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Measuring Levels of Patient Dependency

Title: Should patient dependency be used to set nurse-staffing levels in general hospital wards? Introduction: In this section, we perform a literature review to discuss patient dependency in clinical settings, and examine how we can measure patient dependency levels. We also discuss whether patient dependency levels should and could form the criteria for setting nurse-staffing levels in the hospital. We will also analyze the other different methods and criteria that can help to determine nurse staffing levels within the clinical setting. Patient dependency levels indicates the requirements of nurses and the extent to which patients will need nurses for their continuous care. Nurse patient ratios are often used to discuss the nurse staffing levels and these figures indicate whether staffing levels have to be increased or decreased. We would aim our discussion of patient dependency necessitating increase in staffing levels and the patient nurse ratio as indicators of nurse staffing both within general hospital wards and at critical care and emergency units. Evidential Information Patient dependency may just form an important part of nursing staff and workload of an individual nurse. Hurst (2005) conducted an important study on the nature and value of dependency acuity quality (DAQ) demand side nursing workforce-planning methods, which are set in the context of nursing workforce planning and development. Extensive DAQ data was obtained from UK nursing workforce in 347 wards, which involved 64 high quality, and 62 low quality hospital wards. The study gives special consideration to workload and quality contexts. New insights have been generated with this study and Hurst emphasizes that poor quality care is more common in larger wards that have fluctuating and unstable workload and nurse – patient ratio. Smaller workloads having consistent and high workload of nursing staff results in inflexible nurse staffing so staff levels and performed duties remain the same. Studies definitely suggest that nursing activity and staffing differences do form an important part of defining and contributing to the quality of the wards with higher staffing levels and more consistent work for nurses at high quality wards and lower staffing levels and irregular services with low nurse-patient ratio in low quality wards. From this evidence, it is possible to provide recommendations for nursing management and practice and probe into more accurate relations of dependency acuity quality in DAQ measures. In a study using assessment of patient nurse dependency systems for determining nurse-patient ratio in the ICU and HDU, Adomat et al (2004) point out that a huge range of patient classification systems or tools are used in critical care units to inform workforce planning, and nursing workload although the application of these methods may not always be relevant, complete or appropriate. The systems or tools used for patient classification and categorization were developed solely for the purpose of more efficient distribution of patient across hospital sections, although now the same systems are used for workforce planning, distribution of workload, determining nurse-patient ratio in critical care settings. However these changes can raise a number of issues related to workforce planning, staffing levels and nursing management in general. Adomat and Hewison evaluate the three main assessment systems used in critical care units to effectively determine the necessary nurse-patient ratio that can provide the best quality service in the wards. The application of these tools is to enhance the quality of care by keeping nurse-patient ratio at its optimum. The authors suggest that decisions relating to workload planning and determining the nurse patient ratio are dependent on an understanding of the origins and purpose of the classificatory tools that categorizes patients and measures their dependency on care services. Patient dependency and classification systems as well as patient dependency scoring systems for severity of illness are measures indicating mortality and morbidity although Adomat points out that these dependency measure may not be real indicators or determinants of the nurse-patient ratio that help in measuring nursing input. The costs of providing a nursing service within critical care uses nursing intensity measures to give a framework for nursing management and patient care and also determines the exact role of patient dependency in nurse staffing levels. However, components of the nursing role and how it determines standards of care have not been fully determined (Adomat and Hewison, 2004). They point out that careful consideration of patient dependency and classification systems may be necessary to plan, organize and provide a cost effective critical care service. In a similar study, Adomat and Hicks (2003) evaluates the nursing workload in intensive care a there is a growing shortage of nurses in these care units. The problem identified in this shortage lies in the method for calculating the nurse/patient ratio using the Nurse Workload Patient Category scoring and classificatory system use in most intensive care units. The nurse-patient ratio is determined by using the patient category or dependency scales and the general assumption is that the more critically ill a patient is, the more care and nursing time will be required for the patient. Many critically ill patients placed on a high level of mechanical care such as a feeding or ventilator tube and in intensive units may however require less direct personal nursing care than patients who are self ventilating or have been considered to have lower levels of dependence. Thus patient dependence may be addressed by means other than direct nursing care and artificial care and support systems may b used instead of nursing staff. These and other factors show that patent dependency may not be a completely relevant measure for determining nurse –patient ratio or nurse staffing levels and many associate factors have to be considered. This study by Adomat and Hicks use a video recorder to document nurse activity in 48 continuous shifts within two intensive care units and helped to determine the accuracy of the Nursing Workload Patient Category scoring system to measure nurse workload. The data obtained from the video of nurse activity was then correlated with the Patient category scale score that was allocated to the patient by the nurse in charge. The results of this study showed that the nursing skills required in these care units were of low skill type despite the needs of care being complex in general. It was found that nurses spent less time with patients who were categorized as in need of intensive care than those in need and in high dependency range in all units. The findings indicate that existing nurse patient ratio classifications are inappropriate as nurses spend less and less time with critically ill patients. The authors expose the flaws of classification or scaling systems that tend to correlate care with critical illness. They suggest that radical reconsideration of nursing levels and skills mix should make it possible to increase provisions and levels of intensive care providing the right numbers of staff at the appropriate units where patients need them most suggesting more flexible and alternative approaches to the use of nurse-patient ratios. In a similar study discussing relationship between workload, skill mix and staff supervision, Tibby et al (2004) proposes a systems approach and suggests that hospital adverse events or AE are more likely when sub-optimal working conditions occur. Proper working conditions are thus absolutely necessary to ensure the smooth working of the clinical setting. Tibby and colleagues analyzed the adverse events in a pediatric intensive care unit using a systems approach and observational study to investigate the association between the occurrence of these adverse events and latent risk factors including temporal workload, supervision issues, skills mix, nurse staffing and the interactions between established clinically related risk factors (Tibby et a, 2004). The data was collected form 730 nursing shifts and the analysis was done with logistic regression modeling. The rate of adverse events was 6 for every hundred patient days and the factors associated with increased AE including day shift, patient dependency, number of occupied beds, and simultaneous management related issues although these were considerably decreased with enhanced supervisory ability of the nurses. Decreased number of adverse events have been found to be related to the presence of a senior nurse in charge, high proportion of shifts handled by rostered, trained, permanent staff and the presence of junior doctors. Patient workload factors such as bed occupancy and the extent to which the patient needs help and nursing supervisory levels and level of staffing such as presence of a senior nurse have been found to be associated. This study sheds light on the factors increasing or decreasing adverse events and helps in identifying the issues closely related to the need of regulating and optimizing nurse staffing levels. As we have already suggested through a study by Adomat and Hicks, patients in high dependency units may require more frequent nursing care and higher nurse-patient ratios than critical care units where patients may be supported by artificial methods. According to a study by Garfield et al (2000) high dependency units are increasing in the hospitals and becoming more important as part of a hospital’s facilities. Although the optimum staffing ratio for patients is unknown for such units, the Department of Health and Intensive Care Society recommend a level of one nurse for every two patients. Garfield et al recorded Therapeutic Intervention Scoring System scores and Nurse Dependency Scores in high dependency units over 7 months. The results indicated a weak correlation between nurse dependency score and therapeutic intervention scoring system score. The authors argue that a nurse-patient ratio of 1:2 may be insufficient for the management of a high dependency unit and based on their findings recommends a nurse to patient ratio of 2:3. Balogh (1992) points out that the literature on audits of nursing care shows a strong relation between the quality of nursing care provided and nursing labour force and staffing issues. Balogh suggests that all assumptions for setting nurse staffing levels on the basis of variations in patient dependency are unscientific and there are moreover no opportunities to use personal judgment in decision-making within hospitals to determine nurse-patient ratios. Balogh points out that such methods for determining staffing levels as well as audit instruments are outdated and insufficient to optimize service levels. The paper highlights the need for greater flexibility, more decision making power, and a more significant role of nurses’ personal judgment in selection and management of appropriate nurse staffing levels in dependency and critical care units. Conclusion: In this review of literature on the exact role of patient dependency in determining nurse staffing levels, we began by suggesting that it is generally believed that the more critical condition a patient is in, the higher the requirements of direct care suggesting that nurse patient ratio should be high in critical care units. This assumption however has been refuted by studies which shows that such clear criteria may not be sufficient for nurse management and staffing level decisions and other factors have to be considered. These include artificial means of life support and other mechanical devices that minimizes the need for manual staffing and reduces a critical patient’s nursing needs. A related study suggested that high dependency units rather than critical care units should be provided with higher levels of staffing although many other factors such as supervisory levels of senior nurses, skills available and already established method of determining nurse patient ratios seem to be crucial factors. Along with the approach taken by several authors we can also suggest that personal judgment of nurses on the care needed by patients rather than inflexible scaling or scoring systems should be used by hospitals to determine staffing levels, considering patient dependency levels as well. Bibliography Adomat R, Hicks C. Measuring nursing workload in intensive care: an observational study using closed circuit video cameras. J Adv Nurs. 2003 May;42(4):402-12. Adomat R, Hewison A. Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. J Nurs Manag. 2004 Sep;12(5):299-308. Ruth Balogh Audits of nursing care in Britain: A review and a critique of approaches to validating them International Journal of Nursing Studies, Volume 29, Issue 2, May 1992, Pages 119-133 The importance of data in verifying nurse staffing requirements Intensive Care Nursing, Volume 4, Issue 1, March 1988, Pages 21-23 Lynne Callaway and Edward Major Curtis C. A system of measurement of patient dependency and nurse utilization. Aust Nurses J. 1977 Apr;6(10):36-8, 42. Donoghue J, Decker V, Mitten-Lewis S, Blay N. Critical care dependency tool: monitoring the changes. Aust Crit Care. 2001 May;14(2):56-63. Garfield M, Jeffrey R, Ridley S. An assessment of the staffing level required for a high-dependency unit. Anaesthesia. 2000 Feb;55(2):137-43. Hurst K. Relationships between patient dependency, nursing workload and quality. Int J Nurs Stud. 2005 Jan;42(1):75-84. Hearn CR, Hearn CJ. A study of patient dependency and nurse staffing in nursing homes for the elderly in three Australian states. Community Health Stud. 1986;10(3 Suppl):20s-34s. Miller A. Nurse/patient dependency–is it iatrogenic? J Adv Nurs. 1985 Jan;10(1):63-9. O’Brien GJ. The intuitive method of patient dependency. Nurs Times. 1986 Jun 4-10;82(23):57-61. Prescott PA, Ryan JW, Soeken KL, Castorr AH, Thompson KO, Phillips CY. The Patient Intensity for Nursing Index: a validity assessment. Res Nurs Health. 1991 Jun;14(3):213-21. Seelye A. Hospital ward layout and nurse staffing. J Adv Nurs. 1982 May;7(3):195-201. Tibby SM, Correa-West J, Durward A, Ferguson L, Murdoch IA. Adverse events in a paediatric intensive care unit: relationship to workload, skill mix and staff supervision. Intensive Care Med. 2004 Jun;30(6):1160-6. Epub 2004 Apr 6. Williams A. Dependency scoring in palliative care. Nurs Stand. 1995 Oct 25-31;10(5):27-30. For scoring systems Depatment of health – www.dh.gov.uk Department of Health (2000) Comprehensive Critical Care; a review of adult critical care services. London. The stationary office. Its also available from the Department of health website.

Differences between styles of therapeutic relationships

In order to answer the above, I will first outline the key principles of psychodynamic and person centred counselling, next I will discuss the similarities and differences between the therapeutic relationships in the two approaches. I will then move on to highlighting the challenges that would be involved if a counsellor chose to integrate the two approaches. The Person centred approach was devised by Carl Rogers in the 1950’s (McLeod, 2004), it had emerged from the humanistic tradition. According to Mearnes and Thornes (2007) Roger’s strongly believed humans were good natured and emphasised on the notion of self actualisation, this means every person has the capacity to control and regulate themselves to reach their full potential and if they require therapy, they are in a state of incongruence (which refers to not being genuine or fully accepting themselves). It is the therapist’s role using the core conditions (congruence, unconditional positive regard and empathy) which helps to encourage the individual to reach their full potential and reflect their learning on other relationships (Mearns

Punjabi: the Culture Essay

help writing Punjabi is a specific area located in the region of five rivers. This is a particular area of Pakistan and northern India with the oldest culture which has been distributed all over the countries. Speaking about the cultural peculiarity of the place, it is important to start with the language. Frankly speaking, the place does not contain one language as there are a lot of dialects. Saraiki/Multani, Dogri and Pothohari/Pothwari are the largest accents in the rejoin, however, they are not the only and there are officially more that 20 dialects. Those who know Arabic and Persian state that Punjabi accent is a combination of those two languages. Punjab women are treated specifically as being Eastern area, the tradition and religious canons require from women specific behavior. Religious aspect is important in considering the culture of the area. Punjabi follows three main religions, Islam, Sikhism, and Hinduism. However, this is not the whole list and there are many religions which are pursued in small regions of the area. Islam, Sikhism, and Hinduism are similar religions, however, there are a lot of differences there. Marriage is not just the registration of a new family, it is a specific event which is to be followed in accordance with the cultural needs. Marriage may have differences depending on the religious peculiarities. In most cases, Punjabi marriage is full of customs and traditions which are to be followed. Even nowadays, when Western culture has penetrated into the smallest parts of the world having changed the perspectives and visions of many events, marriage in Punjabi still remains a sacred and purely traditional issue. For example, Jaggo is a specific tradition which insists on women going at night to the neighbors and waking them up, singing and dancing to them, the day before the marriage. This is like the announcement to the wedding and an invitation to it. Get your 100% original paper on any topic done in as little as 3 hours Learn More Cuisine is one more reflection of a culture. Speaking about Punjabi, the cuisine of this area is distinguished from other cultural meals by species. Punjab cuisine is very spicy. Each of the products is prepared under particular technique, therefore, the distinguishing feature is in the number and the nature of species. Many people have not got used to Punjab cuisine are unable to eat it due to pepper and other hot species, such as paper and others. Finally, speaking about Punjab culture, it is impossible to avoid cloths. The tradition of clothes is too particular. National dresses and suits for women presuppose absence of short skirts. Punjabi Salwar Kameez is one of the well-known suits for women in Punjabi culture. Even though Western culture effects Punjabi area and many cultural aspects have changed under its influence, the main characteristics of traditional Punjabi clothing has not changed. Finally, speaking about Punjabi and its culture, it should be stated that ye recent changes are connected with the intrusion of the Western culture, however, this specific are has conserved the specifics of the ancestry’s traditions and try to follow them now. Religion plays an important role in the area even though due to the lengthy territory there are three major religions in Punjabi and a number of smaller ones. Language differs as well that makes it possible for the closest regions to speak different accents and fail to understand each other.

A student is taking notes and “doodling” on a yellow note pad during a long lecture class. He covers

A student is taking notes and “doodling” on a yellow note pad during a long lecture class. He covers several pages with class notes and drawings, including one which portrays the classroom and a scene where an angry student jumps up and yells: “I can’t take it anymore!” The student in the cartoon is portrayed as firing a handgun at the boring professor. At the end of the lecture, the student crumples up the picture and throws the drawing into the trashcan. However, another student who witnessed the “doodling” pulls the picture out of the trashcan and delivers it to the professor. Should the professor report the incident to the Dean of Students? Is this a threat to the professor? What action – if any – should be taken against the student? What if the College has a “zero tolerance” policy for students who threaten professors? Post your reflection, and then comment on two of your fellow classmates’ responses as well. As always, if you have any questions, please contact me. Best wishes, Prof. Hill P.S. Remember: Again, we have plenty of time, so make sure that you have read Chapter Six (6) BEFORE responding to the case study. The biggest problem we have had so far is contributions to the discussions that have not incorporated the material from the textbook. Read the chapter, and then give a complete, comprehensive response to the issue raised in the case study, AND respond to (at least two) of the contributions of your classmates. Do not rush into this. Here is why you want to give this some time and thought: 1) The responses need to be on-time (I will accept late responses, but they are graded down); 2) The responses need to be complete, meaning they answer fully all the questions in the case study (I will accept short responses, but they are graded down); 3) You need to offer your own contribution, and then respond to the contribution of at least two classmates (if you submit only your contribution, you will be marked down for not responding to your classmates); and 4) Most importantly, you need to incorporate the lessons of the chapter into your contribution (if you offer only your moral thinking, but not how it is reflecting in the terms or concepts of the chapter, you will be marked down). The four guidelines above are not meant to be negative, but to offer you a rubric so that you know ahead of time how you will be graded.

Northern Virginia Community College Statistics Stat Crunch Project

Northern Virginia Community College Statistics Stat Crunch Project.

I’m working on a statistics project and need an explanation to help me learn.

The Database of UVA students Data for UVA students ACT Math.xlsx contains information on the undergraduate students at University of Virginia. This list contains the data for different Qualitative and Quantitative variable. Your project is to obtain the results based on the following questions using StatCrunch.Copy the StatCrunch results (graph plus answer) into your solutions documentObtain the mean and the standard deviation for ACT Math score for each class levels and interpret the results.Obtain the five number summary of ACT Math score for each class levels. Do any of these class levels have outliers? If yes, then which class level has outlier?Obtain Histogram, box plot and normal probability plot for each ACT Math score for each class level. What interpretation can you make for each of these class levels? Which one looks more approximately normal?Obtain and interpret a 95% confidence interval for the mean ACT Math score for each class level. (Note: You could use the mean and standard deviation obtained from part 1.)Requirements:Type your name/group members on your paper.Number your pages across your entire solutions document.Use complete and coherent sentences to answer the questions. Typed (10-12pt font), double-spaced, 1 inch margins.4 Generate all requested graphs using StatCrunch.Title and label all of your graphs “correctly”Discuss how has this project helped you understand the purpose and value of the study of statistics?
Northern Virginia Community College Statistics Stat Crunch Project

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