Post-insertion Catheter Care Audit

Post-insertion Catheter Care Audit Portfolio Activity 1 Permissions and ethics considerations This audit is a part of quality assurance (QA) that aim is to assess the adequacy of existing practice about the post-insertion catheter care against the standards, in order to minimize the central venous catheter related infections (CVCRIs) in a medical ward. This QA activity will possesses a negligible risk (NHMRC 2015) because the data will be analyzed for the purpose of maintaining standards and data will not be gather beyond that which is collected routinely from the participants (NHMRC 2014). That includes assessing nurses’ practice about the central venous catheter (CVC), its dressing skills, and patient’s CVC condition. Therefore, this audit will own more benefits than harm and will not require human research ethical committee (HREC) permission (NHMRC 2014). However, permission will be obtained from non-HREC. Informed consent: The opt-out approach will be used to recruit the participants into this audit, where the general information about this audit will be shared to all participants and their involvement. Those participants who are not willing to participate will notify the auditor; otherwise their participation is presumed (NHMRC 2015a). This audit information will be posted on the unit notice board a week before the actual audit starts. The poster will only contain the general information about the infection control audit and will not specify, which infection control policy is going to assess. The reason for not disclosed all the information to participant is to obtain the true data of staff practice about the CVC, because if participants get familiar with the audit aim, they will intentional started to behave differently (NHMRC 2015a). Moreover, before starting of the each shift, auditors will notify participants that those nurses, who are going to perform CVC dressing skills, will accompany auditors. But auditors will not permit participants’ to know what aspect of dressing skills will be assessed. However, once audit will finish, its aim and method will be shared and posted on the unit notice board. The data about the condition of CVC and nurses ‘dressing skills will be obtained by assessing the patients’ CVC site and nurses’ practice about the CVC dressing on patients. Thus, auditor will also take the verbal consent from the patients. Patients’ who are highly dependent on medical care or not capable of making decision, consent should be sought from participant’s guardian (NHMRC 2015b). Privacy and confidentiality: Participants’ confidentiality will be maintained (HREC 2008). The collected data will not contain any personal identifying information about participants. Collected data will be shared, once it get analyzed without disclosing the participants’ name to staff, head nurse, clinical nurse instructor, manager, director of nursing services and infection control committee (ICC) in order to develop the action plan based on identified needs. While assessing the patient CVC site and nurse’s practice about the CVC dressing, auditor will ensure patient privacy (HREC 2008). Moreover, to maintain the patient privacy, two auditors will be selected from the ICC, from which one would be male and other would be female. Female auditor will assess the female patient CVC site and same goes with male auditor. Infection Control Committee (ICC): Permission will be obtained from the ICC because they have following responsibilities: to manage infection control programs; to monitor hospital acquire infections through frequent audits; to facilitate in continuing education and ongoing training programs for HCWs to prevent and control all aspect of infections. Moreover, ethical issues about this audit will be discussed and modified after ICC feedback. Nursing Director and Manager: Permission will be obtained from nursing director and manager because they are responsible for safety and quality of their hospital; staffing; employee satisfaction; consumer satisfaction; and budgeting. Head Nurse (HN): Permission will be taken from the unit HN because they have a responsibility to manage their unit; to assure the quality care to all patients. Moreover, HN assists and conducts education and training programs for their unit staff. Portfolio Activity 2: Barriers and Facilitators: Impact on clinical practice change Elements of practice that assist my project: The element that will assist my project are the dominant organization culture leaders that includes the nursing directors, manager and ICC have significant impact on the ability of head nurse and clinical nurse instructor (CNI) to bring about the changes in nursing practice (Helfrich et al. 201). ICC will be involved in this audit as a stakeholder (ECDC 2013), facilitator to bring changes on staff practice and sustainability of that project. Because they are: Expert in infection control field. Responsible to develop, revise and implement the infection control policies based on standard guidelines. Conducting audits to evaluate the practice and performance of health care workers with standards and participate in those activities that improve compliance by monitoring parameters with regard to process or outcome. Identifying barriers to adherence with policy and procedure, by involving health care workers. Facilitate clinical care organization to implement infection control guideline, e.g. through proper training of employees about the infection control and prevention. Unit HN and Clinical Nurse Instructor (CNI) will be involved during the process of change management and sustainability of that project because both are responsible to regularly conduct the unit rounds. During the unit rounds, they will assess the staff performance and practice about the CVC on regular basis; reinforce staff to follow the ICC guidelines; and conduct the training session for their staff based on identifying needs particularly about the CVC. Elements that become a barrier for my project: Jeffery Pickler (2014) have identified the following barriers to become non-compliance with CVC guideline could be the cognitive and contextual factors. Cognitive barriers: Nurses are working with the many competing priorities of patient needs that lead them to prioritize their activities. Therefore, they are skipping those activities which they considered least important. Nurses are not following the guidelines when they do not see evidence of harm; understand the rational of policy’s; and want to waste the resources. Lack of knowledge and forgetfulness about the policy. Nurses do not wash their hands frequently, when they are continuously using patient’s CVC site. Contextual barriers: The organization is placing an importance to such activities that staff consider least valuable. These priorities includes aspect of documentation (staff feels that they are documenting more than providing care), frequent changes in practice, and lack of training. Shortage of staff, resulting in taken shorts cuts. Unavailability and inaccessibility of supplies and equipments. Strategies that assist staff and sustain to change their practice: Jeffery Pickler (2014) have mentioned some strategies that assist staff to change their practice are as follows: Commonly supplies and equipment should be readily available. Training and education about the infection control policy should be offered to all staff. User-friendly documentation system should be made. Sanitizer should be available on patient’s bedside. Staffing should be adequate. Other strategies stated by SA Health (2012a) SA Health (2012b) could be: Surveillance and auditing programs should be frequently performed by ICC. Ongoing feedback or appraisal should be given to staff to improve their practice. Ensure that online infection control policy should be accessible to all the staff or posted on the notice board. Encourage staff to use incident reporting system to notify any breeches in infection control practice. Elect the infection control nurses (ICN) from each shift that will be responsible to monitor the infection control practices in their own groups. So in this way, unit staff will start taken the responsibility to prevent and control the rate of infections from their units (Kitson Straus 2013). To conclude, this audit will only achieve its aims and significant outcome, when organization will understand the staff barriers and take some actions against those barriers, which staffs are facing at interpersonal, intrapersonal and organizational level, results in sustainability of this project. References: European Centre for Disease Prevention and Control (ECDC) 2013, Core competencies for infection control and hospital hygiene professionals in the European Union, Stockholm, ECDC. Helfrich, CD, Yu-Fang, L, Sharp, ND, Sales, AE, 2009, ‘Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on research in health services (PARIHS) framework’, Implementation Science, vol. 4, no. 1. Human Research Ethics Committee (HREC) 2008, Quality Assurance Guideline, viewed on 27 May 2015, http://www.newcastle.edu.au/research-and-innovation/resources/human-ethics/policies-and-guidelines?a=28875> Jeffery, AD, Pickler, RH 2014,’ Barriers to Nurses’ Adherence to Central Venous Catheter Guidelines’, The Journal of Nursing Administration, vol. 44, no. 7/8, pp. 429-435. National Health and Medical Research Council 2014, Ethical Considerations in Quality Assurance and Evaluation Activities, viewed 26 May 2015, https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e111_ethical_considerations_in_quality_assurance_140326.pdf> National Health and Medical Research Council (NHMRC) 2015, Chapter 2.1 Risk and Benefits, viewed 22 May 2015, http://www.nhmrc.gov.au/book/chapter-2-1-risk-and-benefit> National Health and Medical Research Council (NHMRC) 2015a, Chapter 2.3: Qualifying or waiving conditions for consent, viewed 23 May 2015, http://www.nhmrc.gov.au/book/national-statement-ethical-conduct-human-research-2007-updated-december-2013/chapter-2-3-qualif> National Health and Medical Research Council (NHMRC) 2015b, Chapter 4.4: People highly dependent on medical care who may be unable to give consent, viewed 23 May 2015, http://www.nhmrc.gov.au/book/chapter-4-4-people-highly-dependent-medical-care-who-may-be-unable-give-consent> South Australia Health 2012a, Healthcare Associated Infection (HAI) Action Plan 2012 – 2014, viewed 23 May 2015, http://www.sahealth.sa.gov.au/wps/wcm/connect/7ec93b004d4617539bc8dbf08cd2a4a7/Clinical+Directive_HAI+Action+Plan+2012-2014_Oct2012.pdf?MOD=AJPERESCACHEID=7ec93b004d4617539bc8dbf08cd2a4a7> South Australia Health 2012b, Health care associated infection prevention: Strategic Framework, viewed 23 May 2015, http://www.sahealth.sa.gov.au/wps/wcm/connect/fa5710804d461a0f9c0adff08cd2a4a7/Clinical+Directive_HAI+Strategic+Framework_Oct2012.pdf?MOD=AJPERESCACHEID=fa5710804d461a0f9c0adff08cd2a4a7>

Team Decision Making Essay -- Organizational Development, Teams

The given case asks for one team decision-making structure that is most effective for the following creative project: Eight administrators are given one afternoon to generate as many creative ideas as possible and to decide which one of these is the best. To solve this question we first need to determine which kind of team is involved. McShane and Von Glinow state that â€Å"Teams are groups of two or more people who interact and influence each other, are mutually accountable for achieving common goals associated with organizational objectives, and perceive themselves as a social entity within the organization† (234). Furthermore we can say that this group can be called a â€Å"Task force (project) team† because these eight administrators are a temporary team â€Å"whose assignment is to realize an opportunity† (McShane and Von Glinow 235). Now, that we know these people can be called a team, the next step is to look at the constraints on team decision-makin g because this will enable us to choose the most suitable decision-making structure. Therefore, I will first give a brief overview of the existing structures and then decide for one method which I will explain in depth. Finally I will provide a brief conclusion and recommendation. Constraints on Team Decision Making There are plenty problems within team decision-making. According to McShane and Von Glinow the four most common problems in team decision-making are: time constraints, evaluation apprehension, pressure to conform, and groupthink (256). Time Constraints refers to the fact that a team requires more time to come to a conclusion than an individual. That is because team members have to communicate with each other about their ideas, and also have to debate about these i... ... (Time Constraints). Second, NGT reduces conflicts in the team. The case already predicted that some administrators in the group often disagree with each other and might criticize each other's ideas. Because NGT does not allow debating and criticism, conflicts won’t be a problem. Third, NGT includes silent and independent development of the individual ideas which minimizes the other decision making constraints like evaluation apprehension, pressure to conform, and groupthink. My statement is also supported by Mitchell and Danielson who carried out a study that also indicates that the Nominal Group Technique is most effective for creative projects (19). Therefore, I recommend choosing the Nominal Group Technique for the eight administrators to identify new revenue-generating uses of classrooms and related facilities between teaching semesters in one afternoon.

A Suburbian Murder

The pearl white pigeon glided into the open window bringing with it the stenches of central London traffic. It cocked its head to one side while perched on the windowsill, as if in limbo. The blonde, wavy haired boy lay, sprawled out on his bed. His eyelids twitched as his dark eyes attempted to adjust to the ferocious rays of sunlight flooding the room. No sooner did he lift his heads. Then the black monster blared excruciatingly from across the room forcing him to summon the will power to trudge along and slap the alarm on the head, silencing it for a further twenty four hours. What day was it? He didn't care. Each day was the same and he couldn't tell the difference. He felt something. He walked outside into the cool breezing, looking upwards towards the day with a large smirk in his face. He was quite young, about in his late twenties, tall and relatively thin. He had a certain style of clothing, wearing a white polo shirt, with jeans of a faded blue colour. He had no facial hair and his hair was flipped upwards, his green sparkling eyes reflected from the stunning sun like a diamond. He started to shiver. He stopped. He stood guard, glancing very sharply at them. Thunder screamed! And the burning intense weather died away. The shell spinning around had ripped his life. He hid panicking, wondering who it was? Why? Will someone help? Did he see me? Am I going to die? Out of the blue, tires screeched and the speeding car drove away into the gloomy night its number plate half out of its position, streaks of mud on the cars bright headlights and fresh mud falling off the bumper. He unleashed his face from the dark and ran fast as possible to shelter. He had just witnessed a hideous murder. The fluorescent moon shone beams of darkness through the condensed window into the minute aura of evil; he could not terminate the appalling judgment of the revolting murder, his head was spinning due to the puzzle thoughts of what he would do subsequently. He couldn't bring the images of the ruthless murder to an end as it repeated in his distressed mind. Having watched his only family murdered, he could not eject the sensation of the evil thought of his brother being murdered! The door rang; it was the policemen, come around asking questions about the death of his late brother. Having asked firm and draining questions they had still no suspects or any set offs with the murder connecting towards the murderer, they had no choice but to close the case. The one and only time he needed help and he was turned down. After a short ineffective period of nap the door bell rang yet again, this time it was Andrew his brother's superlative pal. He had heard the news of the harsh murder and had come to give his wishes and support. He felt a bit rickety and had many large breaks in-between sentences as though he was hiding something. My suspicions grew larger and I too started to feel in-secure. It seemed he was in a hurry so I walked him to the door. My heart started to beat faster, my hands flooded as sweat was unleashed from the palms of my hands, I became breathless as my lungs felt compressed. I could not believe that my eyes were telling me the truth. The same old car with the same old broken number plate could it be he murdered my loving brother I was bolt from the blue and I knew what to do for the sake of my beloved brother . Just before the ice blood curdling night I waited. Sitting on an old rusty tree like a dull owl. I got out a blood thirsty razor sharp knife grasping to be used. I glanced at it and saw a sharp reflection of myself. Its face was shivering; it could its tired and strained face bearing the marks of harsh warfare. Then suddenly the chilly air spun around him like a smooth python trying to suffocate it. He sat back in stress. Thunder screamed! And the house awoke sending out a large breeze, he could sense the presence of his foe. The bleak chilly air had died away and then the vigorous rain was unleashed from the jet black sky and he was ready to make his move. The black car drove into the driveway. The number plate half out of its position, streaks of mud on cars head lights, fresh mud falling off the bumper. He walked towards the door wearing a white striped suit. His hair was wet and flat from the rain he had no facial hair but wore glasses. He was very muscular and also had a mole on his right cheek and looked quite similar to his brother. His jingles of keys fell as he ran towards his house for shelter from the rain, he kneeled he paused; Thunder screamed! He pulled it! The shell spinning around had ripped his life. He fell back thinking who it was? Why? Will someone help? Am I going to die? The predator walked up towards its prey as he was raising his hands for help, he unleashed his face from the dark. The atmosphere drew a sigh as the trigger was pulled and a bullet was released again. The cold blooded killer dragged the deceased into the cold shivering pool of chlorine water and left it to drown. He packed his carnage weapon and removed the traces of his presence. The storm cried away leaving a romantic dark pitch sky with bright glowing stars. He walked home having justice for his brother and now his best mate was dead at last!

The Heros Journey and Archetypes in Literature

Carl Jung called archetypes the ancient patterns of personality that are the shared heritage of the human race. Archetypes are amazingly constant throughout all times and cultures in the collective unconscious, and youll find them in all of the most satisfying literature. An understanding of these forces is one of the most powerful elements in the storyteller’s toolbox. Understanding these ancient patterns can help you better understand literature and become a better writer yourself. Youll also be able to identify archetypes in your life experience and bring that wealth to your  work.   When you grasp the function of the archetype a character expresses, you will know his or her purpose in the story. Christopher Vogler, author of The Writers Journey: Mythic Structure, writes about how every good story reflects the total human story. In other words, the heros journey represents the universal human condition of being born into this world, growing, learning, struggling to become an individual, and dying. The next time you watch a movie, TV program, even a commercial, identify the following archetypes. I guarantee youll see some or all of them. The Heros Journey The word hero comes from a Greek root that means to protect and serve. The hero is connected with self-sacrifice. He or she is the person who transcends ego, but at first, the hero is all ego. The hero’s job is to incorporate all the separate parts of himself to become a true Self, which he then recognizes as part of the whole, Vogler says. The reader is usually invited to identify with the hero. You admire the heros qualities and want to be like him or her, but the hero also has flaws. Weaknesses, quirks, and vices make a hero more appealing. The hero also has one or more  inner conflicts. For example, he or she may struggle over the conflicts of love versus duty, trust versus suspicion, or  hope versus despair. In The Wizard of Oz  Dorothy is the storys hero, a girl trying to find her place in the world. The Job of the Herald Heralds issue challenges and announce the coming of significant change. Something changes the hero’s situation, and nothing is the same ever again. The herald often delivers the Call to Adventure, sometimes in the form of a letter, a phone call, an accident. Heralds provide the important psychological function of announcing the need for change, Vogler says. Miss Gulch, at the beginning of the film version of The Wizard of Oz, makes a visit to Dorothys house to complain that Toto is trouble. Toto is taken away, and the adventure begins. The Purpose of the Mentor Mentors provide heroes with motivation, inspiration, guidance, training, and gifts for the journey. Their gifts often come in the form of information or gadgets that come in handy later. Mentors seem inspired by divine wisdom; they are the voice of a god. They stand for the hero’s highest aspirations, Vogler says. The gift or help given by the mentor should be earned by learning, sacrifice, or commitment. Yoda is a classic mentor. So is Q from the James Bond series. Glinda, the Good Witch, is Dorothys mentor in The Wizard of Oz. Overcoming the Threshold Guardian At each gateway on the journey, there are powerful guardians placed to keep the unworthy from entering. If properly understood, these guardians can be overcome, bypassed, or turned into allies. These characters are not the journeys main villain  but are often lieutenants of the villain. They are the naysayers, doorkeepers, bouncers, bodyguards, and gunslingers, according to Vogler. On a deeper psychological level, threshold guardians represent our internal demons. Their function is not necessarily to stop the hero but to test if he or she is really determined to accept the challenge of change. Heroes learn to recognize resistance as a source of strength. Threshold Guardians are not to be defeated  but incorporated into the self. The message: those who are put off by outward appearances cannot enter the Special World, but those who can see past surface impressions to the inner reality are welcome, according to Vogler. The Doorman at the Emerald City, who attempts to stop Dorothy and her friends from seeing the wizard, is one threshold guardian. Another is the group of flying monkeys who attack the group. Finally, the Winkie Guards are literal threshold guardians who are enslaved by the Wicked Witch. Meeting Ourselves in Shapeshifters Shapeshifters express the energy of the animus (the male element in the female consciousness) and anima (the female element in the male consciousness). Vogler says we often recognize a resemblance of our own anima or animus in a person, project the full image onto him or her, enter a relationship with this ideal fantasy, and commence trying to force the partner to match our projection. The shapeshifter is a catalyst for change, a symbol of the psychological urge to transform. The role serves the dramatic function of bringing doubt and suspense into a story. It is a mask that may be worn by any character in the story, and is often expressed by a character whose loyalty and true nature are always in question, Vogler says. Think Scarecrow, Tin Man, Lion. Confronting the Shadow The shadow represents the energy of the dark side, the unexpressed, unrealized, or rejected aspects of something. The negative face of the shadow is the villain, antagonist, or enemy. It may also be an ally who is after the same goal but who disagrees with the hero’s tactics. Vogler says the function of the shadow is to challenge the hero and give her a worthy opponent in the struggle. Femmes  Fatale  are lovers who shift shapes to such a degree they become the shadow. The best shadows have some admirable quality that humanizes them. Most shadows do not see themselves as villains, but merely as heroes of their own myths. Internal shadows may be deeply repressed parts of the hero, according to Vogler. External shadows must be destroyed by the hero or redeemed and turned into a positive force. Shadows may also represent unexplored potentials, such as affection, creativity, or psychic ability that goes unexpressed. The Wicked Witch is the obvious shadow in the Wizard of Oz. Changes Brought About By the Trickster The trickster embodies the energies of mischief and the desire for change. He cuts big egos down to size and brings heroes and readers down to earth, Vogler says. He brings change by drawing attention to the imbalance or absurdity of a stagnant situation and often provokes laughter. Tricksters are catalyst characters who affect the lives of others but are unchanged themselves. The Wizard himself is both a shapeshifter and a trickster.