Significance of Evidence Based Practice in Nursing

Significance of Evidence Based Practice in Nursing Nursing is a profession accountable to society for providing high quality cost-effective care for patients and their families (Burns Grove, 2007). This assignment will define evidence based practice and its significance in the nursing process. In addition, it will critically analyse the research article Community Psychiatric Nurses experience of working with people who engage in deliberate self harm carried out by Thompson et al (2008). Furthermore it will define Hierarchy of Evidence and its importance in research studies. A clinical question has been formulated using Population, Intervention, Comparison and Outcome (PICO) and the key words in the article to search for another article which support or contradicts the main review article. Brown defines evidence based practices as the use of the best quality research to deliver an effective quality of care in the best interest of the patient as well as promoting cost effectiveness within the healthcare system (Brown, 1999). In order for health care professionals to deliver the best quality of care, they need to use the combination of evidence based clinical treatments and practices (Lindsay, 2007). Evidence based knowledge is important as it guides and maintains the clinical competencies of health care practitioners and provides a research based explanations to assist patients in the process of clinical decision making (Burns and Grove, 2007). According to Ciliska et al (2005), the skills necessary to provide evidence based solution to a clinical dilemma includes defining the problem, conducting the effective research to locate the best evidence, critically appraising the evidence and considering that evidence and its implications in the context of patients circumstances and values. Research into the experience of community psychiatric nurses working with people who engage in deliberate self-harm was carried out using the qualitative research design, as it is primarily concerned with understanding human beings experiences in a humanistic, interpretive approach (Ronald et al, 2007). The purpose of the research was to understand CPNs experience while they are working with people who deliberately self-harm. In this research it was found suitable as it relies less on non numerical data. A study by Playle (2000) suggest that readers need to read, critically study and evaluate a research article to demonstrate their understanding of research and to identify implications for practice. In this study, Tarling and Crofts (2002)s framework and The Critical Appraisal Skill Programme (CASP) accessed on http://www.phru.nhs.uk/Pages/PHD/CASP.htm has been used to review the strength, credibility, validity and weakness of the above study. The title Community Psychiatric nurses experience of working with people who deliberately self-harm is clear, concise and informative as it reflects the contents of the whole study. Informative titles are important in research process as it allows the reader to identify the research approach (Roe and Webb, 1999), however the title does not reveal the approach which may be seen as a weakness (Dempsey and Dempsey, 2000). The authors of this article are qualified professional with clinical and psychological expertise as well as experience of working with people with mental health problems as Dempsey and Dempsey (2000) suggests that authors should be qualified to carry out a research study and their qualifications should be verified if need be. This may be seen as powerful, hence reliability and credibility of this article is not questionable as they will be perceived as professionals with clinical credibility to eliminate bias (Hoskins et al, 2005). However it can be argued that the community psychiatric nurses had not undertaken psychotherapy training although they had a minimum of eighteen years of experience (Thompson et al, 2008). The abstract is short, brief and concise. According to Parahoo (2006) a research report should begin with an abstract which summarises the major findings of the study as well as attracting the readers attention to read the whole research article thus adding credibility and validity to the report. Lack of clear summary may be seen as a weakness as readers may lose interest in reading the whole article as it may fail to express the important information about the study (Morrison, 1992). According to Newell Burnard (2006), an introduction should clearly define the key words and stating the purpose of the research. This study clearly explains in detail what is meant by deliberate self-harm and yet there is little research into the actual experience of working with people who deliberate self-harm (Thompson et al, 2008). The research used Interpretative Phenomenological Analysis (IPA), which allowed an in-depth exploration of individual personal experience, underpinning the theory of interpretation and interaction which focuses on individuals experiences to the central concern and can only be accessed through IPA (Smith, 1995). According to Streubert and Carpenter (1995), Interpretative is the understanding of life experiences and events and Phenomenology is the appearance of things as lived experiences. This may be seen as strength as it is fundamentally important, as without knowing exactly how the study was carried out, it is difficult for the reader to judge its strengths and weaknesses (Gillis, 2002). In this study, the researchers and the participants were all from the North of England thereby eliminating the theory of ethnography which requires the investigator to learn about a culture and be part of it (Burns and Grove, 2007). The participants were made up of four male and four females from t he community mental health teams who had an average age of forty years and eighteen years of experience of working with people who engage in deliberate self -harm. The researcher did not explain why different age groups did not participate or other ethnic minority groups which limited their findings. For the purpose of this study, a purposive (participants with a specific characteristics (Lindsay, 2007) sample was recruited. According to Parahoo (2006), sampling is important in qualitative research as it seeks to collect valid and reliable data from a small division of the population that would be representative of the whole population. This showed to be suitable to the study which may be seen as reliable and valid although, it can be argued that sampling method may produce biased results. It may be seen as a selective method to fulfil the aims of the study (Streubert-Speziale Carpenter, 2007). Data was collected through semi-structured interview and open-ended questionnaires according to IPA (Smith, 1995). The interviews lasted for forty five minutes to an hour which was guided but did not dictate the exact course of the interview. This was chosen in order to allow the interviewees to talk freely to explain their thoughts and experiences. The method accessed the participants natural attitudes and understanding of deliberate self harm. This enabled certain responses to be questioned in greater depth, while collecting similar data from all the informants as well as creating a relaxed comfortable environment for the interviewees, (Holloway and Wheeler, 2002). However it can be argued that it is a time-consuming method, not just the collecting of the data, but the transcribing and analysis of the data. There are risks of interviewer bias as face to face interviews often require training, (Parahoo, 2006). All interviews were recorded and transcribed verbatim. According to Holloway and Wheeler (2002), researchers must preserve participants words as accurately as possible before analysing the data. The researchers had a chance to replay the tapes several times to improve the quality of the transcripts. The transcripts were then analysed using IPA principals (Smith and Osborn, 2003). The researcher read the transcripts to familiarise with the data, noting down the key words and phrases said by the participants, thus summarising the sample (Rowntree, 1991). The notes were classified in more general term to form initial themes to try and capture the essence of the participants accounts which were then copied to a computer program which assisted in managing connections between the emerging themes but no direct analysis was made. According to Morse and Field (2007), transcripts from different informants should be compared categorised and coded into substantive themes and sub-themes to produce a high degree of interpretation and integration. A master list of themes and subthemes was then produced for transcript which contained a degree of interpretation and integration. The process was repeated on every interview to maintain consistence of data analysis as suggested by Burns and Grove (2007). The themes were highly developed and compared to original text as Speziale Streubert and Carpenter (2007) suggests that researchers needs to move forward and backward between levels until saturation is achieved to ensure a comprehensive understanding of the phenomena. A table was produced for each theme indicating the sub themes and identifying where each transcript could be evidenced. Different methods were employed to ensure trustworthiness and the master themes audited by the three authors including an independent researcher to ensure that themes were warrantable and grounded in the data. Although the researchers have carefully considered how to ensure validity of the study, it is noted that the findings were subject to limitations as all the nurses were experienced white British, limiting the applicability of nurses from other ethnic origins or trained in other countries. In addition, it is a small study based in a small geographical area which limits reliability as well as the generalizability of the results (Meadows, 2004). There is also evidence that there may be differences in assessment practices between different professional groups and different levels of experience, (Weston, 2003). Furthermore, the findings are based on reflective accounts of the experience of working with patients, who self-harm and may therefore be subject to memory bias, (Thompson et al, 2008). The authors recommends further studies to explore the extent of experiences and evaluate further interventions to improve professional awareness of deliberate self-harm as well as training for nurses to provide high standards of care as suggested by NMC (2008). The researcher sought approval from the NHS (National Health Service) ethical and research government as suggested by Parahoo (2006) thus adding credibility. However the research does not specify if consent, was sort from the participants which may appear as a weakness as it important to respect for autonomy and beneficence (Polit and Beck, 2006). Ensuring of confidentiality NHS (2008) of information discussed, was not addressed to the participants before the research was carried out which may have led to withholding of important information which would affect the validity of the report (Clifford, 1997). This can be seen as a weakness in the research. Hierarchy of evidence is the ranking of research methods according to their effectiveness, strength and weaknesses (Ciliska et al, 2005). In the healthcare system, depending on its source, some research methods are considered to be stronger and produce better quality evidence than others hence credibility, reliability and validity differs (Lindsay, 2007). According to Polit Beck (2008), qualitative research falls on level V because of its systematic descriptive of psychological studies Craig and Smyth (2002) suggests the use of PICO (systematic way to identify important ideas in a research article), in formulating a clinical question in health care. P is Population which was Deliberate Self harm I is Intervention which was Not Applicable C is Comparison which was Not Applicable O is Outcome which was CPN experience. To search for the second article clinical question has been formulated using PICO. The following link was used to access the article. Student Portal Log In my studies summon type in key words Go Button. The search was carried out using the key words, CPNs experience in deliberate self harm in all fields and 310 articles were retrieved. The search was limited to product content journals only which retrieved 306 journals. The search was further limited with the number of years from 2009 to 2010 which yielded 35 journals articles. Among the articles, Analysis of Accident and Emergency Doctors Response To Treating People Who Self-Harm was retrieved and read through which supported the reviewed article adding to its strength, validity and credibility. A study by Craig Smythe (2002) suggests the search of electronic database as a method of finding research studies as all journals have indexes that have been converted to electronic databases. The University subscribe to Summon which can be accessed freely by all students which makes it easier to search articles for educational purposes. In conclusion, evidence based knowledge is important in implementation of cost effective nursing intervention and therefore it is the responsibility of health care professionals to critically analyse any piece of evidence for credibility, validity, reliability and its source, in clinical decision making (Brown ,1999). They also have a legal and professional responsibility under the Human Rights Act 1998, Health and Safety 1974, The Consumer Protection 1987 as well as The Duty of Care (NMC 2008).

The Pitiful Campus Dining Experience Essay example -- Argumentative Pe

The Pitiful Campus Dining Experience      Ã‚  Ã‚  Ã‚  Ã‚   When I was a waiter at a local pizza parlor, the area manager would come in once every two weeks and give the restaurant an inspection. He would watch us through the course of an evening, and when the crowds subsided, he would gather us all around and give us our review. At the onset of every debriefing, as they were called among the crew, the first words from his mouth would always be, "From the moment the customer enters those doors, his dining experience begins. He will form an opinion in his mind about us, and it is your job to make sure that opinion is good! If it isn't, I'll know about it, and then so will you." Even though my experiences at that restaurant are a year behind me, whenever I eat out I always keep in mind the customer's opinion -- especially when I am the customer. When  Ã‚   State students eat at the campus facilities, they form opinions about their dining experience just as any customer would, and whether that opinion is good or bad is the responsibility of the food service. Recently I conducted a survey to determine the student opinion of the food service at  Ã‚   State. My purpose was simply to see if the students were satisfied with the overall performance of Service America, the catering company that handles all of the campus dining facilities. I surveyed fifty students over a period of two days at different times and locations. All of those I surveyed ate at least occasionally at one of the dining facilities. The survey rated such aspects as variety, quality, and taste of the food offered as well as the student's opinion of the prices they paid and overall service they received. The ratings given were initially somewhat mediocre. ... ...ts known will have them resolved in one manner or another, and by solving the students' problems as best they are able, Service America will ensure good public opinion and keep its contract. This arrangement is beneficial for both parties involved, and since my results concluded that there is no widespread discontent with the food service, there is no real justification for procedures any more radical than those I have suggested. Perhaps a monopoly does exist at  Ã‚   State in the form of Service America, but it is a monopoly that is ultimately controlled by its patrons, who have the freedom and the power to act on their opinions. The choice for action lies in their hands.      Sources Cited Goodman, Stephanie. "Dinner Is Served--At the Mall." Adweek's Marketing Week 24 Ju1y 2013:30-34. Loprete, Michael. Personal interview. 26 Feb. 2014.   

Alices Adventures in Wonderland: Hunger, Dominance, and Undesirability

Hunger, Dominance, and Undesirability Lewis Carroll’s fairy tale, Alice’s Adventures in Wonderland, written in 1865, fuels the stereotype of how girls are required to be petite, feminine, and submissive to men through Alice’s eating habits, the contrast between young Alice and older women characters, male control, and Alice’s behaviour at the end of the story. This influences the minds of young audience members who read Carroll’s work instills the idea that in order to be beautiful, a girl must control her desire to eat and never overpower the men they associate with.In Carroll’s Alice’s Adventures in Wonderland, the author targets the importance of a woman’s size and how food consumption influences femininity and desirability. During the story, Alice is exposed to various situations involving food and beverages. Carroll’s first introduction on the emphasis on Alice’s size, is when she is falling down the rabbit ho le and she sees a jar labelled â€Å"Orange Marmalade†. When she grabs the jar, she finds that there is nothing inside. This is an early indication that unless Alice is instructed to satisfy her hunger,she must not indulge her desires or her level of perfection will decrease.Throughout the story, Alice is then exposed to bottles and foods that are labelled â€Å"Eat Me† or â€Å"Drink Me. † Without hesitation, she ingests the products with labels. Alice’s petiteness, and thus her beauty, come directly from her eating and drinking habits. Only when she is allowed to eat, does her body undergo positive Brewer 2 changes. These positive changes lead her to experience new adventures and improve her education, which is another noticeable attribute in the tale.Anna Helle-Valle and Per-Elinar Binder argue that â€Å"the body is central to self-experience† and to Alice, the size of her body determines what she is able to do and how she sees herself (Helle-V alle and Binder 4). The Caterpillar in Alice’s Adventures in Wonderland, offers insight into the ideal of size. The extreme changes in size damages one’s self identity. Alice shares her confusion with the Caterpillar during their first meeting: â€Å"I’m not myself, you see-being so many different sizes in a day is very confusing† (81).The Caterpillar forces her to say who she is, but because of her recent changes in size, she is not able to say who she believes herself to be. Size is critical to one’s understanding of the self, and Carroll’s Alice struggles with understanding that a small size is important. In a societal context, Alice represents what a girl should be: petite and feminine. However, she expresses her concern for her small size during a conversation with the Caterpillar. The Caterpillar is the male authoritarian figure in the section and is furious with her concern. He then informs Alice that three inches is, in fact, a †Å"good height to be† (84).The Caterpillar forces Alice to be comfortable with herself, for being any larger causes her to be less desirable to her new found dominant male figure. The Caterpillar’s statement offers no argument, and Alice’s perfect and submissive attitude cause her to listen to the dominant with no complaint. In Alice’s Adventures in Wonderland is the idea that female sexuality consists of the importance of curiosity and politeness, and a submissive attitude: this is due to Carroll’s desires and the Victorian beliefs. In the story, Alice’s character is that of an ideal girl, and her curiosity often leads to find new and exciting ventures in Wonderland.The reason that Alice is able to experience Wonderland is because of her curious nature that led her to tumble down the rabbit Brewer 3 hole. Jennifer Geer contends that Alice’s manners, as well as the want to impress the creatures in Wonderland, comes from the moral implic ation of Victorian literature (Geer 2). The literature in the 1800s centers on politeness and manners, which Alice offers to all of the creatures and people in Wonderland. One of the most positive attributes that female sexuality should possess is a submissive female attitude.Through the fairy tale, mature female sexuality is portrayed as â€Å"frightening and destructive† (Garland 2). This is evident through the Queen of Hearts and her influence on the King of Heart’s behaviour. The Queen in Alice’s Adventures in Wonderland, is in direct opposition of Alice’s character. Where Alice is the ideal, polite and petite, the Queen is aggressive and large in stature. The ‘suit’ of hearts, that the Queen has cloaked herself in, is in no coincidence the colour red, for this is often associated with a tumultuous and confident sexuality.In Alice’s Adventures in Wonderland, the colour red is given a negative connotation by the Queen’s negat ive attitude. She often thunders the expression â€Å"off with their head†, and Garland explains that this is the Queen’s desire of male castration (Garland 8). The dislike for female domination is evident in the literature of the time, as well as the ideas of Sigmund Freud. The Queen’s concern with castration would be comparable to the worry of female authority in society. The Queen, once again, expresses undesirability by her heavy weight and yearning for tarts.It affects her personality, and makes her become evil and arrogant, thus making her unwanted and a threat to male competence. Her desire for male subordination and ugly nature, is the author’s way to sway female readers to keep their aggressiveness at bay. An aggressive female not only creates shame for manhood, but does not correspond with the ideologies of those living in Mid-Victorian times when Carroll wrote Alice’s Adventures in Wonderland. The effect of a dominant female is shown in the King of Hearts. The Queen of Brewer 4Hearts’ husband is constantly being forced to carry out her will and listen to her often violent demands. The King of Hearts, because of his treatment by the Queen, is weak and submissive and thus, has nothing to offer. The ideal for male dominance is expressed by the male superiors that control Alice. When she is instructed to take food or beverages, it is either done by no director or a male authoritarian figure. The King would never offer instruction to a female and simply just follows demands made by the Queen. In Mid-Victorian times, the latter was not acceptable behaviour.Geer claims that in the Victorian era, the adult world belongs to the male whereas a woman’s world should be entirely dedicated to motherhood (Geer 14). In Alice’s Adventures in Wonderland, Carroll chooses the Duchess to be the antagonist to this position. The Duchess is characterized as a mother who continually causes harm to her child due to her aggressive nature and desire to eat. She often brings food into situations where it is not applicable, and in Alice’s Adventures in Wonderland, it is directly linked to why she is a neglectful mother and horrible woman.The ideas that women lose their desirability and femininity when they are not submissive to their male counterparts and when their lives are not dedicated to the raising of a family are shown through the aggressive nature of the Queen and the Duchess, and ultimately Alice’s fall into barbaric womanhood. Throughout Carroll’s story, Alice is everything that a mature woman should be. She is polite, kind, submissive, and has control over her desire to eat. She would take direction from the Mouse, the Caterpillar, the Queen and the Duchess without hesitation.However, during the trial scene of the tale, her fate of womanhood is foreshadowed. During the trial, Alice begins to Brewer 5 take notice of the food that was in the jury room. She immediately beg ins to feel herself becoming larger. When her name was called to take the stand during the trial, the King politely informs Alice that she will not be able to take her seat due to her enlarged size. However, she refuses to entertain the meek King’s instruction. Alice continues to grow and becomes more arrogant and the Queen is forced to order her execution.In the beginning of the fairy tale, Alice is a petite and beautiful girl, but the desire for food turned her into a rude and undesirable woman. Carroll’s Alice’s Adventures in Wonderland not only is influenced by the beliefs of the people living in the Mid-Victorian era, but also by the belief that eating causes inferiority. In the twenty-first century, the image of beauty is causing women of all ages to be concerned with becoming large and undesirable, and Carroll’s story only encourages the overwhelming concern by idealizing petite Alice, creating a grotesque image of large women, and how male authori tarianism should control womanhood.Alice’s fall from grace as she grows larger reinstates that belief and influences readers that to be feminine, one must never become too large and forget the role that Carroll had wanted for women in society. Brewer 6 Work Cited Carroll, Lewis. Alice’s Adventures in Wonderland. Sam’l Gabriel Sons and Company New York, 1916. Electronic. 02. Nov. 2012 Garland, Carina. â€Å"Curious Appetites: Food, Desire, Gender and Subjectivity in Lewis Carroll’s Alice Texts†. Lion and the Unicorn 32. 1 (2008): 22-39.Academic Search Premier. Web. 30 Oct. 2012. Geer, Jennifer. â€Å"All Sorts of Pitfalls and Surprises: Competing Views of Idealized Girlhood in Lewis Carroll’s Alice Books. † Children’s Literature 31 (2003): 1-24. Professional Development Collection. Web. 30. Oct. 2012. Helle-Valle, Anna and Per-Elinar Binder. â€Å"In Wonderland: A Phenomenological, Developmental and Self Psychological Analysis of a Child’s Playful Encounter with a New Reality. † Nordic Psychology 61. 2 (2009): 16-28. PsycARTICLES. Web. 30. Oct. 2012.

Types Of Business Plans Developing A Business Plan

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There are various types of business plans depending upon the need or project at hand. Some common types of business plan are operational plan, strategic plan, start-up plan and a tactical business plan. The follow paper compares these four types of business plans and looks at their strengths and limitations. Also included in the paper is the best plan that would work for the assigned Collaborative Learning Community (CLC) assignment. Operational plan An operational business plan is developed to carry out the daily operations of a business. AnShow MoreRelatedThe Role Of Ethics And Social Responsibility On Developing A Strategic Plan746 Words   |  3 Pagesoccupation, trade, or profession† (Wheelen Hunger, 2010, p. G4). Ethics in business involve different standards based on the location and customs. What is ethically acceptable in one environment may not be acceptable in another. Analyzing ethics is essential when developing strategic plans. 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