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Pressure Ulcers: Reliability of Risk Assessment Tools

Share this: Facebook Twitter Reddit LinkedIn WhatsApp The purpose of this assignment, is to identify a patient, under the care of the district nursing team, with a Grade 1 pressure ulcer, to their sacral area. To begin with, it will give a brief overview of the patient and their clinical history. Throughout the assignment the patient will be referred to as Mrs A, in order to protect the patients identity and maintain confidentiality, in accordance with the guidelines set out by the Nursing and Midwifery Council (NMC 2008). A brief description of a Grade 1 pressure ulcer will be given, along with a description of the steps taken in assessing the wound, using The Waterlow Scale (1985). This assignment will discuss the literature review that was carried out, along with other methods of research used, to gather vital information on wound care , such as the different classifications of wounds and the different risk assessment tools available. This assignment, will include brief overviews, of some the other commonly used pressure ulcer risk assessment tools, that are put to use by practitioners and how they compare to the Waterlow Scale. This assignment will also seek to highlight the importance of using a combination of clinical judgement, by carefully monitoring the patients physical and psychological conditions, alongside the ‘at risk’ score calculated from the Waterlow Scale, in order to deliver holistic care to the patient. Mrs A is a 84 year old lady who has been referred to the district nurses by her General Practitioner, as he has concerns regarding her pressure areas . Following a recent fall she lost her confidence and is now house bound. She now spends more time in her chair as she has become nervous when mobilising around the house and in her garden. She has a history of high blood pressure and occasional angina for which she currently takes Nicorandil 30mg b.d. as prescribed by her General Practitioner , Nicorandil has been recognised as an aetiological aspect of non – healing ulcers and wounds (Watson, 2002), this has to be taken into consideration during the assessment and throughout the management of her wound. Mrs A has no history of previous falls or problems with her balance. She has always been a confident and independent lady, with no current issues surrounding continence or diet. She has always enjoyed a large network of friends who visit her regularly. It is recommended by National Institute for Health and Clinical Excellence (NICE) that patients should receive an Initial assessment (within the first 6 hours of inpatient care) and ongoing risk assessments and so referrals of this nature are seen on the day, if it is received if not within 24 hrs. In order to establish Mrs A’s current risk of developing a pressure area, an assessment must take place. An initial holistic assessment, looking at all contributing factors such as mobility, continence and nutrition will provide a baseline that will identify her level of risk as well as identifying any existing pressure damage. A pressure ulcer is defined as, a localised injury to the skin and / or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing, or confounding factors, are also associated with pressure ulcers. According to the European Pressure Ulcer Advisory Panel (EPUAP 2009), the significance of these factors, is yet to be elucidated. Mrs A is more vulnerable to pressure damage, as her skin has become more fragile and thinner with age (NICE 2005). There are risk factors associated to the integrity of the patient’s skin and also to the patients general health. Skin that is already damaged, has a higher incidence of developing a pressure ulcer, than that of healthy skin. Skin that becomes too dry, or is more moist due to possible incontinence, is also at higher risk of developing a pressure ulcer than healthy skin. An elderly person’s skin is at increased risk, because it is more fragile and thinner than the skin of a younger person. Boore et al (1987) identified the following principles in caring for the skin to prevent pressure damage, skin should be kept clean and dry and not left to remain wet. The skin should also not be left to dry out to prevent any accidental damage . Due to Mrs A spending more time sitting in her chair, she has become at a higher risk of developing a pressure sore, as she is less mobile. The reason being It becomes difficult for the blood to circulate causing a lack of oxygen and nutrients to the tissue cells. Furthermore, the lymphatic system also begins to suffer and becomes unable, to properly remove waste products. If the pressure continues to increase and is not relieved by equipment or movement. The cells can begin to die, leaving an area of dead tissue resulting in pressure damage. Nelson et al (2009) states, pressure ulcers can cause patients functional limitations, emotional distress, and pain for persons affected. The development of pressure ulcers, in various healthcare settings, is often seen as a reflection of the quality of care which is being provided (Nakrem 2009). Pressure ulcer prevention is very important in everyday clinical practise, as pressure ulcer treatment is expensive and factors such as legal issues have become more important. EPAUP (2009) have recommended strategies, which include frequent repositioning the use of special support surfaces, or providing nutritional support to be included in the prevention. In order to gather evidence based research, to support my assignment. I undertook a literature review of the Waterlow Scale and Classifications of Grade 1 pressure sores. The databases used were the Culmulative Index to Nursing and Allied Health Literature (CINAHL) and OpenAthens. I used a variety of search terms including ‘pressure sores’, ‘Grade 1 classification’, ‘Waterlow Scale’, and ‘How pressure sore risk assessment tools compare’. Throughout the literature review the information was gathered from sources using a date range between the years of 2000 – 2011, although some references were found from sources of information that are from a much later date. This method of research ensured a plethora of articles and guidelines were collated and analysed. The trust guidelines in wound care were used, to show how we implement theory into practise in the community, using the wound care formulary. There was a vast amount of information available, as pressure area care is such a broad subject. The search criteria had to be narrowed down, in some cases to ensure the information gathered was relevant and not beyond the scope of the assignment. The evidence used throughout this assignment, is based on guidelines and recommendations given by NICE (2001), EPUAP (2001) and articles sourced from The Journal of Community Nursing (JCN). This was the most accurate information and guidance on pressure ulcer classifications and assessment although, some articles may not have been the most recent. The assessment tool used throughout my area of work, is the Waterlow Scale. The Waterlow Scale was developed by Judy Waterlow in 1985, while working as a clinical nurse teacher. It was originally designed for use by her student and is used to measure a patient’s risk of developing a pressure sore. It can also be used as a guide, for the ordering of effective pressure relieving equipment. All National Health Service (NHS) trusts have their own pressure ulcer prevention policy, or guidelines and practitioners are expected to use the risk assessment tool, specified in their trust’s policy. NICE (2003), guidance states, that all trusts should have a pressure ulcer policy, which should include a pressure ulcer risk assessment tool. However, it reminds practitioners that the use of risk assessment tools, should be thought of as an aid to the clinical judgement of the practitioner. The use of the Waterlow tool enables, the nurse to assess each patient according to their individual risk of developing pressure sores (Pancorbo-Hidalgo et al 2006). The scale illustrates a risk assessment scoring system and on the reverse side, provides information and guidance on wound assessment, dressings and preventative aids. There is information regarding pressure relieving equipment surrounding, the three levels of risk highlighted on the scale, and also provides guidance, concerning the nursing care given to patients. Although the Waterlow score is used in the community setting, when calculating the risk assessment score, it is vital that the nurse is aware of the difference in environment the tool was originally developed for. The tool uses a combination of core and external risk factors that contribute to the development of pressure ulcers. These are used to determine the risk level for an individual patient. The fundamental factors include disease, medication, malnourishment, age, dehydration / fluid status, lack of mobility, incontinence, skin condition and weight. The external factors, which refer to external influences which can cause skin distortion, include pressure, shearing forces, friction, and moisture. There is also a special risk section of the tool, which can be used if the patient is on certain medication or recently had surgery. This contributes to a holistic assessment of a patient and enables the practitioner to provide the most effective care and appropriate pressure relieving equipment. The score is calculated, by counting the scores given in each category, which apply to your patient’s current condition. Once these have been added up, you will have your ‘at risk’ score. This will then indicate the steps that need to be taken, in order to provide the appropriate level of care to the patient. Identification of a patients risk of developing a pressure sore is often considered the most important stage in pressure sore prevention (Davis 1994). During the assessment a skin inspection takes place of the most vulnerable areas of risk, typically these are heels, sacrum and parts of the body, where sheer or friction could take place. Elbows, shoulders, back of head and toes are also considered to be more vulnerable areas (NICE 2001). When using the Waterlow tool to assess Mrs A’s pressure risk, I found she had a score of 9. According to the Waterlow scoring system she is not considered as being at risk as her score is less than 10. As I had identified in my assessment, she had a score of 2, for her skin condition due to Grade 1 pressure ulcer to her sacrum. I felt it necessary, to highlight her as being at risk. A grade 1 pressure ulcer on her sacral area, maybe due to her recent loss of confidence and reduced mobility which has left Mrs A spending more time in her chair. Pressure ulcers are assessed and graded, according to the degree of damage to the tissue. The National Pressure Ulcer Advisory Panel (NPUAP), classifies pressure ulcers based on the depth of the wound. There are four classifications (Category/Stage I through IV) of pressure damage. In addition to these, two other categories have been defined, unstageable pressure ulcers and deep tissue injury (EPUAP, 2009) Grade 1 pressure damage is defined, as a non-blanchable erythema of intact skin. Indicators can be, discolouration of the skin, warmth, oedema, induration or hardness, particularly in people with darker pigmentation (EPUAP, 2003). It is believed by some practitioners, that blanching erythema indicates Grade 1 pressure damage (Hitch 1995) although others suggest that, Grade 1 pressure damage is present, when there is non-blanching erythema (Maklebust and Margolis, 1995; Yarkony et al, 1990). The majority of practitioners, agree that temperature and colour play an important role, in identifying grade 1 pressure ulcers (EPUAP, 1999) and erythema, is a factor in almost all classifications (Lyder, 1991). The pressure damage usually occurs, over boney prominences (Barton and Barton 1981). The skin in a Grade 1 pressure ulcer, is not broken, but it requires protection and monitoring. At this stage, it will not be known how deep the pressure damage is, regular monitoring and assessment is essential. The pressure ulcer may fade, but if the damage is deeper than the superficial layers of the skin, this wound could eventually develop into a much deeper pressure ulcer over, the following days or weeks. A Grade 1 pressure ulcer, is classed as a wound and so I have commenced a wound care plan and also a pressure area care plan. I will also ensure, Mrs A has regular pressure area checks in order to prevent the area breaking down. The pressure area checks will take place weekly until the pressure relieving equipment arrives, this will then be reduced to 3 monthly checks. Dressings can be applied to a Grade 1 pressure ulcer. They should be simple and offer some level of protection. Also, to prevent any further skin damage a film dressing is often used, or a hydrocolloid to protect the wound area (EPAUP, 2009) . These dressings will assist in reducing further friction, or shearing, if these factors are involved. It is considered the best way to treat a wound, is to prevent it from ever occurring. Removing the existing external pressure, reducing any moisture, which can occur if the patient is incontinent and employing pressure relief devices, may contribute to wound healing. Along with adequate nutrition, hydration and addressing any underlying medical conditions. The advice given to practitioners, on the reverse of the Waterlow tool is to provide a 100mm foam cushion, if a patients risk score is above 10. As Mrs A has an ‘at risk’ score of 9, with a Grade 1 pressure sore evident, I feel it appropriate to provide the pressure relieving mattress and cushion to prevent any further pressure damage developing. All individuals, assessed as being vulnerable to pressure ulcers should, as a minimum provision, be placed on a high specification foam mattress with pressure relieving properties (NICE, 2001). As I am providing a cushion and a mattress, it is not felt necessary to apply a dressing at this point. However, the area will need regular monitoring, as at this stage it is unknown how deep the pressure damage is. If proactive care is given in the prevention and treatment of pressure ulcers, with the use of risk assessments and providing pressure relieving resources, the pressure area may resolve. Pressure ulcers can be costly for the NHS, debilitating and painful for the patient. With basic and effective nursing care offered to the patients, this can often be the key to success. Bliss (2000) suggests that the majority of Grade I ulcers heal, or resolve without breaking down if pressure relief is put into place immediately. However, experiences in a clinical settings supports observations, that non-blanching erythema can often result in irreversible damage (James, 1998; Dailey, 1992). McGough (1999) during a literature search, highlighted 40 pressure ulcer risk assessment tools, but not all have be considered suitable, or reliable for all clinical environments. As there are many different patient groups this often results in a wide spectrum of different patient needs. The three most commonly used tools in the United Kingdom (U.K.) are, The Norton scale, The Braden Scale and The Waterlow Scale. The first pressure ulcer risk assessment tool was the Norton scale. It was devised by Doreen Norton in 1962. The tool was used for estimating a patient’s risk for developing pressure ulcers by giving the patient a rating from 1 to 4 on five different factors. A patients with a score of 14 or more, was identified as being at high risk. Initially, this tool was aimed at elderly patients and there is little evidence from research gathered over the years, to support its use outside of an elderly care setting. Due to increased research over the years, concerning the identification and risk of developing pressure ulcers, a modified version of the Norton scale was created in 1987. The Braden Scale was created in the mid 1980’s, in America and based on a conceptual schema of aetiological factors. Tissue tolerance and pressure where identified, as being significant factors in pressure ulcer development. However, the validity of the Braden Scale is not considered to be high in all clinical areas (Capobianco and McDonald, 1996). However, EPAUP (2003) state The Braden Risk Assessment Scale is considered by many, to be the most valid and reliable scoring system for a wide age range of patients. The Waterlow Scale, first devised in 1987, identifies more risk factors than the Braden and the Norton Scale. However, even though it is used widely across the U.K., it has still be criticised for its ability to over predict risk and ultimately result in the misuse of resources (Edwards 1995; McGough, 1999). Although there are various tools, which have been developed to identify a patients individual risk, of developing pressure sores. The majority of scales have been developed, based on ad hoc opinions, of the importance of possible risk factors, according to the Effective Healthcare Bulletins (EHCB, 1995). The predictive validity of these tools, has also been challenged (Franks et al, 2003; Nixon and Mc Gough, 2001) suggesting they may over predict the risk, incurring expensive cost implications, as preventative equipment is put in place, when it may not always be necessary. Or they may under predict risk, so that someone assessed as not being at high risk develops a pressure ulcer. Although the Waterlow scoring system, now includes more objective measurements such as Body Mass Index (BMI) and weight loss after a recent update. It is still unknown, due to no published information, whether the inter-rater reliability of the tool, has been improved by these changes. It has been acknowledged, that this is a fundamental flaw of these tools and due to this clinical judgement, must always support the decisions made by the results, of the risk assessment. This is clearly recognised by NICE, as they advise their use as an aide-mémoire (2001). The aim of Pressure ulcer risk assessment tools, is to measure and quantify pressure ulcer risk. To determine the quality of these measurements the evaluation of validity and reliability would usually take place. The validity and reliability limitations, of pressure ulcer risk tools are widely acknowledged. To overcome these problems, the solution that is recommended is to combine the scores of pressure ulcer risk tools, with clinical judgment (EPAUP 2009). This recommendation, which is often seen in the literature, unfortunately is inconsistent as Papanikolaou et al (2007) states: “If pressure ulcer risk assessment tools have such limitations, what contribution can they make to our confidence in clinical judgment, other than prompting us about the items, which should be considered when making such judgments?”. Investigations of the validity and reliability, of pressure ulcer risk tools are important, in evaluating the quality, but they are not sufficient to judge their clinical value. In the research of pressure ulcer tools, there have been few attempts made to compare, the different pressure ulcer risk assessment strategies. Referring to literature until 2003, Pancorbo – Hidalgo et al (2006) identified three studies, investigating the Norton scale compared to clinical judgment and the impact on pressure ulcer incidence. From these studies, it was concluded that there was no evidence, that the risk of pressure ulcer incidence was reduced by the use of the risk assessment tools. The Cochrane review (2008), set out to determine, whether the use of pressure ulcer risk assessment , in all health care settings , reduced the incidence of pressure ulcers. As no studies met the criteria, the authors have been unable to answer the review question. At present there is only weak evidence to support the validity, of pressure ulcer risk assessment scale tools and obtained scores contain varying amounts of measurement error. To improve our clinical practise, it is suggested that although tools such as the Waterlow Scale are used to distinguish a patients pressure ulcer risk, other investigations and tests, may need to be carried out to ensure a effective assessment is taking place. Practitioners may consider, various blood tests and more in depth history taking, including previous pressure damage and medications. Patients lifestyle and diet should also be taken into consideration and where appropriate, a nutritional assessment should be done if recent weight loss, or reduced appetite is evident. Nutritional assessment and screening tools are being used more readily and appear to be becoming more relevant in managing patients who are at risk of or have a pressure ulcer. The assessment tools should be reliable and valid, and as discussed previously with other risk assessment tools they should not replace clinical judgement. However, the use of nutritional assessment tools can help to bring the nutritional status of the patient to the attention of the practitioner, they should then consider nutrition when assessing the patients vulnerability to pressure ulcer development. The nutritional status of the patient should be updated and re-assessed at regular intervals following a assessment plan which is individual to the patient and includes an evaluation date. The condition of the individual will then allow the practitioner to decide how frequent the assessments will occur. The EPUAP (2003) recommends that as a minimum, assessment of nutritional status should include regular weighing of patients, skin assessment, documentation of food and fluid intake. As Mrs A currently has a balanced diet, it is not felt necessary to undertake, a nutritional assessment at this point. Her weight can be updated on each review visit, to assess any weight loss during each visit. If there is any deterioration in her condition, an assessment can be done when required. Continence should also be taken into consideration and where necessary a continence assessment should take place. Incontinence and pressure ulcers are common and often occur together. Patients who are incontinent are generally more likely to have difficulties with their mobility and elderly, both of which have a strong association with the development of pressure ulcers (Lyder, 2003). The education of staff, surrounding pressure ulcer management and prevention, is also very important. NICE (2001) suggest, that all health care professionals, should receive relevant training and education, in pressure ulcer risk assessment and prevention. The information, skills and knowledge, gained from these training sessions, should then be cascaded down, to other members of the team. The training and education sessions, which are provided by the trust, are expected to cover a number of topics. These should include, risk factors for pressure ulcer development, skin assessment, and the selection of pressure equipment. Staff are also updated on policies, guidelines and the latest patient educational information (NICE 2001). Education of the patient, carers and family, is essential in order to achieve optimum pressure area care. Mrs A is encouraged to mobilise regularly, in order to relieve the pressure as a Grade 1 pressure sore has been identified, she is at a significant risk of developing a more severe ulcer. Interventions to prevent deterioration, are crucial at this point. It is thought, that this could prevent the pressure sore from developing into a Grade 2 or worse. NICE (2001) have suggested, that individuals vulnerable to or at elevated risk of developing pressure ulcers, who are able and willing, should be informed and educated about the risk assessment and resulting prevention strategies. NICE have devised a booklet for patients and relatives, called Pressure Ulcers – Prevention and Treatment (NICE Clinical Guidance 29), which gives information and guidance on the treatment of pressure ulcers. It encourages patients to check their skin and change their position regularly. As a part of good practise, this booklet is given to Mrs A at the time of assessment, in order for her to develop some understanding of her pressure sore. This booklet is also given to the care givers or relatives so they can also gain understanding, regarding the care and prevention, of her pressure ulcer. An essential part of nursing documentation, is care planning. It demonstrates the care, that the individual patient requires and can be used to include patients and carers or relatives in the patients care. Involvement of the patient and their relative, or carer is advisable, as this could be invaluable, to the nurse planning the patient’s care. The National Health Service Modernisation Agency (NHSMA 2005) states clearly that person – centred care is vital and that care planning involves negotiation, discussion and shared decision – making, between the nurse and the patient. There were a number of improvements that I feel could have been made to the holistic care of Mrs A. I feel that one of the fundamental factors that needed to be considered , were the social needs of the patient. As I feel they are a large contributing factor, towards why the patient may have developed her pressure sore. The patient was previously known to be a very sociable lady, who gradually lost her confidence, resulting in her not leaving the house. There are various schemes and services available, which are provided by the local council or volunteer services, to enable the elderly or people unable to get around. For example, an option which could of been suggested to Mrs A are services such as Ring and Ride, or Werneth Communicare. Using these services or being involved in these types of schemes, may have empowered Mrs A to leave the house on a more regular basis. This would enable her to build up the confidence, she lost following her fall. This would have also lead to positive impact on the patient’s psychological care, as Mrs A would have been able to overcome her fears of leaving the house, enabling her to see friends and gain communications lost. As previously mentioned in this assignment, although Mrs A had a score of 9, which is not considered an ‘at risk’ score. I still felt it necessary to act on this score, even though the wound was a not considered to be critical. If it is felt the patient is at a higher risk than that shown on the assessment tool, the practitioner should use their clinical judgement, to make crucial care decisions. It should also be considered, by the practitioner that risk assessment tools such as The Waterlow scale, may not have been developed, for their area of practise. Throughout the duration of Mrs A’s wound healing process, a holistic assessment of her pressure areas and general health assessment were carried and all relevant factors, were taken into consideration. The assessment tool used to assess her pressure areas, is the most common tool used currently in practise and the tool recommended by the Trust. To conclude, there is evidence to prove that pressure ulcer risk assessment tools are useful, when used as a guide for the procurement of equipment. However, they cannot be relied upon solely to provide holistic care to a patient. It has been highlighted, that to ensure a holistic assessment of patients, it is necessary to complete a variety of assessments, to create a complete picture. Although The Waterlow scale covers a number of factors that need to be considered, throughout the assessment, it has become evident that the ‘at risk’ score, can often be over or under scored depending on the practitioner. Clinical judgement has proved to be, a very important aspect of pressure ulcer prevention and treatment. The education of the patient, carer and relatives has also been highlighted, as an important aspect of care. Empowering the patient with information regarding their illness, may decrease the healing time and help prevent has further issues. Share this: Facebook Twitter Reddit LinkedIn WhatsApp
University of Central Florida Environmental Beliefs and Psychology Essay.

Hello, I just sent you besides this question Another question that is the discussion prompt I need these 2 By tomorrow can you make it? Thank you so much oh this one is to talk a little bit about me I know you have a lot of clients but I am the one from Brazil who studied psychology there and graduated there and moved here to the US seven years ago and I’m starting over psychology here too.I am 36 years old and have a daughter that’s is nine My father is American in my mothers from the brazil just so you have some info on me I live in Orlando FloridaYour professor and fellow students would like to know something about you. Please read your professor’s biography and post your personal biography information by answering the following questions.Describe one significant environmental or behavioral issue during your growing up years that has affected your behavior or choices as an adult.How do your beliefs about behavioral or environmental influences relate to the subject of psychology?If you could change one thing about yourself, what would you change?
University of Central Florida Environmental Beliefs and Psychology Essay

Psychology homework help. Topic: MBA executive / Project Management / formative responce,Task:,Please ensure that you provide formative feedback on this student paper., Take following aspects out of the assignment and highlight these:, 1. I agree in theory and studying the aspect of project management based on literature and peer-viewed articles. Especially tools need to be understood on a high level., 2. Highlight the importance of analysis and PM-tools: GANTT, PERT, CPA (critical path analysis) and others. Name benefits for a project manager to use these. But name also the risks likewise if these tools and the estimations of this are not supported by the team, experts and stakeholders., 3. To get the right estimations it needs “transformational leadership” and “open communication”. This to followers but also to the project board. A project information system seems to be a good tool to secure this.,500 words, formative feedback, stay academic on a high level., Use peer-viewed articles only!, ,Personal  strategy  and  approach   For  me  I  think  that  the  focus  of  a  project  manager  should  be  to  get  the  job  done  (Meredith  &  Mantel,   2014),  to  make  a  success  of  the  project.  However  since  each  project  is  by  definition  unique  (Meredith   &  Mantel,  2014),  the  strategy  of  how  to  achieve  this  will  depend  on  the  project  type.  When  I’m   reading  about  the  interpersonal  leadership  skills  (Meredith  &  Mantel,  2014)  then  I  think  that  I’ve  a   problem-­‐solver  orientation,  I’m  usually  optimistic  although  from  time  to  time  you  need  also  to  be   realistic.  And  I’ve  also  a  can-­‐do  attitude.   I  think  that  critical  success  factor  of  a  project  is  acquiring  enough  adequate  resources  (Meredith  &   Mantel,  2014).  What  I  like  to  do  is  adding  some  extra  resource  budget  for  when  “Murphy’s  law”  is   encountered  in  the  project.  To  resolve  the  ethical  question  about  adding  extra  time,  I  would  add  the   extra  time  as  an  extra  item  of  a  Gantt  chart.  This  way  it  isn’t  hidden.   In  my  sector,  IT  sector,  I’m  seeing  more  and  more  that  projects  are  working  with  a  virtual  team.  I   agree  with  Furst  et  al  (2004)  that  even  for  virtual  teams  it’s  very  good  if  they’re  seeing  each  other   occasionally  face-­‐to-­‐face.  An  advantage  of  that  it’s  good  to  “break  the  ice”  and  to  establish  lines  of   communication  (Furst  et  al,  2004).  Being  cultural  sensitive  is  also  an  important  aspect  if  your  project   has  to  deal  with  cultural  differences.  A  critical  aspect  that  shouldn’t  be  overlooked  in  cultural   differences  are  languages  (Meredith  &  Mantel,  2014).  In  my  current  project  we’ve  a  project  team   consisting  of  both  French  and  Dutch  speaking  team  members  and  that  brings  along  certain  extra   challenges.   For  me  by  following  this  MBA  I  wish  to  acquire  a  better  theoretical  knowledge  so  that  I  understand   better  “how”  and  “why”  things  in  businesses  are  done  the  way  they’re  done.  The  knowledge  I’m   seeing  in  this  module  is  immediately  useful.  It’s  making  me  reflecting  why  some  projects  I  participated   in  were  a  success  or  a  failure.  By  better  understanding  this  I  hope  that  I  can  get  more  projects  where   I’m  participating  in  towards  a  success.   Experience   I  think  that  the  most  effective  way  to  learn  about  leadership  is  to  be  in  a  leaderships  role.  Years  ago  I   started  playing  a  MMORPG  and  I  joined  a  guild  and  a  few  months  later  I  became  guild  leader.  In  that   function  I  could  practice  my  leadership  skills  and  I  learned  a  lot  about  leadership.  Currently  I’m   working  project  based  and  usually  I’m  a  team  member  but  sometimes  I’m  also  project  leader  and  I   must  say  the  skills  I  learned  from  my  MMORPG  guild  leadership  are  helping  me  as  a  project  leader.   IBM  is  also  interested  in  those  virtual  worlds  to  see  how  they  can  help  with  training  leadership  skills   and  what  can  be  learned  from  virtual  economies  (Yee,  2006).  For  me  being  a  leader  in  a  MMORPG   certainly  helped  me  in  getting  experience  and  practicing  my  leading,  negotiations  and  communication   skills.   In  my  experience  communication  is  a  very  important  critical  success  factor  and  therefore  in  the  where   I  was  project  leader  I  tried  to  establish  a  good  communication  with  both  the  team  members  and  other   stakeholders.”   References   Furst,  S.A.  &  Reeves,  M.  &  Rosen,  B.  &  Blackburn,  R.S.  (2004)  ‘Managing  the  life  cycle  of  virtual   teams’,  Academy  of  Management  Executives,  18  (2),  pp.  6-­‐20.   Meredith,  J.R.  &  Mantel,  S.J.  (2014)  Project  management  –  a  managerial  approach.  9th  ed.  New  York:   John  Wiley  &  Sons., Yee,  N.  (2006)  The  Daedalus  project  –  Seriosity/IBM  Report  on  the  Future  of  Leadership,Project management is a wide field that concerns how various undertakings of any given functions should be carried out or be executed. The theory of studying various aspects of project management that is based on literature and peer-viewed articles is critical. This makes sure that various researchers who are being given the responsibility of project management attain the necessary information regarding the implementation and application of any new idea that is generated from those sources (‘Index of 2013 Project Management Journal Papers and Authors’, 2014, p. 87)., The presence of peer viewed articles plays a critical role ensuring that the success of any given project undertaking is arrived at. The presence of peer reviewed articles leads to the project having good consultation forums that are intended to ensure that the project goals and objectives are attained at any given time. The tools that are needed in the aspect of project management are critical since they guide the project managers and other stakeholders in ensuring that the decisions that are made fit the aims and goals of the project. In addition to that, tools for project management are significant as they help the success of the project and also provide extra information that the project may require at any given time of the project undertaking (Patel, 2008, p. 88)., In project management is an important to have various tools such as Gantt charts that are used in ensuring that there is good management of time. In any given project management, it is important to have good time management apparatus that are used to ensure that various stakeholders. The program evaluation and review technique which is commonly regarded as PERT.PERT is a statistical tool that is used in project management which was specifically designed for analyzing various tasks that are involved in the completion of any given project undertaking. The tool was initially developed by United States Navy in conjunction with critical path method CPM.PERT is an approach that is used to analyze tasks and necessary time to complete every task. On the other hand, CPA is a tool that is widely used in a project (Ponnappa, 2014). Management functions that use network analysis to assist project administrators to handle complex and time sensitive operations. All these tools are critical since they ensure that the project time and guidelines that are required to complete all tasks are required to complete any given task (Hyväri, 2006)., Project information tool is an important component of enhancing various forms of communication and leadership skills that every project team must possess. Good forms of communication in ensuring that all the important forms of communication are passed between various members of any given project. Project information systems are also critical since they store various forms of decisions in the form of metadata. Data warehousing is a form of an element that is found in decision support systems that assist the managers in making various decisions concerning the project (‘Recognizing excellence in project management research’, 2015,p.99). In terms of communication, project information systems play a vital role in ensuring that various forms of data is passed and processed as per the requirements of any given undertaking. As far as transformation and leadership qualities are concerned it becomes easy to have these details being performed more effectively due to the process of having well-functioning project information system. This is because project information system plays an important role in ensuring that every given form of data is preserved and used as per its purpose in the project (Sankaran, 2014, p .88)., , ,References List,Hyväri, I. (2006). Project management effectiveness in project-oriented business organizations. ,International Journal Of Project Management,, ,24,(3), 216-225. doi:10.1016/j.ijproman.2005.09.001,Index of 2013 Project Management Journal Papers and Authors. (2014). ,Project Management Journal,, ,45,(1), 88-89. doi:10.1002/pmj.21384,Mehta, R. (2007). ,Project management,. Jaipur: Aavishkar Publishers.,Patel, V. (2008). ,Project management,. Jaipur, India: Oxford Book Co.,Ponnappa, G. (2014). Project Stakeholder Management. ,Project Management Journal,, ,45,(2), e3-e3. doi:10.1002/pmj.21400,Recognizing excellence in project management research. (2015). ,International Journal Of Project Management,. doi:10.1016/j.ijproman.2015.03.011,Sankaran, S. (2014). Editorial. ,Organisational Project Management,, ,1,(1). doi:10.5130/opm.v1i1.3934, ,Psychology homework help

HCM481 Colorado State Dave Foundation Hospital Strategic Business Plan Paper Infographic

HCM481 Colorado State Dave Foundation Hospital Strategic Business Plan Paper Infographic.

Stand-Alone Hospital or Another Healthcare OrganizationFor this project, you are to evaluate an existing strategic initiative, or program (e.g., addition of a hospital wing, opening of a new location, closing of an existing branch) for an actual/real stand-alone hospital or other independent healthcare organization (you may select a hospital, large medical group, nursing home, or an ambulatory care facility) within your community.For the purpose of the assignment, assume that you are the Director of Strategic Planning for this organization, and the CEO has assigned you the responsibility for assessing (1) where the program is in its life cycle and (2) making an informed decision as to the best way forward strategically; i.e., should the organization expand the program, continue the current strategy it employs, change certain aspects of operational strategy, fully maintain the program as is, merge the program with an existing one, or close the program? The summary of your assessment will be presented to the Board of Directors, CEO, COO, and CFO.Write a paper that proposes the process you would implement for assessing this project.The paper should include the following:Executive SummaryIntroduction:A brief description of the current program.Alignment with the organization’s mission, vision, and goals that support the project.Assessment: An evaluation of various factors that affect the feasibility and project development.Justification for the project via a robust assessment of the internal and external environment, using at least two tools discussed in our course; such as SWOT+PEST, Five Forces, BCG, etc.Consideration of organizational restrictions and constraints, mission, vision, values, capabilities, strengths, and weaknesses.Consideration of organizational issues, context, and multiple perspectives and dimensions are considered.Implementation: Provide a summary of your recommendations and strategies for implementation.Realistic strategies and tactics identified with sufficient detail.Articulates the who, what, when, where, and why.Considers organizational restrictions and constraints, mission, vision, values, capabilities, strengths, and weaknesses.Relevant forces are adequately considered.Program Evaluation: A brief discussion of how you will evaluate and benchmark the project post-implementation.Specifies measures that would be tracked and trended post-implementation to ensure the action was effective and efficient.Organizational issues, context, and multiple perspectives and dimensions are considered.Infographic depicting the various strategic development stages you will employ, as learned in Module 5Conclusion: This brief summary should pull together your assessment and recommendations and leave the audience with a clear sense of your results and the next steps in light of the overall vision of the organization.The paper should be:8-12 pages (not including the required cover and reference pages),Be supported with a minimum of seven recent (within the past three to six years), scholarly sources to substantiate your position in the matter,Be formatted according to the CSU-Global Guide to Writing and APA (Links to an external site.)Links to an external site., andThe Infographic should be on one page. It should have notes within or an addendum highlighting the various aspects of strategic analysis that you undertook.
HCM481 Colorado State Dave Foundation Hospital Strategic Business Plan Paper Infographic

TCC Martin Robinson Delanys Advice to Former Slaves Analytical Review

essay writing help TCC Martin Robinson Delanys Advice to Former Slaves Analytical Review.

Here is my rubric and instructions. I also will send the links for the primary source documents when this gets assigned. PSA RubricEssay Format:1000 word minimum.1-inch margins all around. 12-point font.Times New Roman.Double-spaced.MLA Citation.Ex: “Insert quote here” (King 14). Header example: Only on first pageYour NameMy NameHIST 1301DateTitle of EssaySuggestive Approach:First:Select any document from the link labeled Primary Source Analysis Documents located on blackboard. You are to write an analysis of this document. It is part informative but more analytical. Intro:When trying to develop the structure for an essay always understand the importance and purpose of an introduction. The introduction should provide any background information that sets the stage for you to introduce your thesis statement. The thesis should address the purpose of your paper and outline body paragraphs. If you are answering a question you should address that question entirely. Your thesis usually concludes your introduction. Body Paragraphs:When it comes to developing your body paragraphs it is important to think about the context in which your document was written. What was going on in America at that time? Why was it written? By whom? What does the document actually say? Who was the intended audience? What was the intention/goal(s) of the document? What was achieved? What did you find important about the document? Was there anything left unsaid or do you have any questions for the author? Use information from your textbook, notes, and of course direct evidence from document, because this is supposed to be a primary source analysis. Outro:The purpose of a conclusion for this course will be to actually conclude something. Simply restating your thesis or rephrasing your essay in four sentences or less is redundant. Do not do this. I want you to actually provide conclusive analysis based on the evidence that you have documented throughout your body paragraphs. Some of the questions posed in the “body paragraphs” section could be used to structure your conclusion around. You have to submit the paper electronically (I will not accept a hard copy under any circumstances). You will need to establish an account/profile with Turnitin.com. If you have never used Turnitin before, on their login page there is a hyperlink which asks, “Would you like to create your user profile?” Click on it and follow the directions. Do Not Copy and Paste your paper. You must UPLOAD it. Primary Source Documents- A Great Difference Between Red and White: Red Jacket, Iroquois (1805)- Brief Account of the Devastation of the Indies: Bartoleme de Las Casas (1542)- David Walker’s Appeal: David Walker (1830)- Dispatch on Texas Colonists: Miguel Barragan (1835)- Narrative of the Life of Frederick Douglass: Frederick Douglass (1845)- Understanding Power: Noam Chomsky- Disaffection in the South During the Civil War: Various Authors (1864-1865)- Letter to Thomas Jefferson: Benjamin Banneker (1791)- Advice to Former Slaves: Martin Delany (1865)- Not Christianity, but Priestcraft: Lucretia Mott (1854)- A Plea for the Oppressed: Lucy Stanton (1850)- Letter to President Washington: Big Tree/Cornplanter/Half-Town (1790)- Samuel Drowne’s Testimony on the Boston Massacre: Samuel Drowne (1770)- A Narrative of Some of the Adventures, Dangers, and Sufferings of a Revolutionary Soldier: Joseph Plumb Martin (1830)- On the Duty of Civil Disobedience: Henry David Thoreau (1849)- Tecumseh’s Speech to the Osages: Tecumseh (1811-1812)- The Cherokee Removal Through the Eyes of a Private Soldier: John G. Burnett (1890)- Common Sense: Thomas Paine- John Brown’s Last Speech: John Brown
TCC Martin Robinson Delanys Advice to Former Slaves Analytical Review

MGT 322 SEU Enterprise Resource Planning & Supply Chain MGT FLYNAS Airline Case

MGT 322 SEU Enterprise Resource Planning & Supply Chain MGT FLYNAS Airline Case.

The Assignment must be submitted on Blackboard (WORD format only) via allocated folder.Assignments submitted through email will not be accepted.Students are advised to make their work clear and well presented, marks may be reduced for poor presentation. This includes filling your information on the cover page.Students must mention question number clearly in their answer.Late submission will NOT be accepted.Avoid plagiarism, the work should be in your own words, copying from students or other resources without proper referencing will result in ZERO marks. No exceptions. All answered must be typed using Times New Roman (size 12, double-spaced) font. No pictures containing text will be accepted and will be considered plagiarism).undefinedwithout this cover page
MGT 322 SEU Enterprise Resource Planning & Supply Chain MGT FLYNAS Airline Case

Writing Assignment: Use the Social Research Project Format Guide of Chapter 3, Methodology and Design. Use the Examples of

Writing Assignment: Use the Social Research Project Format Guide of Chapter 3, Methodology and Design. Use the Examples of the Quantitative and Qualitative studies references earlier in this course as a guide. Even though this is still a draft, make sure you address all sections in Chapter 3. Please include your draft data collection instrument as the last page of your Chapter 3. Remember as you develop your project, you will have a chance to come back to this chapter to revise and expand it.