Forces Initiating or Inhibiting Change in Organizations Essay

Forces Initiating or Inhibiting Change in Organizations - Essay Example The coming of new technology, Robins said, affects the jobs and the organization. There was a time when pagers were in vogue. It was a necessary communication tool for sales and field personnel, but cellular phones took them out of the picture. Computer knowledge is an added requirement for new employees, a necessity in almost all business outfits. Technology, likewise, affects a company or industry, especially the music industry with online downloads and sharing. He commented that genetic technology allows pharmaceutical corporations to produce drugs for particular individuals, which in turn produces a dilemma for insurance companies on who would be insured or not. With competition no longer confined within a geographic territory but globally, new products and services should be introduced for survival. With business deals being transacted and concluded online, technical and support units became part of the structure.

Alcohol as an acceptable adjunct for occasions in our society Essay Example for Free

Alcohol as an acceptable adjunct for occasions in our society Essay There are approximately 50% or 126 million of Americans whom are past month alcohol drinkers, or also known as current drinkers. Also, approximately 23% or 55 million of Americans binge drink, and 6.6% or 16 million Americans reported heavy drinking. The estimated spending for healthcare services to treat alcohol problems, and its medical consequences of alcohol is 18.8 billion dollars a year. Alcohol is also officially linked to at least over half of all highway fatalities. To date, alcohol has been tried by 41% of 8th graders, 63% of 10th graders, 75% of 12th graders, and 87% of college students. Also there was an estimated 82 billion dollars lost in potential productivity due to alcohol and other drug use. We all know that alcohol is offered almost everywhere we go. At parties, in bars, in clubs, in stores, and restaurants. People consume alcohol for every occasion they can think of, or just to make their problems go away and to make them feel better, even though it is just for a limited amount of time. We all know what alcohol does, and can do. Why do we always chose alcohol at a party, in a bar, at a restaurant, or in a store? People can have fun without it. Alcohol is used to socialize better, but why cant people socialize without it? Why is alcohol used as an acceptable, unnecessary addition to celebrations such as parties, weddings, birthdays, and anniversaries, and as a way of relaxing and relieving stress and anxiety? People know what alcohol is about but yet continue drinking massively into more disasters. Reference: Drugs and Society Tenth Edition Chapter 8 p.182-191, U.S. National Library of Medicine and the National Institutes of Health http://www.nlm.nih.gov/medlineplus/alcoholconsumption.html#cat1 People use alcoholic beverages to enjoy while chatting with friends. Thinking about the effects of alcohol on the health of a person using it is never apparent. The holidays are the time when alcoholic beverages are mostly abused of which includes parties and small gatherings of friends and families. In this case, the people responsible in that activity such as hosts and party organizers must think of the safety of every drinking pattern. Any risky of harmful pattern must be regulated and prevented. I am not saying that it is acceptable to use alcohol during parties. What I am trying to say is that when drinking alcoholic beverages cannot be prevented during holidays, proper caution must be used in doing so to prevent untoward incidents.

J.B.Priestley’s play, An Inspector Calls Essay -- English Literature

By what means, and how successfully is suspense created and sustained in An Inspector Calls? An Inspector Calls Essay By what means, and how successfully is suspense created and sustained in ‘An Inspector Calls?’  · Show analytical and interpretative skills  · The effects of dramatic devices and structure  · Layers of meaning in language, ideas and themes  · The social and historical setting/context JB Priestley wrote ‘An Inspector Calls’ towards the end of World War 2. The play however, is set in 1912 at a wealthy, middle-class family home. The play is about a family celebrating an engagement, when an Inspector calls, and tells them of a young girl’s suicide. The play is always set in the family’s dining room, but it has precise stage directions, so each character must be sitting in a certain place. Suspense is used right through the play, usually at its peak at the end of an act. I think JB Priestley was trying to get a message across to us that we need to abolish the social class differences, and all be equal. The play is very good because you are always trying to find out who was responsible for the suicide, and you know that everybody fits in, but you don’t know when or how. As you find, or think you’ve found something out, the play takes a new dramatic turn, which definitely makes suspense the key factor. What makes the play even better is that the audience always knows a lot more than the characters do, and you are always wondering: â€Å"why haven’t they worked that out?† Suspense is very successfully created and sustained in ‘An Inspector Calls.’ When Act one begins, the mood is merry, and civilised in the dining room, at The Birlings’ house. The family are happy, excited and ... ...er this phone call means that yes everything was true, or no, it was a hoax. Then, it is used as a dramatic device again when it rings, and the local Inspector says he is coming round to question the Birlings about a young girl’s death. The play ends here. Now, we have found out the suspense is created and sustained very successfully in ‘An Inspector Calls’. With you always wondering whether the Inspector is real, and all the cliffhangers that are used, you are constantly left in suspense, even after the very unusual ending. You are wondering at the end whether this time it really is real, or is it another hoax? We will never know. Dramatic devices are a key element in this play, for example in Act 3; a telephone is the focal point. It can be little things like that. I hope this brings a good conclusion to a very good, interesting, even if strange play.

Shark Attacks

On 11 July, 1916 Rensselaer Cartan Jr. saw a looming dark figure and noticed a large fin protruding from the water. A shark, the newest fear of many after the several attacks that occurred just days before. Yet he was 17 miles inland, he knew what he saw and set out to warn the town of the â€Å"sea monster† looming in the creek. â€Å"No way† were the thoughts of many as they heard Caratan Jr. tell his tale, and they continued on with their normal lives, despite his desperate cries of fear and warning. The attacks of Lester Stilwell and Stanley Fisher show that the technology of this era was very un-advanced, this was also the first recorded shark attack in fresh water, and the amount of time it took for a doctor to reach the place of the attack was lengthy and costly. The technology in this era was very weak in comparison to today’s modern medicine and was not efficient in life if death situations. In this time there was no ambulances and the way to be rushed to the hospital was by train and by automobile. If theses attacks had occurred in modern times, the death of Fisher may have been stopped. The death of Stilwell was definite, due to the fact that the shark mangled Stilwell’s body beneath the water, where he drowned. He also would have died from sheer amounts of blood loss and the fact that no one would have reached the eleven year old boy on time. Though modern technology has changed the amount of help that doctors can provide patients the patient, must be first saved from the cause of death. In this case the shark did not let young Stilwell have the opportunity of medical treatment that he so desperately needed. These attacks were a shock to the world because they occurred in a creek seventeen miles inland. Bull sharks have been found in various fresh water sources, sometimes far upriver or upstream in some cases, their high tolerance for fresh water nearly unique among shark species. (Davidson) The bull shark is a shark that is known to be found in modern times to swim into the mouths of rivers to find better prey. This was unknown to the people of 1916 as was many facts of the entire species of sharks. Nobody thought a shark would travel so far inland and in a creek no larger than 45 feet across. (capuzzo 89) The shark had been allowed to travel so far up due to the fact the the tide was at its highest point due to the lunar cycle. (capuzzo 91) The shark was easily able to maneuver and find its prey in the murky water. The amount of time that it took for a doctor to reach the scene, where Stilwell and Fisher were attacked was far too long. According to Julius Kish, no doctor lived or worked in the town of Matawan in 1916. This may have contributed to the fact that Fisher died and did not receive medical attention right away as was needed. The only immediate he received was that of his friends, who were in shock. His friends made a makeshift tourniquet using rope to stop the excessive blood flow. (Capuzzo 101) This was not enough to save the mans life, he needed immediate medical attention. Stanley fisher slowly began to die as he waited for the doctors to arrive to treat his wound, a large chunk of flesh missing from his pelvis. Fisher’s wounds were dire, yet he willed to live. â€Å"That afternoon in 1916, however, the treatment Stanley Fisher required was two hours and thirty-nine minutes away. † (Capuzzo 101) At this time hospitals lay far apart and the travel to a hospital may be too far and by the time patients reach the hospital, death has already set in. When Fisher pulled his body out of the water he lied there in a pool of his own blood. (capuzzo 100) As the blood would continue to flow he was at risk for blood loss and also diseases of having an uncared for open gash. With such a limited supply of medical attention in this era caused casualties that would be routine in todays modern age. The attacks of 1916 started an epidemic of natural fear against man eating sharks. Lester Stilwell’s body took two days to resurface. In those two days rumors flowed through America on what had happened to the boy. The curiosity on what caused this â€Å"rouge† shark to go on such vicious attacks initiated people to begin researching these mysterious predators. presently we now no much more about sharks and continue to research to better understand how these suspicious animals tick.

Managerial Leadership role for Nurses’ Use of Research Evidence Essay

The rapid noticeable change in healthcare delivery coupled with professional responsibilities of nurses to incorporate research evidence into their decision making underscores the need to understand the factors involved in implementing evidence-based practice. Linking current research findings with patients’ conditions, values, and circumstances is the defining feature of evidence-based practice. Significant and rational for using evidence in practice in nursing care Evidence-based practice (EBP) is an approach to health care where the best evidence possible is used in health professionals to make clinical decisions for individual. It involves complex and conscientious decision-making based on the available evidence, patient characteristics, situations, and preferences( McKibbon, 1998). Evidence-based practice in nursing is defined as â€Å"integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served† (â€Å"Sigma Theta Tau International position statement on evidence-based practice February 2007 summary,† 2008). The gist of evidence based health care is the integration of individual clinical expertise with the best available external clinical evidence and the values and expectations of the patient. There are different recourses of evidence which includes the following: †¢Research Evidence: which refers to methodologically sound, clinically relevant research about the effectiveness and safety of interventions, the accuracy of assessment measures, the strength of causal relationships and the cost-effectiveness of nursing interventions. †¢Patients Experiences and Preferences: identification and consideration of patient’s experiences and preferences are central to evidence-based decision making. Patients may have varying views about their health care options, depending on factors such as their condition personal values and experiences, degree of aversion to risk, resources, availability of information, cultural beliefs, and family influences. †¢ Clinical Expertise. AS the mixing of these different types of evidence may be influenced by factors in the practice context such as available resources, practice cultures and norms leadership styles, and data management, we must consider the level of evidence while using the research evidence to take the proper decision, look to appendix A which is represent the level of evidence. (Haynes, Devereaux, & Guyatt, 2002; Sigma Theta Tau International position statement on evidence-based practice February 2007 summary,† 2008). Evidence-based practice is a prominent issue in international health care which is intended to develop and promote an explicit and rational process for clinical decision making that emphasizing the importance of incorporating the best research findings into clinical care to ensure the best possible treatment and care derived from the best available evidence (E. Fineout-Overholt, Levin, & Melnyk, 2004) Once a new research is completed new evidence comes into play every day, technology advances, and patients present with unique challenges and personal experiences(Krainovich-Miller, Haber, Yost, & Jacobs, 2009). The nurse who bases practice on what was learned in basic nursing education soon becomes outdated, then becomes dangerous. Patients are not safe if they do not receive care that is based on the best evidence available to assist them at the time their needs arise, so all aspects of nursing, from education to management to direct patient care, should be based on the best evidence available at the time (Reavy & Tavernier, 2008). Through reviewing the literature there is a dramatically changing and advancing in the technology, available body information and quality of care provided, the rapid pace of change in healthcare delivery coupled with professional responsibilities of nurses to incorporate research evidence into their provided care and decision making underscores the need to understand the factors involved in implementing evidence-based practice (Bostrà ¶m, Ehrenberg, Gustavsson, & Wallin, 2009; Ellen Fineout-Overholt, Williamson, Kent, & Hutchinson, 2010; Gerrish, et al., 2011; Gifford, Davies, Edwards, Griffin, & Lybanon, 2007). Before that nurses must first believe that basing their practice on the best evidence will lead to the highest quality of care and outcomes for patients and their families(Ellen Fineout-Overholt, et al., 2010; Melnyk, et al., 2004). To let change occuring, â€Å"there must be a clear vision, written goals, and a well-developed strategic plan, including strategies for overcoming anticipated barriers along the course of the change†(Melnyk, et al., 2004). Emerging evidence indicates that the  leadership behaviors’ of nurse managers and administrators play an important role in successfully utlizing research evidence into clinical nursing(Amabile, Schatzel, Moneta, & Kramer, 2004; Antrobus & Kitson, 1999; Gifford, et al., 2007). There is a consistency between many researches that clamethe importance role of the leadership and leadership factors such as support and commitment of managers on the staff at the implication of EBP(Aitken, et al., 2011; Antrobus & Kitson, 1999; Melnyk, et al., 2004; Winch, Creedy, & Chaboyer, 2002). Nurse managers and administrators are responsible for the professional practice environments where nurses provide care, and are strategically positioned to enable nurses to use research. As being a role model, administrators must be committed to provide the necessary resources such as EBP mentors, computers, and EBP education. Some administrators have tried to encourage a change to EBP by integrating EBP competencies into clinical promotions. However, Miller (2010) argue that this extrinsic motivational strategy is unlikely to be as effective as when people are intrinsically motivated to change. Also there is a claimed that if people are involved in the strategic planning process, they are more likely to change to EBP. Intervention protocol for promoting nurses compliance to EBP As the Decision making in health care has changed dramatically, with nurses expected to make choices which based on the best available evidence and continually review them as new evidence comes to light (Pearson et al, 2007). Evidence-based practice involves the use of reliable, explicit and judicious evidence to make decisions about the care of individual patients. As an important role in providing safe and high quality care the nurses must take into account the quality of evidence, assessing the degree to which it meets the four principles of feasibility, appropriateness, meaningfulness and (Doody & Doody, 2011; Johnson, Gardner, Kelly, Maas, & McCloskey, 1991). What nurses need to operate in an evidence-based manner, is to be aware of how to introduce, develop and evaluate evidence-based practice. There more than one model for introducing the EBP in health care one of them that I chose is the Iowa model. The Iowa model focuses on organization and collaboration incorporating conduct use of research, along with other types of evidence(Doody & Doody, 2011; Johnson, et al., 1991). Since its origin in 1994, it has been continually referenced in nursing journal articles and extensively used in clinical research programmes. This model uses key triggers that can be either problem focused or knowledge focused, leading staff to question current nursing practices and whether care can be improved through the use of current research findings(Bauer, 2010; Doody & Doody, 2011; Johnson, et al., 1991; Titler, et al., 2001). By using Iowa Model; a question is generated either from a problem or as a result of becoming aware of new knowledge. Then a determination is made about the question relevance to organizational priorities. If the question posed is relevant, then the next step is to determine if there is any evidence to answer the question. Once the evidence has been examined, if there is sufficient evidence, then a pilot of the practice change is performed. If there is insufficient evidence, then the model supports that new evidence should be generated through research (Bauer, 2010). Step one of the Iowa model is to formulate a question. The question if asked in a PICO format is easier to use to search the literature. A PICO format uses the following method to frame the question: Frame question in PICO format †¢ P= Population of interest †¢ I= Intervention †¢ C= Comparison of what you will do †¢ O= Outcome(Hoogendam, de Vries Robbà ©, & Overbeke, 2012). The final step to the process is to share the outcomes of the practice change with other in the form of an article or poster. In using the Iowa model, there are seven steps to follow in detail as it is outlined in the figure shown in appendix B. Step 1: Selection of a topic In selecting a topic for evidence-based practice, several factors need to be considered. These include the priority and magnitude of the problem, its application to all areas of practice, its contribution to improving care, the availability of data and evidence in the problem area, the multidisciplinary nature of the problem, and the commitment of staff. Step 2: Forming a team The team is responsible for development, implementation, and evaluation. The composition of the team should be directed by the chosen topic and include all interested stakeholders. The process of changing a specific area of practice will be assisted by specialist staff team members, who can provide input and support, and discuss the practicality of guideline. A bottom-up approach to implementing evidence-based practice is essential as change is more successful when initiated by frontline practitioners, rather than imposed by management. Staff support is also important. Without the necessary resources and managerial involvement, the team will not feel they have the authority to change care or the support from their organization to implement the change in practice. To develop evidence-based practice at unit level, the team should draw up written policies, procedures and guidelines that are evidence based. Interaction should take place between the organization’s direct care providers and management such as nurse managers, to support these changes(Antrobus & Kitson, 1999; Cookson, 2005; Doody & Doody, 2011; Hughes, Duke, Bamford, & Moss, 2006). Step 3: Evidence retrieval Evidence should be retrieved through electronic databases such as Cinahl, Medline, Cochrane and up-to-date web site. Step 4: Grading the evidence To grade the evidence, the team will address quality areas of the individual research and the strength of the body of evidence overall (see appendix A for level of evidence). Step 5: Developing an Evidence-Based Practice (EBP) standard After a critique of the literature, team members come together to set recommendations for practice. The type and strength of evidence used in practice needs to be and based in the consistency of replicated studies. The design of the studies and recommendations made should be based on identifiable benefits and risks to the patient. This sets the standard of practice guidelines, assessments, actions, and treatment as required. These will be based on the group decision, considering the relevance for practice, its feasibility, appropriateness, meaningfulness, and effectiveness for practice. To support evidence-based practice, guidelines should be devised for the patient group, health screening issues addressed, and policy and procedural guidelines devised highlighting frequency and areas of screening. Evidence-based practice is ideally a patient centered approach, which when implemented is highly individualized. Step 6: Implementing EPB For implementation to occur, aspects such as written policy, procedures and guidelines that are evidence based need to be considered. There needs to be a direct interaction between the direct care providers, the organization, and its leadership roles (e.g. nurse managers) to support these changes. The evidence also needs to be diffused and should focus on its strengths and perceived benefits, including the manner in which it is communicated. This can be achieved through in-service education, audit and feedback provided by team members. Social and organizational factors can affect implementation and there needs to be support and value placed on the integration of evidence into practice and the application of research findings(Aitken, et al., 2011; Doody & Doody, 2011; Gerrish, et al., 2011; Reavy & Tavernier, 2008) Step 7: Evaluation Evaluation is essential to seeing the value and contribution of the evidence into practice. A baseline of the data before implementation would benefit, as it would show how the evidence has contributed to patient care. Audit and feedback through the process of implementation should be conducted and support from leaders and the organization is needed for success. Evaluation will highlight the programme’s impact. Barriers also need to be identified. Information and skill deficit are common barriers to evidence-based practice. A lack of knowledge regarding the indications and contraindications, current recommendations, and guidelines or results of research, has the potential to cause nurses to feel they do not have sufficient training, skill or expertise to implement the change. Awareness of evidence must be increased to promote the translation of evidence into practice . A useful method for identifying perceived barriers is the use of a force field analysis conducted by the team leader. Impact evaluation, which relates to the immediate effect of the intervention, should be carried out. However, some benefits may only become apparent after a considerable period of time. This is known as the sleep effect. On the contrary, the back-sliding effect could also occur where the intervention has a more or less immediate effect, which decreases over time. We must not to evaluate  too late, to avoid missing the measures of the immediate impact. Even if we do observe the early effect, we cannot assume it will last. Therefore, evaluation should be carried out at different periods during and following the intervention (Doody & Doody, 2011). Nursing leadership is an essential role for promoting evidence-based practice while the nurse managers and administrators are responsible for the professional practice environments where nurses provide care, are strategically positioned to enable nurses to use research. AS the leadership is essential for creating change for effective patient care the leadership behaviors are critical in successfully influencing the stimulation, acceptance, and utilization of innovations in organizations (Antrobus & Kitson, 1999; Gifford, et al., 2007). From my perspective I consider that the leaders and managers are the corner stone for utilizing researches and make practices based on evidence. By playing a role model for staff and handling the authority they have a magic force to urges the staff to use evidence based in there practice. Leaders can encourage the staff to use EBP in their practice in several ways such as increase the staff awareness, stimulating the intrinsic motivation of people, implying an effort to increase the will and internal desire to change through support encouragement, education, and appealing to a common purpose, monitoring performance, strengthen the body of knowledge that the staff have by forcing them to attend and participate in conferences, workshops & Journal clups, giving rewards to staff who collaborate in finding, utilizing and applying the EBP and make promotion and appraisal according to adherence to application of EBP. Implication of EBP For implementation to occur, aspects such as written policy, procedures and guidelines that are evidence based need to be considered. There needs to be a direct interaction between the direct care providers, the organization, and its leadership roles (e.g. nurse managers) to support these changes. The evidence also needs to be diffused and should focus on its strengths and perceived benefits, including the manner in which it is communicated. This can be achieved through in-service education, audit and feedback provided by team members. Social and organizational factors can affect implementation and there needs to be support and value placed on the integration of evidence into practice and the application of research findings. There are many ways that can be used to create an environment to implement and sustain an area of EBP such as : -Development of EBP champions; – Use of EBP mentors; – Provision of resources such as time and money; – Creation of a culture and expectation related to EBP; – Use of practical strategies including EBP workgroups, journal club and nursing rounds (Aitken, et al., 2011). EBP is being used in every aspect of the life, especially in the health care. The most common application of EBP is not only in intervention or treatment plane, but also the EBP process has been applied to making choices about diagnostic tests and protocols to insure thorough and accurate diagnosis, selecting preventive or harm-reduction interventions or programs, determining the etiology of a disorder or illness, determining the course or progression of a disorder or illness, determining the prevalence of symptoms as part of establishing or refining diagnostic criteria, completing economic decision-making about medical and social service programs. Nursing research proves pivotal to achieving Magnet recognition, yet the term research often evokes an hunch of mystery. Most of the policy, guidelines. And protocols that guide the work in the organization are based on evidance (Weeks & Satusky, 2005). Also, it is also useful to think of EBP as a much larger social movement. Drisko and Grady (2012) argue that at a macro-level, EBP is actively used by policy makers to shape service delivery and funding. EBP is impacting the kinds of interventions that agencies offer, and even shaping how supervision is done. EBP is establishing a hierarchy of research evidence that is privileging experimental research over other ways of knowing. There are other aspects of EBP beyond the core practice decision-making process that are re-shaping social work practice, social work education, and our clients’ lives. As such, it may be viewed as a public idea or a social movement at a macro level (â€Å"Evidence-Based Practice: Why Does It Matter?,† 2012). Cost effectiveness of using EBP in health care  Beneficial outcomes of the implementation and use of evidence-based practice by staff nurses include increased ability to offer safe, cost-effective,  and patient-specific interventions. Critical thinking skills and leadership abilities can also grow because of the use of evidence based practice; it is a way for staff nurses to become involved in change and regain ownership of their practice (Reavy & Tavernier, 2008). EBP used in clinical practice lead to make improvement in quality of provided care, which lead to improve the patients outcome, patient satisfaction and employee satisfaction. All these aspect are directly and indirectly lead to increase the cost effectiveness of the organization. When the patient satisfaction increased the patient acceptance to the organization increased, the employee satisfaction also increases and turnover will decrease all these things will increase the financial revenue to the organization. Also when using EBP in health care this will lead to decrease errors, complications and losses (e.g. compliance of evidence based infection control guidelines will lead to decrease incidence of infection, decrease length of stay an d decrease the cost of patient treatment), another example is using EBP to treat diabetic foot will result in decreasing the loses and increases the satisfaction so adherence to EBP will be costly effective when it result in better outcome, quality of care and satisfaction. Sometimes using EBP in certain area is costly; in such cases we must weighing the benefits ( immediately and after considered period of time) and mak e our decision based on the collected data and information. References: Aitken, L. M., Hackwood, B., Crouch, S., Clayton, S., West, N., Carney, D., et al. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process. Australian Critical Care, 24(4), 244-254. Amabile, T. M., Schatzel, E. A., Moneta, G. B., & Kramer, S. J. (2004). Leader behaviors and the work environment for creativity: Perceived leader support. The Leadership Quarterly, 15(1), 5-32. Antrobus, S., & Kitson, A. (1999). Nursing leadership: influencing and shaping health policy and nursing practice. Journal of Advanced Nursing, 29(3), 746-753. Bauer, C. (2010). Evidence Based Practice:Demystifying the Iowa Model Providing optimal care through promotion of professional standard, networking and development, 25(2). Bostrà ¶m, A.-M., Ehrenberg, A., Gustavsson, J. P., & Wallin, L. (2009). Registered nurses’ application of evidence-based practice: a national survey. Journal Of Evaluation In Clinical Practice, 15(6), 1159-1163. Cookson, R. (2005). Evidence-based policy making in health care: what it is and what it isn’t. Journal Of Health Services Research & Policy, 10(2), 118-121. Doody, C. M., & Doody, O. (2011). Introducing evidence into nursing practice: using the IOWA model. British Journal of Nursing, 20(11), 661-664. Evidence-Based Practice: Why Does It Matter? (2012). ISNA Bulletin, 39(1), 6-10. Fineout-Overholt, E., Levin, R. F., & Melnyk, B. M. (2004). Strategies for advancing evidence-based practice in clinical settings. Journal of the New York State Nurses Association, 35(2), 28-32. Fineout-Overholt, E., Williamson, K. M., Kent, B., & Hutchinson, A. M. (2010). Teaching EBP: strategies for achieving sustainable organizational change toward evidence-based practice. Worldviews On Evidence-Based Nursing / Sigma Theta Tau International, Honor Society Of Nursing, 7(1), 51-53. Gerrish, K., Guillaume, L., Kirshbaum, M., McDonnell, A., Tod, A., & Nolan, M. (2011). Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey. Journal of Advanced Nursing, 67(5), 1079-1090. Gifford, W., Davies, B., Edwards, N., Griffin, P., & Lybanon, V. (2007). Managerial leadership for nurses’ use of research evidence: an integrative review of the literature. Worldviews on Evidence-Based Nursing, 4(3), 126-145. Haynes, R. B., Devereaux, P. J., & Guyatt, G. H. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. ACP Journal Club, 136(2), A11-A14. Hoogendam, A., de Vries Robbà ©, P. F., & Overbeke, A. J. P. M. (2012). Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. Journal Of The Medical Library Association: JMLA, 100(2), 121-126. Hughes, F., Duke, J., Bamford, A., & Moss, C. (2006). Enhancing nursing leadership: Through policy, politics, and strategic alliances. Nurse Leader, 4(2), 24-27. Johnson, M., Gardner, D., Kelly, K., Maas, M., & McCloskey, J. C. (1991). The Iowa Model: a proposed model for nursing administration. Nursing Economic$, 9(4), 255-262. Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journa l of Nursing Education, 48(4), 186-195. Melnyk, B. M., Fineout-Overholt, E., Feinstein, N. F., Li, H., Small, L., Wilcox, L., et al. (2004). Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing, 1(3), 185-193. Reavy, K., & Tavernier, S. (2008). Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process. Journal of Continuing Education in Nursing, 39(4), 166-172. Sigma Theta Tau International position statement on evidence-based practice February 2007 summary. (2008). Worldviews on Evidence-Based Nursing, 5(2), 57-59. Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, C. L. Q., et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America, 13(4), 497-509. Weeks, S. K., & Satusky, M. J. (2005). Demystifying nursing research: to encourage compliance with Magnet accreditation standards, f urther your facility’s research initiatives. Nursing Management, 36(2), 42. Winch, S., Creedy, D., & Chaboyer, W. (2002). Governing nursing conduct: the rise of evidence-based practice. Nursing Inquiry, 9(3), 156-161.

How to Kill a Tree Without Chemicals

How to Kill a Tree Without Chemicals Killing a tree is hard work, particularly if you avoid using chemical assistance. You have to cut off a trees water, food and/or sunlight at a critical time in its life cycle to do the job. Herbicides work by gumming up or shutting down a trees working parts to deprive the plant of one or more of the above.   Using the Bark Trees can be killed without herbicides or chemicals but extra time, patience, and understanding of tree anatomy are necessary. You most especially need to know about the function of a trees inner bark- cambium, xylem, and phloem- and how they combine forces to affect a trees life.   The bark is a trees most vulnerable body part above ground and the easiest target for an effective kill. Damaging enough roots to kill the tree quickly is complicated and hard to do without using chemicals. The bark is made up of cork and phloem which protects the cambium and xylem. Dead xylem cells carry water and minerals from the roots to the leaves and are considered the trees wood. Phloem, a living tissue, carries manufactured food (sugars) from the leaves to the roots. The cambium, which is a moist layer only a few cells thick, is the regenerative layer that gives birth to xylem on its inside and phloem to its outside. Destroying the Bark If the food-transporting phloem is severed all the way around the tree (a process called girdling), food cannot be carried to the roots and they will eventually die. As the roots die, so does the tree. Periods of rapid growth, usually from March until June in North America, are the best times to girdle a tree. These spring growth spurts are when tree bark slips. The phloem and cork layer easily peels free, leaving the cambium and xylem exposed. Remove as wide a section of bark as you have time to make an adequate girdle ring. Then scrape (or chop) into the surface of the xylem to remove the cambium. If any cambial material remains, the tree will heal by overgrowing the girdle. The best time to girdle is before the trees leaf out. The process of leafing out will deplete energy stores from the roots, which stores cannot be renewed if the phloem conduit has been interrupted. Avoid the Sprout Some trees are prolific sprouters and produce adventitious twigs near an injury. If you dont remove or kill the entire root, you just may have to control these sprouts. Sprouts coming out below the girdle must be removed as they will continue the process of feeding the roots if left to grow. When you are removing these sprouts, it is a good idea to check the girdled strip and remove any bark and cambium that may be trying to bridge the wound. Even cutting a tree down cant guarantee it will be killed. Many tree species, particularly some deciduous broad-leaf species, will sprout back from the original stump and root system.

Inspirational Quotes About Teacher

Inspirational Quotes About Teacher Do you remember a teacher who inspired you? Do you want to thank that teacher for her or his selfless service? Here is your chance. Pick an inspirational quote for your teacher from this page and send it as a special message for your teacher. Each inspirational quote lauds the efforts of good teachers. Martin HeideggerTeaching is more difficult than learning because what teaching calls for is this: to let learn. The real teacher, in fact, lets nothing else be learned than learning. His conduct, therefore, often produces the impression that we properly learn nothing from him, if by learning we now suddenly understand merely the procurement of useful information.AnonymousIf you can read this, thank a teacher.Albert EinsteinIt is the supreme art of the teacher to awaken joy in creative expression and knowledge.John GarrettThe job of a teacher is to excite in the young a boundless sense of curiosity about life, so that the growing child shall come to apprehend it with an excitement tempered by awe and wonder.Edmond H. FischerIt is commonly said that a teacher fails if he has not been surpassed by his students.David E. PriceThe impending teacher shortage is the most critical education issue we will face in the next decade.Malcolm S. ForbesEducations purpose is to replace an empty mind w ith an open one. Morihei UeshibaStudy how water flows in a valley stream, smoothly and freely between the rocks. Also learn from holy books and wise people. Everything even mountains, rivers, plants and trees should be your teacher.Richard BachLearning is finding out what we already know. Doing is demonstrating that you know it. Teaching is reminding others that they know just as well as you. You are all learners, doers and teachers.Thomas H. HuxleySit down before fact as a little child, be prepared to give up every preconceived notion, follow humbly wherever or whatever abysses nature leads, or you will learn nothing.