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Walden University Complexity of Eating Disorder Recovery in the Digital Age Essay

Walden University Complexity of Eating Disorder Recovery in the Digital Age Essay.

Through this week’s Learning Resources, you become aware not only of the prevalence of factors involved in the treatment of eating disorders, but also the societal, medical, and cultural influences that help individuals develop and sustain the unhealthy behaviors related to an eating disorder. These behaviors have drastic impacts on health. In clinical practice, social workers need to know about the resources available to clients living with an eating disorder and be comfortable developing interdisciplinary, individualized treatment plans for recovery that incorporate medical and other specialists.For this Discussion, you focus on guiding clients through treatment and recovery.To prepare:Review the Learning Resources on experiences of living with an eating disorder, as well as social and cultural influences on the disorder.Read the case provided by your instructor for this week’s Discussion. (CASE OF GINA ATTACHEDPost a 300- to 500-word response in which you address the following:Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services.Explain how you would use the client’s family to support recovery. Include specific behavioral examples.Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan.Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder.
Walden University Complexity of Eating Disorder Recovery in the Digital Age Essay

A nurse with good communication skill is someone who really listens to the patients, understands their problems and queries and answers in a way the patients will understand. Communication in nursing profession can be a complicated process, and the possibility of sending or receiving incorrect messages frequently exists. It is important to know the key components of the communication process, how to improve the nursing skills and the potential problems that exist with errors in communication. In this case, we take a nurse as an example. A nurse who can explain in a simple manner to a sick man why a particular diet is very useful to get well soon, is said to have good communication skills. Both verbal and non-verbal communication plays a very important role in communication in nursing. For most patients, the nurse becomes the primary contact in the medical world. The nurse serves as the liaison between doctor and patient. She must understand the doctor’s instructions and the patient’s concerns. Her communications skills focus on both giving and receiving information as well as creating an environment of confidence. The relationship between nurse and patient should be a therapeutic nurse-patient relationship. According to Pullen and Matthias (2010), a therapeutic nurse-patient relationship is defined as a helping relationship that is based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patients physical, emotional, and spiritual needs through your knowledge and skill. In other words, a therapeutic nurse-patient relationship focuses mainly on the patient. Today, it is sad to say that there are many nurses who fail to grasp the importance of good communication between the nurses and the patients and therapeutic nurse-patient relationship. They neglect their duty to keep the needs of the patients as their first priority. Poor communication is dangerous as misunderstandings can lead to misdiagnosis and even medication errors. This area is also one of the main sources of complaints made to the health service ombudsman every year and some believe that a separate module for communication should be used in nursing training instead of being subsumed into the general curriculum. The barriers to good communication skills are many and include time pressures (nurses are so busy ad may not be able to get time to sit and talk with patients); lack of privacy; skills mix on the wards can mean there is a shortage of qualified nurses who are available to talk to patients; lack of training; and different languages. There are also several useful things to remember in having good communication including being prepared and know what you are going to say; having the right information to give when patients ask questions; maintain eye contact and observe the patient’s body language; listen properly; pick up on the non-verbal signs as well as the verbal ones; avoid the use of medical jargon; and in cases of breaking bad news, be emotionally prepared, try to find the right environment, and be sensitive, honest and compassionate. In this assignment, however, I will only discuss on factors that lead to poor communication in nursing. Research Problem 1. Problem Statement The problem statement for this research is ‘To determine the factors that lead to poor communication skills in nursing’. Poor communication skills in nurses are a major problem today and can be widely seen in most hospitals and clinics. There are many cases where the nurses speak rudely to the patient and ignore any questions asked by them. They are more concerned with their own welfare than that of the patient and many nurses hesitate and feel embarrassed to ask questions when there are things they do not understand. Their ignorance and poor communication skills can be due to several factors such as emotional stress, language barriers, overworking, fear and education or experience gaps. This problem of poor communication, if it is not dealt with at its earlier stage may lead to the destruction of the delicate relationship between the patients and the nurses. The patient will no longer trust the nurses and this may not only give a bad name to the nurses but also to the hospital. I believe that, when the root of this poor communication in nurses has been identified, we can take immediate action to correct and improve the current communication between the nurses and the patients. In this research, our scope is within the Miri General Hospital. The nurses in the hospital act as a mediator between the doctor and the patients. Nurses are the group of hospital staff that are the eligible to explain any queries of the patients and give comfort to patients. This is the main reason why good communication skill is a compulsory trait that all nurses must possess. It is from this research that I hope, we will get a better understanding of the cause of poor communication in nurses and from there, and we will be able to take necessary steps to overcome this problem. 2. Research Objectives (a) To understand the importance of good communication skills in nursing. The best relationship between a nurse and her patient is the therapeutic nurse-patient relationship. Therapeutic nurse-patient relationships are based on mutual trust, nurturing, and sensitivity to the patient’s needs. In this research, we wished to determine why good communication is very important in the nursing field. What are the advantages of good communication in nursing and what are the drawbacks of poor communication in this field. (b) To determine if overworking is the cause of poor communication in nursing. Nurses today have more responsibilities compared to nurses of previous times. Today, nurses not only are responsible for the welfare of their patients but their paperwork load has increased. Nurses also need to ensure the cleanliness of the ward especially if the housekeeping staffs are not around. They need to be able to fix the machineries if the technicians are not available. All these additional responsibilities lead to the overworking of nurses and thus leads to them not having the time to communicate and interact well with the patients. (c) To determine if shortage of nurses is the cause of poor communication in nursing. With each passing year, there are more sick patients that require a lot of time and attention from the nurses. But due to lack of nurses, there is only very limited things a nurse can do for each patient. The nurse allocates a very short while to attend her patients, not having time to talk or listen to the patient’s questions or doubts. This will make the patient feel neglected and unattended to. This high nurse to patient ratio may also be a reason that contributes to the poor communication between nurses and patients and also degradation of therapeutic nurse-patient relationship. (d) To determine whether language barrier is leading to poor communication in nursing. Language plays an important role in communication. The inability to understand a language can lead to misunderstanding and miscommunication, worst still, misdiagnosis. In nursing, it is very important that the nurse should understand what the patient tries to convey to them and vice versa. If both the nurses and the patients cannot understand each other due to use of different language, it will lead to many problems and misunderstandings. Language may also be a factor that leads to poor communication in nursing. (e) To determine if fear is one of the contribution to poor communication in nursing. One common reason for poor communication is that it has to do with a nurse having a lack of comfort or fear in communicating with another nurse or doctor. These type of issues usually occurs when a nurse feels threatened by a co-worker, fears the possibility of making a mistake and doesn’t say anything to avoid judgement or lacks confidence in her abilities as a competent nurse. (f) To determine if education and experience gaps leads to poor communication in nursing. An education or experience gap can occur when a less educated/experienced nurse works with another senior nurse who is much more educated and/or experienced and the junior nurse has trouble understanding the concepts, procedures and/or medical terminology used by the more experienced nurse. These types of gaps can lead to confusion, misinterpretation, inaction and errors due to the inability to communicate effectively and fully understand what is being communicated. (g) To determine whether emotional stress leads to poor communication in nursing. Nurses who are experiencing a lot of emotional stress or a trauma may have difficulty focusing or expressing or communicating their feelings, perceptions, beliefs and attitude towards certain situations. This can lead to mistakes being made and/or reduce the amount of attention they are able to put towards their work, patients and co workers. 3. Hypothesis/ Research Questions I have come to believe that modern day nurse-patient relationship is undergoing serious strain due to poor communication between the nurses and the patients. There are several factors that might contribute to this problem. Firstly, the modern nurses are being overworked, causing them to lack in their communication skills. When nurses work long shifts for extended periods of time it can cause fatigue, which lowers their focus, effectiveness and ability to communicate effectively with patients and staff. Today, nurses must spend an inordinate amount of time completing redundant documentation in several different places, hunting for supplies, wearing multiple hats and performing other tasks. For instance, if the need for a cleanup arises and the housekeeping staffs are not present, nursing staff must address it. If the remote control is not functioning properly and the maintenance staffs are nowhere to be found, the nurse is usually the person who must try to resolve the issue. The next reason is due to shortage of nurses. Every year there are more sick patients that require much of the nurses’ time. This leaves them with very limited time with other patients. The nurses may be doing their job but they fail to form a relationship with the patients. We take for example, a nurse approaching the bedside to empty a patient’s indwelling urinary catheter. As she approached she didn’t make any eye contact and duly went about emptying the catheter, recorded the details on his fluid balance chart and walked away. At no time during the procedure did she speak. This example shows how essential communication skills are when caring for patients. Had he wanted to ask a question, the opportunity was lost. At this time, it would have been a good opportunity to take a look at the patient and perhaps ask how he was feeling. Poor non verbal communication also leads to poor nurse-patient communication. Poor communication also occurs when the nurse and patient speak different first languages. Idioms and frames of reference can carry shades of meaning in one language that may not exist in another. Mispronunciation or incorrect signing can mislead the provider or patient, causing the patient to lose his trust on the nurse. This problem usually occurs among the elderly patients and also the foreign patients. Due to the difference in language, both the nurses and the patients fail to convey each message to another. Especially in Malaysia, a country full of different races and languages, it is impossible for the nurses to be able to understand and speak all these different languages. There are also some patients, especially those who live in the interiors; they are not able to speak the national language but only their one native language. This phenomenon also leads to poor communication skills. Poor communication also tends to evolve out of the level of power within hospitals. The presence of hierarchies in hospitals tends to increase the likelihood of poor communication developing at some level or another within the vertical power structure. The main cause of this communication failure is due to fear but this does not to mean that the hierarchical organization of power in hospitals is a bad thing-it only means that it can lead to poor communication to develop multiple places within the medical hierarchy. One of these places is between physicians and nurses. Nurses frequently hesitate from asking physicians potentially “obvious” or unimportant questions. As both physicians and nurses are very much involved in the care and support of patients, major communication breakdown between them could lead into serious medical difficulties for their patients. For example when a physician instructs a nurse to convey important medical information to patients but the nurse does not fully understand the information and due to fear, she does not ask for further explanation from the doctor and gives the wrong information to the patient. Poor communication between physicians and nurses also often develop when physicians fully rely on written orders to convey instructions to nurses. They will write important details into patients’ medical files-often including crucial instructions for nurses, such as when to administer particular treatments to patients. If nurses missed checking patients’ medical files, they consequently also missed the important instructions that were written in them. This raises the crucial question of why physicians continue to employ indirect modes of communication to the extent they do, and why nurses don’t object to it. This is not to suggest that written communication should be prohibited, but that written communication is a poor substitute for direct verbal communication. Perhaps one reason why written communication remains prevalent is that nurses fear questioning what they might consider to be a standard practice among all physicians. Here again it can be seen that the reluctance to question the practices of superiors may lead to a communication breakdown-or, more seriously, to a complete communication failure. As nurses usually feel inferior to the physician in charge, so do junior nurses feel inferior to the senior or more experienced nurses. The younger nurses hesitate to ask questions to the senior nurses in fear of being labelled as not well educated. Sometimes, the senior nurses explains a certain procedure or information to the junior nurses, but due to lack of experience, she may not fully understand it and hesitate to ask any questions after that. The senior nurses also take for granted that the junior nurses understand all that has been explained. Miscommunication as such is very dangerous as it will affect the patient. Nurses are the backbone of any healthcare unit. The pressures of overtime and long working hours create a work-personal life imbalance, which begins to affect the health of the nurses. All nurses have to do shift work or attend emergencies at night. The stress of shift work can also worsen the nurse’s health conditions leading to depression, low morale, and low motivation. Other factors such as long commuting hours and chaotic traffic conditions adding to their stress affect the employee’s efficiency and effectiveness. All these can affect the nurse’s relationship at home as well as on the job. Home stress contributes significantly to the stress faced by nurses. Their home life is disturbed due to night shifts, overtime, transport delays, and difficulty in getting leave. They constantly worry about their children and their studies not being properly supervised. Nurses have to look after the home, cooking and cleaning as they cannot afford domestic help. This can have a negative influence on their physical and emotional health and lead to psychosomatic disorders. Psychosomatic illness is a disorder that affects the body and the mind. These illnesses have emotional origins causing physical symptoms. Some examples are acidity, anaemia, backache, and stiffness in the neck and shoulders. Sometimes, in the absence of doctors, nurses are on the front line and have to face verbal abuse from patients and relatives for issues that may not be directly connected to their work. Physical violence and aggressiveness is also on the rise in patients and their relations. Demanding patients and their relatives can cause conflict and lead to more stress. Another cause of stress is economic loss to the organization due to errors, wrong decisions, wrong choice, lack of attention, and injury. All these stress factors demotivate the nurses causing them to slack in their communication skills. Conclusion Communication in nursing is specifically used to identify the nurse-patient relationship amongst other things; some of the ways include translating, getting to know you and establishing trust to ensure the patient receives the best treatment (Fosbinder, 1994). In a place where an individual’s health and well-being is largely determined by the level of cooperation amongst nurses and other medical professionals who are assisting them, there are things that are more important than education, training and open communication. Poor communication often leads to big mistakes such as prescribing the wrong medication, improper diagnosis of a patient ailment or medical condition, administering the wrong treatment plans and in some cases even death of a patient due to misdiagnosis due to lack of communication. We also know that nurses and physicians are trained to communicate differently. Nurses learn to communicate by being descriptive, detailed, and narrative while physicians learn to summarize, diagnose, mend, and repair. This makes nurses the best mediator between the physician and the patient as nurses are taught to explain and give information in the most understandable manner to the patient. Communication is at the heart of these goals and patients are being encouraged to be more involved in their care. This can only be achieved if patients truly understand what is available and feel empowered to make those choices. Therefore, when talking to a patient next time, take time to reflect on how you think the consultation went and how it could be improved. Determine whether you use jargon or abbreviations that the patient might not understand, and more importantly did you find out if the patient understood what had been said.

Service Delivery in Adult Social Care

Service Delivery in Adult Social Care. Introduction Recent demographic indicators reveal that over the next decade the effect of ageing on the UK adult population will result in a 20%increase in those of 65 and a 60% increase in “the over 85 year-olds” by 2027 (DoH 2007a, p.1). This trend, together with the increase in the numbers of the population suffering from medical and health issues, including dementia and disability, presents a challenge to the provision of adult social care, in terms of both funding and the need to deliver appropriate services designed to provide this segment of the population with “equality of citizenship” (ibid). As a response to the changing demography, in 2006, the Department of Health (hereinafter DoH) produced a white paper outlining a new direction for the provision of adult social care services within the community, which indicated the need for a fundamental change from previously existing policies and procedures (DoH 2006). Subsequent DoH (2007a, 2007b and 2009) publications have served to provide guidance on how it was anticipated these change would transition into the practical environment. The central theme of this new direction was based upon a personalised agenda, with users and their carers being given more control and choice over the care services they required and the format in which they wished these services to be provided. In other words, the objective was for adult social care services to be provided based upon a person-centred approach rather than the internal social care services decision-driven model (Department of Health 2007b). As with all new fundamental and structural changes of this nature, a key element of the ‘personalisation agenda’ is to ensure that the quality of service delivery matches the health and social needs of the local community. It is this aspect of the new adult social care than forms the basis for this paper. Following a brief overview of the objectives and requirements of the ‘personalisation agenda,’ the paper will outline the measurement hat are required to be put in place to ensure the delivery of the requisite quality service to the end user and their carer (Mullins 2006). The ‘Personalisation agenda’ The basic premise of the ‘personalisation agenda’ programme and its aim of moving control of adult social care services to a user/carer-centred model. In other words, instead of professionals within the social services making the decision in relation to the support services required, and how this would be provided, under the new systems, these issues will be determined by the individual user. Therefore, with the aid of the social services team as and when required, the purpose of ‘personalisation’ was to deliver four main objectives, which are outlined as follows: Budgetary control The user/carer will have the opportunity to design and create their own budget to cover their health and care needs. Based upon this budget, an allocation of funds will be provided over which the user/carer will retain control Choice of support requirement spending Within the context of the budget and resources that has been designed by the user/carer, they will retain the choice of what support services they require and how the budget will be allocated across these services Choice of service providers Rather than social services deciding the service provider, that choice will now be in the control of the user/carer. In this respect, the user/carer can decide whether the support services they require should be delivered at their home, at an external location, such as a care home or respite centre and, ultimately, whether the provider of these services should be the local social care service or an external private organisation. Appropriate and timely access to support Instead of having the delivery of their health and social care services determined by the professionals within the health care sector, the personalised approach gives the user/carer the right to choose the time of these services, for example, at night or during the day. To ensure that these objectives could be met, with a target data for their full implementation being set at April 2011 (ADASS 2009), were tasked with introducing a system based upon the following changes: Integrated working with the NHS Commissioning Strategies, which maximise choice and control whilst balancing investment in prevention and early intervention Universal information and advice services for all citizens Proportionate social care assessments processes Person centred planning and self-directed support to become mainstream activities with personal budgets which maximise choice and control Mechanisms to involve family members and other carers A framework which ensures people can exercise choice and control with advocacy and brokerage linked to the building of user-led organisations Appropriate safeguarding arrangements Effective quality assurance and benchmarking arrangements To deliver these changes successfully within the target time scales set, this process has required local social services departments to take steps to redesign the manner in which their organisation were operating as outlined within the following section of this report. 3 Re-designing the provision of adult social care For the adult social care departments of local authorities, main areas of change required to develop a user/carer-centred approach to service provision, the most important factors that needed to be addressed were concentrated upon three main areas. These can be defined as follows: Ensuring the resources are available to assisting the user with the creation of their own care assessment needs and budget Ensuring the facilitators of that choice were available and making sure that the required quality of service is delivered, and Providing and communicating information in a manner that enables the user to make an informed choice Consequently, there was a need to focus upon introducing improvements to three key operational elements: 3.1. Human resource capabilities It will be apparent that some user/carers may require assistance with the process of conducting a personal assessment of their ongoing health and social care needs and designing the budget required to ensure that these needs are capable of being met. For this purpose therefore, it has been important for the local authority to provide users’ with access to employees with the required level of skills and capabilities to assist the user/carer with this process. In many cases, the requisite skills and competences required to achieve this transformation of services might not have existed within the roles of existing frontline service team members. Therefore, it has been important to introduce training programmes designed to assist the workforce to adapt to the new roles. 3.2. Physical internal and external resources As user/carers now have the choice of how, where and who they wish to provide their service needs, it has been important to realign existing internal existing and external physical and, in some cases human, resources to provide the appropriate range of choice. In basic terms, this choice can be divided into two main categories, these being whether the user/carer requires the service to be delivered in the home or at an external location and having the choice as to whether the service is delivered by the public or private sector. Home or external delivery of service Within this context of choice, the main area of change has occurred where user/carers have wished their service requirements to be delivered in their own home. To facilitate this choice, adult care services have needed to ensure two requirements are met. Firstly, there has been a need to ensure that there is a sufficiency of employees experienced in the delivery of home based care services to users/carers, which in some cases has again meant retraining existing members of the workforce to ensure their ability to transition from working in a controlled environment to one where self-control is the main requirement. Secondly, it has meant that the adult social care service has an adequacy of physical and portable equipment required to facilitate home based service provision. Public or private service provider Concerning the choice of provider, it was incumbent upon the adult social care services to achieve two objectives. Firstly, there was a need to develop relationships with a sufficient number of external private care providers to enable sufficiency of choice for the user/carer. Secondly, as part of their remit to providing the appropriate type and quality of care, the department also needed to be assured that the quality of service available from the external private provider complied with the standards and quality of care as set down within the government and DoH requirements. Private health and social care providers in this context can refer to agencies and individuals who are trained in the provision of individual care services as well as the external organisations that are operate nursing, care home and other health care facilities. 3.3. Communication process The final change required, and perhaps in many ways equally important as those discussed previously, has been the need to introduce a robust process of bi-direction communication between all the stakeholders, which includes the adult social care management teams, employees, external service providers, both public and private and, of course, the service user/carer. In order to make an informed choice it is critical that the user/carer has access to data and information related to all the available options open to them. For example, in the case of private care homes, this would include details of the accommodation amenities, the type of care services available from the provider, and overview of their quality standards and the price of the service being provided. In other words, there is a need to create a knowledge based organisation (Nonaka and Takeuchi 1995). In practice therefore, the communication process within the adult care service environment in accordance with the following diagram (figure 1). 4. Measuring quality service delivery 4.1. The rationale for measuring quality service Major Service delivery transformation of the nature being discussed within this report requires change and, as Turner (2009, p.1) rightly confirms, “Change: and the need to manage change through projects, touches all our lives, in working and social environments.” This has certainly been the case in designing a process that requires the adoption of a user/carer-centred approach to adult social care. Similarly, as with all changes of this nature, not all aspects of the process can be completed at the same time, in other words it needs to be introduced in stages (Allan 2004, Cameron and Green 2004, Blake and Bush 2009 and Turner 2009). For example, providing carers with information related to private provider service choice cannot occur unless or until these providers have been contacted and a relationship built with them to facilitate their willingness and appropriateness to be included in the process. Lewin (Wirth 2004) in developing what he terms as the ‘freeze model’ suggests that stages required to complete this change are three in number: Motivation of need for change (Frozen) Design and implementing the change (Unfrozen and moving to a new state) Making the change permanent (Refreezing) Source: Wirth (2004) Of equally critical importance having identified that structure that needs to be put in place to effect the change/transformation to the ‘personalised agenda’ requirements for the organisation, is to ensure that each aspect of this process is managed in an efficient and effective manner in order to deliver the quality of service that meets the user./carer needs. It is equally important to continue to measure the quality of service delivered on an ongoing basis. The ADASS (2009) have suggested that the transformation to the new service structure should be based upon the extent to which the local adult social service department has achieved the following five key priorities: That the transformation of adult social care has been developed in partnership with existing service users (both public and private), their careers and other citizens who are interested in these services. That a process is in place to ensure that all those eligible for council funded adult social care support will receive a personal budget via a suitable assessment process. That partners are investing in cost effective preventative interventions, which reduce the demand for social care and health services. That citizens have access to information and advice regarding how to identify and access options available in their communities to meet their care and support needs. That service users are experiencing a broadening of choice and improvement in quality of care and support service supply, built upon involvement of key stakeholders (Councils, Primary Care Trusts, service users, providers, 3rd sector organisations etc), that can meet the aspirations of all local people (whether council or self-funded) wanting to procure social care services. Source: ADASS (2009) Consequently, it is clear that as an integral part of delivering these priorities, the local adult social services department to have implemented a number of performance assessment and measurement models are discussed in the following section of this report. 4.2. Measurement models for quality service delivery For measuring the effectiveness of quality service delivery within the context of any organisation, there are a number of management and measurement models that can be used. The objective of some of these, as Turner (2009, p.357) comments is to analyse and assess the performance of the changes that are taking place, such as the transformation of adult social care being discussed in this report. However, in addition to these measurement models, there are others that are designed to measure service quality for specific elements and stakeholders within the change process and post change performance. Taking the above issues into account, the focus of this discussion is aimed at measurements to be used during the course of the adult social service transformation, the effectiveness of individual employees and external provider’s provision of quality services and the measurements used to assess the satisfaction levels of the user/carer. This triangular approach is designed to achieve the following objectives for the adult social services department: Monitoring quality service delivery against timelines and milestones set Enabling department to comply within regulatory agendas Ensuring required skills and competences of work force and external provider’s Monitoring development of appropriate team based relationships Measuring extent to which services provided meet with user/carer needs In all of these areas, the measurement models being used are designed to be part of a continuing process of ensuring the service delivery remains at the highest level of quality (Mullins 2010). 4.2.2. Project and post-project performance In the view of the author of this report, in order to evaluate the change and improvement to the quality of service during both its implementation and execution stages, it is considered that the measurement model based upon the KPI and Balanced Scorecard approach which was developed by Kaplan et al (2006) is the most appropriate for use. This is especially true within the implementation stages of the change process. The reason for this is that it provides regular opportunities for reassessment and the rapid introduction of measures to address issues that might have arisen (Johnson and Clark 2008). Moreover, within the context of the ‘personalised agenda’ approach, it has the added benefit of being able to combine the financial as well as the non-financial outcomes. In this respect therefore, when used in the adult social services this model not only enables an assessment of the service quality being delivered but will also help to ascertain whether the user/carer is being provided with value for money. The design and benefits of this measurement model can best be explained from the following diagram, which clearly shows the objective of the Balance Scorecard is to assess and evaluate the performance of quality service delivery from four main perspectives. There are to provide a process for learning and growth, to provide guidance for the management of the organisation, ensuring satisfaction of user/carer needs and, as a result to achieve the financial objectives (Kaplan et al 2006). In terms of improvement to the service quality, are clearing identified within the appraisal of the KPI’s (figure 3), in that it provides learning for the organisation, which leads to better decision making and continues the process of improved service quality delivery. Source: API (2010) 4.2.3. Employee performance appraisal Skills and competences of employees, whether part of the internal social services workforce or engaged by an external provider, are another key an essential area of service quality delivery that needs to be constantly kept under review (Leat 2001 and Armstrong 2006). The extent to which an employee is able to perform their duties in a manner that satisfies the user/carer, will have a significant impact upon the latter’s level of satisfaction. Consequently, it is important for managers to work with the employees to ensure that they are both acquiring the skills needed to perform their roles and motivated to undertake these duties in a manner that seeks to achieve excellence. The most appropriate model in this instance is the use an individual employee ‘performance appraisal’ system. This model is based upon interactive communication and discussion process that takes place between the employer/manager and the employee (Leat 2001). The first stage is for both parties to complete a previously designed ‘performance appraisal’ form, which can be similar to the example that is provided in appendix 1 and attached to this report. The purpose of both parties completing this document is so that the level and standard of the employee’s performance is provided from both perspectives. This provides the opportunity for the employer to gain an insight into where the employee feels they are excelling and/or consider that further assistance from the organisation, perhaps in the form of additional training, may be considered helpful. Following completion of the appraisal form, the employee will then deliver a copy of this to his/her employer for consideration. It is preferable at this stage to ensure that a meeting has been arranged at which both employee and employer will be able to discuss freely the results of the appraisal (Armstrong 2006). It should be deliberately designed for this appraisal process to take the form of a two-way conversation or discussion. From an employer’s viewpoint, this will provide them with the opportunity to provide the additional assistance that the employee perceives to be missing from their development, and discuss those areas where the employer considers improvements are required. For the employee, this process is likely to lead to them feeling more involvement with the organisation and therefore more motivated to produce the best service performance they can (Leat 2001). Further, to enhance the levels of employee involvement and motivation, which as Armstrong (2006) argues, is key to gaining the best quality of service from the workforce, it is important that the adult social services department introduces a system of employee discussion groups. During these sessions, all employees should be encouraged to participate and share their views and opinions on the effectiveness of the processes that is intended to improve service quality for the user/carer. Often, these discussion sessions will lead to the innovative ideas being suggested which, although not previously considered, could produce benefit for the process, as well as improving employee’s level of involvement with the organisation. 4.2.4. User and carer service quality satisfaction Academics and researchers, especially those who are intimately involved with the social and health care sectors, have sought to provide a number of tools aimed at improving the quality of service delivered to the user/carer. Two of these models, which have recently been assessed, are the SPRU and ASCOT models (SCIE 2010), the objective of both being to find ‘excellence in adult care services.” The SPRU (Social Policy Research Unit) model (SCIE 2010, p.4) The focus of the SPRU is based upon the conducting post-service delivery assessments and evaluation which, in other words means that this models, through some format, measures the extent to which the service quality has provide the required service and needs priority for the user/carer. It is a model that is often relied upon for inspection and compliance purposes, such as when the Quality Care Commission conducts an inspection of a private care home (Francis 2009). The ASCOT (Adult Social Care Outcomes Toolkit) model The ASCOT model of performance measurement is very similar to the SPRU model, with the difference being that in this case there are a more defined number of specific issues that the research in question is endeavouring to use for their assessment of the quality of the service being delivered to or experienced by the user/carer, as outlined below: Accommodation, cleanliness and comfort – The person using the service feels their home environment, including all the rooms, is clean and comfortable. Control over daily life – The person using the service can choose what to do and when to do it, having control over their daily life and activities. Dignity – The negative and positive psychological impact of support and care on the personal sense of significance of the person using the service. Food and nutrition – The person using the service feels they have a nutritious, varied and culturally appropriate diet with enough food and drink they enjoy at regular and timely intervals. Occupation – The person using the service is sufficiently occupied in a range of meaningful activities whether it be formal employment, unpaid work, caring for others or leisure activities. Personal cleanliness and comfort – The person using the service feels they are personally clean and comfortable and look presentable or, at best, are dressed and groomed in a way that reflects their personal preferences. Safety – The person using the service feels safe and secure. This means being free from fear of abuse, falling or other physical harm and fear of being attacked or robbed. Social participation and involvement – The person using the service is content with their social situation, where social situation is taken to mean the sustenance of meaningful relationships with friends, family and feeling involved or part of a community should this be important to them Source: SCIE (2010, p.5) What both of these models have in common is that they are based upon the recognised processes of quantitative primary research, which is commonly used by academics for a wide range of investigations (Johnson and Durberley 2000, Easterby-Smith et al 2004 and Gill and Johnson 2010). With the overall objective of ‘personalised agenda’ being to deliver a quality of service that meets the user/care’s needs and requirement, it follows that the only way that this quality can truly be measured is by gathering information from the source that is intimately connected with, and experiencing, the service being provided, this being the end users. Consequently, it is important for the adult social care department to introduce a continuing process of measures designed to accumulate feedback from the user/carer, which should include: Regular conduct of a survey questionnaire aimed at gaining user/carer feedback and comments on all aspects of the services delivery process that they have decided to be included within their care management plan Regular individual one-to-one meetings with user/carers to allow for more comprehensive bi-directional discussion related to their experience of the service quality provided Of course, the most important part of this process is for the organisation to ensure that where issues or concerns are raised by the user/carer, These are referred to the relevant stakeholder group or person within the organisation so that they can be appropriately be addressed. Additionally, regular contact should be maintained with the user/carer, to advise them of the outcome of any measures taken to improve the quality of the service delivered. 5. Conclusion There is no doubt that the transformation of adult social care has not only signalled one of the most comprehensive reforms of quality service delivery to the user/carer in many decades, but also one of the most complex in terms of its introduction and successful implementation (DoH 2009). Consequently, ensuring that the quality of the services being delivered are maintained during and post this implementation has required the introduction of a number of measures designed specifically to ensure that that this remains the case. As indicated within this report, those measures, the central part of which is to evaluate and examine the user/carers perception of service quality is being met, need to be applied to all stakeholder groups, including those internal to adult social services and the external services providers whose services are also utilised. It is considered that the measurement and managed tools discussed within this report provide the best models for this purpose. Bibliography ADASS (2009), Transforming Adult Social Care Services, Available from: [Accessed 10 December 2010] Allan, Barbara (2004). Project Management: tools and techniques for today’s ILS professional. London: Facet Publishing Armstrong, Michael (2006). Performance Management: Key Strategies and Practical Guidelines. 3rd Rev. ed. London: Koran Page Ltd Blake, I and Bush, C (2009). Project Managing Change: Practical Tools and Techniques to Make Change Happen, Harlow: Harlow: Pearson Education Cameron, Ester and Green, Mike (2004). Making Sense of Change Management: A Complete Guide to the Models, Tools and Techniques of Organisational Change, London: Kogan Page Ltd DoH (2006), Our health, our care, our say: Available from: [Accessed 10 December 2011] DoH (2007a), Putting People First, Available from: [Accessed 9 December 2011] DoH (2007b), Commissioning Framework for HealthService Delivery in Adult Social Care

Please answer all questions with approximately 1-2 single spaced page each

essay help online Please answer all questions with approximately 1-2 single spaced page each.

Please answer all questions with approximately 1-2
single spaced page each. PLEASE make sure to reference and cite readings
(especially the readings in attachments). Feel free to quote extensively from sources
(make sure to cite in APA style) and please no attachments.1. Describe the differences in
Anyon’s study between the working, middle, affluent professional and elite
schools? What do each prepare graduates for? Which aligns most with your
education? Give examples.2. How do gender, sexuality and
race play out in American high schools? How are dominant modes of these
identities imposed on non-dominant children? How do they resist these
impositions? What are some of the historical dynamics that led to this?Please write the answers based on these readings below: Anyon, Social Class and School Lareau, Cracks in the Ivory Tower; Caplan, Case Against Education,Angry White Men, Dude You’re a Fag (1-4), Why all black students sitting together in cafeteria.
Please answer all questions with approximately 1-2 single spaced page each

Los Angeles Valley Anthropology Theory of Evolution by Natural Selection Question

Los Angeles Valley Anthropology Theory of Evolution by Natural Selection Question.

1. Explain the process of natural selection (Darwin’s 3 postulates). Why is variation necessary for natural selection to work? In the example of  Darwin’s finches, how did the birds vary? What was the selective pressure that the population experienced and how did that alter the population from one generation to the next? Define microevolution and macroevolution. How did Darwin’s finches show microevolution? How did  Do they show macroevolution?

Use the measurements in the table below to calculate the facial index for the listed species. What does the facial index tell us about hominin skulls? Explain how and why the facial index of hominin species has changed over evolutionary history.  Discuss the selective pressures that have favored these changes. Compare at least three different species we have examined as examples to illustrate these  changes.
Chimpanzee (male) Human (euro male) A. Afarensis H. erectus   nasion to prosthion  
70 84 80   basion to bregma  
132 91 104   
                 Your Answer:

Compare the features of the skeleton related to locomotion for  chimps, modern humans, and one species of hominin of your choice. Be  sure to talk about at least 4 parts of the skeleton, including the iliac  blade. Compare how they are shaped in the different species, and  explain how they function in the bipeds. Include a discussion of the  iliac index and what the index tells us about the iliac blade and how it  has changed over hominin evolution.

Chimpanzee (male) Human (euro male) A. afarensis H. erectus  iliac width  
125 96 130 iliac height 
Los Angeles Valley Anthropology Theory of Evolution by Natural Selection Question

Culture Differences In Social Anxiety Psychology Essay

The purpose of this study is to examine as to whether there are cultural differences giving rise to social anxiety. Also, it is to investigate whether social anxiety gives rise to internet use. The theoretical argument and empirical findings generally support the notion that cultural differences define and social anxiety. The research in this area has largely been conducted comparing Asian American and White American. Generally, it is found that Asian American are more influenced to social anxiety and hence internet use. It can be concluded that an individual’s culture background can affect a person’s social development which can completely to figure out the dimension of social anxiety among the different culture society. The aim of this study is to investigate whether there are cultural differences in social anxiety and also to determine the relationship between social anxiety and internet use. Social anxiety refers to how excessive emotional discomfort, fear, worry about social situation. Internet use refers internet addiction which causes uncertain use of the internet for online social media for examples social networking sites. Social anxiety is the 3rd common mental health problem in United States. Social anxiety only to identify with a person’s social life but somehow it also affect a person’s routine and an individual’s professional life. This is mainly because a person which he or she faced excessive fear or emotional discomfort in everyday social interactions and evoke extreme anxiety. Social anxiety also known as social phobia which refer where fear and anxiety being analyse by others, impede in daily routine and results in serious disorder (America Psychiatric Association, 1994). According to Schneider, Younger, Smith, and Freeman (1998), social anxiety refers to identify with variety of negative actions which may affect the quality of life, occupational life, educational attainment and also weaken the between each others. Social anxiety refers to a person’s with sensibility indicate the sensitivity to their thought, feeling and assess reactions of one’s social group (Markus, Kitayama, 1991). Internet refers as a person on daily routine they use online media for social networking website, electronic mails, chat rooms which to keep their social circles via mass media and provide different social experience rather than face to face conversation with each others (McKenna, Bargh, 2000). Closely related to the concept of internet use is a person who using internet to release their unpleasant moods, and finally become benefits between social and internet provides, which withdrawn symptoms of social and the consequences of a person’s life (Caplan, 2002). According to Shaw and Black (2008), internet use refers excessive controlled behaviours regarding of computer use which involve internet access that may lead to serious disorder. There are several theoretical analyses exploring the reasons for cultural differences in social anxiety. According to Ho and Lau (2011) self-construal theory, where it is argued that an individual’s cultural background can influence self-construal and social anxiety was associated with higher social anxiety on Asian. According to this theory, the culture differences between Asian American and white American affect the level of independent self-construal and interdependent self-construal (Okazaki, S., 1997). In addition, according to Markus and Kitayama (1991) models, they stated that independent and interdependent self-construals used to explain the cross-culture in the society. They characterised independent held by the Western European and American while interdependent self-construal held by non-Western such as Asian cultures. According to this theory, Markus and Kitayama found that in Western culture, independent self-construal as a key for their development goal and independent self-contrual also of the factor which to regulate a person’s bahviour. In the other hand, non-Western European such as Asian they are more likely have interdependent self-construal because Asian are more distinguished their feeling towards another person. For example, Asian culture may bring out the culture toward to the Asian American which might have highly interdependent self-construal. Thus, an individual with highly interdependent self-construal may face high social anxiety (Okazaki, S., 2007). Self-construal in difference culture may affect an individual’s emotion (Park, I.J.K, Schwartz, S. J., Kim, S. Y., Ham, L. S., 2011). For example, people with higher interdependent self-construal may easily express their emotions compared to independent self-construal people. According to Ho and Lau (2011), they found that Asian American with interdependent self-construal have high social anxiety compared to white American with interdependent self-construal. They found that the interdependent self-construal may take up the liability the symptoms of social anxiety among the Asian America. However, in Norasakkunkit and Kalick (2002) studied, they found that there was inaccurate score on interdependent self-construal mamong the Asian or Asian Americans. Secondly, is the emotional regulation in differences culture towards social anxiety. According to Kitayama (2004) model, the collective level and individual level are the factors which made emotional regulation to occur. The collective level of a person may affect a person’s behaviour while individual level of person is to regulate the emotion based on the cultural norms. For example, an individual who has a strong interdependent self-construal they tend to put down their emotion while a person who has strong independent self-construal less to suppress emotion. According to Matsumoto (2008), he conducted a study and found that collectives countries people have high social anxiety compared to individualistic countries people. Closely related to this study, an American who showed more Asian values have high possibility to emotional suppression compared to European Americans. According to Heinrichs (2006), he found that collectivistic and individualistic countries have their own social norms and social anxiety. Results found out that emotional suppression is related between social anxiety and self-construal among Asian American college students and a stronger independent self-construal can decrease the level of social symptoms amomg Asian American college studnets (Park, I.J.K, Schwartz, S. J., Kim, S. Y., Ham, L. S., 2011). However, according to Ho and Lau (2011) they found that there is no culture differences between and emotional suppression. Not only Asian American but somehow White American will also have social symptoms due to the low daily mood or low socializing relationship. In the other hand, there is a relationship between social anxiety and internet use. Negative impact on social networking brings up highly social anxiety among society (Gross, 2004). There is a positive correlation between social anxiety and internet use (Campbell, 2006). Valkenburg and Peter (2009), stated that an individual has higher social anxiety will make internet as a social medium. A researcher had found that when a person is using internet regularly tend to have social anxiety (Shepherd, Edelmann, 2005). However, there is a studied which found that perceptions of the internet more comfortable to socialize as a factor which causes higher social anxiety in online communication compared to communicate with people face-to-face (Erwin, Turk, Heimberg, Fresco, Hantula, 2004). According to Young and Lo (2012), the benefits of internet use may lead to high social anxiety among the society. According to Weidman (2012), he found that an individual showed high social anxiety from social comfort and self-disclosure which a person has low self-esteem in the offline communication. For example, a person who has high social anxiety was expected increases shame and increasing embarrassment with social mistakes. In addition, in Erwin ( 2004) studies, he found out there is a negative and positive effects of internet uses in social anxiety. One of the positive effect is an individual with high social anxiety will spend more time to online to search for a social support. According to Park and Floyd (2005), found that which there is a positive correlation between social support and duration online. The more the time for online, the more social support. Besides, the negative effect from Erwin (2004), one of the reason a person who have high social anxiety spend more time to online and lead to negative evaluation online. This may affect the natural communication, face-to-face communication with each others and it will decrease the chance to talk with others in this society. Online communication might apply for people have high social anxiety because they are more interdependent in online relationship compared to face-to-face communication. In addition, as result an individual has high level of social anxiety have low face-to-face communication but have a good dependence in online relationship. However, according to King and Poulos (2008), a high level of face-to-face communication can against the development of internet uses and decrease the social anxiety among the society (Lee, B. W., Stapinski, L. A., 2011). However, a study found that a person with social anxiety, prefer to have a online relationship because to fulfilment their needs and have a satisfaction feeling from online. This study reveals that there are cultural differences giving rise to social anxiety of an individual. Generally, research has been conducted comparing Asian American with white American. Research largely concludes that Asian American have highly social anxiety compared to white American. Asian American have high interdependent self-construal which may bring out high social anxiety compared to white American who have independent self-construal which showed low social anxiety among them. In addition, they are relationship between social anxiety and internet use. The beneficial internet use can evoke a person who has high social anxiety to use internet for communication rather than offline communication.