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Can nurses do to lessen malnutrition in hospitals

Reducing the incidences of malnutrition that quite often occurs during entrance to hospital has been a concern within the nursing care profession for many years. There were various explanations because of this such as lack of staff, patients not able or will be unwilling to admit they require assistance, poor use of assessment equipment and care pathways. An integral factor in the prevalence of sufferers presenting with malnourishment is the disturbances patient’s endure during mealtimes, such as for example ward rounds, non urgent medical interventions, housekeeping actions and tourists. This essay will check out the incidences of malnutrition, and the ones who are virtually all at risk and the alterations that have been designed to reduce such incidences.

Change management should be regarded as a continuing process, which requires great communication, planning, positive leadership and cooperation. This essay will try to explore the change operations processes, leadership and workforce management skills found in the implementation of shielded mealtimes. It’ll explore the negative elements and complications encountered when applying a modification and the ongoing control skills necessary to maintain such changes.

For many people admitted to hospital, specifically the elderly, malnutrition is a prevalent occurrence. It’s the nurse’s fundamental duty of care to provide patients with the highest of care possible, a major requirement for any human being to survive and live a healthy life is the intake of a healthy nutritious diet plan, be that by standard methods or artificial procedures ideal for the patient’s status of health in those days (Royal College or university of Nursing 2007). Research into hospital malnutrition show that as much as four out of ten elderly individuals admitted to hospital already are malnourished and as a result of a hospital entrance as much as six out of ten elderly people, become malnourished, their circumstances worsens and their condition frequently escalates (Age Concern 2006; BAPEN 2007). The NHS Improvement Plan (2004) place standards to manage the increasing incidences of malnutrition within hospital settings; it is becoming apparent that these examples of good practice tips have certainly not been implemented in every hospital in the united states, as incidences of malnutrition continue to exist. Davidson and Scholefield (2005) reports that inadequate nutrition can bring about longer hospital stays, impairs the restoration of patients and increases financial costs; many hospitals have useful suggestions on how to write a quote in an essay certainly planned and implemented changes to lessen such incidences but on the whole have had limited victory. The authors found that constant interruptions from medication, rounds, clinical activities and lack of nursing staff staying on the ward at mealtimes (because of lunch breaks coinciding with mealtimes) all accounted for clients being given very little or sometimes no nutritional absorption at any given mealtime. Savage and Scott (2005) does agree with this statement somewhat but argues that it’s all to easy to blame nursing staff alone, it’s the responsibility of each person NHS trust to apply managerial adjustments and policies and make certain that they happen to be monitored, evaluated and improved upon to provide the best care possible for every single sufferer. Mamhidir et al (2007) argues that since the implementation of shielded mealtimes in a few hospitals there is substantial evidence to suggest that patients, particularly the elderly benefit immensely; people gained weight, healing time reduced, were discharged previously and mealtime experience were a more nice experience for patients and also nursing staff. Mooney (2008) argues that there is evidence to suggest even after hospital trusts have been presented with unarguable evidence that malnutrition is a major problem and a catalyst for longer medical center stays, just 43 percent of these trusts have not however provided evidence that they have implemented schemes to be able to reduce hunger and malnutrition. A HEALTHCARE FACILITY Caterers Association (2004) even more comment that mealtimes shouldn’t primarily concentrate on the provision of diet, it also makes method for social interaction between people and carers, they further more comment that in general the quality of the food provided is not the issue, the inability of the patient in order to feed themselves is far more the worrying concern. Council of Europe (2003) comment that hospitals should be designed to show patience centred, ensuring that the delivery of nutrition is adaptable and all deliverance of health care is set within a framework; all staff should work together in partnership to make sure that incidences of poor diet are handled. Repetitive reports of malnourishment is facts enough to suggest that current practices are no more working, change is a necessary force to ensure incidences are reduced. It’s the responsibility of the leader to ensure that is tackled (Age Concern 2006).

Change Management serves as a the process of creating a planned method of change in a organisation. The objective ought to be to maximise the collective benefits for all stakeholders mixed up in change and minimise the chance of inability implementing the change. Change involves assessment, arranging and evaluation; changes where people are nursed should always be focused on the huge benefits individuals will receive if transformation is implemented (National Institute of Health and Clinical Excellence, 2007). Welford (2006) writes that there are many theories which explore the necessity for change; the goal should be the provision of the best quality of care, each individual mixed up in delivery of such good care should interact, be dedicated and supportive of one another during times of modification. Change within a team which brings about new practices and thoughts affects each individual differently; it can be a very daunting task for some and for others it is embraced to permit for personal expansion and the posting of knowledge (Murphy 2006). There are many theories which uses measures or phases that can evaluate if a transformation is needed and if the improvements that are implemented job. For the intended purpose of this essay the author refers to a popular theory developed by Lewin in the 1950’s which necessitates three levels to implement effective modification the acceptance and participation of all those mixed up in area requiring switch. The first phase, generally referred to as the ‘unfreezing’ stage of this theory requires the individuals to acknowledge the need for change; evidence ought to be provided to encourage latest thinking and beliefs about current practices. Hallpike (2008) writes that there surely is evidence to suggest that teams can be divided into groups who have their own individual thoughts and opinions on certain regimes, practices and care deliverance. This is often stated for the provision of nourishment to patients. In this particular study the writer reports that some associates did not think there is a problem with the existing provision, some weren’t convinced that changes would be made and others did not have faith in a holistic approach across

the team. In this example it is the responsibility of the team leader to persuade all of the team members that the necessity for change is essential in order to provide the best service likely, that the whole team work towards a common target. Welford (2006) discusses the second period of Lewin’s theory; describing this level as the moving stage, allowing individuals to voice their individual ideas, experiment with numerous regimes, it allows time for reflection, to go over positive or negative results. Past practices may have seen some team leaders adopt the fact that employees were seen to work better when the first choice provided strict task descriptions and a apparent plan of that which was expected of them; their opinions and thoughts weren’t of value to the entire success of a staff. Main (2002) argues that for a leader to look at such thinking is only going to bring about flaws and a sense of negativity within a workforce; the leader should adopt good connection skills and openness to allow for effective team building, positive group dynamics, all doing work successfully and productively. Dennis and Morgan (2008) shows that although change may be the responsibility of the service provider, input from the provider user is unquestionably a valuable device in assessing if a change is working for the higher good. Feedback, irrespective of being positive or harmful ascertains if the modification has been a positive one. If the brand new change has a detrimental influence to the service individual then the change has been a negative one, this requires a go back to the freezing stage to permit the team to create further changes to boost the benefits to the service user. The authors’ further comment that managers ought to be seen as advocates for the program user; it ought to be the responsibility of the manager to challenge team members over poor practice, poor attitudes and resistance to change for the better. Conflict within a team leads to unrest, a disbelief that transformation is for the greater good resulting in a dysfunctional team. The 3rd period of Lewin’s theory can be commonly known as the ‘refreezing’ stage, where new thoughts and behaviours become a new or prevalent practice. Pearce (2007) argues that to mention this stage as such denotes that the change remains to be static, leaders should continually strive to make adjustments for the better, connection across the whole team allows for individual’s points of look at to be exposed and discussed; feedback about how a fresh change is working is necessary as a way to achieve the highest degrees of quality care.

Leadership styles become a key concern when developing, implementing and upholding transformation. Motivation of staff also plays a key position in the acceptance of change; leaders should demonstrate that they are a good role model, adopt a friendly attitude towards associates, accepting of criticism and become willing to provide positive opinions, when the team endeavour to believe in and apply the modification (Darlington 2006). Corkindale (2009) argues that leaders will need balance their function within a group to ensure that they don’t become too over acquainted with individual associates, as this may result in team members relying too greatly on the first choice to make all of the decisions and authority could be compromised.

Murphy (2006) writes that leaders have to adopt a style of leadership that fits the workforce; a laissez-faire approach can be seen as the first choice not considering individual team member’s ideas, work ethics and determination seriously, it can cause a team sense devalued and unorganised. The National Institute for Mental Wellness (2007) further shows that leaders who display their commitment, by functioning alongside their co-workers, adopting and maintaining the improvements themselves demonstrates a head who is at the forefront in the deliverance of top quality care. They further recommend that each leader provides their own set of ethics, life experience and education to a team, will most likely adopt their own style of leadership that may be a mixture of several styles moulded to suit the team and the area of practice they are used to manage. Opportunities for team members to voice their thoughts and concerns are invaluable; they want all the primary implementers of the transformation and can have be the first to recognise if the switch has gained great or negative benefits. The change can only work if leaders enable reflection, conversation and adaptation of the change to suit each individual involved in the change process. A transformation that is difficult to implement or maintain will end in failure, this leads a workforce adopting negative feelings and a resistance to change in the future.

Goleman (2000) shows that to look at an authoritarian methodology, can sometimes be a positive method of leadership especially if some associates resist change or there exists a have to produce quick benefits. Goffee and Jones (2000) disagree with this assertion and suggest that a good leader is somebody who other people want to follow without bullying, threats or worries of reprisals; they lead by interacting effectively and adopt a method of leadership that allows the team to understand what is expected of these.

RCN (2007) writes that the only path malnourishment can be identified and managed effectively is with effective utilization of recognised screening tools.Perry (2009) argues that in many cases nursing staff receive the means and tools to determine a patient, but most are inadequately trained to comprehend the findings of the assessment or are unwilling to involve various other health professionals in the attention of the individual. A multidisciplinary approach to tackle such problems should be used. Protected mealtimes have been proven to be beneficial to not only the patient but to the complete care team, it permits assessment in areas such as for example speech and dialect, mental medical issues and other physical concerns that may affect the nutritional intake of individuals. South Staffordshire Primary Treatment Trust (2009) reviews that protected mealtimes affects and involves all staff within in the organisation from physiotherapists, domestic staff, maintenance staff through to outside professionals such as social workers. It involves all areas of scientific practice where people require nutritional intake, not only for patients who cannot feed themselves but also for those sufferers who require and are worthy of a tranquil, interruption free period to eat, drink and relax.

To maintain and keep an eye on the change process and could require several attempts prior to the target is reached. takes time and may not always be successful first time. National Patient Safety Firm (2008) states that lots of clinical staff referred to the implementation of covered mealtimes as a hindrance with their daily routine, but once the benefits for patients as well as the staff members were explained they truly became more compliant and understanding for the necessity to change.

Diversification Approach Of Amazon Com Advertising Essay

Diversification Technique Of Amazon Com Advertising Essay was started out as a book-selling internet site and with the achievement of it Jeff diversified into certain areas. Now they are selling cell phones, motor spare parts, electric powered goods, medicines, cosmetics and cloths etc. The mostly used unit for analysing the feasible strategic guidelines, which an organisation can follow is the Ansoff Matrix. This version provides clear idea about the diversification tactics of the amazon dot com.

Under market penetration companies increase market show in existing market segments utilizing existing goods. Amazon has adopted number of strategies on market penetration, where it takes time to go over all. The important technique according to my perspective under market penetration is “Offer to send presents to market products during distinctive occasions”. That’s where amazon can incredibly increase its existing market. Say for instance if a person purchase a high-fi setup in the charismas season amazon will give him/her free five sound or video CDs. This motivates the online buyers of the amazon dot com and they’re going to tend to purchase more goods & services.

Companies enter into new markets & segments using existing goods. Amazon dot com is selling items like pharmaceuticals, liquor, plans & properties etc. There are people who tend to acquire these types of products through internet. Amazon dot com is providing a convenient service because of this segments, where it leads them to get into to latest markets.

Develop new products to serve existing marketplaces. Amazon dot com supplies free repair provider. This where they are able to provide an assurance for the consumers for products like electric powered goods, cell phones and motor extra parts etc. So that it leads the client satisfaction and persons will tend to acquire more items from amazon dot com.

Developing new products to serve new markets. Amazon dot began with selling books however now that they had expanded. So they are using “unrelated/ conglomerate diversification” technique to their industry. It is growth into merchandise and industry areas that are completely new and with that your organization shares no commonality at all. Unrelated diversification carries grater risk due to insufficient market or customer knowledge

Through these elements amazon was being able to build-up a brand photograph on U.S.A. As we know other nationalities tend to copy what Americans do. Lot of companies, especially computer game industry first aim for on U.S.A market and go for other markets. Earliest the copying trend start from Japan, then it would go to Europe & two three years later trend distributed to Asian & Latin-American countries. This as well helped to fully capture a considerable industry and provided them the opportunity to diversify into new art history research paper topics areas.

It is quite clear the business unit that Amazon dot com uses is usually clicks model, where they do not have a physical store. Only element they do can be once client purchased an purchase they acquire it from the suppliers reflective essay outline and mail it to the client. This is very similar to “Just In Time” (JIT) methodology, where providing merchandise and services exactly if they are needed. This provides benefits for both vendor & buyer.

Amazon dot com was had the opportunity to dampen the bargaining electricity of channels by providing new more immediate avenues to the clients. Alternatively through this company was been able to expand the overall size of industry by increasing its position relative to traditional substitutes.

On the other hands when the purchasing vitality of customer increases they’ll switch on to another company offering services and products on-line. On the other hand it appears to be large amount of buyers are loosing the curiosity on e marketing. Clients can easily find the details of suppliers of products on Amazon dot com and they can immediately contact suppliers and purchase goods. The customers want have the ability to pay for any commission to intermediaries and they’ll manage to buy with right quality and cheap price.

Lot of corporations are going towards e-marketing to market their services and products in the international marketplace, where they see it is a way to attract more consumers aswell as to improve the market show. There are restrictions of using internet based strategy, where companies need to face difficulties. So therefore it is important to discuss the problems face by the firms & the limitations of online strategies.

The initial point is that whole lot of folks don’t like to provide their credit card amount because there will be net hackers who hacks these quantities. As we know so that you can buy a product through Internet you will need to give your credit cards number. But there are large amount of soft wares have already been designed to hack these numbers. We had come across in certain circumstances where one person’s credit card quantity being hacked & use for some other purpose. So this is the major problem businesses face in using Internet strategy.

As we know lot of companies use “dot com” at the conclusion of its web address. For example A enterprise in U.S.A in 1997 employed “dot cz (.cz)” instead of dot com at the end of their website. The internet site was They applied dot cz domain so that you can create uniqueness with their websites and be rid form the problems faced by the dot com corporations. Through this website you can buy fibber buffers, side mouldings, crystal lighting & alloy wheels etc. How ever before they were been able to use the dot cz domain limited to four a few months. The authorities possessed filed a case against the company for applying dot cz domain & court order was given to them use dot com. Today they are working as Lot of companies face complications in applying dot com. The authorities must allow them to use additional domains instead of dot com.

Amazon dot com to use the online videoconference technology. Employing this technology their customer service representatives will be able to provide a much better service, where they are able to speak directly to the clients through their computers. The business will be able to identify the specific needs of a person and they will be able to fulfil the wants of a customer. What goes on ordinary is clients send emails to the company if they would like to get information and it takes at least twenty-four hours to reply for them. So it is time consuming. By using this video technology they are able to answer at that moment to the customer and it’ll attract more clients to the website.

Now there are mobile phones with camera that you can use these phones rather than computers, with new advance systems like WAP, GPRS, Infra Crimson and 3G. So customers will go for these things and company can use Text message and MMS to appeal to customers. This can help amazon to move into new market and improve the sales.

They can diversify into lot of segments, where they’ll be in a position to generate more profits on those areas. They aren’t selling flowers, flower trees, biodegradable items, lubricants etc on their website. And also they can promote Lord Buddha sermon CDs because generally in most western countries people are tend listen closely these sermons in order to get away from stress and their complications.

The Amazon dot com internet search engine is run by the google. So it indicates that whatever the merchandise or provider you search in the Amazon dot-com search engine it will be possible to get in the google internet search engine as well. This is not a favorable fact for the business where customers can go to google and purchase goods and services from another webpage. By featuring its own search engine for the business, whatever the product or service customer search through Amazon dot com is certainly available through the website and they’ll purchase through Amazon.

It is better if Amazon dot com can provide a search engine where customers can provide the specifications and purchase goods. For instance suppose someone wants to buy 500 milligram (500 mg) vitamin-c tablets through Amazon dot com. What he/she can do is certainly choose the medicine category in the website and do it now. They ask what the client needs under remedies with certain categories, and offer what he/she wants. Therefore if they provide consumer to type the specification therefore any one can simply purchase with right top quality he/she expected.

In order to help make the distribution channel more robust amazon dot com to merge or get of competitor’s online. Through this amazon can increase its market show, while capturing new marketplaces. The partnership and integration of businesses may improve. So therefore they can share concepts and bring the business into a strong position.

Amazon dot com to enter into partnerships with non online retailers to sell their items online. This makes the company to get products, which are experiencing valuable brand names. On the other hand company can get a commission from the non trusted online retailers. These factors lead the company to get more money and expand its organization operations.

Amazon dot com to look at “Bricks and Mortar” version. Therefore again the distribution channel will be more powerful and it will be more flexibility for his or her production department. The business will be able to have a better storage than present. (Appendix 1)

Amazon dot com can move into the stream-line operations, where they will be able to own partnerships with their competitors to sell product or service on the website. So if indeed they move we can clearly say, first you will have a huge decrease in Amazon’s operating costs. Operating expenses is among the major problems for Amazon. Operations are not streamlined properly, from maintaining inventory to transport of goods. This might help in bringing down the inventory to extensive extends, significantly reducing the operating expenses. Amazon may also save millions of dollars in delivery, by streamlining the whole operation. Once operating bills goes down the company can provide goods and offerings at an inexpensive price. Therefore the selling capacity increase which leads them to increase their revenue.

Amazon dot com is the primary mover in the e advertising market. They started with a small beginigng from selling literature and today they will be the pioneers in online browsing. It’s the “Earth’s Biggest Assortment” of products within one website. The business had diversified into various areas nevertheless they are successful simply in few items like literature and music CD’s etc. They can use the brand-new technology to communicate effectively with their customers, to protect the customers credit card quantities from hackers’ to protected their web-site from viruses & to update the website. Lot of companies are now getting into to the same sector and it contributes to boost the competition. Therefore Amazon should have to give an improved service to the customers.