Case Study Theory Guided Practice Evidence Based Practice Nursing Essay

Case Study Theory Guided Practice Evidence Based Practice Nursing Essay This paper is a presentation of the board of the hospital which will present the arguments from two committees; an evidence-based committee and theory-based committee. A summarized report of each committees presentation is included on why the hospital should implement integrated evidenced-based practice (EBP) or theory-based practice into their clinical setting. After analysing the arguments and supporting points of both sides, merits and drawbacks of the implementation of each practice were taken into account and put forward. Finally, the rationale and recommendation for a theory-guided, evidence-based nursing approach will be asserted. The evidence-guided committee states that by implementing an evidence-based approach into the hospital, nurses will be able to make clinical decisions using current best research evidence. This is then blended with approved policies and clinical guidelines, clinical expertise and judgment, and patient preferences (). They argue that EBP will improve clients present and future health outcomes. The committee brought into example a study done in a hospital setting using research-based nursing intervention. The study found that 72% of the clients had 28% better outcomes physically, behaviourally, intellectually, and socio-psychologically when evidence-based practice (1988). They stressed the importance of integrating the best sound evidence of client care in the nursing profession with an aim to improve that care. The committee also believes that EBP will help to narrow the existing gap between research and practice. When EBP is utilized, nurses will be able to use research finding to establish or guide their actions in clinical settings. They will no longer rely on fads or the advice of colleagues that may not be valid or reliable (). In addition, EBP will increase the availability and utilization of quality research that is based on randomised controlled trail designs (). This will in turn help nurses to keep up with the large amounts of continuously yield research findings and will allow them to utilize rigorous research rather than methodologically weak and unreliable research (). The theory-guided committee argued that implementing a conceptual approach in clinical practice would facilitate processes that significantly benefit clients, nurses, the healthcare system and the broader environment (). Theory would provide nurses with a purpose in their clinical practice while giving them a perspective with which to view clients situations. By implementing theory-based practice nurses, we would be able to systematize, analyse and interpret the daily experiences and information gained from providing care to clients. This in turn would help nurses better manipulate outcomes of the care provided, better communicate with clients and other health care professionals and make their practice more efficient overall. Theory-guided nursing practice will make nursing a unique profession with its own boundaries and will help guide the direction the profession to follow in the future. The theory-based committee also provided examples of applying major human science theories into practice and strongly urged us to designate a specific theory to guide the nursing practice within the hospital. Some examples include Parses theory of human becoming and the formation of meaning to health and quality of life, and Newmans theory of expanding consciousness and pattern recognition through the collaboration with clients. They described a hospice setting and how such theories can be implemented to dying clients and their families. For example, if the practice is guided by Parses theory, the nurse is able to provide an individualized care to clients, viewing each client as a unique human being and an expert of his or her own life. Another example given was towards clients with disabilities. When the practice is guided by Newmans theory, nurses are able to form relationships with their clients and find an unfolding pattern in their lives. In this way both are able to expand thei r consciousness; nurses and clients are able to grow, find new meanings in life, and form new and deeper relationships. Many nurses reported that when such theories were implemented in clinical settings, their job was more rewarding and professional, in turn improving both client and nurse satisfaction (). The committee argues that implementing theory based practice will help nurses understand clients better and in turn improve clients health and well-being, as well as provide the nurses with a unique body of knowledge. After closely listening to both committees it is clear that both EBP and theory-based practice have both advantages and disadvantages. Firstly, when EBP is used, some nurses might find it difficult to incorporate it into the clinical setting as they might simply not understand how to do so, or they may lack the knowledge and skill of interpreting research finding and applying them to practice. Whereas, when theory-guided practice is used to guide nurses thinking and actions, nurses can better comprehend and put meaning to what they are doing and why. Furthermore, time constrains can impede nurses from utilizing EBP (Canadian Nurses Association, 2004). Nurses often have heavy workloads and so can be too busy to engage in such practices. In addition, nurses may not have the appropriate access to current information and resources to support the search for new knowledge. For example, hospital libraries may not have current research journals. Nurses may also find it difficult to implement theory-based practice into clinical settings. Nurses may have hard time to decide how and in what situations to apply theory as they may not have a clear understanding of or may not recognize the principles and concepts related to client care and needs. In fact, there is very little material in the literature relating to the application of theory to modern practice. All of the later contributes further to the already existing theory-practice gap. Moreover, nursing theory in the literature often is subjective and focuses on restricted, ideal situations. Nursing theory often describes how nursing practice should be rather than how it really is in real life situations. In fact, the knowledge of theory does not always produce good practice. As observed by Allmark (1995), practice development and progression many times lacks theoretical base. Therefore, we must be vigilant in the conscientious application of nursing theory to relevant situati ons. If used effectively, both EBP and theory-based practice can greatly contribute to nursing practice. EBP is a universally applicable phenomenon which uses up-to-date top research evidences and facilitates sound judgment in clinical settings and cost-effective care. It can also promote nurses and students alike to question common clinical practice actions. Nursing theory can create new ideas and help put forward solutions to the many problems that are encountered in the experiential world of the clinical setting. Whereas nursing theory puts greater emphasis on client centered care, EBP also considers client preferences and so together they can ensure a more client centered approach. This way, clients and nurses will be able to engage in a therapeutic relationship, where trust, acceptance and mutuality are co-created by nursing and client, improving quality of care. I believe that theory guided practice in a way allows EBP to progress by generating conceptual problems. I think that integrating both EBP and theory based practice would yield the best results for both clients and nurses alike. It would lead to improved professional autonomy and give nurses a unique identity that guides our practice by what we know rather than by delegating nursing responsibilities. Also, nurses will be able to care for clients in a way that improves their health and well being within their own environments. Nursing theory can be used to provide guidance in creating and implementing evidence-based practice. In order to make a theory-guided, evidence-based practice possible and narrow the gap between research, theory and practice, a number of factors must be considered and addressed. Firstly, to help narrow the theory-practice gap, theory development should be targeted towards nurse educators as well as nurse practitioners. Institutions must make efforts to promote theory and practice as a whole unit rather than separate nursing actions. This in turn will help nurses apply relevance to academic knowledge in clinical practice. Students and nurses should also be exposed to theoretical principles more often. As well, effective guidelines for the application of theory in nursing practice should be developed and encouraged to be utilized. Furthermore, EBP can also be incorporated in educational faculties such as universities and within practice settings themselves. Hospitals should incorporate programs, seminars, orientation sessions, workshops and offer nurses continuing education courses that will focus on theoretical concepts and principles as well as skills such as searching and critiquing research and applying it to practice. Other programs can also be developed that will train nurses and focus on improving their knowledge and skill to critically evaluate research findings and its effect of their practice. Moreover, hospitals should have libraries near or within the clinical setting that will include current research journals in the libraries. Hospitals should also provide internet access in the clinical setting with good databases containing theory-based and evidence-based research articles. Hospitals should also implement policies, procedures and practice guidelines that are based on current evidence. It is also important for the theorists and researchers to directly participate in clinical settings. This will allow them to base their theories or research on real life experiences and use a language that could be easily understood by nurses. Moreover, it is essential to support information-seeking behaviours that demonstrate the use of present evidence- based and theory based practices. By promoting the benefits of EBP and theory-based practice, nurses can be the change champions who implement the best of both practices. Raudonis, B., Acton, G. (1997). Theory-based nursing practice. Journal of Advanced Nursing, 26(1), 138-145. Canadian Nurses Association (2004). Making Best Practice Guidelines a Reality from Nursing Now: Issues and Trends in Canadian Nursing, No 17, 1-4.

De Beers Case Study

Case Study 2 Jason Jerew PEST Analysis Political: Most significance troubles for De Beers are due to government consequences in the United States due to diamond warfare in West Africa, diamonds are commencing to run by the destroyed areas of Republic of Sierra Leone as well as Republic of Angola, along with in Soviet Russia, mines are comprising controlled topically as contrary to together with De Beers. Economic: With a possible increase in diamond gross sales anticipated in the United States, stresses the fact that De Beers be abandoned in company merchandising as well as gross sales endeavor.Diminish in costs can severely hurt De Beers as well as the whole diamond manufacturer. Another problem De Beers is facing is company technique of bracing the diamond cost. Technology: By marketing for diamond merchandisers by the Central marketing company in Greater London, as well as ascertaining the supplying of diamonds provided for these merchandisers, De Beers assure what stones embark t he marketplace at what cost. This exclusive dispersion line has comprised at the center of company power to determine the diamond marketplace. Social:The symbolization of romance with diamonds has been in play for years. With the supply growing diamonds have continued the rise of uncommon and appreciated goods. Legal: Alterations to lawmaking. This might affect work, approach to stuffs, quotas, resourcefulness, consequences or exportations, revenue and so forth. Environmental: What is passing off with reference to ecologic as well as environmental consequences. Numerous of these components would be economical or sociable in nature. SWOT Analysis: Strength: 1. De Beers employs approximately 20,000 people around the world? 2.It is one of the biggest companies in the diamond industry, mining, trading and manufacturing? 3. Offers premium diamond jewelry which include necklaces, rings, bracelets, gifts etc. through 50 exclusive stores globally? 4. Strong brand name and brand equity globa lly? 5. De Beers is known for its association with international celebrities as brand ambassadors? Weakness: 1. Strong competition from other brands means limited market share growth? 2. Preference of people choosing gold over diamond, making it a premium product for occasions Opportunity: 1. It can increase its presence in global markets? . Acquisition of smaller businesses to increase brand position and reach? 3. Tie-ups with corporate and business partners Threats: 1. Trends change quickly, 2. Economic fluctuations mean people decrease their spending? 3. Government policies, taxes etc. also affect the premium jewelry segment Five Forces Substitutes: 1. No substitutes for diamonds 2. Cultural history 3. High cost of entry 4. Social Issues and status New Entrants: 1. Substantial brand name 2. High cost of entry 3. Existing mining relationships 4. Access to new mines 5. Control of output Customers: 1. No substitutes for diamonds . Customs and traditions 3. Quality of product 4. Not a necessity (luxury item) Suppliers: 1. Controls output 2. Alliances 3. Cash on delivery Competitive Rivalry 1. Strong brand 2. Trust already built with customers 3. Expertise 4. Control of output De Beers lost its grip on the market when the Soviet Union collapsed, which weakened their partnership, huge mine broke off from the cartel in Australia, new mines in Canada were discovered, and the rise of popularity with synthetic diamonds. De Beers decided to stop trying to control the market and instead focus on using its brand and marketing.De Beers devised a marketing planned that included public relations, and direct advertising in print and radio. To try and maintain its leading role in the market De Beers carried out monopolized practices. The company used different methods to exercise this control over the market: First, it convinced independent producers to join its single channel monopoly, it overloaded the market with diamonds similar to those of producers who refused to join the cartel and last, it purchased and stockpiled diamonds produced by other manufacturers in order to control prices through supply.

De Beers Case Study

Case Study 2 Jason Jerew PEST Analysis Political: Most significance troubles for De Beers are due to government consequences in the United States due to diamond warfare in West Africa, diamonds are commencing to run by the destroyed areas of Republic of Sierra Leone as well as Republic of Angola, along with in Soviet Russia, mines are comprising controlled topically as contrary to together with De Beers. Economic: With a possible increase in diamond gross sales anticipated in the United States, stresses the fact that De Beers be abandoned in company merchandising as well as gross sales endeavor.Diminish in costs can severely hurt De Beers as well as the whole diamond manufacturer. Another problem De Beers is facing is company technique of bracing the diamond cost. Technology: By marketing for diamond merchandisers by the Central marketing company in Greater London, as well as ascertaining the supplying of diamonds provided for these merchandisers, De Beers assure what stones embark t he marketplace at what cost. This exclusive dispersion line has comprised at the center of company power to determine the diamond marketplace. Social:The symbolization of romance with diamonds has been in play for years. With the supply growing diamonds have continued the rise of uncommon and appreciated goods. Legal: Alterations to lawmaking. This might affect work, approach to stuffs, quotas, resourcefulness, consequences or exportations, revenue and so forth. Environmental: What is passing off with reference to ecologic as well as environmental consequences. Numerous of these components would be economical or sociable in nature. SWOT Analysis: Strength: 1. De Beers employs approximately 20,000 people around the world? 2.It is one of the biggest companies in the diamond industry, mining, trading and manufacturing? 3. Offers premium diamond jewelry which include necklaces, rings, bracelets, gifts etc. through 50 exclusive stores globally? 4. Strong brand name and brand equity globa lly? 5. De Beers is known for its association with international celebrities as brand ambassadors? Weakness: 1. Strong competition from other brands means limited market share growth? 2. Preference of people choosing gold over diamond, making it a premium product for occasions Opportunity: 1. It can increase its presence in global markets? . Acquisition of smaller businesses to increase brand position and reach? 3. Tie-ups with corporate and business partners Threats: 1. Trends change quickly, 2. Economic fluctuations mean people decrease their spending? 3. Government policies, taxes etc. also affect the premium jewelry segment Five Forces Substitutes: 1. No substitutes for diamonds 2. Cultural history 3. High cost of entry 4. Social Issues and status New Entrants: 1. Substantial brand name 2. High cost of entry 3. Existing mining relationships 4. Access to new mines 5. Control of output Customers: 1. No substitutes for diamonds . Customs and traditions 3. Quality of product 4. Not a necessity (luxury item) Suppliers: 1. Controls output 2. Alliances 3. Cash on delivery Competitive Rivalry 1. Strong brand 2. Trust already built with customers 3. Expertise 4. Control of output De Beers lost its grip on the market when the Soviet Union collapsed, which weakened their partnership, huge mine broke off from the cartel in Australia, new mines in Canada were discovered, and the rise of popularity with synthetic diamonds. De Beers decided to stop trying to control the market and instead focus on using its brand and marketing.De Beers devised a marketing planned that included public relations, and direct advertising in print and radio. To try and maintain its leading role in the market De Beers carried out monopolized practices. The company used different methods to exercise this control over the market: First, it convinced independent producers to join its single channel monopoly, it overloaded the market with diamonds similar to those of producers who refused to join the cartel and last, it purchased and stockpiled diamonds produced by other manufacturers in order to control prices through supply.

De Beers Case Study

Case Study 2 Jason Jerew PEST Analysis Political: Most significance troubles for De Beers are due to government consequences in the United States due to diamond warfare in West Africa, diamonds are commencing to run by the destroyed areas of Republic of Sierra Leone as well as Republic of Angola, along with in Soviet Russia, mines are comprising controlled topically as contrary to together with De Beers. Economic: With a possible increase in diamond gross sales anticipated in the United States, stresses the fact that De Beers be abandoned in company merchandising as well as gross sales endeavor.Diminish in costs can severely hurt De Beers as well as the whole diamond manufacturer. Another problem De Beers is facing is company technique of bracing the diamond cost. Technology: By marketing for diamond merchandisers by the Central marketing company in Greater London, as well as ascertaining the supplying of diamonds provided for these merchandisers, De Beers assure what stones embark t he marketplace at what cost. This exclusive dispersion line has comprised at the center of company power to determine the diamond marketplace. Social:The symbolization of romance with diamonds has been in play for years. With the supply growing diamonds have continued the rise of uncommon and appreciated goods. Legal: Alterations to lawmaking. This might affect work, approach to stuffs, quotas, resourcefulness, consequences or exportations, revenue and so forth. Environmental: What is passing off with reference to ecologic as well as environmental consequences. Numerous of these components would be economical or sociable in nature. SWOT Analysis: Strength: 1. De Beers employs approximately 20,000 people around the world? 2.It is one of the biggest companies in the diamond industry, mining, trading and manufacturing? 3. Offers premium diamond jewelry which include necklaces, rings, bracelets, gifts etc. through 50 exclusive stores globally? 4. Strong brand name and brand equity globa lly? 5. De Beers is known for its association with international celebrities as brand ambassadors? Weakness: 1. Strong competition from other brands means limited market share growth? 2. Preference of people choosing gold over diamond, making it a premium product for occasions Opportunity: 1. It can increase its presence in global markets? . Acquisition of smaller businesses to increase brand position and reach? 3. Tie-ups with corporate and business partners Threats: 1. Trends change quickly, 2. Economic fluctuations mean people decrease their spending? 3. Government policies, taxes etc. also affect the premium jewelry segment Five Forces Substitutes: 1. No substitutes for diamonds 2. Cultural history 3. High cost of entry 4. Social Issues and status New Entrants: 1. Substantial brand name 2. High cost of entry 3. Existing mining relationships 4. Access to new mines 5. Control of output Customers: 1. No substitutes for diamonds . Customs and traditions 3. Quality of product 4. Not a necessity (luxury item) Suppliers: 1. Controls output 2. Alliances 3. Cash on delivery Competitive Rivalry 1. Strong brand 2. Trust already built with customers 3. Expertise 4. Control of output De Beers lost its grip on the market when the Soviet Union collapsed, which weakened their partnership, huge mine broke off from the cartel in Australia, new mines in Canada were discovered, and the rise of popularity with synthetic diamonds. De Beers decided to stop trying to control the market and instead focus on using its brand and marketing.De Beers devised a marketing planned that included public relations, and direct advertising in print and radio. To try and maintain its leading role in the market De Beers carried out monopolized practices. The company used different methods to exercise this control over the market: First, it convinced independent producers to join its single channel monopoly, it overloaded the market with diamonds similar to those of producers who refused to join the cartel and last, it purchased and stockpiled diamonds produced by other manufacturers in order to control prices through supply.

A Nurse is a Nurse

The public and professional images of nursing and the portrayal of nurses in the media have a great impact on several work-related issues – how health care as a collaborative enterprise is provided to patients, the extent that nurses’ work is valued, the participation of the nurse in healthcare team decision-making, the visibility of nurses in shaping national health care and the effect of these images on nurses’ job performance (Fletcher, 2007.Most researchers agree that although there have been improvements in the image of nursing, the portrayal today is still largely negative – an issue that has been raised by nurses for the past century. Gender issues seem to be at the core of this situation.Other disciplines, specifically the medical profession, view nurses based on certain qualities. In a study by Weinberg, Miner and Rivlin (2009) on the perspectives of medical residents on working with nurses, nurses were trusted and regarded as colleagues depending on how competent, congenial and hardworking the residents perceived them to be (p.37).This implies that the collaborative approach does not always permeate the nurse-medical resident relationship despite nursing practice being elevated into a profession that is equal to other health disciplines. To be respected as a colleague requires a condition – nurses must first have to prove that they possess the qualities expected of them.Meanwhile, the media reinforces the image of nurses as a health worker that is lower in status than physicians or as other concepts other than being a professional. In a literature review conducted by Fletcher (2007) concerning the media portrayal of nurses, the author found that television shows, novels, films and advertisements then and now mainly portray nurses in four categories, namely â€Å"as ministering angel, battleaxe, physician handmaiden and naughty nurse† – negative images because these do not capture the reality of nursing (p.208).As an acute nursing shortage looms ahead, the campaign to improve the image of nursing, in order to attract more students into the profession, yielded a positive outcome. A recent Gallup survey on professional ethics and honesty found that 84% of Americans agreed that nurses are the most trusted professionals (Singleton, 2009). The Gallup survey image of nurses represents a positive development because nurses were viewed as professionals who are bound by a code of ethics and who adhered to such a code.Both the positive and negative images of nursing seem to reflect the unequal power relationship between men and women in society where women are viewed as either sex objects or as domestic partners. The end product is a stereotypical view of women’s roles as subservient to men.Along with this role are the associated feminine traits ranging from obedience, hard work, compassion and congeniality to promiscuity. The physician-nurse relationship reflects these stereotypes as physicians are disproportionately male and while nurses are disproportionately female. As a male-dominated profession, the physician’s work is highly recognized and valued while the nurse’s work is undervalued and unrecognized.Because of the stereotypes reinforced by media, the public largely identifies nurses only with bedside care and with carrying out physician’s orders. Most would think that since the work involved seems trivial, nurses do not need to obtain a 4-year BSN degree. They do not see the complex daily responsibilities of the nurse that requires education, training and autonomy or the current scope of nursing practice. As such, they fail to appreciate the significant impact of nurses’ work on patient health and outcomes.Although men have enrolled in nursing, it is still mainly a women’s profession and as Lavinia Dock (cited in Fletcher) aptly put it, â€Å"the status of nursing in all countries and at all times depends on the status of women† (2007, p.210). Because the nurse is a woman in a caring profession, expectations of her relate to female gender roles as well. Hence, further improvements in the status of women will similarly uplift the status of nursing.

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