Nursing Shortage and Turnover Management

Introduction

A nursing shortage and turnover remain to be a serious problem for many American hospitals. Thousands of nurses are eager to leave their jobs in the next year after their graduation due to poor or unstable working conditions, long working hours, and the amount of work that has to be performed (Boamah & Laschinger, 2016). In this paper, several theories and practices will be discussed to understand what kind of work can be done by nursing leaders and managers to promote the decrease of a shortage and turnover, what philosophies and approaches may inspire nurses, and what funding source can be used to support medical workers in Florida.

Nursing Shortage and Turnover in the United States

In this project, two main nursing concepts have to be identified: shortage and turnover. A nursing shortage is a current problem of many American organizations when the demand for professional nurses turns out to be higher than its current supply (The nursing shortage, 2018). As soon as a facility experiences a nursing shortage, the quality of healthcare undergoes considerable changes and negative outcomes. Turnover is another challenge when the movement of employees cannot be controlled by the employers, and the number of leaving nurses influences the overall performance of an organization.

The reasons for these problems may vary, including unexpected or unclear healthcare reforms, increased population, the age of retirement, or poorly developed nursing programs that cannot promote the required number of nurses. In addition, a nursing shortage may be defined as one of the possible reasons for poor job satisfaction, organizational conflicts, increased emotional changes, and stress (The nursing shortage, 2018). Regarding such causes and outcomes, there is a burning need to solve this problem and promote some changes at the organizational level including the possible impact of leaders and managers.

The Role of Leaders and Managers

There are many methods of how nursing leaders and managers can approach the solution and improvement of the situation with the nursing shortage and turnover. For example, according to Lewin, there are three main styles of leadership that can be applied to nursing practice: autocratic (when all decisions are made by leaders), democratic (when decisions are made by leaders after thorough discussions with the rest of the team), and laissez-faire (when leaders are not involved in decision making). However, the choice of one particular style is not enough to solve the problem of the nursing shortage in organizations.

Compared to leaders who have to make decisions and motivate all employees, nursing managers are more task-oriented. They have to gather enough material for their leaders. Managers also perform the role of a guide and advisor for nurses to ensure that everything functions properly in an organization. This job includes the creation and implementation of schedules, teaching, and coaching. Leaders, in their turn, should follow appropriate completion of all tasks managers have to take. Leaders may establish policies and measures to promote order and identify responsibilities. However, despite the existing differences between these two professions, managers and leaders cannot work without each other. They complement each other in terms of motivation, decision-making, and organization. Leaders and managers have to cooperate and develop mixed approaches in their work to promote such principles as care, trust, cooperation, development, and satisfaction. To achieve such organizational goals, it is possible to use Lewins change theory to support nurses and Watsons caring theory to guide nurses.

Theory One

A nursing shortage and turnover can be reduced in case leaders and managers implement some changes in their organizational processes. Some people face serious problems when a change has to be applied to a facility. Therefore, it is possible to follow the theory of Lewin and take three main steps, including unfreezing (to identify and define a problem), moving (to analyze and clarify the alternatives), and refreezing (to implement and evaluate the ideas) (Garon, 2017). Nursing turnover can be reduced when the leaders and managers clarify the reasons for why nurses want to change their jobs, get some time to think over the benefits and threats of change, and implement a new approach. The main task of leaders and managers in the discussion of this concept is not to stay and wait for some change or improvement to happen without any work. Managers have to investigate what change they can offer to the staff, and leaders have to make a final decision to reduce the number of decisions of nurses to leave hospitals.

Theory Two

In addition to organizational change, it is expected to provide nurses with a helpful guide. Despite the already received knowledge, nurses want to observe support of their leaders. Regarding this need, leaders and managers may use Watsons theory of caring where the ideas of love and kindness, equanimity, a caring environment, and recognition of personal beliefs are promoted. This theory can help to recognize the expectations patients may have when they visit hospitals and cooperate with nurses. Similar approaches and skills may be appropriate to the relationships developed between nurses, their leaders, and mangers. As soon as leaders explain to managers what they want to observe in nursing work, managers can demand similar things from their nurses, and nurses can explain their attitudes to managers. Watsons theory is a good approach to rely on in the discussion of nursing shortage and turnover issues.

Approach to Nursing Practice

My personal philosophy is similar to my professional tactics when the recognition of personal needs and organizational responsibilities is required. It is wrong to expect something from people if you are not able to meet similar expectations. Therefore, I want to believe that the democratic style of leadership and a determined leadership approach can be effective for the solution of turnover and shortage problems. This choice helps to recognize personal weaknesses and opportunities and use them in the development of demands in the workplace.

Funding Source

To address the chosen issue, leaders and managers should also consider a possible funding source. According to the Title VIII of the Public Health Service Act, the distribution and supply of qualified nurses have to be supported by each state to meet healthcare needs of the population. There are many funding systems and grants that can be used by students to become nurses. These grants can increase the number of nurses and decrease nursing turnover. For example, one of the grants offered by the Health Resources & Services Administration (2016) provides about 45-50 grantees from Florida with financial aid annually. Though such support is not huge, it is regular, and students may ask for it regardless of their age, gender, and race.

Conclusion

In general, the discussion of the nursing shortage and turnover issues is open today. Researchers, nurses, managers, and leaders are free to make their own contributions to the promotion of solutions and alternatives. Some hospitals may not experience serious challenges because of turnover, and some organizations cannot demonstrate high-quality care as soon as a nursing shortage occurs. Therefore, it is expected to change the work of leaders and managers so that they can comprehend the level of their responsibility in regard to their nurses and develop the conditions that may be appropriate to hospitals, nurses, and leaders with the help of available funding sources.

References

Boamah, S.A., & Laschinger, H. (2016). The influence of areas of worklife fit and work-life interference on burnout and turnover intentions among new graduate nurses. Journal of Nursing Management, 24(2), 164-174.

Garon, M. (2017). Change and innovation. In D. Huber (Ed.), Leadership and nursing care management (6th ed.) (pp. 32-48). St. Louis, MO: Elsevier.

Health Resources & Services Administration. (2016). 2016 Florida health center data. Web.

The nursing shortage  Why we need more qualified nurses in the field. (2018). Web.

Internship in Sports Management Program

Participation in accessible internships for a sports management program broadens job alternatives for starters in the flexible field of the sports industry. Such experiences allow students to apply their newly acquired skills and hands-on proficiencies in actual training contexts and real-world conditions (Wallrodt & Thieme, 2020). Internships further prepare prospective sports managers to understand the function and complexity of sports organizations alongside the trending approaches to use while managing employees and running daily routines. A breakdown of the benefits of an internship in the sports management niche alongside my perspective regarding the remote program offered by Hitmarker forms the basis of this paper.

According to the American Sports Management Association (ASMA), undertaking an internship in a recognized sports school assists participants in determining appropriate job environments that suites their personal needs and preferences. Additionally, a sports management internship is valuable because it allows interns to interact with different industry professionals. Interns can learn about how other related businesses handle different administrative responsibilities through job shadowing. Concurrently, they are allowed to polish their communication and networking skills, which are essential for gaining the contacts needed to be a successful sports manager.

I consider the Hitmarker remote internship program an ideal chance to pursue a career based on my specific goals. The remote program is, in my opinion, quite flexible, individualized, and progressive. This is because I am trying to fit an internship into my rigorous school schedule, thus, the virtual placement will be incredibly convenient. I will be able to make personalized schedules that will not only ensure compatibility with the other facets of my life but further allow me to pursue my ultimate goal of being a sports manager. Furthermore, the fact that these placements are remote suggests that I will be able to significantly reduce the additional spending such as transport costs.

Reference

Wallrodt, S., & Thieme, L. (2020). The role of sports volunteering as a signal in the job application process. European Sport Management Quarterly, 20(3), 255-275.

Risk Management and Safety

Introduction

Quality of care is critical in a hospital; therefore, the risk management system should work on identifying and resolving issues to prevent patients from being injured. This paper will identify an issue, discuss related nurse leader competencies, and propose guidelines.

Inefficiency

Hand hygiene compliance is low, and both staff and patients violate these protocols regularly. Hand hygiene is the most critical measure for the reduction of infection, and thus policies and other personal factors should drive staff and patients to comply.

Explanation of Inefficiency

Hand hygiene is relevant both before and after contact with a patient in order to avoid infecting the patient or being infected. Current staff is not properly educated on the issue, the required infrastructure is not present, and the workflow is not adjusted to accommodate hand sanitization, which results in hospital-acquired infections.

Implications

Hand hygiene is a significant indicator for patient safety because almost 100,000 people die annually because of hospital-acquired infections (Doronina et al., 2017). Infections may travel across different healthcare providers because of patients.

Regulatory Guideline

There are guidelines issued by the CDC and HICPAC that are based on recommendations of WHO. In summary, these guidelines tell that healthcare personnel should wash their hands with soap or use an alcohol-based hand sanitizer.

Expectations of Regulations

Regulations expect that staff wash their hands or use hand sanitizer before and after touching a patient, after contact with blood and other bodily fluids, before performing an aseptic task, when moving between soiled body and clean sites, and after removing gloves.

Variable one Clinical Setting

Soaps and hand sanitizers should be available to all staff and should be placed in such a way so as not to disrupt workflow. In each room, alcohol-based hand rub should be available for both the patients and staff.

Variable 2 in Clinical Setting

Necessary education should be provided for nurses and reminders should be used extensively to reinforce learning. Risks are often underestimated; therefore, nurses need comprehensive education to improve compliance (Doronina et al., 2017).

Variable 3 in Clinical Setting

Administration should provide support and conduct campaigns targeted at improving HH compliance. If necessary, the workflow should be altered to accommodate HH activities. By observing whether the staff is complying and establishing a work culture where HH is critical, healthcare facilities will decrease the number of hospital-acquired infections (Gould et al., 2017).

Quality Improvement Model

Plan-Do-Study-Act (PDSA) cycles will allow personnel to achieve necessary habits by accomplishing repetitive cycles of short tasks. In addition, it should be noted that emphasis should be put on systemic processes rather than individual compliance.

Application of Quality Improvement

Application of quality improvement measures includes achieving a higher HH compliance and lowering the number of hospital-acquired infections. This change is beneficial for hospital safety and health of both patients and staff.

Nursing Leader Competency I

When applying administrative intervention, it is important for a nurse leader to be communicative. Personnel should understand the reasons behind interventions and their importance. In addition, nurse leaders should be ready to offer information on HH and health implications.

Nursing Leader Competency II

Nurse leaders should also be influential in discussing the issues with both nurses and managers. This competency is vital for establishing the culture of safety. Also, nurse leaders should be able to deliver the messages of nurses on the issues in HH infrastructure or workflow.

Nursing Leader Competency III

Vision and strategy are also critical because a nurse leader should be able to set objectives and propose strategies for achieving those goals. This competency will allow the leader to improve current practices and adjust regulations based on current circumstances.

Conclusion

Hand hygiene is critical for ensuring patient safety and providing clients with quality care. Necessary guidelines should be established to ensure hand hygiene compliance. Personnel should receive training, and all necessary HH materials should be placed accordingly.

References

Doronina, O., Jones, D., Martello, M., Biron, A., & Lavoie-Tremblay, M. (2017). A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship, 49(2), 143152.

Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews 9. Web.

Technology Trends in Hotel Management

Technology usage for various purposes is becoming increasingly prominent among various hospitality providers. According to Ivanov and Webster (2019), hotels are now implementing automation in various areas, such as check-ins and cleaning, and some companies are experimenting with hotels staffed fully by robots. By doing so, they can save the money they would otherwise be spending on staff while possibly improving the customer experience by removing human error.

However, such technologies are often still in the experimental stage, with their effectiveness varying based on the specific implementation. As such, hospitality facilities have begun employing data analysis, another aspect of company performance that can be substantially enhanced through automation.

Khosrow-Pour (2019) discusses the usage of big data to analyze customer patterns worldwide and evaluate the effectiveness of specific measures as well as the differences between particular groups. With that said, the practice can lead to privacy concerns, particularly when the customers whose data is being collected and used do not understand that they give their consent to such operations. Data breaches are another issue, as the need to store customers information puts it in danger if any malicious activities take place.

Lastly, companies are experimenting with potential future improvements that take advantage of the Internet of Things. Information Technology Management Association (2018) discuss the usage of smart locks that communicate with smartphones and smartwatches, manipulation of light sources when one enters the room, and data retrieval from vehicles. As shown in Figure 1, chains such as Marriott are experimenting with concepts that provide more comprehensive customer experiences, such as fitness applications. Overall, the uses of technology in hotel management are likely to become more widespread and advanced in the future.

References

Information Technology Management Association (2018) Wearable technologies: concepts, methodologies, tools, and applications. Hershey, PA: IGI Global.

Ivanov, S. and Webster, C. (eds.) (2019) Robots, artificial intelligence and service automation in travel, tourism and hospitality. Bingley, United Kingdom: Emerald Publishing.

Khosrow-Pour, M. (2019) Advanced methodologies and technologies in network architecture, mobile computing, and data analytics. Hershey, PA: IGI Global.

Marriott unveils smart hotel room prototypes with personalized presets and voice control (2018). Web.

Project Management Tools in Nursing

Introduction

As a temporary endeavor that focuses on the production of unique operational entities, a project plays a vital role in nursing. Projects outcomes help either solve particular negative problems or create positive issues, such as new clinical procedures, practices, and products. Therefore, project management may be regarded as a complex process that requires proper overview, planning, organization, and evaluation for the most successful results. Project scope and charter are among tools designed to facilitate the planning and implementation of a project. In this paper, these tools, their functions, and their significance for project management will be addressed.

Project Scope

As a matter of fact, a project scope has a great impact on the outcomes of any project. As in an efficient project, time, budget, standards, and stakeholders are considered, managing project scope is the best solution to eliminating any ambiguity and uncertainty in it (Ajmal et al., 2019, p. 483). Documented in a specific scope statement, it implies the identification and recording of all project decisions. In other words, the scope includes the projects goals, objectives, steps, tasks, purposes, timeline, and budget. In addition, a project scope identifies deliverables, risks, constraints, limitations, and everything out of it.

The significance of a project scope is determined by the fact that this document provides assistance for the project team and all stakeholders in their work towards goals achievement within the agreed budget and timeframe. That is why the scope statement should be elaborated on by all people involved in the project to represent a comprehensive overall plan with key elements accessible for examination. In addition, with defined project scope, a project manager may present a project to stakeholders in the most appropriate way as its expedience and benefits will be easily observed.

Project Charter

A project charter is a crucial element of planning as it is traditionally used throughout the whole lifecycle of a project. In general, a charter is a formal short, though official, document that addresses a projects objectives, reasons, an overall plan and how it will be implemented, stakeholders and their responsibilities, the projects scope, risks, benefits, budget, and timeframe (What is a project charter? 2021). Similar to a project scope, a project charter is elaborated on at the beginning and both documents serve as guidelines that define the projects steps for its successful implementation and appropriate results.

The importance of a project charter is primarily determined by its official status. In other words, if a charter is not officially approved, there is no proof or official document that an authorized project manager defined and presented a project and gained its approval from stakeholders to proceed (What is a project charter? 2021, para. 5). In addition, along with its basic function of sharing understanding and creating the projects vision, a project charter empowers a project manager, predicts success, identifies the levels of objectives importance, and ensures stakeholders awareness.

Conclusion

It goes without saying, that any project related to nursing will be unsuccessful without appropriate planning and understanding of its main goals, objectives, and purposes. Project scope and a project chart are highly essential project management tools that help efficiently plan a project for its successful implementation in the future. Using these tools, a project manager, project team, executive leaders, and other stakeholders have a clear vision of their projects potential outcomes, barriers, and risks.

References

Ajmal, M., Khan, M., & Al-Yafei, H. (2019). Exploring factors behind project scope creep -stakeholders perspective. International Journal of Managing Projects in Business, 13(3), 483-504. Web.

What is a project charter? (2021). Web.

Sports Management Internship: Lessons Learnt

Sports facility management is a concept in sports designed to help keep leagues, tournaments, sports complexes, and all other activities orderly and running most efficiently (American Association for Health Education). Sport facility management is not just an issue of making sure that the leisure center is organized. It also involves providing better services and ensuring all stakeholders, especially the customers (players), are familiar with the services.

In this report, I will highlight an array of activities that I performed at a sports facility center as an intern for a period of [Insert time/months/weeks]. I will extensively discuss how I carried out daily activities as I sought to gain practical experience in sports management.

As an intern, I expected to gain practical experience in sports facility management areas. For this reason, I had to be actively involved in all departments of sport facility management. This called for collaboration and a strong team working with other colleagues to get maximum output most efficiently. To be specific, I was actively involved in management, scheduling budgeting, and baseball coaching, among other activities. I was very excited to work as an intern in managing a sports facility, and I was motivated by the fact that I would be coaching baseball, which is one of my favorite sports.

The first week was only for orientation. I was introduced to all the staff members on the first day, and during the entire week, I was taken around the sports facility to familiarize myself with my new work environment. The supervisor was the one who took me around, and once I had fully acquainted myself with the sports complex and all activities offered, I was assigned one of the employees at the facility who did an extensive orientation in the offices and stores.

He took me around the offices, and I was introduced to almost all employees, especially those I would be working closely with. Finally, I was taken to my new office, which was well equipped with a computer, a printer, files, and all the necessary office tools. Here, I was introduced to several management systems, including the sports facility management software, which I learned to use within a few days. I was given comprehensive training for the rest of the week in all areas. The exercise was necessary for understanding the practical part of sport facility management, which I must say was very useful and exciting.

Having received an extensive and broad orientation, I began running duties independently in the second week. I was provided with the work schedule, which changed from time to time, depending on the clients demands. Being new and having no experience was quite challenging, but I consulted my supervisor and work colleagues whenever I encountered any difficulties. Based on the level of cooperation with highly esteemed individuals, I had less worry about, as my colleagues were ready to solve any problem.

Daily activities

Because of continually traveling to different sports complexes for exposure, my day-to-day activities began with morning assessments. As a routine management practice, I walked around every morning, checking over to familiarize myself with all activities that happened when I was away. This also meant that I had to talk to different staff members and go round the sports facility. Whenever necessary, other colleagues and I would have a meeting for briefing about daily activities and general progress. Where a problem was detected, I would consult my supervisor for help, and sometimes I would help the staff members to resolve emerging issues.

Once back in my office, I would make all the day plans and organize the daily schedule. Mostly, I managed the daily schedule for all staff members under my department, and later I would organize my program. However, every staff member had a programmed plan that was well outlined on the notice board. From time-to-time, I would make adjustments and record the changes according to everyday schedule. In case there were no changes, I would assess the progress, sort out daily activities, and finally plan for prioritiesthis enabled efficiency and organization.

In the case of new developments, I would develop a new program to fit the new services. However, before making appropriate modifications, I would discuss all products with the supervisor before presenting suggestions to the staff members. Depending on the topic, the staff members would give their opinion, and we would make an informed decision as a team.

As part of the sports facility management, I would ensure that all routine administrative duties were kept up to date. This involved checking that accident report forms were recorded and filed appropriately. This was very necessary for ensuring the health and safety of all involved stakeholders.

In addition to this, I was responsible for accounting and budgeting. On a daily basis, I would ensure that all financial transactions were recorded appropriately and kept up to date. I also confirmed that such records were filed appropriately for future reference. At the end of every week, I would monitor the documents and assess all costs against financial targets due to issues of accountability and for the purpose of smooth running of the sports facility. I would also get involved in setting plans, including all financial budgets.

On the other hand, I had the responsibility of developing new marketing strategies. I would decide on my target group, discuss the issues with the supervisor, and, if approved, I would research the best method for attracting and reaching potential clients. In most cases, this involved working on advertisement strategies that would be most efficient. To facilitate the process, we worked as a team together with other staff members on various ways of reaching the public and getting them to familiarize themselves with the sport facility activities. At times, this would mean planning and organizing special events to sensitize the public.

Finally, in order to ensure quality service delivery, I would walk around talking to the clients and listening to their views. This was important in improving service delivery. On a daily basis, I would speak to a number of clients on issues of quality service, facilitates efficiency, and staffing levels. I would assess their feedback and make a general conclusion. The most important thing was ensuring that customers were satisfied with the services offered. Based on clients feedback, we, as staff members, would discuss necessary amendments with other staff members. I would oversee all changes, if any were proposed, to ensure quality service delivery.

Coaching baseball

As an intern, I was also involved in baseball coaching, and I trained the Old Travel baseball team made of teenagers between 16 and 18 years old. The training was routinely scheduled for two hours daily from Monday to Friday. In addition, over the weekend, the movement took place between10 and 12 in the morning hours. My primary responsibility was scheduling and managing the players on a daily basis.

As a baseball coach, it was my responsibility to train my players primarily on the basics of baseball. Warming up was the first step that we would get involved in before engaging in the actual playing. Through this procedure, I would be able to isolate fast players, strong ones, as well as creative ones. This would help me to know where to field each player for the purposes of training. I would endeavor to keep the notes on each player, including the time he uses to get the ball to the first base, the length of the hits in the field, and who ran fastest. The training was scheduled as follows: Monday was for physical exercises only.

On Tuesday, the first one hour was for sprinting, and the other hour was for batting. On Wednesday, training would involve pitching only after warming up. On Thursday, physical exercises again with an emphasis on sprinting. Friday was scheduled for training on catching, while Saturday, we would go for tournaments to the East Coast. Sunday was usually for recreation and team-building skills.

After the entire period of internship, the players had learned adequately one of the most useful skills in baseball: batting. The first thing they learned was to select a bat that fits one by swinging it a lot. I ensured that they understood the significance of the connection between the ball at high speed and the bat. At the end of the fourth week, each player had identified their potential and had known where they best fitted: pitching, catching or batting.

More specifically, by this time, they had learned how to keep their heads steady with eyes on the pitcher and always getting ready to swing when a good pitch is made. In addition, they were able to keep the front shoulder down and had conceptualized the idea of avoiding uppercuts by knowing the zone they were comfortable hitting. In summary, it was a pleasant experience as we interacted each Sunday and evaluated the progress of each player. By interacting, the players were able to share their views, and this helped in building the team spirit. Under my coach ship, the team won three crucial games.

Lessons acquired from this internship

Before enrolling for the internship, I hoped that it would provide me with real field experiences and skills that are useful in developing my career. I knew the training would provide me with direct experience. Foremost, the internship program really helped me to gain practical experience in the area of sports facility management and supplemented the knowledge that I had acquired in class.

Secondly, working at a sports facility actually helped me to develop leadership and management skills. Because of many responsibilities and challenges, I was forced to make crucial decisions, and this helped me in assessing the strengths and weaknesses of my leadership and management skills. Today, I believe that the experience I gained during this period equips me with competent skills to manage any other sports facility.

Thirdly, working at the sports facility provided me with an opportunity to gain cross-cultural experience hence learning to appreciate and accept diversity. As an intern, I worked with colleagues from different cultural backgrounds. This opportunity helped me to exchange ideas and experiences with other people, and because of this experience, I significantly improved teamwork and communication skills.

Finally, through the internship, I learned new dimensions in the area of sports and facility management. Due to handling many tasks and responsibilities, I was able to learn new things. On a number of occasions, I interacted with experienced individuals in this field, giving me an opportunity to develop unique aspects of sport and facility management that I may not have been able to learn in the classroom.

Conclusion

In conclusion, the internship program was beneficial and interesting too. I became familiar with issues of sport facility management, and more importantly, I developed a network while working with other professionals in this field. Although managing sports facilities was quite challenging and demanding too, I was able to handle my duties with the help of my superiors and other colleagues.

Indeed, I realized teamwork is necessary for good organization and maximum productivity. It is during this internship program that I was able to assess my strength and weakness, which has helped me improve both in terms of career and in terms of personality. With the experience gained from this internship, I believe I have acquired quality management and leadership skills. With such skills, I am confident that I can efficiently run a sports facility center in the future. The opinion is that more internship programs should be offered to students so that they can gain practical experience, which is essential in any vocation.

Works Cited

American Association for Health Education. Fields of Study-Sport Management. 2012. Web.

Acutely Ill Patient: Care Management

Introduction

People are often diagnosed with diverse illnesses, and some diseases can cause prompt changes in a persons condition. Healthcare professionals face various challenges in terms of recognising and assisting acutely ill patients in a timely manner (Bliss and Aitken, 2018). Typically, deteriorating patients have modifications in their physiological parameters, which can be indicated by the usage of early warning tools (Bliss and Aitken, 2018). However, providing medical assistance to individuals whose soundness is rapidly declining is demanding due to the involvement of various factors and processes. Care management of an acutely ill patient encompasses assessment, planning, monitoring, and treatment procedures that should be tailored to each specific patient.

Case Study

MA, a 67-year-old male, had been complaining of persistent chest pain and was delivered to the intensive care unit (ICU). Initially, the patient was brought to the hospital due to community-acquired pneumonia, and his condition worsened on the fifth day of the clinic stay. On arrival at the ICU, MA exhibited difficulty breathing, drowsiness, and inability to complete sentences. Some results of the physical exam for MA were as follows:

  • Blood pressure: 126/71 mmHg
  • Heart rate: 120 beats per minute
  • Respiratory rate: 29 breaths per minute
  • Oxygen saturation: 76% on room air
  • Temperature: 37,7 °C

Furthermore, the patient indicated hypoxia, worsening confusion, and memory loss. MA tested negatively for COVID-19, had no sick contacts, did not travel recently, and was retired. The patient reported smoking cigarettes on a daily basis for the past several years alongside increased alcohol consumption but denied using recreational drugs. MA exhibited signs of acute respiratory failure and was kept in the ICU until full recovery through oxygen therapy.

Acute Respiratory Failure

Prior to discussing the care management of the patient, one must comprehend the nature of acute respiratory failure (ARF) identified in MA. ARF is a life-threatening condition associated with a variety of clinical signs, gas exchange alterations, and radiographic findings (Azoulay et al., 2018; Parcha et al., 2020). Such an illness can be seen in all acute care settings and can be hypoxaemic or hypercapnic (Robinson and Scullion, 2021; Rolfe and Paul, 2018). ARF is often caused by acute respiratory distress syndrome (ARDS), which can be characterised by impairment in gas exchange due to fluids leaking into the alveolar spaces (Parcha et al., 2020; Robinson and Scullion, 2021). Similar to several other respiratory problems, ARDS and ARF can be induced by pneumonia, as the disease leads to breathlessness and can result in rapid deterioration in a short time frame (Peate and Dutton, 2021). Notably, the rates of ARDS and subsequent ARF have raised because of the spread of COVID-19 (Carter, Aedy, and Notter, 2020). Accordingly, the case study suggests that MA experienced ARF due to pneumonia.

Assessment

People admitted to hospitals are at risk of becoming acutely ill, and patients representing the older population require special attention. An acute care setting can be considered an unfamiliar environment for older adults who face considerable challenges as their condition changes (Guidet et al., 2018; Potter et al., 2021). Individuals whose health is deteriorating experience major physiological transformations since the body attempts to maintain homeostasis and activates compensatory mechanisms associated with additional physiological demands on the person (Peate and Dutton, 2021). Therefore, patients who are likely to become critically ill, especially those of older age, like MA, need comprehensive care management, which begins with assessment procedures.

ACVPU

Healthcare professionals can start the examination of patients whose health may be deteriorating by utilising the ACVPU (Alert, Confusion, Voice, Pain, and Unresponsive) scale. The approach is an extension of the previous version that did not consider the Confusion parameter (Grant, 2018). The ACVPU assesses an individuals consciousness level based on how they react to different triggers (Grant, 2018). The Alert indicator determines if the patient is fully awake, whereas Confusion displays any new change to mentation (Grant, 2018). Voice detects a response to a verbal stimulus, and Pain shows whether the person is reactive to a pain impulse (Grant, 2018). Finally, the Unresponsive scale signifies that the individual does not respond to either of the influences (Grant, 2018). Consequently, the ACVPU demonstrates if a patient functions in a normal way or requires medical assistance.

Furthermore, although the case study does not mention if the ACVPU was applied to MA, it appears that he was not completely responsive. In particular, on his arrival at the ICU, MA was drowsy, meaning that he was not quite awake, and could not complete sentences, signifying that he probably could not adequately react to verbal stimuli. In addition, while it is not clear if MA was affected by a pain trigger, his worsening confusion and memory loss can be considered relevant for the Confusion scale (Grant, 2018). Therefore, the ACVPUs parameters suggest that MA was not quite conscious.

ABCDE

Another way to assess an acutely ill patient is by employing the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach. The ABCDE structure is well recognised in rapidly examining patients at risk of deterioration (Peate and Dutton, 2021). The method is meant to identify and stabilise the most life-threatening signs and give healthcare practitioners time to determine a diagnosis and relevant treatment (Peate and Brent, 2021). First, the airway has to be reviewed for any obstruction indicated by abnormal speech, paradoxical breathing, or central cyanosis (Peate and Brent, 2021; Peate and Dutton, 2021). Second, the patients breathing must be examined based on respiratory rate, oxygen saturation, and quality of breathing (Peate and Brent, 2021; Peate and Dutton, 2021). Third, circulation can be assessed by measuring pulse, blood pressure, and urine output (Peate and Dutton, 2021). Fourth, disability is analysed by using the ACVPU scale, as the AVPU method may not be accurate enough (Peate and Brent, 2021). Fifth, exposure should be examined based on body temperature, laboratory investigations, and clinical history (Peate and Brent, 2021). The ABCDE encompasses many parameters, but the listed ones can display the start of deterioration.

Consequently, MAs condition can be investigated by utilising the ABCDE approach. First, the patients airway was impaired due to difficulty breathing and inability to complete sentences. Second, MAs respiratory rate of 29 breaths per minute surpassed the most commonly accepted pace of not exceeding 20 breaths per minute (Grant, 2018; Peate and Brent, 2021; Robinson and Scullion, 2021). Moreover, MAs oxygen saturation of 76% on room air was significantly lower than the normal level of 94% and above (Grant, 2018; Robinson and Scullion, 2021). Third, the patients blood pressure was 126/71 mmHg, and the average parameters should be approximately 100-140 mmHg systolic and around 60-80 mmHg diastolic (Grant, 2018; Peate and Dutton, 2021). Fourth, as discussed earlier, the ACVPU scale suggests that MA was not quite conscious. Fifth, the patients laboratory investigations are unavailable, but his body temperature was 37,7 °C, normally between 35,6-38,7 °C (Grant, 2018; Peate and Dutton, 2021). In addition, MA had a history of smoking and consuming alcohol, which may increase the chance of pneumonia and ARDS, followed by ARF (Peate and Dutton, 2021). The ABCDE approach demonstrates that MAs condition was at considerable risk.

Notably, although the ABCDE method provides a comprehensive assessment, in MAs situation, one specific factor would indicate trouble. In particular, the patients health could be considered endangered even based on his oxygen saturation, as a percentage below 90 exhibits life-threatening hypoxia, which was identified in MA (Robinson and Scullion, 2021). Therefore, upon reviewing MAs oxygen saturation level, the medical team would need to respond immediately.

Planning

Upon examining and responding to a person whose condition is deteriorating, healthcare providers should proceed with planning the care of the patient. A care plan (CP) is formulated based on the information gathered during the assessment and provides goals that direct care (Carter, Aedy, and Notter, 2020). The case study suggests that MA exhibited signs of ARF and, alongside the above appraisal, indicates hypoxia in the patient. Consequently, MAs CP may center around ways to help the older man overcome the symptoms and make his condition stable. As noted earlier, ARF can be hypoxaemic or hypercapnic, and it appears that MA had the former type (Robinson and Scullion, 2021; Rolfe and Paul, 2018). Hypoxaemic ARF represents an insufficient level of oxygen in the blood (hypoxaemia) that can lead to cellular oxygen shortage (hypoxia), with oxygen saturation being below 90% (Robinson and Scullion, 2021; Rolfe and Paul, 2018). Accordingly, to handle ARF in MA, healthcare providers would need to address his hypoxia.

Furthermore, ARF and lack of oxygen in MA are associated with more concerns. For instance, the patients worsening confusion may have developed because of hypoxia (Grant, 2018; Robinson and Scullion, 2021). Consequently, to improve MAs overall condition and relieve the life-threatening situation, hypoxia should be handled first. Therefore, a primary objective of CP for MA would be overcoming hypoxia, which could be done through oxygen therapy (Robinson and Scullion, 2021; Rolfe and Paul, 2018). The care plan for MA would need to focus on ARF with the main goal of managing hypoxia by increasing the patients oxygen saturation to a normal level.

Monitoring

The condition of a person whose health is deteriorating should be monitored throughout their stay under the care of medical professionals. For example, patients can be observed utilising a continuous electrocardiogram (ECG) or based on their blood pressure and central venous pressure (Carter, Aedy, and Notter, 2020). However, individuals having acute respiratory problems, like MA, should be specifically monitored by using a pulse oximeter (PO). The device is a probe that is attached to the finger or ear lobe and employed to survey the haemoglobin percentage saturated with oxygen (Peate and Dutton, 2021). POs are simple but practical instruments that are necessary for those in respiratory distress.

Pulse oximetry can be utilised to monitor MAs condition toward achieving his CPs goal of overcoming hypoxia caused by hypoxaemia and increasing oxygen saturation. While not covering a variety of indicators, PO provides valuable information about oxygen saturation and enables the detection of hypoxaemia (Carter, Aedy, and Notter, 2020; Peate and Dutton, 2021). The average normal oxygen saturation level on a PO is about 94-98% on room air, with an exactness of approximately 3-5% (Peate and Dutton, 2021; Robinson and Scullion, 2021). Nonetheless, modern POs are likely to demonstrate unreliable measurements at saturations below 70% (Robinson and Scullion, 2021). Notably, although the most common method is the finger probe, some researchers argue that ear probes offer greater accuracy at lower saturations (Potter et al., 2021; Robinson and Scullion, 2021). Therefore, considering that MAs oxygen saturation indicated 76% during the assessment, the patients condition can be monitored with a PO on his ear lobe or finger.

Another approach to observing an individuals health parameters is by using the EarlySense system. The technique represents a contactless sensor that is placed under a patients mattress (Breteler et al., 2019). The system measures the persons heart rate and respiratory rate, updating the vital signs every 60 seconds (Breteler et al., 2019). While the case study does not specify MAs heart rate, the ABCDE approach showed that the patients respiratory rate was higher than normal. Consequently, monitoring MAs respiratory rate would be crucial in addressing ARF and stabilising his condition.

Treatment

Care management of an acutely ill patient depends on the treatment, and ARF, hypoxaemia, and hypoxia can be relieved through oxygen therapy (OT). Although the method does not significantly help with breathlessness, OT should be administered without delay to hypoxaemic patients (Peate and Dutton, 2021). OT is based on distributing supplementary oxygen to achieve a higher concentration of oxygen than is received when breathing air (Peate and Dutton, 2021; Rolfe and Paul, 2018). Many patients experiencing acute respiratory deterioration are at risk due to insufficient oxygen (Robinson and Scullion, 2021). However, one must remember that for the older generation, the most appropriate treatment does not necessarily mean maximal (Guidet et al., 2018). Oxygen must always be considered a drug prescribed by a qualified practitioner (Robinson and Scullion, 2021; Rolfe and Paul, 2018). Accordingly, oxygen dosage depends on several factors, and treatment of older patients should be based on shared decision-making (Guidet et al., 2018; Robinson and Scullion, 2021). The case study states that MA was cared for by utilising OT, which appears to be a relevant approach, but it should be done carefully, considering the mans age and condition.

Healthcare providers administering OT should consider some important aspects. In particular, the amount of oxygen received depends on the system used, the persons breathing pattern, and the flow rate (Robinson and Scullion, 2021). For instance, patients experiencing ARF are often prescribed more than 6l/min of standard oxygen (Azoulay et al., 2018). Nonetheless, for those with saturation below 85%, the drug should be at 10-15l/min dispensed via a non-rebreather reservoir mask (Peate and Dutton, 2021). Such an instrument is a low-flow device that can quickly deliver the highest possible oxygen concentration of 60-80% but should be used only for short periods (Azoulay et al., 2018; Robinson and Scullion, 2021). Notably, OT is administered upright to facilitate ventilation, and unless the patient has a specific requirement, such as a spinal trauma, the supine position should be avoided (Peate and Dutton, 2021). Accordingly, to treat ARF with consideration of his low oxygen saturation, MA should receive OT through a non-rebreather mask at 10-15l/min while being seated.

Professional Practice

The professional practice of a nurse plays a crucial role in the management of acutely ill patients. Nurses participate in all processes of providing care for people whose health is deteriorating while connecting patients with other medical specialists (Peate and Dutton, 2021; Robinson and Scullion, 2021). For example, nurses must act as recognisers with assessment skills who can interpret signs of changing conditions (Peate and Dutton, 2021). Moreover, in various settings, nurses are the ones administering treatments that can save a persons life (Peate and Dutton, 2021; Robinson and Scullion, 2021). Therefore, a nurses professional practice can be evaluated as highly important in managing deteriorating patients.

Conclusion

To summarise, the discussion of assessment, planning, monitoring, and treatment procedures and the reflection on MAs case demonstrate that care management of an acutely ill patient must consider various factors specific to each person. For instance, an individual in respiratory distress can be assessed in many ways, yet the one suitable for MA is the ABCDE approach due to providing a comprehensive examination of vital parameters and mental state. Furthermore, while monitoring can be done using multiple instruments, a pulse oximeter is the one relevant to the primary goal of MAs care plan. Oxygen therapy is a treatment that can help MA overcome hypoxaemic ARF and subsequent hypoxia because the method can increase MAs oxygen saturation to a normal level, thus reducing the threat to the patients life. However, OT for MA is likely to differ from other patients in respiratory distress due to MAs distinct characteristics, like his age and low oxygen saturation. Therefore, care management of an acutely ill patient is a complex process that depends on diverse factors, indicating that medical professionals must be knowledgeable and critically approach each situation.

Reference List

Azoulay, E. et al. (2018) Acute respiratory failure in immunocompromised adults, The Lancet Respiratory Medicine, 7(2), pp. 173-186. Web.

Bliss, M. and Aitken, L. M. (2018) Does simulation enhance nurses ability to assess deteriorating patients?, Nurse Education in Practice, 28, pp. 20-26. Web.

Breteler, M. J. et al. (2019) Are current wireless monitoring systems capable of detecting adverse events in high-risk surgical patients? A descriptive study, Injury, 51(2), pp. 1-9. Web.

Carter, C., Aedy, H., and Notter, J. (2020) COVID-19 disease: assessment of a critically ill patient, Clinics in Integrated Care, 1, pp. 1-8. Web.

Grant, S. (2018) Limitations of track and trigger systems and the National Early Warning Score. Part 1: areas of contention, British Journal of Nursing, 27(11), pp. 624-631. Web.

Guidet, B. et al. (2018) Caring for the critically ill patients over 80: a narrative review, Annals of Intensive Care, 8(1), pp. 1-15. Web.

Parcha, V. et al. (2020) Trends and geographic variation in acute respiratory failure and ARDS mortality in the United States, Chest, 159(4), pp. 1460-1472. Web.

Peate, I. and Brent, D. (2021) Using the ABCDE approach for all critically unwell patients, British Journal of Healthcare Assistants, 15(2), pp. 84-89. Web.

Peate, I. and Dutton, H. (2021) Acute nursing care: recognising and responding to medical emergencies. 2nd edn. Abigndon: Routledge.

Potter, R. et al. (2021) Fundamentals of nursing. 10th edn. St. Louis: Elsevier.

Robinson, T. and Scullion, J. (2021) Oxford handbook of respiratory nursing. 2nd edn. Oxford: Oxford University Press.

Rolfe, S. and Paul, F. (2018) Oxygen therapy in adult patients. Part 1: understanding the relevant physiology and pathophysiology, British Journal of Nursing, 27(14), pp. 798-804. Web.

Self-Efficacy and Confidence in Sports Management

Introduction

Sport management is a very important aspect in sports industry. Sports management is highly related to business aspect in sports industry. Sportsmen and women need to have vast knowledge in sports management as this is essential to enable them to succeed in sports. There are many sports activities that are available in the world today. They include football, baseball, cricket, hockey, volley ball, athletics, swimming and other in door games among others.

Many people are venturing in sports activities in this twenty first century. This could be for recreation, business or even health purposes. In the case of health purpose, the doctor prescribes sports and exercise as part of the curative and preventive measures. All these reasons are quite essential in the day to day lives of the participants. There are two aspects that are quite important in sports and exercises. These are self efficacy and self confidence. Both sports men and women need to know more about these aspects and their effects to their performance. (Bandura, 1997)

Self efficacy

Research shows that self efficacy actually has the overall impression that an individual has the capability to perform. This is in relation to the attainment of his or her articulated goals and objectives. This is actually the belief that an individual has what it takes in the execution of courses of actions. In this case, a person believes that he or she has the power to produce what is required. For instance, high self efficacy is revealed in instances where an individual will engage in exercises and sports even in instances when there are signs of illness, desperations or hopelessness. Individuals with low self efficacy will on the other hand mourn the situation and hence raise the desperation and worsen the situation.

Self confidence

According to scholars, self confidence is a strong mental conviction in relation to ones capability. In sports and exercise industry, self confidence is an integral part of a participants success. Some people assert that self confidence is actually a self fulfilling prophesy. (Bandura, 1997)

This is highly linked to an individuals belief that he or she can make it in the sports activity. On the other hand, if one lacks self confidence, it dooms the participants progress even when they posses the innate ability to excel. Self confidence in sports industry in most cases is known to build with time and experience. For instance, a footballer who has just joined the team will automatically exhibit moderate self confidence. (Parks, 2005)

On the other hand, a footballer with vast experience in playing the world cup will show great self confidence in excelling in the game. This clearly indicates that there are different levels of self confidence. There is low and high self confidence. However, overconfidence in sports can also result in failure and the participant can overlook the challenges on the ground. (Pajares, 2005)

Self confidence versus self efficacy

According to Parks (2005), self confidence and self efficacy are essential in sports management. This is so because they both play a big role towards success of an individual and the team at large. When an individual lacks either self efficacy or self confidence or both, he may eventual fail in sports activities. This explains why footballers among other sports men and women undergo training so that they can be knowledgeable on the effects of having self confidence and efficacy in relation to sports and exercise.

Similarities

There are various similarities between self efficacy and self confidence in relation to sports and exercise. One of the major similarities is that in both, the individuals believe that they are capable of achieving the goal. This means that a golfer with self confidence and self efficacy believes he or she is able to excel. This belief actually drives the sports men and women. (Pajares, 2005)

Another similarity between self efficacy and self confidence is that it is internal. It is not found on the outside or rather one cannot easily see it. It is rather exhibited in actions. One can also know that a sportsman or woman has self confidence and self efficacy by talking to the person. Both self confidence and self efficacy are not in an individuals physique. (Parks, 2005)

Looking at both self efficacy and self confidence is that they can be developed. This means that sports men and women can enhance their self efficacy and their self confidence. These two can be developed through proper training and motivational talks from experts and mentors. They grow with time and effort on the part of the individual participating in the sports and exercises. Anything that can grow can also be destroyed. This is also very relevant to both self efficacy and self confidence. Without proper nurturing and mentoring both self efficacy and self confidence can decline and eventually die completely. This renders the sports man or woman ineffective in their performance.

Differences

While these two terminologies have similarities, they also have their differences. A sports man or womans self confidence is derived from many effective memories of the sports man or womans past experiences in the industry. This clearly means that self confidence is more based on an individuals past experience and exposure. On the other self efficacy is not based on the individuals past experience but rather on his or her overall impression of the self. (Parks, 2005)

The other difference between self confidence and self efficacy is that self confidence is much more resilient. This is according to research carried out amongst sports men and women in the year 2007.A persons overall perception of his or her self efficacy in most cases will differ from one domain to another domain. This can also differ within one domain too. For instance, an athlete can lack self efficacy in short races and then change to long races. This is not the case to self confidence because it cannot be re-channeled.

Conclusion

Sports management is an essential aspect in sports and it is highly linked to the business aspect of this industry. Sports activities and exercises are quite vast in nature. They include football, baseball, swimming, cricket, athletics and hockey among others. Self efficacy is defined as the overall impression that an individual has towards himself or herself in relation to his or her capabilities. On the other hand, self confidence is defined as a strong mental conviction in relation to capabilities. There are many similarities and differences between self efficacy and self confidence. One major similarity is that both of them are internal. The major difference is that self confidence is based on experience while self efficacy is based on impression of the ability.

Reference

Bandura, A. (1997): Self-efficacy; the exercise of control; New York; WH Freeman and Company.

Pajares, F. (2005): Self efficacy and self confidence; New York; Macmillan Press.

Parks, B. (2005): Contemporary Sports Management; New York; Prentice Press.

Kotters Change Management Theory in Nursing Practice

This essay example analyses Kotters change management theory: its background, assumptions, characteristics, and other essential aspects. Learn more about Kotters change model with the help of our sample!

Introduction

To achieve long-term quality improvement, it is critical to create an appropriate theoretical foundation for change implementation. In professional nursing, a great variety of theories can be used as a basis for change initiatives. Kotters change management theory, also known as Kotters 8-Step Model of Change, can assist in quality improvement projects in various settings, including interventional radiology. The present paper will seek to explain Kotters theory and its key components, as well as describe how it can be applied in clinical practice.

Kotters Change Model in Healthcare: Background

Kotters change management theory can be described as a middle-range theory, as it is used to describe and predict the change process. This theory can also be tested empirically, which distinguishes it from grand theories. Kotters model is not specific to nursing and can be utilized in various settings and organizations. According to Kotters theory, the change implementation process consists of 8 distinctive steps (Small et al., 2016):

  1. Create a sense of urgency;
  2. Form a guiding coalition;
  3. Create a vision;
  4. Communicate the vision;
  5. Empower employees to act on the vision;
  6. Create quick wins;
  7. Build on the change;
  8. Institutionalize the change.

The primary goal of the model is to help leaders implement the change by transforming organizational culture and motivating employees to contribute to quality improvement. By engaging employees in the process, Kotters theory can help to ensure acceptance of change, thus increasing the chances of success.

Kotters Change Model in Nursing: Assumptions

Kotters change management theory rests on several main assumptions. Firstly, the author assumes that the change process consists of multiple phases, each requiring different leadership and management actions. This assumption is at the foundation of the theory, as it affects the structure of Kotters model. Secondly, the theory presumes that the success of a change depends on whether or not it is accepted by people in the organization (Rajan & Ganesan, 2017). The theory also accepts that employee empowerment and motivation directly impact the success of change implementation.

Kotters approach to change involves transforming organizational culture, vision, and strategy while enhancing employee motivation to ensure the change is accepted. Hence, the final assumption made by the author is that organizational culture influences quality. Many of these assumptions were based on research, as studies show a positive correlation between change acceptance, organizational culture, employee motivation, and the success of a change initiative.

Change Management Theory: Characteristics

The theory of change proposed by Kotter has four key characteristics. First, it represents change as a series of stages, depending on the actions that need to be taken. The theory is also oriented toward leaders and management, as it argues that change begins at the higher levels of the organization. Another essential characteristic of the model is that it is focused on motivation and strategic success. This feature enables leaders to fit the change into the companys strategic goals, thus increasing the probability of success. Lastly, Kotters theory provides sufficient organizational support for the change process by engaging employees from various levels of the hierarchy in the implementation.

Key Concepts and Relationships of Kotters Change Model

There are six key concepts involved in Kotters change management theory: urgency, motivation, vision, strategy, short-term wins, and organizational culture. All of these concepts are interrelated and have a positive effect on the change process. For instance, a sense of urgency, created in the first step of the change process, includes motivation, which, in turn, increases employees contribution to change implementation. Vision and strategy are also connected to organizational culture and motivation since they help to foster employee engagement and set clear goals for the company. Short-term or quick wins are created during the seventh stage of the change program. Short-term wins are necessary because they create a feeling of success, which, in turn, provides empowerment and improves acceptance of the change. According to Rajan and Ganesan (2017), It is essential for the leaders to show [employee] that change being implemented is beneficial with tangible and quick results for [employees] to visualize the larger picture (p. 194). Therefore, the success of a change initiative relies on the relationships between the key concepts of Kotters theory.

Examples of Application

The proposed change management theory has been applied in various areas of nursing practice to assist in quality improvement. For instance, Small et al. (2016) studied the use of the model for implementing bedside handoff. The study found that using Kotters change management theory helped to improve communication, adherence to quality standards, and nurse satisfaction during bedside handoff. Different research by Auguste (2013) examined the usefulness of Kotters model for adopting electronic medical records in orthopedic surgical practice. The results showed that the model assisted in the implementation process and helped to improve organizational culture, thus supporting a digital transformation of the unit.

Conclusion

All in all, Kotters change management theory can be successfully applied to achieve quality improvement in nursing practice. The model helps to ensure the acceptance of change, which is among the critical predictors of success. Thus, apart from reducing downtime in interventional radiology, Kotters theory would assist in improving the quality of care throughout the unit by enhancing organizational culture and employee motivation.

References

Auguste, J. (2013). Applying Kotters 8-step process for leading change to the digital transformation of an orthopedic surgical practice group in Toronto, Canada. Journal of Health and Medical Informatics, 4(3), 1-4.

Rajan, R., & Ganesan, R. (2017). A critical analysis of John P. Kotters change management framework. Asian Journal of Research in Business Economics and Management, 7(7), 181-203.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotters change model for implementing bedside handoff: A quality improvement project. Journal of Nursing Care Quality, 31(4), 304-309.

Utilization Management, Utilization Review, and Case Management Essentials

Utilization management, utilization review, and case management play a crucial role in the health care system for patients, insurance companies, and health care providers. These processes aim to improve the quality of health care delivery and optimize medical services in relation to their expediency and costs. In this paper, utilization review and management will be thoroughly examined, along with the significance of ethically appropriate case management for a hospitals performance.

Difference Between Utilization Review and Management

While utilization review and utilization management are frequently used as similar terms referring to the improvement processes in the health care system, these concepts remain different. On the one hand, both processes aim to ensure that patients receive affordable health care of the highest quality; on the other hand, they differ in consistency. In general, utilization review aims to ensure that the use of health care services is appropriate. In particular, the purpose of this process is to evaluate the quality of health care delivery that should be provided on the basis of proven methods by appropriate specialists and in appropriate medical settings. Moreover, utilization review should guarantee that health care is provided cost-efficiently and according to the latest evidence-based care guidelines. At the same time, the main peculiarity of utilization review is that it may be defined as a retrospective process. In other words, it is done on the basis of the results of health care after its completion through specific protocols in which all aspects of health care delivery to a particular patient are described.

In turn, utilization management is the process based on the results of the utilization review. It focuses on health care organizations policies and strategies elaborated to improve the quality of operating activities and avoid unnecessary or inappropriate care. In other words, utilization management refers to particular procedures and plans that address issues identified during utilization review for their solution. Even if utilization management identifies service metrics outside the scope of utilization review, it nevertheless ensures the development and improvement of the health care system that helps prevent patient-related and organizational issues in the future. Thus, in contrast with utilization review, utilization management is a prospective process as it occurs prior to health care delivery ensuring its efficiency.

Utilization Practices Roles

Utilization review is traditionally used by multiple stakeholders, including fee-for-service and public payers, managed care organizations, hospitals, and other medical facilities. They aim to ensure that health care is provided accurately in relation to cost, place, methods, providers qualifications, and time (Desai et al., 2017). The use of utilization review software helps reduce the number of denied days, minimize variations in care across hospital systems through standardized criteria, and improve transparency between health care providers and payers (Desai et al., 2017, p. 623). In general, utilization review aims to ensure the provision of quality care, reduce costs, and gain insurance approval, however, it also focuses on the well-being of particular patients. While utilization review nurses check medical records, perform case reviews, and communicate with patients, they are responsible for the appropriateness of procedures, therapies, and medication for a persons diagnosis and overall condition.

The purpose of utilization management is to ensure that patients receive appropriate health care on the basis of their needs without unnecessary costs and excessive testing. It evaluates the expediency, relevance, necessity, and efficiency of health care services or their aspects within the framework of health care plans to determine their benefits. It is a multidimensional and long-lasting process  for instance, according to El-Othmani et al. (2019), the utilization of a bundle payment method in relation to total joint arthroplasties was evaluated for two years in order to assess how this method impacted post-acute care utilization, the length of stay, in-patient rehabilitation, and readmission. In general, the issue of raising costs plays a crucial role in the application of utilization management for their minimization.

In addition, both utilization review and utilization management have particular benefits for all stakeholders involved in it. It goes without saying that they benefit patients first of all as the improvement of health care delivery and cost practices affect their health and the availability of care. Moreover, utilization review and management allow insurance companies to optimize costs and avoid unnecessary expenditures, especially within the framework of quality care delivery. Finally, the whole health care system benefits from utilization techniques as well as they ensure high-quality and accessible health care contributing to the nations commonwealth.

Importance of Case Management

Individual case management is critical for a hospitals long-term survival as it focuses on care coordination, resource utilization, and financial management to ensure that patients receive health care delivery of the highest quality. Its practice refers to the assessment, planning, implementation, coordination, monitoring, and evaluation of multiple health care services, procedures, and other options to meet a patients needs. Case managers ensure the collaboration of health care system stakeholders to elaborate on health care plans and maximize cost-efficient and safe outcomes for clients.

Working closely with patients, payers, and health care providers, case managers ensure their coordinated efforts that lead to appropriate health outcomes and cost-efficiency of care. They aim to empower patients by promoting their self-determination and self-advocacy, contributing to appropriate results of care after discharge as well. Moreover, case management emphasizes the significance of quality control through information management, human resource management, and the availability of relevant data that ensures the efficiency of decision-making (Parast & Golmohammadi, 2019). In addition, case management controls the provision of health care according to national standards, enhancing the patient experience and an absence of underutilization or overutilization of services. In this case, a business will be attracted by the quality of health care that allows to avoid unnecessary expenditures.

Ethical Pitfalls

It goes without saying that quality reviews that aim to improve the quality of health care delivery frequently presuppose the involvement of patients. In this case, they should be based on the ethical principles of beneficence, non-maleficence, informed consent, the confidentiality of patient data, autonomy, justice, the opportunity to reject care, and independence. In other words, health care managers should act in the interests of patients respecting their right to make decisions and receive information concerning their health and the consequences of treatment. In addition, they should respect patients values and beliefs, considering them in health care delivery. Ethical pitfalls may occur when the perceptions and attitudes to particular health-related aspects of health care providers and patients contradict each other.

In addition, according to the ethical standards, health care should be delivered on the basis of patients health-related needs. However, in the case of insurance companies involvement, ethical dilemmas appear. In other words, healthcare providers should consider the financial aspect of health care delivery  thus, their freedom in medical assistance is limited. That is why utilization review and management are applied to eliminate these ethical pitfalls. First of all, care managers are responsible for appropriate health care, however, it should be patient-centered, and the provision of all necessary information for clients decision-making is ethical. In addition, the collaboration of all stakeholders and the implementation of various techniques to minimize unnecessary costs and services with their subsequent evaluation may reduce health care providers necessity to choose between costs and the quality of care.

References

Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., Vasquez, V., Kim, H. T., & Terp, S. (2017). The effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.

El-Othmani, M. M., Sayeed, Z., Jnise, A. R., Abaab, L., Little, B. E., & Saleh, K. J. (2019). The joint utilization management programimplementation of a bundle payment model and comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537.

Parast, M. M., & Golmohammadi, D. (2019). Quality management in healthcare organizations: Empirical evidence from the Baldrige data. International Journal of Production Economics, 216, 133-144.