Reducing The Incidences Of Malnutrition Nursing Essay

Reducing The Incidences Of Malnutrition Nursing Essay -Reducing the incidences of malnutrition that often occurs during admission to hospital has been a priority within the nursing care profession for many years. There have been various explanations for this such as lack of staff, patients not able or are unwilling to admit they require assistance, poor use of assessment tools and care pathways. A key factor in the prevalence of patients presenting with malnourishment is the disturbances patients endure during mealtimes, such as ward rounds, non urgent medical interventions, housekeeping activities and visitors. This essay will explore the incidences of malnutrition, and those who are most at risk and the changes that have been made to reduce such incidences. Change management should be regarded as an ongoing process, which requires good communication, planning, positive leadership and cooperation. This essay will endeavor to explore the change management processes, leadership and team management skills used in the implementation of protected mealtimes. It will explore the negative aspects and problems encountered when implementing a change and the ongoing management skills required to maintain such changes. For many patients admitted to hospital, in particular the elderly, malnutrition is a common occurrence. It is the nurses fundamental duty of care to provide patients with the highest of care possible, a major requirement for any human being to survive and live a healthy life is the intake of a healthy nutritious diet, be that by conventional methods or artificial measures suitable for the patients state of health at that time (Royal College of Nursing 2007). Studies into hospital malnutrition show that as many as four out of ten elderly patients admitted to hospital are already malnourished and as a result of a hospital admission as many as six out of ten elderly patients, become malnourished, their situation worsens and their illness very often escalates (Age Concern 2006; BAPEN 2007). The NHS Improvement Plan (2004) set standards to deal with the increasing incidences of malnutrition within hospital settings; it has become apparent that these examples of good practice recommendatio ns have not been implemented in every hospital in the country, as incidences of malnutrition continue to exist. Davidson and Scholefield (2005) reports that inadequate nutrition can lead to longer hospital stays, impairs the recovery of patients and increases financial costs; several hospitals have indeed planned and implemented changes to reduce such incidences but on the whole have had limited success. The authors found that constant interruptions from drug, rounds, clinical activities and lack of nursing staff being on the ward at mealtimes (due to lunch breaks coinciding with mealtimes) all accounted for patients being provided with very little or on occasion no nutritional intake at any given mealtime. Savage and Scott (2005) does agree with this statement to some extent but argues that it is all to easy to blame nursing staff alone, it is the responsibility of each individual NHS trust to implement managerial changes and policies and ensure that they are monitored, evaluated a nd improved to provide the best care possible for each patient. Mamhidir et al (2007) argues that since the implementation of protected mealtimes in some hospitals there is substantial evidence to suggest that patients, particularly the elderly benefit immensely; patients gained weight, healing time reduced, were discharged earlier and mealtime experiences were a more pleasant experience for patients as well as nursing staff. Mooney (2008) argues that there is evidence to suggest even after hospital trusts have been presented with unarguable evidence that malnutrition is a major problem and a catalyst for longer hospital stays, only 43 percent of those trusts have not yet provided evidence that they have implemented schemes in order to reduce hunger and malnutrition. The Hospital Caterers Association (2004) further comment that mealtimes should not primarily focus on the provision of nutrition, it also makes way for social interaction between patients and carers, they further commen t that in general the quality of the food provided is not the issue, the inability of the patient to be able to feed themselves is far more the worrying issue. Council of Europe (2003) comment that hospitals should be designed to be patient centred, ensuring that the delivery of nutrition is flexible and all deliverance of care is set within a framework; all staff should work together in partnership to ensure that incidences of poor nutrition are dealt with. Repetitive reports of malnourishment is evidence enough to suggest that current practices are no longer working, change is a necessary force to ensure incidences are reduced. It is the responsibility of the leader to ensure this is tackled (Age Concern 2006). Change Management can be described as the process of developing a planned approach to change within an organisation. The objective should be to maximise the collective benefits for all stakeholders involved in the change and minimise the risk of failure implementing the change. Change involves assessment, planning and evaluation; changes in which people are nursed should always be focused on the benefits patients will receive if change is implemented (National Institute of Health and Clinical Excellence, 2007). Welford (2006) writes that there are many theories which explore the need for change; the goal should be the provision of the highest quality of care, each individual involved in the delivery of such care should work together, be committed and supportive of each other during times of change. Change within a team which leads to new practices and ideas affects each individual differently; it can be a very daunting task for some and for others it is embraced to allow for personal development and the sharing of knowledge (Murphy 2006). There are many theories which uses steps or phases that can evaluate if a change is needed and if the changes that are implemented work. For the purpose of this essay the author refers to a popular theory developed by Lewin in the 1950s which requires three stages to implement effective change the acceptance and participation of all those involved in the area requiring change. The first phase, commonly referred to as the unfreezing stage of this theory requires the participants to acknowledge the need for change; evidence should be provided to encourage new thinking and beliefs about current practices. Hallpike (2008) writes that there is evidence to suggest that teams can be divided into groups who have their own individual opinion on certain regimes, practices and care deliverance. This can be said for the provision of nutrition to patients. In this particular study the author reports that some team members did not think the re was a problem with the current provision, some were not convinced that changes would be made and others did not have faith in a holistic approach across the team. In this situation it is the responsibility of the team leader to persuade all the team members that the need for change is necessary in order to provide the best service possible, that the whole team work towards a common goal. Welford (2006) discusses the second phase of Lewins theory; describing this stage as the moving stage, allowing individuals to voice their own ideas, experiment with different regimes, it allows time for reflection, to discuss positive or negative findings. Past practices may have seen some team leaders adopt the belief that employees were seen to work better when the leader provided strict job descriptions and a clear plan of what was expected of them; their opinions and ideas were not of value to the overall success of a team. Major (2002) argues that for a leader to adopt such thinking will on ly lead to flaws and a feeling of negativity within a team; the leader should adopt good communication skills and openness to allow for effective team building, positive group dynamics, all working efficiently and productively. Dennis and Morgan (2008) suggests that although change is the responsibility of the service provider, input from the service user is without doubt a valuable tool in assessing if a change is working for the greater good. Feedback, regardless of being positive or negative ascertains if the change has been a positive one. If the new change has a detrimental affect to the service user then the change has been a negative one, this requires a return to the freezing stage to allow the team to make further changes to increase the benefits to the service user. The authors further comment that managers should be seen as advocates for the service user; it should be the responsibility of the manager to challenge team members over poor practice, poor attitudes and resist ance to change for the better. Conflict within a team leads to unrest, a disbelief that change is for the greater good leading to a dysfunctional team. The third phase of Lewins theory can be commonly referred to as the refreezing stage, where new ideas and behaviours become a new or common practice. Pearce (2007) argues that to name this phase as such denotes that the change remains static, leaders should continuously strive to make changes for the better, communication across the whole team allows for individuals points of view to be exposed and discussed; feedback on how a new change is working is necessary in order to achieve the highest levels of quality care. Leadership styles become a key issue when developing, implementing and upholding change. Motivation of staff also plays a key role in the acceptance of change; leaders should demonstrate that they are a good role model, adopt a friendly attitude towards team members, accepting of criticism and be willing to provide positive feedback, when the team endeavour to believe in and implement the change (Darlington 2006). Corkindale (2009) argues that leaders need balance their role within a team to ensure that they do not become too over familiar with individual team members, as this may lead to team members relying too heavily on the leader to make all the decisions and authority may be compromised. Murphy (2006) writes that leaders need to adopt a style of leadership that suits the workforce; a laissez-faire approach can be seen as the leader not taking into account individual team members ideas, work ethics and commitment seriously, it can lead to a team feeling devalued and unorganised. The National Institute for Mental Health (2007) further suggests that leaders who show their commitment, by working alongside their colleagues, adopting and maintaining the changes themselves demonstrates a leader who is at the forefront in the deliverance of quality care. They further suggest that each leader will bring their own set of ethics, life experiences and education to a team, will often adopt their own style of leadership that may be a mixture of several styles moulded to suit the team and the area of practice they are employed to manage. Opportunities for team members to voice their opinions and concerns are invaluable; they are after all the main implementers of the change and wil l have be the first to recognise if the change has gained positive or negative results. The change can only work if leaders allow for reflection, discussion and adaptation of the change to suit each individual involved in the change process. A change that is difficult to implement or maintain will end in failure, this leads a team adopting negative feelings and a resistance to change in the future. Goleman (2000) suggests that to adopt an authoritarian approach, can at times be a positive approach to leadership especially if some team members resist change or there is a need to produce quick results. Goffee and Jones (2000) disagree with this statement and suggest that a good leader is someone who other people want to follow without bullying, threats or the fear of reprisals; they lead by communicating effectively and adopt a style of leadership that allows the team to understand what is expected of them. RCN (2007) writes that the only way malnourishment can be identified and managed effectively is with effective use of recognised screening tools.Perry (2009) argues that in many cases nursing staff are given the means and tools to assess a patient, but many are inadequately trained to understand the findings of the assessment or are unwilling to involve other health professionals in the care of the patient. A multidisciplinary approach to tackle such problems should be used. Protected mealtimes have been proven to be useful to not only the patient but to the whole care team, it allows for assessment in areas such as speech and language, mental health issues and other physical problems which can affect the nutritional intake of individuals. South Staffordshire Primary Care Trust (2009) reports that protected mealtimes affects and involves all staff within in the organisation from physiotherapists, domestic staff, maintenance staff through to outside professionals such as social worker s. It involves all areas of clinical practice where patients require nutritional intake, not only for patients who are unable to feed themselves but for those patients who require and deserve a quiet, interruption free period to eat, drink and relax. To maintain and monitor the change process and may require several attempts before the target is reached. takes time and may not always be successful first time. National Patient Safety Agency (2008) states that many clinical staff referred to the implementation of protected mealtimes as a hindrance to their daily routine, but once the benefits for patients as well as the staff members were explained they became more compliant and understanding for the need to change.

A Good Business Essay -- GCSE Business Marketing Coursework

A Good Business What the characteristics of a good business looks like? The basic element of a good business is derived from good management. It is true since business is run by individuals known as managers that perform specific business functions, such as manufacturing and production, finance and accounting, sales and marketing, and human resource departments. Identifying a good business is not an easy job; an understanding of Managerial Economics is needed because it provides some tools, techniques of analysis and Economic concepts to make good managerial decisions. The purpose of this paper is to identify some characteristics of a good business and list names of the companies having these certain characteristics. Most of good businesses have characteristics such as promising prospect, high rates of return on equity, steady growth of sales, and also strong brands equity. When we talk about a good business, we are not only talking about past and present condition of a firm, but a good business should also have a good prospect. It is true that past successes do not ensure future successes; however the most common way to predict the future is based on the companies’ historical data because those all data are available for us. Those data must depict consistent sales growth and high rates of return on equity. Moreover, since many changes can happened, it is also important for a business to anticipate and adapt continuously to the changing conditions. Since the commo...

Mouth Cavity of Pig

Mouth Cavity Mouth: Opening into the oral cavity. Where food enters the body. Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food). Teeth: Used to break food down by (chewing) into smaller particles. Tongue: is used to manoeuvre food that is being chewed. Pharynx: tube-like structure that connects oral and nasal cavities to the larynx; provides passageway for respiratory and digestive tracts. Located in the back of the oral cavity. Esophageal opening: The entrance to the esophagus (food tube) can also be found in the nasopharynx. Esophagus- A muscular tube. The passage of food (via peristalsis) from the pharynx to the stomach. The esophagus is located dorsal to the trachea Nasopharynx opening: Passageway between the oralpharynx (throat) and the nasopharynx (nasal cavity) Nasopharynx: The nasopharynx is located above the part of the pharynx that food enters. Located just above the throat where food enters, the nasopharynx is connected to the middle ear, and it's purpose is to equalize ear pressure. And to allow air passage? Hard palate: hard bony structure that makes up the roof of the mouth. This separates the oral cavity from the nasal cavity. Soft palate: The movable fold, at the rear of the hard palate that closes off the nasal cavity from the oral cavity during swallowing or sucking. Epiglottis : a cone-shaped structure at the back of the mouth. fleshy flap the covers the glottis (which leads to the trachea) to prevent food and liquid from entering the trachea during swallowing. Glottis: The opening between the vocal cords at the upper part of the larynx.

Corruption- A threat to Democracy essays

Corruption- A threat to Democracy essays Corruption A Threat To Democracy Human history has so far witnessed three modes or forms of governance: (a) governance by a monarch king; (b) rule by a dictator; and (c) democratic governance. Through a process of trial and error, democracy with all its flaws has come to be accepted as the best form of governance. India with its great heritage of moral values, culture and civilization is undoubtedly the largest democratic country in the world. After independence, India accepted the Parliamentary form of democracy in which all powers of the state were vested in the hands of elected representatives of the people. Parliament and State Legislatures are the most important pillars of Indian democracy. People elect their representatives periodically and elections form an integral part of our democratic system. The genuine aspirations and expectations of the people can be reflected only through fair elections. It was thus obligatory on the part of the Members of Parliament (MPs) and the Members of the Legislative Assemblies (MLAs) in the states to behave according to the norms laid down in our Constitution and to strive to protect our great heritage and moral values. But the proverbial dictum, Power corrupts and absolute power corrupts absolutely has come to stay in our political system also. In a moment of retrospection of the Indian politics, one realizes with alarm that the democratic system is increasingly being driven by money, muscle power, individual greed and unconcealed ambitions of political leaders. The system fails to serve the common man and as a People we have been forced to relinquish the ideals that inspired the founders of modern India to envision the country as a model of people-oriented politics and development for the rest of the world. A vibrant political system means a multiplicity of political parties, which is all very good. But the vibrancy of the system does not mean that the politic...

Definition and Examples of Infinitive Clauses

Definition and Examples of Infinitive Clauses In English grammar, an infinitive clause is a subordinate  clause whose verb is in the infinitive form. Also known as an infinitival clause or a to-infinitive clause The infinitive clause is called a clause because it may contain such clausal elements as a subject, object, complement, or modifier. Unlike most other subordinate clauses  in English, infinitive clauses are not introduced by a subordinating conjunction. Verbs that can be followed by infinitive clauses (as objects) include: agree, begin, decide, hope, intend, like, plan, and propose. Examples and Observations Im sorry but theres a handsome man in my spoon. Youll have to come back later.(Tom Tucker, The Kiss Seen Round the World. Family Guy, 2001)Jane was firm in her desire to live life on her own terms.Desperate to prove his innocence, Jamal tells the story of his life in the slums of Mumbai.If you want to make God laugh, tell him about your plans.(Yiddish proverb)We merely want​ to live in peace with all the world, to trade with them, to commune with them, to learn from their culture as they may learn from ours, so that the products of our toil may be used for our schools and our roads and our churches and not for guns and planes and tanks and ships of war.(President Dwight Eisenhower, quoted in Time magazine, 1955) Infinitive Clauses as Subjects and Objects A subordinate clause with an infinitive often acts as the subject or object of the main clause. In the following examples, the whole infinitive clause [in bold] is understood as the subject of is human, is decadent or was unnecessary. - To err is human.- To drink Martinis before noon is decadent.- For Mervyn to redirect Maggies mail was unnecessary. And in the following examples, the whole infinitive clause [again in bold] is understood as the direct object of hates, loves and expected. - Jim hates to wash his car.- Rosie loves to plan parties.- Phil expected Martha to stay at home all day. In case this is not obvious at first, you can test this by answering questions such as What does Jim hate? (answer: to wash his car), or What did Phil expect? (answer: Martha to stay at home all day). (James R. Hurford, Grammar: A Students Guide. Cambridge University Press, 1994) Perfect Infinitives To express time preceding that of the main verb, the infinitive takes a perfect form: to have past participle. (58) The parents were lucky to have found this specialist for their sick child. The perfect infinitive can be used with progressive aspect to emphasize duration. This construction consists of to have been V-ing. (59) He was too scared of the police to have been telling lies all the time. (Andrea DeCapua, Grammar for Teachers: A Guide to American English for Native and Non-Native Speakers. Springer, 2008) Passive Infinitives An infinitive that is derived from a passive finite verb clause will itself be passive: (20) a. I expect that all the calamari will be eaten before 7:00. (passive verb)(20) b. I expect all the calamari to be eaten before 7:00. (passive infinitive) You can verify that to be eaten is a passive infinitive in (20b) because it contains the passive marker [BE (-en)]: be eaten. Remember that eaten is a transitive verb; in its active form, it will have a subject (an indefinite pronoun like someone or they) and a direct object (all the calamari). (Thomas Klammer et al., Analyzing English Grammar, 5th ed. Pearson, 2007)

Competitiveness and investment attractiveness of the South African Essay

Competitiveness and investment attractiveness of the South African food retail industry - Essay Example By 2012, the SAFRI is expected to have a value of $98.1 billion which will be an increase of 32.7 percent over 2011 (Appendix A). While the above figures demonstrate the attractiveness of the market for investments, further evaluation would be conducted to determine the competitive advantage in investing in South Africa. This would be conducted through the extended model of Porter’s National Diamond. 2. Porter’s National Diamond The competitive advantage of an industry, according to Porter, derives from the national ‘diamond’. These four diamonds are the four determinants of competitive advantage created within the home base of the nation state – factor conditions, demand conditions, related and supporting industries, and firm strategy, structure and rivalry. The extended model of Porter’s National Diamond includes government and chance events. An important key feature of the model is that the determinants are supportive of each other and oper ate as a system (Clancy, O’Malley, O’Connell and Egeraat, 2001). This implies that there should be effective flow of information about needs, techniques and technology. Here geographic concentration is important because proximity facilitates flow of information. ... While the basic factors pertain to demographics, location and climate, the advanced factors include communications infrastructure, sophisticated skills and research facilities. South Africa’s population has surpassed 50 million and more than 90 percent of its population is non-white (Arisaig, 2012). Unemployment rate is 25.2 percent and the average life expectancy is only 57 years. Unequal distribution of wealth has resulted in the poorest ten percent earning just one percent of the total national income. Poor education system can be attributed to high rates in unemployment. However, the country has modern infrastructure and the retail sector is sophisticated although dominated by local products (Ntloedibe, 2012). The country also has a well developed communications network and electricity supply is also reliable. In addition, South Africa also has a network of merchant banks, brokers, and financial services specialists. Investments in technology and telecommunications are inc reasing which will enhance business infrastructure thereby enabling the companies to compete with the countries in the West (Maxwell, 2013). The southernmost country on the African continent, South Africa is one of the most economically prosperous nations in southern Africa due to its coastal location and presence of gold, diamonds and natural resources (Briney, 2012). However, climate change is prominent in South Africa and this impacts sourcing and transportation of agricultural products for retailers. One way to handle this is through adaptation by sourcing through several suppliers in vulnerable categories. Despite its coastal location, water is scarce and water security is a fundamental challenge faced by retailers. This requires the retailers to actively engage with suppliers for

Marketing Little Known destinations the island of Saaremaa, Estonia Essay

Marketing Little Known destinations the island of Saaremaa, Estonia - Essay Example One key question that needs to be addressed when thinking of the marketing efforts is whether to prioritize their marketing efforts at the established markets or look at newer markets such as distant European countries. As per the context established by the case, the tourism industry is changing very rapidly. The tourists are much more open to traveling to distant places to discover new and little known, but exotic destinations (Yong, 2006). Therefore, with regard to Saaremaa, the marketing efforts should be prioritized to build new markets. Europe is well known for exotic and small destinations and hence, the level of competition is high. Therefore, to attract customers from a new market, it is necessary to have a high focus on building the brand, ensuring sustainability as well as in targeting the right market segment. For example, Saaremaa is famous for its natural beauty, its rich history as well as the sweet-sour bread and beer. Hence, the brand Saaremaa for tourism should adequ ately encompass these different aspects. The initial marketing efforts can center on advertising Saaremaa to create awareness and the subsequent efforts can center on introducing specific theme related holidays such as an exotic theme that centers on the sweet-sour bread and beer in the food category or a historical theme holiday destination. Focusing on new markets will also make the destination popular among a wider set of customers who have various preferences of holidays and hence, it would open Saaremaa’s uniqueness to customers who prefer such destinations. However, it should be ensured that any steps of market expansion should not result in overcrowding. In addition, any word of mouth marketing may already work in the existing markets which will ensure that there is a steady flow of tourists from the already established markets. Therefore, prioritizing the new market will bring in customers from newer markets and at the same time, the customers from the existing market s will continue to visit because of the existing efforts and word of mouth (Holloway, 2004). 2. Should Saaremaa improve access by ferry or plan on the construction of a bridge to the mainland, as a means of expanding tourism? Or, conversely, should the island authorities aim to limit the appeal of the island in its existing isolation, by aiming to boost income from a smaller base of visitors to this island destination? One of the highlights of Saaremaa is how it is exotic and little known, but extremely beautiful and a perfect holiday get away. Therefore, on one hand it is important to build the tourism sector, it should be done in such a way that the pristine surroundings are not disturbed and the serenity of the place is not at risk because of overcrowding. Therefore, to sustain this exoticness and serenity, it is necessary to ensure that the place does not degrade in standard because of overcrowding. Overcrowding may mean more revenue because of increased crowd influx, but it als o can result in pollution, higher crime rates, more buildings and development (Doan, 2000). It can also mean that the natural beauty as well as tourist spots no longer provides peace and tranquility, thereby taking away the charm from the place. Hence, it is recommended that appeal of the island should be maintained by ensuring that there is some amount of isolation. In such cases, the challenge is how to improve the tourism industry without