Interventions Research Paper Example | Topics and Well Written Essays - 500 words

Interventions - Research Paper Example g programs is enlarged to take in the actual job requirements vis-Ã  -vis the knowledge and skill levels on an individual basis, whereby the learning needs of the individual are identified, and the training program removes this deficit in the individual (Buckley & Caple, 2010, p.108). Analyses of the training needs are from two perspectives. The first perspective relates to the knowledge and skills required for the job or task, while the second perspective pertains to the specific learning needs of the individual for the job or task. The analyses provide a list of knowledge and skills that need to be delivered to the individual. The list is then translated into the behavioral objectives of the training, which paves the way for opting for the most appropriate sequence for delivering the training needs. Transfer of the training is achieved through putting into practice the knowledge and skills received through the training at the workplace. No training is complete in the absence of evaluation of the exercise. Evaluation of the training is done through examining the effectiveness of the training and the value provided by the training (Buckley & Caple, 2010, p.108). The system level at which one-to-one training is most applicable is when the individual is about to start on a new job or task assigned. This may occur when a new employee joins the organization, and needs to be trained on the new job. Alternatively, an existing employee may be assigned a new job function or a new job task. In both these eventualities one-to-one training is the most appropriate training method (Buckley & Caple, 2010, p.108). There are three elements involved in the best practices for one-to-one training. The first element is delivering the training at the right time. Immediately prior to an individual undertaking a new job or task is the right time to deliver the training. The second element is delivering the training at the right place. By right place, the meaning pertains to giving

Book Review Essay Example for Free

Book Review Essay The novel is about a wolf called Faolan that survives with a friend of his, Edme. There is another wolf called the Prophet that tries to send out wolves to kill Faolan and Edme. They try to find a shelter to try to hide but end up getting spotted by a wolf. They run away and escape from the wolf. After getting away they go out and find the Prophet. They confront him ask ask him why he wants to kill them and he jumps at them and they finally kill the Prophet. The book is associated with the other five Wolves of the Beyond books Lone Wolf, Shadow Wolf, Watch Wolf, Spirit Wolf, and Star Wolf.  I would give the book a 2 because I like the Wolves of the Beyond books. They explain how the wolves survive and how they hunt their prey. The book shows how they grow up and learn to hunt and communicate with the others. I also like how the author makes it feel like something is going to happen like a fight scene. The book also continues the story of the main character, Faolan and gives the wolf a characteristic for each book the author makes. The novel is about a wolf called Faolan that survives with a friend of his, Edme. There is another wolf called the Prophet that tries to send out wolves to kill Faolan and Edme. They try to find a shelter to try to hide but end up getting spotted by a wolf. They run away and escape from the wolf. After getting away they go out and find the Prophet. They confront him ask ask him why he wants to kill them and he jumps at them and they finally kill the Prophet. The book is associated with the other five Wolves of the Beyond books Lone Wolf, Shadow Wolf, Watch Wolf, Spirit Wolf, and Star Wolf.  I would give the book a 2 because I like the Wolves of the Beyond books. They explain how the wolves survive and how they hunt their prey. The book shows how they grow up and learn to hunt and communicate with the others. I also like how the author makes it feel like something is going to happen like a fight scene. The book also continues the story of the main character, Faolan and gives the wolf a characteristic for each book the author makes.

NHS Public Relations and Customer Care Policy

NHS Public Relations and Customer Care Policy Introduction Public relations are an indirect form of sales motivation ‘a psychology – coated advertising pill’. According to the Institute of Public Relations[1], public relations are defined as: the deliberate planned and sustained effort to establish and maintain mutual understanding between an organisation and its public. Presently in the UK (United Kingdom) most health care providers are managed by the NHS (National Health Service) – the largest public service organisation in Europe. Therefore the direction this report will take is as follows: (1) to investigate the key principles of public relations and customer care; (2) to analyse how a public service organisation deals with public relations – in particular how the NHS deals with public relations; and (3) to examine the customer care policy of the NHS. The key principles of public relations and customer care According to Hall (1971)[2], public relations are based on the following key principles: The company and customers or prospective customers – the primary objective being to create a good public image and the secondary objectives being: (1) Selling the company, by securing and maintaining public goodwill; (2) Unobtrusively advertising the product or service sold; (3) Increasing sales and profits, and paying higher dividends to the shareholders. 2. The company and shareholders or prospective shareholders – It is also important  that the company should maintain good relations with its shareholders and with  the investing public at large, for the following reasons: (1) The shareholders as owners of the company, are entitled to information  concerning its activities. (2) It is essential to keep the shareholders contented, as they are a  prospective source of capital if the company wishes to develop at some future  date. (3) The investing public at large is more likely to invest in a company with  which it has good relations. 3. The company and its employees – personnel relations and public relations are  complementary. A company’s treatment of its employees is an important factor in  enhancing or dimming its public image. Therefore it is useless to spend money on  an elaborate public relations department and then ignore the basic principles of  good personnel relations. Arens (1999)[3] agrees but argues that there are four other principles: 4. Communities – courtesy and friendly support towards the organisations immediate  neighbours strengthens the ties between the organisation and its neighbours. 5. Media – press packets, briefings, and facilitating access to organisation  news makers build trust and goodwill. 6. Government – a desire for favourable legislation and subsidies are good reasons  why organisations should earn and maintain the goodwill and trust of the  government. The systems and procedures involved in dealing with public relations The size of an organisation and the type of business it is often determines the methods of public relations to be used e.g. Large companies are more inclined to have their own public relations department – which contrasts with small companies which would most likely outsource public relations consultants. If an organisation desires external public relations can be achieved through anyone of the following methods: Press relations, comprising press releases and notices relating to the companys activities. Exhibitions and trade fairs Television and radio are used for public relations as well as for advertising. Direct consumer contacts – this is a personal approach to improving public relations and is all about implementing goodwill to others in an attempt at public relations success. Literature produced in various printed forms ranging from journals to an organisation history. Eye-catching functions used to gain public notice, e.g. The sponsorship of sports events such as the annual walk against breast cancer. Open days – the public (inclusive of employees families) is invited to visit the organisations premises – this helps promote personnel relations. The National Health Service The National Health Service of the UK is divided into two divisions; England and Wales, and Northern Ireland. The National Health Service has outlined for the both regions all the personnel who will fall under its umbrella as follows: England and Wales[4] A Patients Forum established under section 15 of the National Health Service Reform and Health Care Professions Act 2002. Any person providing primary medical services or primary dental services In accordance with arrangements made under section 28C of the National Health Service Act 1977; or Under a contract under section 28K or 28Q of that Act; in respect of information relating to the provision of those services. Any person providing general medical services, general dental services, general ophthalmic services or pharmaceutical services under Part II of the National Health Service Act 1977, in respect of information relating to the provision of those services. Any person providing personal medical services or personal dental services under arrangements made under section 28C of the National Health Service Act 1977, in respect of information relating to the provision of those services. Any person providing local pharmaceutical services under A pilot scheme established under section 28 of the Health and Social Care Act 2001; or An LPS scheme established under Schedule 8A to the National Health Service Act 1977 (c 49), in respect of information relating to the provision of those services. Northern Ireland Any person providing primary medical services, general dental services, general ophthalmic services or pharmaceutical services under Part VI of the Health and Personal Social Services (Northern Ireland) Order 1972, in respect of information relating to the provision of those services. Customer Care Policy Davis (2003 p. 47)[5] says that patients are consumers of medical services and deserve customer care. He believes that customer care is critical especially for professionals such as surgeons and dentists; and that customer care creates opportunities for the customers to be informed and form judgements. According to Davis, customers pay for what they receive and as he explains, patients do have family and friends who from a critical public that directly affect the organisations reputation. Therefore if patients receive ill treatment the organisation is likely to have a bad reputation which would most likely lead to a loss of clientà ¨le to competition. Good customer care is also essential when dealing with patients, as this can affect the direction which a grant might take. In particular the NHS has a rating system which encourages feedback – which it then uses to improve its quality of customer service. Systems and Procedures in relation to communication with the media Media specialists are aware of the requirements, preferences, limitations, and strengths of the various media used to serve the client. They find the right media for clients messages (Baran, 2002)[6]. In public relations the accounting, legal and medical professions have had little success in policing their own members. Therefore one should ask what should be done to prevent misleading and dishonest communications from going to the public? The International Association of Businesses Communicators have laid down a code of practice which states that Members of IABC will engage in truthful, accurate and fair communication that facilitates respect and mutual understanding ¡K Accoding to Horton (2002)[7], the fact is that what a CEO wants, a CEO gets. Sometimes a board of directors has the power to stop a CEO from making false statements or misleading customers, investors, regulators and others. But, whistle blowers do not fare well, and it takes a great deal of evidence for a whistle b lower to prove that a corporation has engaged in unethical action or misleading communication. Further, even though one is personally ethical, executives can sanction and encourage unethical activity. This puts a strain on one to go along or get out. Unfortunately, it is usually easier to go along, and there are rewards for doing so. There are many ways that a CEO can corrupt a company, but one of the most insidious is the goals that the CEO sets. Horton explains that defending an unpopular person, organization or issue in the media is a tough PR challenge. He expounds that unlike a court of law where rules of argumentation and fact apply, PR practitioners face uncontrolled media, citizen rumours, political opinion, falsehoods and conclusions based on partial fact. Public relations in such times can be thankless and a losing effort. Yet, as he puts it, successful defence can be a career high point. Practitioners learn what they are made of and how well they have mastered communications. Horton has laid down some rules for dealing with the media as follows: The first rule of defending the indefensible is to start with and stick to facts as much as possible. Unfortunately, in many, if not most situations, facts are missing or incomplete. Facts put to rest speculation and opinion, and they stop a natural tendency to assume there is more behind an issue or event than meets the eye. This means PR practitioners should be trained in gathering and checking facts quickly then getting them out fast to interested parties. However, facts can tell an ugly story, a story that an individual and/or organization do not want to have told. In addition, facts may tell stories that must not be narrated because of personal, political or other confidentiality. PR practitioners often know more than can be said to journalists, and journalists are dedicated to finding out what practitioners cannot say. Silence PR practitioners are taught that silence is harmful. During a crisis, they are told that individuals or organizations must do something with media calls, skittish investors, unhappy suppliers, fearful employees and grandstanding regulators. But silence is not always harmful. There are times when silence is best even though others talk about you, especially when defending unpopular individuals, organizations or issues. An old clichà © attributed to British royalty is, â€Å"Never complain, never explain.† This stiff-upper-lip approach covered up many activities that royalty did not want to expose to public scrutiny. It worked for decades until U.K. media in search of circulation boosts broke a compact of silence about the doings of the palace. Nonetheless, silence helps when: Pressure to speak is not intense If the public, regulators, media and others are not pushing to get answers, it might work well not to volunteer them. When the issue might be a passing one – If an issue arises that is a one-day headline, â€Å"no comment† might suffice. When there is nothing one can say. The only justifiable expression may be confession and remorse. When speaking makes the situation worse. Speed It is a basic PR rule to get out factual information as quickly as possible. Delay is a mistake that happens too frequently because of internal battles, concerns for liability and dictates of privacy. Some speed techniques are: Say â€Å"No comment,† and follow orders. Deliver some kind of statement, even if inadequate â€Å"I have been instructed to tell you†¦. That is all that I can say at this time.† Let another take over. Fight hard – Collect the emerging media stories and go to the CEO to make a forceful case for what is happening to the firm’s reputation by failing to disclose the facts speedily. Resign – This is an extreme option unless a company or CEO is so far in the wrong that a practitioner can be considered complicit by acting as a spokesperson. Damage Control When compelling facts are not readily available, practitioners must use damage control to defend the indefensible individual or organization. Refutation – Paint a story as false. One attacks the teller of the story (â€Å"Consider the source.†) and the story itself as meaningless, incredible, impossible or illogical. Confirmation – Praise the person and story that favour your side. (â€Å"X is an honourable man. He would never lie.†) Note that a story is possible, probably, logical and fitting. (â€Å"From our careful reconstruction, this is the way that events unfolded.†) Of course, even though X is an honourable man, he might sometimes lie and careful reconstructions of stories might be logical and wrong. Vituperation – This has a more modern name – â€Å"character assassination.† It’s an all-out effort to discredit someone making allegations by going after the person’s heritage, education, background, lifestyle or whatever it takes to take away the individual’s credibility in the eyes of target audiences. Appeal to character – This is an effort to build the image of an individual and cast doubt on allegations against that person. Appeals to character use all of the techniques of vituperation but puts a positive spin on them. Diversion – Create a secondary issue that obscures the first issue. A popular movie came out a few years ago that illustrated how to do this by creating a phony war. The film, Wag the Dog, was a cynical portrayal of how Washington political communications work. Comments and Conclusion Defence of an unpopular individual, organization or point of view is probably no more successful than defending an accused in a courtroom. However, because the media and society do not follow strict rules of argumentation or precedent, the chances of a story â€Å"getting away† from the practitioner are greater. (Caywood, 1997)[8] When companies and individuals have been destroyed by negative publicity, only to be vindicated later, they can never recover what they have lost. There is little recourse in the law for such outcomes. One can sue for libel, but if the facts of a case were accurate to the time they were presented, there was no libel. One is a victim of circumstances. The PR practitioner’s job, insofar as the practitioner is able, is to balance perception enough to take pressure off an individual or organization or, if possible, to refute allegations. There is no chance of success unless one tries. It is imperative that public relations departments and personnel remember that they are the main point of contact for radio and television stations, newspapers, and magazines. Footnotes [1] Institute of Public Relations, Guide to the practice of public relations [2] Hall L., (1971, p. 288) Business Administration, 3rd Edition, MacDonald and Evans Ltd. [3] Arens W.F., (1999) Contemporary advertising, Irwin McGraw-Hill [4]National Health Service http://www.foi.gov.uk/coverage.htm#part3http://www.foi.gov.uk/coverage.htm#part3 [Online Source: 15/05/06] [5] Davis A., (2003) Everything You Should Know About Public Relations, Page Kogan [6] Baran S.J., (2002) Introduction to Mass Communication; Maedia, Literacy, and Culture, McGraw Hill [7] Horton J.L., () The ethics question http://www.online-pr.com/Holding/TheEthicsQuandaryARTICLE.pdf [Online Source: 15/05/06] [8] Caywood C.L., (1997) The Handbook of Strategic Public Relations and Integrated Communications, McGraw Hill

Symbolism in Lord of the Flies :: Essays Papers

Symbolism in Lord of the Flies In William Golding's Lord of the Flies, a novel that explores the depths of human nature, plot is irrelevant in comparison to the rich symbolism embedded in nearly all components of the story. The theme of the book is the destructive presence of evil as an influence to mankind, which lies within the breakdown of all order and common sense as a group of british boys stranded on a deserted island evolve into a pack of animalistic savages. The clues to this hidden theme behind the storyline are plentiful, as Golding uses a number of objects to represent certain ideologies and moral values. The first term used in the book that holds much symbolic value throughout the story is the usage of the word "scar" for the stretch of sandy beach that borders the thick jungle on the island. When the plane crashes on the lush island, it disrupts the balance and harmony of nature untouched by man's influence. The twisted wreckage of the plane creates an imperfection in the peacefulness of nature, and leaves the beach a "scar" of what it used to be - beautiful and unharmed by man's destructive impulse. Golding describes the natural surroundings of the island in lush, descriptive detail all throughout the book, beginning with an account of Ralph's proximity : "The shore was fledged with palm trees. These stood or leaned or reclined against the light and their green feathers were a hundred feet up in the air. The ground beneath them was a bank covered with grass, torn everywhere by the upheavals of fallen trees, scattered with decaying coconuts and palm saplings. Behind this was the darkness of the forest proper and the open space of the scar." (9-10) An object which also attains much symoblic relevance as the story unfolds is the conch shell. Delicate, fragile, and white, the conch is what brings the boys together on the first day at the beach. It is used throughout the story as an object of high importance and tradition, as it calls meetings together and determines who has the right to speak, depending on who is holding it at the time. It can be seen as a representation of law and order amongst the boys, as it unites them and prevents chaos from arising.

Standardization versus Adaptation in International Marketing

There has been much debate over implementing a standardization strategy versus an adaptation approach across international markets. There are numerous factors to consider, along with pros and cons of both marketing plans. While standardization is equated with brand consistency, lower advertising costs, and overall synergy, adaptation is often required to address cultural differences for more effective communication and proves that cutting costs does not always facilitate higher profits1.For some time many researchers, such as R. D.  Buzzell in 1968, have concluded that the real question is what marketing elements can be standardized and to what degree2. However, academics support the notion that adaptation is essential to prosper in global markets. 3 And in the instance of advertising to China, the necessity for adaption is ever present. China is a very appealing marketplace to many companies due to its large population and growing economy. Despite the country’s fiscal growt h, there still remains a large disparity between big cities, like Shanghai and Beijing, versus the more inland provinces4.And since the relationship of cultural, political, and economical similarities support the standardization of competitive strategy, treating China as one nation to market to would be a mistake in itself, let along trying to standardize a campaign targeting American and Chinese consumers. Some corporations, such as Coca-Cola and Proctor and Gamble, have achieved extreme success by targeting the affluent, but there is almost a 90% segment left to infiltrate. 5 This may mean lowering product price point, but many firms still deter from positioning their products to the middle or lower class due to the high advertising costs.It is an overcrowded arena to effectively breakthrough, but this is where adaptation would hold the competitive advantage. Along with the vast disproportionate economies of scale, the psychological and cultural drivers of Chinese consumers are tr ansforming as well. The desire to express their individuality is ever present, especially in the younger generations. Nokia has seen their cell phone sales surpass other brands because of its fashion focus that the other phones lacked6.The want  for basic consumer goods is also overlooked for ones that offer a lifestyle benefit of enjoyment. â€Å"The percentage of households reporting they have DVD players jumped from 7% in 1997 to 52% in 2004. The number of households with computers grew from 2% in 1994 to 13% in 2004, and the number of those with mobile phones jumped from 10% in 1999 to 48% in 2004† (Burkholder). Thus, consumers are more likely to spend their money on technology or fashion as opposed to a household item they may need.Globalization is one of the reasons a new Chinese consumer has emerged. Individuality, brand attitudes, and lifestyle preferences in China are more aligned with Western markets, yet multinational corporations have been disappointed from stan dardized marketing strategies7. The drive to purchase Western products has greatly increased between each Chinese generation as well. In fact, generation Y (18-24) has purchased more tech-savvy devices, used the Internet, and purchased more Western brands than any Chinese age demographic before8.This appears to be more of a reason to standardize advertising campaigns, but despite desire and acceptance of Western ideals and products, the younger Chinese demographic is still very in touch and proud of their heritage9. This dynamic consumer requires research and attention, which denotes an adaptation technique to effectively communicate a marketing plan. There seems to be a general consensus from marketing researchers and intellectuals that standardization strategies are more effective, economical, and should be applied initially.However, consumer behavior and perceptions play an integral role in framing an advertising campaign and this is where a degree of adaptation is essential. Sta ndardizing many parts of a marketing mix is beneficial, but there are certain areas where modification will yield the best results. In order to achieve a working model of international marketing, standardization and adaptation strategies should be applied as see fit. And since China has a particularly diverse set of consumers that makes marketing to the country alone dynamic, an adaptation approach would be advantageous in regards to an international campaign.

Free Essays on What Happens After The Attack

Source of Current Reading Article The Wall Street Journal, September 27, 2001, pgA8 Delta Joins Major Carrier in Cost Cuts, With Plans to Lay Off 16% of Work Force Summary Delta Airlines feels that they need to lay workers off because of the drastic decline in sales. Delta is offering six voluntary programs, one to five year leaves, an early retirement plans, and a voluntary severance package that provide as much as 20 weeks’ pay and other benefits. Delta is cutting many of their flights trans-Atlantic routes which they think would likely be hit harder due to the U.S. strikes back at terrorists. After the attack Delta is averaging a passenger load of about 140,000, compared with 300,000 the day before it. Delta is not the only airline choosing the route of laying employees off, Continental Airlines, and Northwest Airlines Critique I feel that this Delta airlines issue is a business ethical situation. On the business side the company is looking at the big decrease in sales. So in order for company to start making profits they must decrease their liabilities. The easiest way to do that from the companies prospective is to let go of some employees. On the flip side there is a ethical issue in the air. It is not right to lay people off every time business gets bad. Delta employees have families to support and bill to pay just like the next person. There are some laws protecting employees from lay offs like unions. Everyone does not join unions because they feel they are a waste of money, but who would have though terrorist would hit the airlines industry. There needs to be some kind of compromise between the business side and the ethical side to come to some kind of resolution.... Free Essays on What Happens After The Attack Free Essays on What Happens After The Attack Source of Current Reading Article The Wall Street Journal, September 27, 2001, pgA8 Delta Joins Major Carrier in Cost Cuts, With Plans to Lay Off 16% of Work Force Summary Delta Airlines feels that they need to lay workers off because of the drastic decline in sales. Delta is offering six voluntary programs, one to five year leaves, an early retirement plans, and a voluntary severance package that provide as much as 20 weeks’ pay and other benefits. Delta is cutting many of their flights trans-Atlantic routes which they think would likely be hit harder due to the U.S. strikes back at terrorists. After the attack Delta is averaging a passenger load of about 140,000, compared with 300,000 the day before it. Delta is not the only airline choosing the route of laying employees off, Continental Airlines, and Northwest Airlines Critique I feel that this Delta airlines issue is a business ethical situation. On the business side the company is looking at the big decrease in sales. So in order for company to start making profits they must decrease their liabilities. The easiest way to do that from the companies prospective is to let go of some employees. On the flip side there is a ethical issue in the air. It is not right to lay people off every time business gets bad. Delta employees have families to support and bill to pay just like the next person. There are some laws protecting employees from lay offs like unions. Everyone does not join unions because they feel they are a waste of money, but who would have though terrorist would hit the airlines industry. There needs to be some kind of compromise between the business side and the ethical side to come to some kind of resolution....

Patient Satisfaction †Nursing Essay

Patient Satisfaction – Nursing Essay Free Online Research Papers Patient satisfaction scores in hospitals have steadily decreased in the United States. According to Zwillich (2007), â€Å"Americans are more dissatisfied than citizens of other nations with their basic health care, even while paying more of their own money for treatment†. Research has shown that the nursing shortage that has plagued the United States has played a large role in the downward trend of patient satisfaction. Citing a report by Press Ganey Associates, Inc., Sara Nemeth (2007) reports that the higher the ratio between working Registered Nurses in any given state, the higher the patient satisfaction scores will be. From this data, it can be surmised that patient satisfaction will increase as the number of nursing staff increases. These results demand a call to action, and patient satisfaction depends upon it. A study published by the American Association of Colleges of Nursing states that the shortage of nurses may be affecting health care quality and patient outcomes, quoting the New England Journal of Medine as reporting that 53% of physicians and 65% of the public cited the nursing shortage as a leading cause of medical errors. The same study also states, according to Joint Commission for Accreditation of Healthcare Organizations (2007), that the shortage of nurses in America is, â€Å"putting patients’ lives in danger†, and found that since 1996, low nursing staff levels were contributing factors in 24% of patient deaths and injuries. The nursing shortage is not going away any time soon. In the same article by the American Association of Colleges of Nurses, it is estimated that 30 states had shortages in the year 2000, and this projection is expected to intensify to where 44 states, plus the District of Columbia will have nursing shortages by the year 2020. In addition, according to the National Council of State Boards of Nursing, the number of nurses taking state boards for the first time decreased by 20% between 1995 and 2003. Finally, Dr. Amy Tuteur quotes results Press Ganey President and CEO, Melvin Hall (2007) as saying, â€Å"The American Consumer Satisfaction Index (ASCI) from the University of Michigan has shown that customers’ satisfaction with healthcare has decreased significantly over the past several years†. Her statement is reflective of the majority of research being done in this area. According to the ECRA group (2007), healthcare leaders must be held accountable for the quality of care they provide. Patient satisfaction is increasingly being looked at as an indicator of positive patient outcomes, and a better quality of life. ECRA states that the patients’ perceptions of the quality of care they receive, and the attention that is paid to them can be as important as clinical health measures when patients are viewing their clinical outcomes. With the research showing that the nursing shortage is going to be here for quite some time, health care professionals must find a way to effectively deliver care, and bring patient satisfaction scores back to baseline, and above. Communicating with patients is key. Levinson (2007) states that poor communication often leads to patient dissatisfaction, whereas, â€Å"Effective communication enhances patient satisfaction and health outcomes.† Levinson also stated that the combination of a bad outcome and patient dissatisfaction, â€Å"Is a recipe for litigation†. In a similar article, J.W. Pichert (2007) stated that healthcare professionals must understand patients’ specific dissatisfactions and prevent them in the first place, thereby rectifying patients’ concerns. These findings suggest that nurses must find a way to enhance their communication with patients, reverse the trend of dissatisfied patients, and change the culture of patient care in a positi ve way. In 2005, the Studer Group (2006) introduced a strategy into the healthcare market, called, â€Å"The Nursing Bundle†. It has been adopted by multiple hospitals across the United States, and has provided the tools for hospitals to significantly increase their patient satisfaction scores, and increase patient safety. The Nursing Bundle is comprised of five key strategies, all aimed at promoting excellent patient care, proactively meeting the needs of patients, and increasing the level of patient satisfaction. Each component of the Nursing Bundle raises the standard of care on it’s own merit, but together, the five components tie into each other and have had a profound effect on the care delivery system. The first component is Individualized Patient Care. This refers to identifying key priorities to the patient upon admission to the nursing unit. The nurse asks the patient what the two most important needs he or she has that if met, would allow them to feel as though they have received excellent care. This information is written on a dry erase board in the patient’s room, and alerts all staff to the patient’s individual needs. The patient’s individual pain scale is also assessed, and written on the board. The patient will see that the staff is concerned about them as individuals, and that they don’t treat everybody the same. The patient’s perspective is valued as being the most important, and they will be reassured that everybody is aware of what their specific needs are, thereby making them less anxious and more compliant with their care and treatments. Individualized patient care also allows staff the opportunity to ask about the patient’s individual needs when rounding, eliminating call lights for unmet needs. The nurse will be alerted to the patient’s pain needs, and the physician will be alerted to the patient’s desired pain level. Ultimately, the patients will be more satisfied that their individual needs are being met. The second component is Bedside Shift Report. Prior to the end of the shift, the nurse informs the patient that they will be doing bedside shift report very soon. The nurse tells the patient that their privacy is important, and asks if they would like the nurse to ask visitors to leave, should visitors be there at the time of shift report. This shows the patient that the nurse recognizes and facilitates their need for privacy. During the shift report, the nurse introduces the oncoming nurse to the patient. The patient’s condition, tests, and procedures are reported to the oncoming nurse, and any needed clarifications are made for the patient at this time. This serves to show the patient that the oncoming nurse is aware of their needs, and reduces anxiety that perhaps the next nurse does not know their case. They will be more satisfied because they know who their nurse is, and that things are being done and monitored throughout the shift. Finally, the process will aid in increasing communication. Studer has determined that communication issues are the root cause of about 30% of patient safety events, and improved communication between caregivers positively impacts patient care and outcomes. For the nurse, bedside shift report improves the sharing of information between healthcare providers by utilizing a standardized method of communicating. If asked questions, the nurse won’t have to say, â€Å"I haven’t seen my patients yet†, and will be more prepared. The off-going nurse can also use this time to use â€Å"hands-on† to show the oncoming nurse how to operate special equipment, or how special orders are being handled. Accountability will increase, since each nurse will know his or her patients’ condition at the beginning of the shift. Finally, bedside report improves the nurse’s understanding of the patient’s condition, as he or she is able to visualize the patient. With the nurse is better prepared and more comprehensively informed, the patient will have an increased sense of well being, and will ultimately be more satisfied. The third element of the nursing bundle, and the most important, is hourly rounding. In a study done by C.M. Meade (2007), â€Å"Specific nursing actions performed at set intervals were associated with statistically significant reduced patient use of the call light overall, as well as a reduction of patient falls, and increased patient satisfaction†. Hourly rounding has eight components that integrate to ensure that the patient is receiving the care that they need, and most important, the care they feel that they deserve. First, the nurse uses key words and/or actions to introduce themselves, their skill set, and their experience. The word â€Å"round† is used, because this is a word that is familiar to most people, and will help frame the context of the interaction. The patient is told when the nurse will round again, thereby decreasing anxiety and building trust. Second, the nurse performs any scheduled tasks during the hourly round. Performing tasks while rounding allows the nurse to include scheduled work into the rounds, thereby accomplishing everything in one trip to the patient’s room. If there is not a scheduled task, the patient still has the reassurance that the nurse is coming to the room, and has the opportunity to voice an unanticipated need. Third, the nurse addresses the â€Å"3 P’s† that Studer has identified as being the most common reasons patient use their call bells. These are pain, potty and position. Proactively assessing and treating pain keeps pain from becoming severe, and increases satisfaction as a result. Scheduling patients to use the bathroom on rounds avoids unassisted walks to the bathroom, which can lead to falls. Helping the patient change positions also helps to keep them comfortable, and reduces the chance of a pressure ulcer, especially in the elderly. Fourth, the nurse performs comfort measures, such as fluffing pillows, straightening sheets, filling water pitchers, and offering something to drink. These are basic nursing functions that often get left undone if not intentionally scheduled, and lead to additional call light requests, and ultimately result in patient dissatisfaction. Fifth, the nurse conducts an environmental assessment of the room. This allows the nurse to determine whether there are any needs the patient has not identified that could raise the potential for the patient needing the nurse to return before the next scheduled hourly round. These needs include making sure the call light and telephone are within reach, the garbage can is next to the bed, and the patient looks comfortable. Sixth, closing key words are used before the nurse leaves the room. These are words such as, â€Å"Is there anything else I can do for you before I leave?† I have time†. This will not only decrease the need for the patient to ring the call light, but will allow the nurse to accomplish any other task while he or she is still in the room. It also tells the patient that all needs, no matter how small, are being addressed. The patient will be more satisfied with the nursing care if he or she knows the nurse has time to meet their needs. Seventh, the nurse explains to the patient when he or she will be back. When the patients know the nurse will be back hourly, they will cluster their requests in the context of the nurses rounds, rather than relying on using the call bell, as long as they know the nurse will be back in an hour, and their request is not urgent. Finally, prior to leaving the room, the nurse documents the rounds on a hourly checklist inside the patient’s room. This allows the patient to visibly see that it’s been only an hour between rounds, it allows the family to see that their loved one is being attended to frequently, and it allows the nurse manager to ensure that rounds are being done appropriately. Hourly rounding not only has the benefit of proactively meeting the needs of the patient, but by decreasing the call lights, the nurse is able to stay focused and round on a schedule. According to Carla Cox, Administrative Director for Cardinal Health (2007), â€Å"A patient who is confident a nurse is checking on them regularly is more likely to wait for the nurse to stop in, rather than hit a call light†. In addition to the research performed by the Studer Group, a study by Christine Mead, PhD, Executive Director of the Alliance for Health Care Research ((2007), had similar findings in regard to rounding. She stated, â€Å"Nurses’ rounds conducted regularly, every 1 or 2 hours, may help decrease patients’ use of call lights, as well as increasing patient safety and level of patient satisfaction†. In another article, Mary Shepherd, RN, Nursing Project Manager at Methodist Hospital in Houston, TX (2007) perhaps brought it together when she said, â€Å"Too many times we take for granted that the patient knows what we are doing when we enter their room. But these are non-clinical people who have no idea why we are asking them their name and birth date 30 times a day. One concept of the hourly rounding program is to take the time to verbalize everything that we are doing, letting them know it is for their safety, for their benefit†. The fourth element of the nursing bundle is Manager Rounds on Patient. The unit manager visits every patient on his or her unit at least once per day, and validates that the elements of the nursing bundle are being accomplished. He or she asks the patient if they have had any difficulty accessing their nurse, if the nurse has been in to see them frequently, and if their pain has been adequately controlled. They also ask if the individual need listed on the board has been consistently met, and if they have had any difficulty accessing the bathroom. The patient has an increased sense of well being, not only knowing that they have been receiving individualized care, but also knowing that the unit manager is rounding daily to ensure that it is being provided. The fifth, and last element of the nursing bundle is Discharge Telephone Calls. Patient’s perspective is valued as being most important. Discharge telephone calls make the patients feel cared about as a person, they decrease patient anxiety, provide an opportunity to evaluate patient education, to determine patients’ compliance with discharge instructions, to assess the overall impressions of the hospital’s performance, and to reinforce the patient’s perception that excellent care has been provided. For the staff, they provide a positive experience for staff, since most discharge calls are positive, they provide an opportunity for service recovery, and they provide an opportunity to identify trends that may require improvement in practice. The discharge telephone call is also the last opportunity the nurse has to be sure the patient was satisfied. The nurse has a scripted dialogue, and begins by identifying him/herself, and asking if it is a good time for the patient to talk. This shows that the nurse respects and values their time. The patient is asked if they understood their discharge instructions, and if any questions have surfaced since their discharge. This shows the patient that even though he or she has been discharged, the staff of the hospital still has their well being in mind. The nurse then states that the hospital always likes to make sure their patients were very happy with their care, and states it just that way, following with, â€Å"How was your care?†. Next, the nurse thanks the patient for allowing the hospital to care for them, and makes sure they have a telephone number to call if they have any other questions. The discharge telephone call gives closure in a positive way to the patie nt, and brings their care into their home setting. When they receive their satisfaction survey in the mail, they are more likely to remember the care they received having received the discharge call as well. With no end in sight to the nursing shortage, and the grim ramifications research has shown as a result, healthcare providers need to find ways to get back to the basics of nursing to improve the care delivery system, without waiting for the tide to turn again. The Studer Group (2006) has put together an excellent program to raise the bar back to where it needs to be. Fox News [Internet]. New York (NY): FOXNews.com; [cited 2007 Jan 12]. Available from: foxnews.com/story/0,2933,136990,00.html Press Ganey Associates, Inc. [Internet]. South Bend (IN): pressganey.com; [cited 2007 Jan 12]. Available from pressganey.com/scripts/news.php?news_id=57 American Association of Colleges of Nursing [Internet]. Washington (DC): aacn.edu; [cited 2007 Jan 12]. Available from aacn.nche.edu/MediaBackgrounders/shortagesfacts.htm Press Ganey Associates, Inc. [Internet]. South Bend (IN): pressganey.com; [cited 2007 Jan 12]. 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Medscape.com [cited 2007 Jan 12]. Available from medscape.com/viewarticle/544021 Methodist Health [Internet]. Houston (TX). Methodisthealth.com [cited 2007 Jan 12]. Available from methodisthealth.com/cgi-bin/hmdim/home/newsItem.do?channelId=-1073829 Cardinal Health Systam [Internet]. Muncie(IN). accesschs.org [cited 2007 Jan 12]. Available from accesschs.org/about_chs/Nurse_Rounding_Story.htm StuderGroup. Patient Care Model: Nursing and Patient Care Excellence. Pensacola, FL: 2006. 80 p. Research Papers on Patient Satisfaction - Nursing EssayArguments for Physician-Assisted Suicide (PAS)The Effects of Illegal ImmigrationThe Fifth HorsemanResearch Process Part OneInfluences of Socio-Economic Status of Married MalesTwilight of the UAWNever Been Kicked Out of a Place This NiceCapital PunishmentGenetic EngineeringThe Relationship Between Delinquency and Drug Use