal study and evaluation of the research articles by the authors. The arrangement cannot be similar that a research critique includes only errors in a report; comparatively it may be principally positive. It helps for analysing the weakness and strength of a specific research article. It also assists to identify repetitions, unrelated information and grammatical errors and overall writing style. It is carried out for a number of reasons, for example, when a research paper is all set to be published and for commenting on the research wok prior to publication. In some cases, it helps the emerging scholars in gaining experience, learning and developing the research skills (Fitzgerald, 2012). Summary of the First Article The first article titled Barriers to nurses adherence to central venous catheter guidelines by Jeffrey Picker (2014) is a qualitative research study which has included a descriptive method. This study has involved then participants and the collection of data has been carried out through interview. The analysis of data was performed with the help of Coloaizzis method. This study has aimed to explore the perceived barriers of nurses for adhering to the standard care practice s of Central Venous Catheters (CVCs). The key findings of this study have suggested that the barriers of adherence are potentially able to produce errors and restrict the nurses to provide a high-quality care to the patients. Critique The key findings of this study have suggested that the barriers of adherence are potentially able to produce errors and restrict the nurses to provide a high-quality care to the patients. The researchers with the logical development of the rationale and understanding of the study have done a detailed review of the cited articles. There has been an integrated assessment of all the articles and the researchers have identified the gaps between the knowledge and practice of the nursing professionals. By making a comparison with the other studies, it has been discovered by the researchers that this study has a minor susceptibility to predisposition because it is more rigorous and hence, it the current knowledge has been extended with the basis for less significant deviation. The method of research utilized by the researchers together with exploration of general credibility has highlighted the apparent barriers of the nurses explicitly. Justification These signify the logic, which has been maintained by the researchers throughout the study to provide a reliable understanding regarding the aim of the research with the purpose of the interventions to establish the hypothesis of the research. The researcher has discussed the discussion regarding post-insertion bleeding as a side effect, though no intervention has been suggested to reduce or avoid this bleeding that could have made this study more practical and safety oriented. A clear demonstration regarding the infections associated with the catheters and the significance of CVCs in managing the severely ill patients has been given by the introduction of this article. Summary of the Second Article The second research article titled A comparative evaluation of antimicrobial-coated versus non-antimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial by Storey et al. (2016) is a quantitative study. The sample populations of this study comprised the patients who were randomly selected and placed with PICC line in the body. The study involved 167 patients from the three high-risk units and was allocated to receive either a non-CHG or a CHG impregnated line. The collection of data was carried out in the form of laboratory and the patients were reviewed regularly. The study was designed to compare the effects of non-CHG and CHG lines on the development of CLABSI and VTE. The findings of the study revealed that no major differences were observed in the development of CLABSI and VTE by using both the lines. Critique The researchers have developed a coherent development regarding the understanding of the topic with respect to the existing knowledge. This is apparent from the fact that a challenge is presented by the PICC lines in the clinical practice because of the development of complications. Hence, it is necessary for identifying the impact of CHG and non-CHG groups on the development of complications and their successive prevention (Sandrucci Mussa, 2014).It relates the review with the research problem directly and after reviewing, the identification of gaps has been done by summarizing the publications of the research. The development of VTE, CLABSI and post-insertion bleeding has been discussed by the researchers. This provided a thorough assessment regarding the findings of the study and associated them with the findings from another study for gaining knowledge. Justification The findings of this have reflected the different factors that have emerged in the form of contextual factors and cognitive barriers, which were later, associated with the main subject of this study. It can be affirmed form the study that the authors could have underlined some additional things regarding the role of the healthcare organizations to facilitate the barriers that are faced by the nurses as it could have presented a clear image about the issue. In addition to this, the study carried out in this research article is logical and well-linked. It has been exhibited by the introduction of this study that every year several patients die because of medical errors and the need for the nurses to adhere to the guidelines of the practices of standard care along with their responsibility for minimizing the errors. General Credibility (Compulsory Section) The general credibility of the research method can be stated in the way that the research method clearly explored the aim of the research in the study. It is apparent from the fact that the researchers have established an apparent and consistent association between the research aim and findings of the study. The study intended to investigate the impact of both the PICC lines on the arising of problems and the findings advocated no major variations mong both the lines resulting in the development of problems. These signify the logic, which has been maintained by the researchers throughout the study to provide a reliable understanding regarding the aim of the research with the purpose of the interventions to establish the hypothesis of the research. Optional Sections Introduction The first article titled Barriers to nurses adherence to central venous catheter guidelines by Jeffrey Picker (2014) is a qualitative research study which has included a descriptive method. This study has involved then participants and the collection of data has been carried out through interview. The analysis of data was performed with the help of Coloaizzis method. This study has aimed to explore the perceived barriers of nurses for adhering to the standard care practice s of Central Venous Catheters (CVCs). The second research article titled A comparative evaluation of antimicrobial-coated versus non-antimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial by Storey et al. (2016) is a quantitative study. The sample populations of this study comprised the patients who were randomly selected and placed with PICC line in the body. Literature Review The literature review systematically reviewed the articles to demonstrate the factors of risk that leads to infection and identifying the patients who are prone to develop infections. A coherent development regarding the understanding of the topic with respect to the existing knowledge has been developed by the researchers. This is apparent from the fact that a challenge is presented by the PICC lines in the clinical practice because of the development of complications. Hence, it is necessary for identifying the impact of CHG and non-CHG groups on the development of complications and their successive prevention (Sandrucci Mussa, 2014).It relates the review with the research problem directly and after reviewing, the identification of gaps has been done by summarizing the publications of the research. Discussion of the Study The results of the study along with their implications and limitations has been analysed by the discussion of the study. It has been associated with the other studies that have been reviewed in the in the background section which assisted in the identification of variables such as resource availability, staffing and documentation. It has been identified that the nurses have an awareness regarding the barriers to standard care practices. Besides the strength, the found weakness was the limitation of the study, which has been recognized properly with recommendations for future research. The discussion regarding the implications of the study has been done that enhanced the validity of the study and they have been proposed by keeping in consideration the complex environments of healthcare. Application to New Zealand Context The two articles involved Central Venous Catheter (CVC), while one of them is concerned with the guidelines by the nurses along with the development of complications such as VTE and CLABSI because of the utilization of PICC lines. The rationales for future research in this area have been provided by these studies. The significant international experiences have been used for reducing the infections that are acquired by healthcare by the Health Quality and Safety Commission of New Zealand (Sturm Antonakis, 2015). The information for helping the healthcare professionals in preventing the infections that re associated with CVC has been provided by this commission. It is clear that in New Zealand; evidence-based guidelines are not followed that brings about differences in the clinical practices. As a result, it is necessary that the nurses along with the other professionals of healthcare should assess the guidelines to ensure the availability of the best evidence (Taylor et al., 2014). T he barriers that are perceived by the nurses in their daily practices must be reduced to facilitate them for adhering to the standard practices of care to minimize the complications associated with CVC (LoBiondo-Wood Haber, 2014).The awareness and knowledge of the nurses can be enhanced by the upgrading of the consistency by developing a model to ensure than evidence-based interventions are received by the patients (Vasudevan, Oddie McGuire, 2016). The healthcare organizations can utilize the findings of these quantitative and qualitative studies for enhancing the quality of care offered to the patients. In order to adhere with the guidelines of management of CVCs, the nurses need to work hard since they are aware regarding the barriers for implementing an evidence-based protocol (Taylor et al., 2014). Conclusion (Compulsory Section) To conclude, by critically analysing the two research articles, it is apparent that in healthcare settings, safe delivery of care is a priority and the main role of the nursing professionals. Negligence in the care of the patients can result in the development bloodstream infections. In order to prevent this from taking place, the orientation of the healthcare organizations together with an official training will play a significant role to provide the essential tools that are needed for carrying out safe practices. They should identify and eliminate the barriers for ensuring the safety of the patient in an efficient manner. References Diggery, R. C. (2012).Catheters: Types, applications and potential complicationsNova Science Publishers, Inc. Dougherty, L., Lister, S. (2015).The Royal Marsden manual of clinical nursing procedures. John Wiley Sons. Fawcett, J. Garity, J. (2009). Evaluating research for evidence-based nursing practice. Philadelphia, PA: F.A. Davis Company. Fitzgerald, L. (2012). Using research evidence in S. Borbasi D. Jackson. Navigating the maze of research: enhancing nursing and midwifery practice (3rd ed., pp193-213). Chatswood, Sydney: Mosby Elsvier Jeffery, A. D., Pickler, R. H. (2014). Barriers to nurses adherence to central venous catheter guidelines.Journal of Nursing Administration,44(7/8), 429-435. Lapp, H., Krakau, I. (2014).Cardiac catheter book(1st ed.). New York: Thieme. LoBiondo-Wood, G., Haber, J. (2014).Nursing research: Methods and critical appraisal for evidence-based practice. Elsevier Health Sciences. Parahoo, K. (2014).Nursing research: principles, process and issues. Palgrave Macmillan. Polit, D. F., Beck, C. T. (2013).Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams Wilkins. Sandrucci, S., Mussa, B. (Eds.). (2014).Peripherally Inserted Central Venous Catheters. Springer Milan. Storey, S., Brown, J., Foley, A., Newkirk, E., Powers, J., Barger, J., Paige, K. (2016). A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial.American journal of infection control,44(6), 636-641. Sturm, R. E., Antonakis, J. (2015). Interpersonal Power A Review, Critique, and Research Agenda.Journal of Management,41(1), 136-163. Taylor, J. E., McDonald, S. J., Tan, K. (2014). A survey of central venous catheter practices in Australian and New Zealand tertiary neonatal units.Australian Critical Care,27(1), 36-42. Valentin, A., Capuzzo, M., Guidet, B., Moreno, R.P., Dolanski, L, Baure, P. Metnitz, P.G.H. (2006). Patient safety in intensive care: Results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Medicine, 32 1591-1598. Vasudevan, C., Oddie, S. J., McGuire, W. (2016). Early removal versus expectant management of central venous catheters in neonates with bloodstream infection.The Cochrane Library. Worth, L. J., Spelman, T., Bull, A. L., Brett, J. A., Richards, M. J. (2015). Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013.American journal of infection control,43(8), 848-852.

Electronic Health Record in the healthcare Organisation Sample

Question: Discuss about the Implementation of Electronic Health Record(EHR) in the Healthcare Organisation. Answer: Introduction The requirement of creation and promotion of an efficient healthcare system is unarguable. The efficiency can be attained when the healthcare organisations are attaining the maximum benefits from the healthcare system. In the healthcare organisations, the efficiency can be achieved by the efficient use of technology (Eurohealth, 2012). The electronic health record (EHR) system has the potential to transform the healthcare system. Over the last few years, technology has intervened in the every major industry and most of the organisations have implemented heavy computerisation to increase the efficiency of the organisation. However, despite these technological advances in the society, there is no provision to maintain the health records of the patients electronically. Moreover, most of the patients are prescribed through hand written records and only a few patients are able to electronically contact their physician or set an appointment with the doctor. The Electronic Health Care Recor d (EHR) has the potential to transform the healthcare system of an organisation from paper-based system to computerised system which is capable of delivering high quality care to the patients. However, a simple EHR system provides only partial benefits to the society and the healthcare organisations; it is important that the Electronic Health Care Record system is implemented in a strategic manner. The EHR can be defined as the longitudinal record of the patients health which is stored electronically. The information is generated in the encounters between the patient and the doctor. The electronic health record also contains information related to the patients demographics, progress, medications, vital statistics, past medical history and the medical reports. One of the primary benefits of the EHR is the avoidance of the poor penmanship and associated difficulties in understanding the reports. There are three vital components of Electronic Health Record (EHR) which can improve the h ealth care quality and reduce the system costs. These are: clinical decision support system tools, computerised physician order entry (CPOE) system and health information exchange (HIE) system. The clinical decision support system assists the physicians in decision-making regarding the patient care. It can be used to obtain latest information of the drugs or check previous records to identify a patents allergy to a specific drug. The CDS system can reduce the instances of medical errors which will assist the physicians in delivering effective healthcare (Menachemi and Collum, 2011). The aim of this article is to recommend the implementation of EHR in small patient setting. The Kotters change model has been applied for the implementation of EHR in the organisation. The intention, attitude and the beliefs of the healthcare personnel and the physicians are critical in acceptance and adoption of any new technology. Also, the perceived usefulness and the perceived easiness of use influen ce the adoption of new technological system. Therefore, it is important that social and the behavioural factors are considered in the EHR planning. In the present article, the case-study method has been used to describe the application of Kotters change management model in the implementation of cost efficiency among the physicians (Martin, Voynov, 2014). Reaching Consensus It is important to reach a consensus in the change management process to reduce the resistance to the change. It promotes acceptance of the change process and ownership of the collaborative decision. It will motivate the people to work towards the common aim. The consensus will build support and among the stakeholders and they will be more acceptable of the change process (Voehl Harrington, 2016). A business organisation can build resistance by clearly defining the mission statement for the group, defining roles and responsibilities of the members, maintaining the group mission, establishing positive and open communication and creating s system of continuous review and feedback. The hospital can use consensus decision making to reach agreement between different group members in a group. The consensus decision-making can be used to find solutions which are actively supported by all group members. The consensus decision making allows the management to take into consideration the opinions, ideas and the concerns of all the members. When the management listens to the viewpoint of all the group members, they can bring proposals which can work for everyone. It can result in innovative and creative solutions which can inspire the people and group as a whole (Ledgerwood White, 2006). In the context of the present organisation, the proposed role of Electronic Health Record (HER) will be determined with the help of consensus decision making. The Electronic Health Records (EHR) will be used to support decision making by discussing the benefits of the system as conducted in Lagoon Hospital in Nigeria. Lagoon Hospital has implemented an innovative consensus management approach to implement the electronic system to maintain the medical records of the patients. An electric medical record system has been introduced as a part of the innovation process in the hospital. The organisation has creates a mission to consistently deliver quality healthcare which exceeds the expectations of the customers. The Lagoon Hospital is the first hospital in the Sub-Saharan Africa which has earned the accreditation from Joint Commission International (JCI) which shows its excellency in clinical practices related to patient care and safety (Hygeia, 2017). The management of Lagoon Hospitals obtained consensus from different officers by highlighting the benefits of the electronic system to them. The benefits of the electronic health record system were discussed with different employees. It was discussed that the implementation of the electronic record system will allow the staff to create an updated record of the medical and critical information such as medical history, future appointments, and medication and allergy histories. It can increase the efficiency of the healthcare professionals by creating structured information source, supporting inter-operability across the system and supporting effective decision-making by easing the process of accessing and interrogating the medical data. The waiting time of the organisation is also reduced and the errors created due to illegitimacy of handwriting are also mitigated. The appointment system will be better managed and more space is created in the hospital which creates conducive environmen t in the organisation (Gbenga-Mustapha, 2013). The strategic alignment process can be used to determine the stages of the change management process. In the change management process, the major challenge for the organisation is to obtain consensus and reduce the resistance of the staff members. Therefore, in the first stage urgency can be created in the organisation to reduce the current operational efficiencies in the organisation. In the subsequent stages, the employees of the organisation should be acknowledged with the benefits of the Electronic Health Record so that the resistance for the system is reduced (Jones Recardo, 2013). Change Management The implementation of the EHR system will bring certain changes in the operations of the organisation. All the system will be automated and the healthcare professionals and the physicians will be required to learn new processes and technology. There will significant changes in the organisation processes which will cause temporary loss in organisations productivity. The implementation of electronic health record will require significant investment in purchasing and installing hardware and software, converting the paper charts to electronic ones and training the users to operate the new systems. The management also has to constantly pay for the software maintenance and support. Moreover, the employees are also needed to be constantly trained to operate the system (Menachemi and Collum, 2011). There are certain factors which forces the implementation of EHR in a healthcare organisation. The incentives, culture of the organisation and access to resources are the critical factors which are associated with building the pressure for the change process. The leadership and the organisation culture are also significant in the implementation process. The success rate of the implementation of clinical information system is one in three which shows high rate of failures of these systems. The inappropriateness in the selection of change management model also contributes to the failure of the system. The organisation should use creative change management approaches to create an efficient change management system (Kotter, 2012). Setting: The administration of Northshore Medical Group followed the Kotters eight-phase approach for the change. It is a multidisciplinary physician group located in Chicago, Illinois. It is accredited by Joint Commission and cares for about 60 patients in a day. The hospital also performs six to eight surgeries in a week. Creating a Sense of Urgency: It could be scrutinised that the Director of the Medical Centre was initially indifferent regarding the benefits of EHR. However, the practice managers and the billers were concerned regarding several issues such as lack of physical space for storing the medical records, the consumption of physical space for storing medical records and wastage of time an efforts in finding the lost medical records. These problems enhance the perception regarding the perceived usefulness of EHRs for the management and the administration. All these situations triggered the practice manager and the biller to create urgency for the use of Electronic Health Records (Kotter Cohen, 2012). The Later, an announcement was made by the manager of the Northshore Medical Centre for the implementation of EHR. The employees were divided into three groups, physicians, allied healthcare staff and the administrative staff. The physicians do not have a significant role in the change management process; however, they ha ve to experience their use and determine whether the organisation should implement EHR or not. After the evaluation process, the physicians were indifferent to the use of EHR. Moreover, the allied health staffs, which comprise of the lab physicians and medical assistants in the age group 40s or 50s strongly, opposed the implementation of the system due to the highly challenging learning curve. The administrative staff which refers to the billers, receptionists and the administrators were more acceptable to the change as they were willing to try something which assists them in the management of thousands of medical records (Edwards, 2009). Forming Coalition: After the creation of a sense of urgency, the next stage is to create a powerful coalition to guide the change. The guiding coalition was established of the manager and the biller. This coalition was responsible for implementation of EHR system with minimal disruption by identifying the facilitating and the restraining forces. The coalition was responsible for all aspects of the EHR implementation which includes clinical, operational and financial factors. An example wherein the guiding coalition assisted in the implementation of EHR process in the organisation is where the members of the guiding coalition actively participated in the EHR training organised by the vendor. It increased by the perceived ease of use of the organisation (Cameron Green, 2015). Create a Vision for Change Norhshore Medical Center, LLC would become leaner by the implementation of EHR. The vision of the organisation is that EHR is not the end goal of the change management process but the means to end. The aim of the organisation is to increase the leanness and the quality of the organisation by successful EHR implementation process (Kotter, 2008). Giving Voice to Vision The vision of the change management process was established by the practice manager and the biller. The manager and the biller communicated regarding the vision with each member of the team. The EHR implementation was not a simple project in the organisation but will create a major shift in the organisation culture. The management communicated immediate changes with the physicians such as enhanced diagnostic and monitoring tools for improved patient care, increased revenue, decreased manual mistakes and the overall liability (Kotter Rathgeber, 2013). The administrative staff was also communicated with the immediate benefits of the change process such as less missed appointments, prevention of double booking of the beds and less time to find missing records, time efficiency in data entry, data management and transparency in the organisation. It also creates possibility of several people working with the same patient at a single time (European Commission Information Society and Media, 2009). Empowering Broad-Based Action The practice manager and the biller also ensured that there is full participation of the most resistant group of the organisation, the allied health staff who do not perceive any immediate benefits with the implementation of the system in comparison to the physicians and the staff. The learning of the complete EHR system is a complex process and requires the time. The manager and the biller were focused on the group learning. They monitored the entire learning process and focused on how learning can be improved (Kotter, 2008). The following learning approaches were taken, individual and group training, setting up dummy patients for the practical implementation and making the teams watch training videos in group so that they can support each other. The managers also make provisions so that the individuals as well as the groups are recognised for their individual efforts and achieving specific milestones. Generating Short Term Wins In the Northshore Medical Centre, the EHR implementation was conducted during the time period from 1st October, 2013 to 31st December, 2013. During this time period, several milestones were created to mark the progress of the project. The particular milestone was set to create an active allergy list of the patients. In this particular milestone, the physicians had to feed any known allergic reaction to the health records. It is important part of the patient care as an adverse outcome can be prevented resulting from known allergic reactions. Using this approach increased the usefulness perception of the healthcare professionals (Kotter, 2014). It also created the perception that the adoption of EHR system is a strategic vision and change in necessary in the organisation. Consolidation of Change The early achievements and issues were consolidated in the management meetings. It provided the motivation to achieve more challenging milestones in the organisation. With the HER, the patients can give educational printout about the diagnosis and the post-procedural instructions related to the appointment and the procedure. The initial goals were easy which increased the perceived competence and confidence of the people which will be impacted by the change. Anchor new Approaches in the Organisation Culture The implementation of EHR at Northshore can increase the operational efficiency and increase the capital revenue generation. After five months of the implementation of the EHR system, the medical record system was completely transformed from the paper-based record keeping to electronic-record keeping. The implementation of EHR system will change the operations of administrative staff as instead of hunting down the medical charts, they have to notify when a task is needed. The attitude of the staff was also changed and the medical staff that was initially resistant to the change created a positive attitude. They more often enquired about the additional functionality of EHR process (Cameron Green, 2015). Planning Development The Electronic Health Record system has the capability to increase the safety and the quality of care provided to the patients. However, the major challenge with the use of EHR is its proper use by the physicians. The integration of EHR system can impact positively in the operations of the organisation. The EHR system can increase the time efficiency of the nurses as the use of computer will reduce the documentation time. The documentation of admission information can be conducted easily. With EHR, the personal digital assistant can be used which can reduce the manual error and increase time efficiency of the nurses. The major challenges in the use of EHR system are lack of adequate knowledge by the nurses or lack of confidence to operate the device. The physicians can also increase their time efficiency with the use of EHR system. The use of bedside or point-of-care computer system can reduce the documentation time of the physicians. Moreover, the use of central station desktops is less time consuming than thee point-of-care computer system. The integration of EHR system also directly impacts on the patient care, user satisfaction, information accuracy, and completeness of data entered and the nature of workflow. However, time efficiency is the only possible impact which can be assessed. The implementation of EHR can also positively impact on the shift times and working periods. The physicians schedule can be developed accurately with the use of EHR system. The time efficiencies can be enhanced regarding the patient encounters (Poissant et al., 2005). It could be reflected that Electronic Health Record will positively impact on the quality of healthcare provided to the patients. It can reduce the time devoted to the care of each patient which can increase the efficiency of the patients. Moreover, it will also reduce the cases of negligence on the healthcare entity due to negligence. The competing healthcare organisations which are using Electronic Health Records are becoming more efficient in the patient care and have become resourceful to deal with more patients daily. The customers have become more satisfied with the services provided by the hospitals. The physicians and the administrative staff have become more time-efficient and the integration of EHR system has reduced the burnout of these employees. Outsourcing Process With the advancements in technology, the paper-based medical records are becoming obsolete. The Electronic Health Record system will allow seamless flow of information which is readily available and easy to use. However, several Electronic Health Record (EHR) systems are challenged by the lack of effective use. Moreover, the issue of selection of the most-appropriate EHR system is also a complex task. Therefore, outsourcing EHR is the best option for the healthcare organisations. In the outsourcing process, the healthcare organisations can outsource the services of data migration of Electronic Medical Records, use it a SaaS service and up-gradation of the existing EHR system. With the outsourcing activities, the healthcare organisations can increase the doctor-patient engagement in a digitally-interactive manner. The processing of the medical records of the patients, using EHR system as service and privacy and security management are approaches which can be outsources from other comp anies (Amatayakul Lazarus, 2005). All the services should be outsourced from one company so that all the services are streamlined. The services provided to the patients are entered into the system by the administrative staff. The calculation of the total cost endured by the patient can be outsourced. Moreover, the health care organisations can also produce adequate supporting documents which can speed up the reimbursement process of the organisations (Walker et al., 2006). There should be constant communication and collaboration between the administrative staff and the outsourcing personnel. Training should be provided so that the physicians remain updated with the current operational processes. The outsourcing agency should provide real-time updates to the software. Moreover, all the processing should be conducted regularly and the information should be updated in real-time (Hammaker Knadig, 2017). Privacy Considerations and Increasing Awareness The Data Protection Act (DPA) control how the personal information of an individual can be used by the business organisations or the government. In the EHR system, the data protection Act is relevant as the personal information of the patients is attained by the healthcare organisations and outsourced to the other companies. According to the data protection principles, the personal data of the individuals can be obtained for lawful purposes and should not be excessive or more than required. Moreover, the personal information of the individuals can only be outsourced to the countries which give adequate protection to the rights of personal data usage. Accordingly, the company should outsource the information processing to the companies which give adequate data protection rights. The unauthorised use of information by the healthcare personnel can adversely impact on the security of the people. Certain methods can be used such as limited accessibility and password protection to protect the information. Increasing Awareness for Business Growth and Information Investment The Electronic Health Record (EHR) system can open numerous business opportunities for the healthcare organization. The electronic health record can support the clinical care by assisting in clinical research. The EHRs have significant use in the routine clinical care of the organisation. It can also be used for secondary purposes such as clinical research, design and execution of clinical trials for new medicines. The EHR system should be used to exchange the information internationally as it ensures consistent and complete recording of clinical information (Coorevits et al., 2013). The healthcare organizations can also customize the services to increase the business efficiency. The healthcare organizations can customize electronic health record templates to increase the proficiency of the system. The companies can also implement strategies to enhance the training and development of the employees (Gardner, Pearce, 2013). The Electronic Health Records are commonly used by a large nu mber developing countries to increase the quality of health care and as they are cost-effective. However, technology can introduce certain hazards such as safety of information in the organization. The malicious elements have found it easier to breach the security of the system with the technological methods. The use of Electronic Health Records can create certain privacy issues which raises ethical concerns for the governments. Several governments have made laws to safeguard the privacy of the people whose data in stored in these electronic systems (Ozair et al., 2015). The information generated through Electronic Health Records can be used in the clinical research and mediating insurance and compensation issues. The patients past records can be used to efficiently provide treatment. It can be used to detect past allergies and reactions to certain chemicals. The information can be used by the organizations effectively by proper management of the system. The administrative staff sho uld be given training to properly manage the system. The electronic health record system should be password protected so that the unauthorized candidates cannot access the personal information of the patients (Ticher, 2008). Report findings Electronic Health Records (EHR) is a system in which the patients records are stored electronically rather than on papers. It is an efficient system and the healthcare organizations require it to reduce the manual errors, due to the illegitimacy of the writings and to reduce the consumption of the physical space. However, before the implementation of changes, the employees always resist it. It is important to bring a consensus for the change so that appropriate efforts are made for the success of the change. The management of the organization can obtain consensus from the employees by promoting the benefits of the Electronic Health Record (EHR) system with the employees. The company can also define a clear mission statement; establish open communication, transparency and feedback in the organization. After obtaining the consensus, the company should plan change by selecting appropriate change management model. The Kotters model has been selected for implementing the organization chan ge. It has been successfully used by the Northshore Hospital in Chicago to implement the Electronic Health Record (EHR) system. In this model, the change is implemented in eight phases. In the initial phase, urgency is created in the organization for the change. The management broadcast the importance of the change in the organization and motivate the employees in embracing the change. The management actively participates in the change process so that the change can be accepted easily. The Electronic Health Record (EHR) can be used to increase the efficiency of the nurses as well as the physicians. It will reduce the average reporting time of the physicians. With the enhanced services, the customers will also be satisfied with the services. In electronic Health Record system, the companies can use outsourcing to be more cost-effective. However, it is important to collaborate and communicate with the outsourcing agency for smooth functioning of the system. The companies should also b e considerate of the privacy of the users and the patients while outsourcing the work. Since the patients information is sensitive and comes under the Data Protection Act, the healthcare organization should outsource the work from the agencies which have the same data protection laws as that in the Mauritius. In addition to it, the healthcare organization should also increase the awareness regarding the business benefits of the Electronic Health Record system as it will open new business opportunities for the organization. The information obtained with the Electronic Health Record (EHR) can be used by the organization in clinical researches and eefficient management of thee insurance claims. References Amatayakul, M.K., Lazarus, S.S. (2005). Electronic Health Records: Transforming Your Medical Practice. Medical Group Management Assn. Cameron, E., Green, M. (2015). Making Sense of Change Management: A Complete Guide to the Models, Tools and Techniques of Organizational Change. Kogan Page Publishers. Coorevits, P. et al. (2013). Electronic health records: new opportunities for clinical research. Journal of International Medicine 274(6), 547-560. Edwards, J.N. (2009). NorthShore University Health System: Achieving Rapid Improvement on Core Measures. The Commonwealth Fund Case Study. 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