Nursing

What is meant by “ unwritten eating preparedness in preterm babies? ” This peculiar construct is frequently elusive, contextual, subjective and really complex when used with the preterm population of babies. It has besides been a subject of involvement for many old ages within the scene of the neonatal intensive attention unit ( NICU ) . The ability of a preterm baby to entirely unwritten provender is non merely a mark of competent unwritten eating accomplishments but is a necessary criterion for discharge preparedness from the NICU ( McGrath & A ; Braescu, 2004 ) .

For nurses in the NICU the ability to orally feed a preterm baby is a many-sided undertaking necessitating successful attainment of a battalion of accomplishments: the proficiently to measure preterm baby eating accomplishments, clinical proficiency at preterm baby eating and proficiency in finding unwritten eating preparedness. On the other manus, the ability to orally feed is a complex undertaking for the preterm baby in the NICU every bit good. Questions often arise in the clinical sphere related to unwritten feeding preparedness of the preterm baby including those of physiologic adulthood, motor and province stableness, and the baby ‘s capableness of interactions with the environment and health professionals. All of these factors contribute to the underlying conceptual inquiry: should oral eatings be attempted?

In embarking to reply this inquiry, a figure of instruments have been developed over the old ages to mensurate unwritten feeding preparedness of preterm babies in the NICU scene. Most of these instruments refer to the conceptual facet of unwritten feeding preparedness without specific usage of any theory as a footing for formal instrumentality. However, each of these tools was designed to help in supplying a clearer apprehension of the indispensable elements of unwritten feeding preparedness in the preterm baby as they apply to daily eating patterns. By integrating unwritten eating preparedness into NICU nursing pattern, intercessions that are grounds based can back up day-to-day nursing intercessions and will finally ensue in results that support infant good being and preparedness for discharge to place.

Description of Instruments

The unwritten eating preparedness tools being described were identified by seeking the PubMed, Ovid Medline and CINHAL databases for articles written in English and published between 1980 and 2011. The keywords used for the hunt were unwritten eating, preparedness, preterm, preterm eating measuring, feeding assessment tool and feeding instrument. The footings were used separately and in combinations. Electronic hunts produced three eating tools for preterm newborns related to bottle eating as the primary method of unwritten eating: the Early Feeding Skills Assessment ( EFS ) ( Thoyre, Shaker & A ; Pridham, 2005 ) , the Neonatal Oral-Motor Assessment Scale ( NOMAS ) ( Braun & A ; Palmer, 1986 ) , and the Oral Feeding Skills in Preterm Infants ( OFS ) ( Lau & A ; Smith, 2011 ) .

The Early Feeding Skills Assessment for Preterm Infants

Theoretical Underpinnings

The Early Feeding Skills Assessment ( EFS ) for preterm babies is a checklist for profiling a preterm baby ‘s developmental phase sing specific feeding accomplishments. It has been described as an “ evidence-referenced tool ” ( Sheppard & A ; Fletcher, 2007, p. 206 ) for detecting unwritten eatings by chest or bottle. Items on the checklist refer to theoretical facets of unwritten feeding preparedness: unwritten eating preparedness, ability to stay occupied in feeding, ability to organize swallowing and external respiration, ability to form unwritten motor operation, ability to keep physiologic stableness and unwritten eating recovery ( Sheppard & A ; Fletcher, 2007 ) . There is no published information sing a connexion between a peculiar theory and the beginning or design of the EFS.

Instrument Data Collection

The EFS is a thirty-six point experimental measuring tool that can be used from the “ induction of unwritten feeding through ripening of unwritten eating accomplishment ” ( Thoyre et al. , 2005, p. 8 ) . It is divided into three subdivisions: unwritten eating preparedness, unwritten eating accomplishment, and unwritten eating recovery. The EFS is scored based on observation of an full eating with each point holding scaled picks of yes-no, never-occasionally-often, or all-most-some-none.

The first subdivision is the unwritten eating preparedness subdivision. This subdivision consists of five points and assesses whether the baby has province and motor control to back up orally feeding. If all replies to the five points are yes, the baby is fed orally. If the replies are non all yes, intercessions to fix for unwritten eating can be recommended and accordingly provided. The following subdivision is the unwritten eating accomplishment subdivision. This subdivision assesses four countries felt to be critical for successful eating: the ability to stay occupied during feeding ( three points ) , the ability to form oral-motor operation ( seven points ) , the ability to organize suck-swallow-breathing ( six points ) , and the ability to keep physiologic stableness ( 11 points ) . The unwritten eating recovery subdivision is three points that are completed five proceedingss after the eating session has ended and evaluates the impact of the eating on the baby ‘s province, motor and physiologic control. The EFS besides provides an country at the terminal of the signifier for feeding forms ( e.g. , type mammilla, length and volume of feeding ) and caregiver feeding schemes ( e.g. , chin support, cheek support ) . The method of hiting is non available in any of the published articles depicting the tool, nevertheless a preparation class for usage of the EFS is offered nationally by the instrument developers.

Dependability and Validity

Thoyre et Al. ( 2005 ) study that content cogency of the EFS “ has been established with adept neonatal nurses and unwritten eating research workers ” ( p. 8 ) and that “ intra- and interrater dependability have been found to be stable and acceptable ” ( p. 8 ) . The instrument ‘s developers besides report that prognostic, coincident and concept cogency are presently being tested. To day of the month, no informations sing any of these facets of the EFS has been published.

Related Surveies

Although this instrument has been available for usage since 2005, no surveies using or measuring the unity of this instrument were located in an electronic hunt of PubMed, Ovid Medline and CINHAL databases.

Neonatal Oral Motor Assessment Scale

Theoretical Underpinnings

The NOMAS was designed to place and quantify neonatal non-nutritive and alimentary oral-motor sucking forms by professionals that are specifically trained to utilize this instrument as a method of quantifying an baby ‘s oral-motor accomplishments. The theoretical underpinnings are those related to infant sucking accomplishments: most feeding troubles in preterm babies are caused by immature or unequal suck-swallow-breathe coordination and direct appraisal of suction and sup can be described by agencies of assorted non-invasive, experimental steps of physiologic parametric quantities. These theoretical underpinnings are the footing for the undermentioned three premises sing instrument result measurings of the NOMAS: ( 1 ) normal suction forms are displayed by babies who display coordinated suction, sup and breathe mechanisms during alimentary and non-nutritive suction, ( 2 ) a disorganised suction form may be displayed in the presence of an baby ‘s inability to organize suction, sup and breathe mechanisms, and ( 3 ) a dysfunctional suction form may be displayed by baby ‘s exhibiting unnatural jaw and lingua motions, as is the instance with babies diagnosed with neurologic upsets ( Costa & A ; Schans, 2007 ) .

Instrument Data Collection

The current NOMAS instrument consists of a 28 point checklist placing features of jaw motion and features of lingua motion which organizes a newborn ‘s oral-motor forms during alimentary sucking into one of three classs: normal, disorganized or dysfunctional. The baby ‘s suction accomplishment is assessed by a trained NOMAS perceiver for two proceedingss during non-nutritive sucking anterior to feeding and during the first five proceedingss of regular eating. The trained NOMAS perceiver does non touch the baby, but simply observes the figure of sucking motions during one sucking explosion and the continuance of intermissions between turns of sucking. Jaw and lingua motions are besides analyzed as a constituent of the checklist. Observed oral-motor forms are marked on the listed behaviours and babies are classified into normal, disorganized or dysfunctional harmonizing to the behaviours that are marked. The hiting method has been revised several times since it was foremost reported by Braun & A ; Palmer in 1985 and badness evaluations for the disorganised and dysfunctional classs were included in the revised version, nevertheless, no numerical marking method is used to day of the month ( Howe, Lin, Fu, Su & A ; Hsieh, 2008 ) .

Dependability and Validity

In several dependability surveies, inter-rater dependability utilizing Cronbach ‘s i?? was found to be 0.93-0.97 ( Case-Smith et al. , 1988 & A ; Palmer et al. , 1993 ) . Test-retest dependability was determined by Case-Smith ( 1988 ) to be 0.67 – 0.82 when used in a survey of 26 babies with feeding jobs. Construct and prognostic cogency has been supported by multiple surveies for all classs of the NOMAS ( Braun & A ; Palmer, 1985 ; Case-Smith et al. , 1989 ; Howe et al. , 2007, & A ; Palmer & A ; Heyman, 1999 ) .

Related Surveies

There are several documented surveies that utilize the NOMAS instrument. The three that will be described here are current surveies that have been published within the past five old ages and are relevant to the usage of NOMAS with the preterm population of babies.

In the 2007 survey by Howe, Sheu, Hinojosa, Lin & A ; Holzman, the NOMAS was used to mensurate unwritten motor accomplishments in order to find factors related to bottle-feeding public presentation in preterm babies. A sum of 116 preterm babies were included in the survey and research workers found that babies who need more unwritten support during eatings and those who have disorganized oral-motor accomplishments tend to take lower volumes of eatings orally. In contrast, babies with more feeding experiences are able to take higher unwritten volumes. These findings are of import in the designation of feeding experience and feeding techniques as being built-in constituents of a preterm baby ‘s unwritten eating public presentation.

In Howe, Sheu, Hsieh & A ; Hseih ‘s 2007 survey sing the psychometric features of the NOMAS in healthy preterm babies, the writers examined the dependability, cogency and reactivity of the NOMAS in healthy preterm babies as the intents of the survey. The survey consisted of 147 medically stable preterm babies. Feeding public presentations were assessed and documented by an occupational healer trained in the disposal of the NOMAS. The writers concluded that the NOMAS demonstrated acceptable degrees of cogency and reactivity in preterm babies from 32 to 35 hebdomads postmenstrual age ( PMA ) but hapless cogency for babies 36 hebdomads PMA in the normal and disorganised classs. The writers suggested farther proof research in response to the findings of this survey.

In Bingham, Ashikaga & A ; Abbasi ‘s survey ( 2010 ) using the NOMAS, 51 preterm babies were evaluated for correlativity of non-nutritive sucking accomplishments with subsequent feeding public presentation. The NOMAS marking was performed by NOMAS-certified healers and NICU nurses within 72 hours of successful induction of unwritten eatings. Findingss were implicative that NOMAS hiting at the induction of unwritten eatings was non significantly associated with the accomplishment of feeding milepost results being measured in the survey including clip from induction of unwritten eatings to clip of sole unwritten eatings.

Oral Feeding Skills in Preterm Babies

Theoretical Underpinnings

The developers of the OFS tool identify two basic theoretical underpinnings of unwritten eating that health professionals are faced with when turn toing the determination of unwritten feeding preparedness: the ability of the baby to finish the eating safely and the appropriate rate of promotion to sole unwritten eating. They propose that the OFS tool offers an nonsubjective index of an baby ‘s ability to orally feed by combing proficiency of unwritten feeding with minimum weariness and rate of milk transportation as a contemplation of feeding accomplishment ( Lau & A ; Smith, 2011, p. 64 ) . They do non depict a peculiar theory in connexion to the beginning or design of the OFS tool.

Instrument Data Collection

Data aggregation for the OFS is comparatively simple and no specialised preparation is needed. Caregivers document the prescribed volume of a eating in millilitres, the volume of feeding taken orally at 5 proceedingss into the eating, the full unwritten volume that is taken and the clip in proceedingss that it takes an baby to orally feed in that peculiar eating session. Proficiency ( PRO ) is calculated as the per centum entire volume taken in the first 5 proceedingss divided by the entire prescribed volume. The rate of milk transportation ( RT ) is calculated as the volume in millilitres ( milliliter ) that is taken orally divided by the figure of proceedingss to take this volume. PRO is so used to index existent eating ability when weariness is minimum ( within the first five proceedingss of unwritten eating ) and RT is used as an index of endurance ( being affected by weariness ) . The OFS tool is divided into four degrees runing from degree one to level four. Level one is low proficiency and low endurance, degree two is low proficiency and high endurance, degree three is high proficiency and low endurance and degree four is high proficiency and high endurance. A PRO greater than 30 per centum is defined as high proficiency while a PRO less than 30 per centum is defined as low proficiency. An RT greater than one and a half milliliter per minute is defined as a high endurance while an RT less than one and a half milliliter per minute is defined as low endurance. Potential intercessions are recommended for unwritten eating therapy at each accomplishment degree with the end of heightening existent eating accomplishment.

Dependability and Validity

To day of the month, no information sing dependability or cogency of the OFS has been published. The 2011 survey by the developers did show that OFS degrees had a important positive correlativity with an baby ‘s feeding public presentation and gestational age strata ( p & lt ; 0.001 ) and had a important opposite association with yearss from the start of unwritten eatings until independent unwritten eatings ( P & lt ; 0.002 ) ( Lau & A ; Smith, 2007, p. 68 ) .

Related Surveies

This instrument was ab initio described in 1997, nevertheless, the prospective survey published by the developers in January 2011 was designed for the intent of utilizing the EFS as an nonsubjective tool for the appraisal of a preterm baby ‘s unwritten eating accomplishments. No other surveies using or measuring the unity of this instrument beyond the initial development were located in an electronic hunt of PubMed, Ovid Medline, and CINHAL databases.

Decision

Relevance to Future Studies

Each of the instruments antecedently described has advantages and disadvantages as an instrument for measuring unwritten eating preparedness. Both the EFS and the NOMAS necessitate specialised preparation in order to be able to utilize them as a valid instrument of unwritten eating ability, whereas the OFS is a simple tool that is designed for usage by any caretaker of preterm babies having unwritten eatings. Neither the EFS nor the OFS has been used in any published clinical survey nor do they hold published dependability or cogency grounds. The NOMAS, on the other manus, has been examined more thoroughly and has multiple internal consistence, dependability and cogency surveies to back up its usage. Another concern of all three instruments is that they differ in both the designation of measureable factors that contribute to readiness for unwritten eatings and in factors lending to success at unwritten eatings, doing comparings between these instruments hard.

One common happening when measuring each of these tools, nevertheless, is the fact that unwritten eating preparedness is a complex construct affecting a battalion of factors for consideration. Instruments to help with the measuring of this construct demand to be consistent with their theoretical underpinnings and construct analyses in order to be able to supply consistent, valid and dependable results that can be farther utilized for future research and farther construct elucidation. Well-designed surveies are needed to measure the cogency and dependability of both the EFS and the OFS as instruments of mensurating unwritten eating ability. Research workers should besides see utilizing one of these instruments in future surveies to prove the feasibleness and effectivity of intercessions that are designed to back up unwritten eating preparedness. Awareness and understanding of indispensable elements of the construct of unwritten feeding preparedness in preterm babies is necessary and will supply for farther elucidation of unwritten eating preparedness. It will besides take to greater consistence in the proviso of evidence-based nursing attention during feeding times for preterm babies hospitalized in the NICU.

Greatest Learning

This activity was much more complex and involved than I originally thought it would be. I was cognizant of the fact that there were several instruments to mensurate unwritten eating preparedness in preterm babies, but was non cognizant of the changing theoretical underpinnings and by differences between these instruments in really mensurating unwritten eating preparedness and differences in general construct elucidation. I was besides non cognizant of the preparation involved for the usage of some of these instruments, either. The necessary preparation is non merely an added disbursal, but it adds to the trouble in being able to implement their usage in a big NICU scene such as the one I presently work in. We have a staff of 127 staff nurses who routinely orally feed babes as a constituent of clinical nursing attention. It would be really hard, every bit good as dearly-won, to develop every nurse in a sensible sum of clip without even sing turnover rates and the demand to develop new staff every bit good. A simpler instrument such as the OFS would be of greater benefit to nursing staff given current staffing tendencies and nurse to patient ratios at feeding times. I besides now realize that in order for an instrument to be able to sufficiently mensurate a construct, the construct must hold been sufficiently analyzed and the instrument must be valid and dependable as a measuring of the construct at manus every bit good as being simplistic to utilize. If this does non go on, consequences have a much higher chance of being erroneous and so the construct that is being measured merely becomes more ill-defined.

The chosen articles for this assignment are articles written by Wallin, et Al ( 2006 ) published by The Journal of Ageing and Society. 27, 147-164 ; Cott, ( 2004 ) published by The Journal of Disability and Rehabilitation. 26. 24 pp1411-1422 ; Trappes-Lomax ( 2006 ) published by the Journal of Health and Social Care 14 ( 1 ) , 49-62 and Cunliffe et Al ( 2004 ) 33: pp246 -252. See appendix 1

Parahoo ( 2006 ) defines a literature reappraisal as an appraising study of information found in literature relate to a chosen capable country. These literature reappraisals are concerned with the significance ‘older people attach to their rehabilitation ‘ . The reappraisal describe, summarise, evaluate and clear up cardinal findings of available literatures. Rehabilitation is concerned with decreasing the impact of disenabling conditions. These are peculiarly common in older people and considerable wellness addition can be achieved by their successful rehabilitation. Physical rehabilitation in the context of long-run attention can better physical and mental province, and be of benefit to those with dementedness ( Forster, 2009 ) .

Rationale for pick of subject:

This subject country was chosen as it is felt that this is a topic that warrants more probe into its effectivity and the deduction it has on the lives of the aged people. With the altering population demographics, there is an increasing age mortality which consequences in a greater figure of old people and although this age group is non the lone group affected by the inquiry of intending attached to rehabilitation but the increasing age tends to rise how it is related to the older people.

In pursuit of updating the writer ‘s cognition in the significance of older peoples ‘ authorization in geriatric rehabilitation, a batch of literatures were reviewed. Extensive manual and electronic hunts of literatures were conducted for the intent of placing reappraisals and articles related specifically to the chosen subject. The undermentioned databases were searched: Cinahl, PubMed, Ovid, Cochrane library, Blackwell synergism, The Swetwise, the Journal of Aging and Society, the Journal of Disability and Rehabilitation, Clinical Rehabilitation, The Journal of Nursing Philosophy, Health and Social Care in the Community and a batch of books. Literatures were besides accessed from local libraries, nursing places intranet and the cyberspace.

Search footings used include: older people ; frail aged ; long-run attention ; rehabilitation ; significance ; interview ; qualitative ; quality of life ; life satisfaction, cogency, and hunts were limited in English Language. Amongst the articles reviewed are: Client – centred rehabilitation: client positions ( Cott, 2004 ) ; Buying Time 1: a prospective, controlled test of a joint wellness / societal attention residential rehabilitation unit for older people on discharge from infirmary ( Trappes-Lomax, 2006 ) ; Rehabilitation and Older Peoples ( Wade, 2003 ) ; Sooner and Healthier: RCT and Interview survey of early discharge rehabilitation service for older people ( Cunliffe et al, 2004 ) . These chosen articles are of great involvement to the writer due to its subjective rating of the participants. From the writer ‘s personal experience and my engagement in the attention of the aged, most aged people perceived rehabilitation as control and as an act of containment. Clients ‘ position tantrums in with clients – centred attacks and some of the research highlighted client centeredness, in footings of determination devising.

It is imperative for research to be critique in order to measure its scientific unity, that is placing strengthens and failings, the pertinence and transferability of it recommendations ( Cormack, 2000 ) . This assignment aims to critically measure scope of surveies / policy paperss surveies which examines “ The Meaning Older People gives to their Rehabilitation Experience ” . An effort will be made to analyze the cogency of the studies utilizing the faculty usher as a model which provide measure – measure attack utilizing systematic headers from the chosen articles aim to analyze the information. The rubric, abstract, writer, debut, methodological analysis, trying consequences, cultural issues will be critique. In all, it transferability will be discussed and decision drawn. Though, the rubric is concise and enlightening, it does non reflect vividly to the full aged population standby, since the mark ages were between 65 – 93 old ages but non all the older people. The rubric includes the cardinal word of the articles, since many retrieval systems depend on the rubric for seeking or indexing ( Denscombe, 2003 ) . The rubric attracts my attending to the country standby, its short words and has the research inquiry being inexplicit in it ( Hollaway and Wheeler, 2002 ) .

About the Writers:

A brief question into the writers ‘ background in respect to their academic, professional making and their experiences are of import to find, it worth as this can act upon the result or consequence of the survey ( Cormack, 2000 and Bell, 2005 ) . In the first article, Talvitie and Wallin are both with the Department of Health Science, University of Jyvaskyla, Finland ; Catta with the Centre for Health Promotion Research, Leeds University and some of her work will be referred to in this assignment Catta et Al ( 2003 ) . And Karppi is with Research Department, Social Insurance Institute of Finland ( SII ) , which funded the survey under review. Burns and Grove ( 2006 ) stated that a funded survey has to be reviewed and be recognised for it scientific and societal virtue by the organic structure funding it. However, working within the funded administration one can easy be influenced. The writers participated in the survey ( Polit et al, 2001 ) . However, their several makings were non provided in the article to find their credibleness in research ( Cormack, 2000 ) .Cott, C.A ( 2004 ) is of the Department of Physical Therapy and Graduate Department of rehabilitation Science, University of Toronto, Canada. Trappes-Lomax, et Al ( 2006 ) are all based within the Department of Public Health & A ; Epidemiology, University of Birmingham UK ; and Cunliffe and co-workers are all of the Department of Health, Determining the Future NHS, Long Term Planning for Hospital and Related Services, London.

Reviews / Subjects:

Many research workers ( Cormack, 2000 ; Burns and Grove, 2003 ) have insisted that debut should place the research purpose, the principle underpinning the statement of intent and importance of the survey. The general purpose of the articles was stated as to advance older people ‘s liberty and to heighten their ability to populate near independent lives which is important to nursing pattern. However, the writers in all the four articles failed to province the intent of their surveies explicitly in the debut. They have made mentions to assorted related plants established in the field standby ( Cormack, 2000 ) . The principle for any restraints such as the being and significance of a cognition spread, have been clearly stated.

The subjects for article written by Wallin et Al ( 2007 ) is that the older grownup perceived rehabilitation as a agency of acquiring off normal life and basking themselves ; as sense of holiday and as a letdown because they had small opportunity to take part in the planning of the rehabilitation programme. The article by Cott ( 2004 ) findings was to show that client – centred rehabilitation embraces much more than end scene and determination devising between single clients and the professionals. The article by Cunlifte et Al, ( ( 2004 ) was to measure an early discharge and rehabilitation service for the older people.

The reappraisal was presented as an built-in portion of the debut ( Denscombe, 2003 ) . Reviewing literature is to derive wide background apprehension of the capable affair to back up the research purpose and how the current survey was informed and built from old work ( Cormack, 2000 and Moore, 2006 ) . There is a superb indicant within the articles and the mention list a batch of primary and secondary beginnings of background reading have been done ( Berry, 2004 and Kumar, 2005 ) . The writers have built on the bing cognition by associating it to both recent and old publications on the topic in their literature reappraisal ( 1994-2006 ) ( Cutcliffe and Ward, 2003 ) . They were able to contrast the old plants on effects of institutionalisation and rehabilitation to older people. They have been influenced by past plants in the rehabilitation of the older people as physical recovery orientated instead than societal engagement, as it was the position and thought of some older people but non many surveies had been explored into the older people ‘s experiences and perceptual experience. They have been able to make more extended research on the range of the survey.

Methodology:

This is defined as the theory and analysis of how the survey should continue. It regulations the pick of method, the techniques or process used to garner and analyze informations ( Parahoo, 2006 ) .This involves roll uping informations of different signifiers from the same topics ( Porter, 2000 ) . Triangulation of different informations beginnings can besides help proof ( Parahoo, 2006 ) . By utilizing two different methods of research, the research workers may derive a different position of the subject under probe and the consequences from any one method can be confirmed, ( Couchman and Dawson, 1995 ) . Research workers need to be cognizant that utilizing both qualitative and quantitative attacks in the same survey will non needfully supply the whole image, findings may be contradictory. This can heighten apprehension of research methodological analysis and the phenomenon being surveies ( Parahoo, 2006 ) .

Within the survey a qualitative method of research will let a focal point upon the position of the clients, ( Couchman and Dawson, 1996 ) . This will let their positions to be valued. Emphasis can so be placed upon significances, descriptions and experiences of the clients, ( Coolican, 1994 ) Qualitative research allows us to understand human behavior, by happening out the readings of events through the eyes of the participants instead than trusting on mensurating concrete facts. To cognize the significance of rehabilitation as per aged people, one should analyze it from the position of the persons ; hence qualitative attacks can be described as holistic instead than reductionist. Qualitative research chiefly concentrates on written words, or address, and aims to understand the motives and readings of people instead than explicating why something happens. It may be exercised where the research worker seeks a deeper truth, taking to do sense of or construe phenomena in footings of people ‘s belief, attitudes, experiences, behavior and interactions which generate non- numerical informations ( Denzin, 2005 ) . A common attack in the qualitative research is phenomenological attack which focuses on depicting how the single experiences this development, ( Patton, 2002 ) . This appears to be appropriate for this survey as the purpose and aim of the survey was to obtain a deeper apprehension of older peoples ‘ significances, which could non hold been adequately be addressed as quantitative attack. In any instance, a little degree quantitative informations ( descriptive statistics ) was incorporated, in all the articles to back up the description the research workers were trying to explicate. A unfavorable judgment of utilizing the qualitative attack is that it is anecdotal, unscientific and produces findings that are non general ( Punch, 2000 ) .

Sampling:

Sampling is the procedure of choosing people or units from a population of involvement, so that by analyzing the sample, the research workers may reasonably generalize their consequences back to the population from which they were chosen. The research workers in this instance used a purposive method in enrolling clients which is a judgemental sample of persons chosen by certain pre-determined standards relevant to the research inquiry ( Robson, 2002 ) . This method is chiefly used when the research workers is seeking to lend to the apprehension of phenomena but non to generalizing the findings to the mark population and is hard to measure the preciseness of the research worker ‘s opinion, ( Parahoo, 2006 ) . This appears to be appropriate in this research since it has the possible to supply rich informations ( Morse, 1994 ) . Patton ( 1990 ) suggested that no guidelines exist for sample size in qualitative surveies, but the sample size was purposively recruited from the indiscriminately selected sample from the chief survey, which is really good for the survey, more informations will be collected before impregnation is reached and have three research workers to work on them ( Holloway and Wheeler, 2002 ) , the age scope ( between 65 and 93 ) , the figure of scenes ( 7 ) , the periods and the exclusion standards strategy, nevertheless they failed to warrant the standards ( Cormack, 2000 ) .

Data Collection:

The authors specified how the information for the survey was collected. Two semi- structured interviews were conducted for 15 to 45 proceedingss and 45 to about 2 hours in the scene and in the participants several places and audio tape were used. The acceptance of qualitative methodological analysis and the usage of semi-structured interviews allowed manner for cross checking so that incompatibilities in callback could be identified and probed ( Cutsliffe and Ward, 2003 ) . The semi-structured interviews are believable in this survey in the sense that the sources can be verbally be assisted to understand the inquiries and the interviewers can inquire any inquiry for elucidations, investigation further for responses every bit good as being able to detect organic structure linguistic communication, which can non be gained when utilizing questionnaires ( Munhall, 2001 ) . However, by interview, it can non be guaranteed that interviewees are being honest as they may non understand the inquiry or they may falsify the truth or withhold critical information and face to confront interviews may compromise the namelessness of the interviewees ( Parahoo, 2006 ) . However, one to one interviews, usage of tape recording can be utile to look into the original diction of any statement one might desire to cite, or maintain to do certain that what one ‘s write is accurate, it helps if one is trying any signifier of content analysis and demand to listen several times in order to place classs and allows one to code, summarise and to observe a peculiar remark ( Bell, 2005 ) . Audio taped information enhances dependability and writer triangulation adopted for cogency ( Burns and Grove, 2005 ) . The notes taken and short diary kept during the interviews guarantee trustiness and supply accurate representations of the participants ‘ experiences such as gestures and facial look. The brooding journal maintained throughout the survey shows clearly their ideas, engagement in the informations and reading of the informations.

The six months interval between the interviews may assist to retest any theories developed in the composing up phase ( Cormack, 2000 ) . The writers nevertheless failed to advert any interruptions during the interview, since it is ethically appropriate for this client group ( Holloway and Wheeler, 2002 ) . They every bit failed to enter any restrictions such as reflexiveness that might hold influenced the procedure of the informations aggregation. Reflexivity is a uninterrupted procedure of contemplation by research workers of how their ain values, behavior, perceptual experiences or presence and those of the respondents may impact the information they collect ( Parahoo, 2006 ) . In the absence of statistical trials for cogency and dependability, this kind of reflexiveness is important to qualitative survey if it is to be persuasive ( Cormack, 2000 ) . The writers gave a brief description of the guiding subjects and some of the specific inquiries that were asked, provided the information for the survey, but they failed to advert any inquiries that appeared uncomfortable to reply by the interviewees and they failed to bespeak their single functions within the survey.

Ethical motives:

Though, qualitative research is non physically invasive but it may ensue in an invasion of the head of the participants ( Bryman, 2005 ) . The articles were approved by their several ethical commissions. The written text of the interview informations amongst themselves ensures the namelessness of the clients ( Sullivan, 1998 ) . An informed consent is an on-going procedure in a qualitative survey but the authors of the articles failed to recognize this and kept silent of the older people who were or may non be competent to subscribe their ain signifiers ( Denscombe, 2003 ) . There was no record of obtaining permission before entering the interviews and what would be done to the informations after the written text.

Datas Analysis:

The procedure of analyzing informations in qualitative research is ongoing, get downing during informations aggregation, with the research worker processing informations and doing opinions about facets of it, as it is received ( Parahoo, 2006 ) . Once all informations from the taped interviews has been collected, it will be transcribed, which will take about three times every bit long as each interview ( Couchman and Dawson, 1995 ) . The consequences were represented in a clear, elaborate description and in simple linguistic communication which makes the text easy to read and understood ( Ogier, 1999 ) . A consideration associating to rigour is credibleness ; the writers returned the interview reading back to the participants so that they can look into for any disagreement ( May and Hope, 2000 ) . It appears that the writers adapted equal strict techniques in the analysis. The usage of writer triangulations enhances cogency, and direct citations, when showing deepness and acknowledgment of single experiences. The identified subjects and applicable citations by and large provide a clear image of how the subjects emerged from the informations. They explained the cryptography ( Polit et al, 2001 ) , which makes it easier for the readers to measure the cogency of the emergent subjects based on the quality and measure of citations provided. Bringing citations from clients, therefore let the reader to carry on his ain significance of the look to the participants. It will besides assist the readers of the research, who may non understand clearly the purpose, nonsubjective and procedure of the research, and to judge its truth and pertinence consequently. In any instance, they fail to advert the model used in the cryptography and the analysis.

The cardinal findings that came out from the saturated subjects shows that the clients have different and changing demands and outlooks of rehabilitation programme, which were categorized into three. They were – the sense of assurance with mundane life ; which they perceived as facilitating mundane life at place ; as sense of holiday ; and it was besides seen as a agency of acquiring off from normal life and basking themselves and eventually as a sense of letdown and defeat with the limited chances to take part in the planning of their rehabilitation programme. There was no proper integrating of the participants since they were grouped on conformity to their geographical beginnings during most of the periods. And they failed to advert any consequence of the abrasion on the consequence.

Discussion:

The authors have addressed the research as set out at the beginning of the research about their treatments, findings and the important of the survey have been a sense of assurance with mundane life ; ‘ a sense of holiday ‘ and a sense of letdown. The result of the survey was besides compared with that of the old plants of the literature such as Hinck, 2004 ; Cattan et Al, 2005 in the literature reappraisal. They acknowledged a mistake in their sampling and have suggested a comparative survey of sub-geriatric clients in order to light the contract ( Cormack, 2000 ) . A recommendation was made about advancing a patient – centred and partnership in attention, which entails a holistic attack. However, the suggestion made by the writers about professional communicating accomplishments can non be justified within the context of their research, since there were no professionals incorporated in their survey.

However, safeguard has to be taken, if these findings are to be replicated across the brotherhood, since significances to a phenomenon alterations with permeating cultural and sub-cultures ( Hammersley, 1992 ) and it is improbable that older people in Finland have the same civilization to older people in United Kingdom ( UK ) . Transfering the findings to UK will hold different impact due to different wellness attention system such as the function of permeant and perceived institutionalized engagement, different professional regulative organic structures and discrepancy in the instruction and preparation, and the function of mental wellness professionals. The overpowering feeling from the positions reported in UK is that rehabilitation scenes are driven by an property of control and containment instead than authorization ( Parry-Crooke, 1999 ) .

In the article by Cunliffe et Al ( 2004 ) it was shown that rehabilitation improves the degrees of activity and the psychological wellbeing of the aged. That individual – centred manner of attention helps to better the result of older people ‘s deficiency of assurance, and may take to better wellness results. All the articles have demonstrated that there is demand for rehabilitation for these client group.

Decision:

It can be seen that the purpose of this literature reappraisal has been achieved in researching the significance of rehabilitation to the aged people. The survey reveals that different people attach different significance to rehabilitation. It has brought an interesting cognition into pattern ; an consciousness of the participants holding changing significances to it concept. Promotion of older peoples ‘ liberty in the community entails a holistic attack which should hold included sociological issues and the scenes should hold been in the clients ‘ places.

An empowerment attack appears to be preferred to medical attack adopted. Though, the overall findings has been biased toward reasonably fit older people, who were get bying at place with a degree of support, the age differences besides might convey approximately different wellness issues, such as mental wellness. Furthermore, clients were non given pick to organize groups during Sessionss, and the groupings were biased towards geographical beginnings. However, the recommendations made – patient – centred and partnership in attention are of great importance.

In the NMC ‘s codification of professional behavior ( 2004 ) , great accent is placed on the duty nurses have in guaranting that clients possess the best up – to – day of the month grounds based cognition and accomplishments to present attention possible. Therefore, improved cognition through instruction and research will be the footing of grounds based practiced for alteration and betterment.

Mention

Bell, J. ( 2005 ) Making Your Research Undertaking. A usher for first clip Researchers in Education and Social Sciences. Buckingham: Open University Press

Bryman, A. ( 2005 ) Social Research Methods Oxford: Oxford University Press

Nathan birnbaums, N. and Grove, S. ( 2006 ) Understanding Nursing Research. Philadelphia: Saunders

Nathan birnbaums, N. and Grove, S. ( 2005 ) The Practice of Nursing Research Conduct Critique and Utilization. Philadelphia: Saunders

Coolican, H. ( 1994 ) Research Methods and Statistics in Psychology. Great Britain: Hodder and Stoughton

Cormack, D. ( 2002 ) The Research Process in Nursing. 4th erectile dysfunction. Oxford: Blackwell Science

Couchman, W. and Dawson, J. ( 1995 ) Nursing and Health Care Research. London: Bailliere Tindall

Denscombe, M. ( 2003 ) The Research Guide for little – graduated table Research Project. Buckingham: Open University

Forster, A. ; Lambly, R. And Handy, J. ( 2009 ) Rehabilitation for Older Peoples in Long Care: Cochrane database of Systematic Review.

Hek, G. , Judd, M. and Moule, P. ( 2002 ) Making Sense of Research: An debut for Nurses. 2nd erectile dysfunction. London: Cassell

Holloway, I. and Wheeler, S. ( 2002 ) Qualitative Research for Nurses. 2nd erectile dysfunction. Oxford: Blackwell Science

Kumar, R. ( 2005 ) Research Methodology. A Measure by Step Guide for Beginners. London: Sage Publication

Munhall, P. ( 2001 ) Institutional reappraisal of qualitative research proposals: a undertaking of no little effects. In Morse, J.M. Qualitative Nursing Research: A modern-day Dialoque. London: Sage Publication

Ogier, M. ( 1999 ) Reading Research. London: Bailliere Tindall

Parahoo, K. ( 2006 ) Nursing Research Principles, Process and Issues. 2nd erectile dysfunction. Hampshire, England: Palgrave Macmillian

Parry-Crooke, ( 1999 ) Consultation with Women in High Secure Settings: Preliminary Findingss. London: University of North London.

Patton, M ( 2002 ) Qualitative Research and Evaluation Methods. Newburgh Park: Sage Publication

Patton, M. ( 1990 ) Qualitative Research and Evaluation Methods. Newburge Park: Sage publication

Polit, D. and Hungler, B. ( 2001 ) Nursing Research Principles and Methods. Philadelphia: J.B. Lippincott

Porter, S. ( 2000 ) Qualitative Research. I Cormack, D. The Research Process in Nursing: London: Blackwell Science

Punch, K. ( 2000 ) Developing Effective Research Proposals. London: Sage Publication

Robson, C. ( 2002 ) Real World Research. A resource for Social Scientists and Practitioners. Oxford: Blackwell

1. Top Management be committed as a prerequisite to benchmarking?

Medical tests deliver a practical method to quantity and liken services. These assistances towards identify learning gaps by establishing values of fineness and humanizing performance. How

1.0 What is Benchmarking?

Benchmarks are an influential management utensil that was originally developed to maintain a high standard in the industry. Although a relatively new initiative for many medical institutions, the benchmark is to gain recognition as a useful tool to help “illuminate the light” in critical areas of nursing (hospice UK 2017) quickly. It is a process for establishing a high smooth of excellence by likening finest rehearses in addition fitness care services frequently since other bodies.

1.1 Advantages of Benchmarking

Advantages of Benchmarking include:
• Provide a methodical tactic towards a valuation of practices.
• Preferment of contemplative practices.
• Deliver an alleyway for alteration during clinical rehearsal.
• Ensure that pouches of innovative methods are not wasted.
• Reduced recurrence of operations in addition resources.
• Reduced disintegration and geographic variant in health maintenance.
• Provide extra resource testing.

1.2 Defining the Scope of Practice

Learning from others and sharing your knowledge of what worked well between benchmarks can go a long way to managing your effort more.
Many hospitals benchmark rules towards enable a procedure
E.g., the NHS Wales (2018) delivers next rules towards recognize an extensive variety of approaches aimed at a characteristic clinical benchmark project.
1. Frequently compare functions otherwise processes for example best practices.
2. Determine where you may recover performance.
3. Find fresh philosophies and opinions towards recover performance.
4. Tool the extension.
5. Screen the welfares of the development and review.
1.3 Teamwork is Essential
To be up to function correctly benchmarking have to remain the squad procedure. Along an opinion towards benchmarking results will probably lead towards alterations during contemporary practices. This resource which the influence of change is palpable during the clinical team and potentially encompasses the whole department. For example an outcome fruitful benchmarking requires a squad procedure that comprehends and ropes likely alterations which will happen during the upcoming. The finest practices we are eager towards part remain also important. Without them benchmarking can’t even begin. Therefore benchmarking is not just for administrators. Nurses and midwives play an important role on all phases during the leading role of health institutes during meeting national reference standards.

1.4 Continuous Quality Improvement

In recent years benchmarks have also develop a valuable excellence reassurance instrument which can remain easily practical aimed at utilize during a diversity of medicinal environments. All these steps are based on four fundamental principles of management-related benchmarking (York 2015).

1. First quality
2. Improve customer satisfaction
3. Improve patient safety
4. Incessant improvement
the sower 2007 remains not lone benchmarking but also proposes likening infirmaries along the ordinary of the countries but too to perceive the finest infirmaries sightsee their activities otherwise see more medicinal maintenance. Business also learning since additional service businesses. Humanizing an excellence in addition efficiency of rehabilitation remains an important objective aimed at everything specialists irrespective of clinical specialties or sizes.

1.5 Benefits of Shared Benchmarking Across Institutions and Across Countries

To allow the conversation of knowledge and experience contact and network promotion identify gaps between common practice and good practice provide external guidance for internal review perceive comparative statistics towards improve decision making serving and facilitating change identify new philosophies and innovative approaches college of Tasmania 2018 most benchmarking projects involve comparisons with other local or national institutions but some practitioners go further by pursuing an international comparison. This can significantly increase workload but it can extend learning and better share best practices and improved quality.

1.6 Reputations Count

Bevan 2018 takes the inherent desire to take one step further and share good practices by signifying that some fragment of the motivation aimed at benchmarking should remain a good reputation. Based on research conducted in Italy in addition the United Kingdom benchmarking has established to recover performance by improving denominations and figures and improving results through competitive benchmarking and peer learning. Benchmarking can be a useful technique for quickly raising an organizations performance. It is not just about examining practices to ensure high clinical standards but it is also a way to support public and shared information to enable continuous improvement and development (Kay 2007) in every dish no doubt nurses have been challenged to adapt to changing health care needs. With this you need.

The nurse manager is vital in creating an environment where nurse-physician collaboration can occur and is the expected norm. It is she, who clarifies the vision of collaboration, sets an example of and practices as a role model for collaboration. The nurse manager also supports and makes necessary changes in the environment to bring together all the elements that are necessary to facilitating effective nurse-physician collaboration.

Many authors (Alpert, Goldman, Kilroy, & Pike, 1992; Baggs & Schmitt, 1997; Betts, 1994; Evans, 1994; Evans & Carlson, 1993; Keeman, Cooke, & Hillis, 1998; Jones, 1994) have indicated that nurse-physician collaboration is not widespread and a number of barriers exist. The following will discuss the necessary ingredients for creating a nursing unit that is conducive to nurse-physician collaboration and supported through transformational leadership.

The first important barrier according to (Keenan et al. (1998) is concerned with how nurses and physicians have not been socialized to collaborate with each other and do not believe they are expected to do so. Nurse and physicians have traditionally operated under the paradigm of physician dominance and the physician”s viewpoint prevails on patient care issues. Collaboration, on the other hand, involves mutual respect for each other”s opinions as well as possible contributions by the other party in optimizing patient care.

Collaboration (Gray, 1989) requires that parties, who see different aspects of a problem, communicate together and constructively explore their differences in search of solutions that go beyond their own limited vision of what is possible. Many researchers have argued (Betts 1994; Evans & Carlson, 1993; Hansen et al. , 1999; Watts et al. , 1995) that nurses and physicians should collaborate to address patient care issues, because consideration of both the professions concerns is important to the development of high quality patient care.

Additionally, effective nurse-physician collaboration has been linked to many positive outcomes over the years, all of which are necessary in today”s rapidly changing health care environment. One study by (Baggs & Schmitt, 1997) found several major positive outcomes form nurses and physicians working together, they were described as improving patient care, feeling better in the job, and controlling costs. In another study (Alpert et al. , 1992) also found that collaboration among physicians and nurses led to increased functional status for patients and a decreased time from admission to discharge.

Along with improved patient outcomes, nurse-physician collaboration has several other reasons why it has become significant in today”s health care environment. Several examples of which are, as identified by (Jones, 1994) the cost containment effort, changing roles for nurses and physicians, the Joint Commission on Accreditation of Health Care Organizations focus on total quality management, and emphasis by professional organizations and investigators have focused attention on this area.

The challenge of creating an environment for patient care in which collaboration is the norm can be difficult and belongs to the domain of the nurse manager. In order to create a collaborative work environment several conditions must be achieved and several natural barriers to nurse-physician collaboration must be overcome. In creating this environment for collaborative practice, (Evans, 1994) identified several more barriers to overcome. She expresses that the most difficult to overcome is the time-honored tradition of the nurse-physician hierarchy of relationships, which encourages a tendency oward superior-subordinate mentality.

Keenan et al. (1998) found that nurses expect the physicians to manage conflict with a dominant/superior attitude. They also found that nurses are oriented towards being passive in conflict situations with physicians. A second barrier to collaboration is a lack of understanding of the scope of each other”s practice, roles, and responsibilities. Evans (1994) feels that one cannot appreciate the contribution of another individual if one has only limited understanding of the dimensions of that individual”s practice.

It is equally true that appreciation of one”s own contribution is blurred if the understanding of one”s own role is limited. A third constraint to collaborative practice might be related to this perceived constraint on effective communication. Although there might be individual differences causing restraint in communication, the organizational and bureaucratic hierarchies of most hospitals hinders lines of communication. Several final factors cited by (Evans, 1994) as barriers to collaborative practice include immaturity of both physician and nurse groups, coupled with unassertive nurse behavior and aggressive physician behaviors.

Factors that promoted collaboration between nurse and physicians were identified by (Keenan et al, 1998). She explained that nurse education was sighted as one of the most outstanding variables that promoted collaboration. The more educated a nurse was the more likely they were to take action in disagreements with physicians. Additionally, when nurses expected physicians to collaborate and to not exhibit strong aggressive behaviors or controversial styles, they were more likely to approach and discuss patient conditions with them.

Researchers also found that male nurse were more likely than female nurses to confront physicians and not avoid dominant or aggressive behavior. Expectations for physicians to collaborate and to not handle situations aggressively appeared to be a stronger predictor of nurse-physician collaboration than any expected normative beliefs. The first step a nurse manager should take in the process of achieving a practice environment that facilitates collaboration is to conduct an assessment of the presence or absence of barriers leading to collaborative practice.

According to (Evans, 1994), the environmental and role variables to assess include role identification and the professional maturity of both the nurses and physicians, communication patterns, and the flexibility of the organizational structure. By assessing the work environment for barriers and facilitators to collaborative practice, the nurse manager can achieve a general idea of how ready the unit is to begin a collaborative practice. The next step would be to plan an effective way to initiate a collaborative practice model of delivering health care on the unit.

This can be done by establishing what is called a Joint Practice Committee, and including nurses and physicians to be a part of this work group. Its purpose would be to examine the needs assessment results of the unit”s readiness for collaborative practice, designing, implementing, and evaluating the process of transforming the unit. This step is an integral part of the process of establishing a collaborative practice and was identified by the National Joint Practice Commission (NJPC) as a necessary element in the process. The NJPC began in 1971 and the commission was dissolved in 1981.

The commission”s work resulted in the publication of guidelines for collaborative practice in hospitals. The NJPC defines a joint-practice committee with a composition of equal number of nurses and physicians who monitor the inter-professional relationships and recommend appropriate strategies to support and maintain those relationships. The NJPC identifies four other structural elements necessary for a collaborative practice as primary nursing, integrated patient care records, joint patient care reviews, and emphasis on and support of nurse independent clinical decision making.

These elements are an important cornerstone for creating a successful collaborative practice unit. In addition, several other factors have been identified by the NJPC as beneficial to maintaining an effective support systems when developing a collaborative practice such as appropriate staffing, committed medical leadership, standardized clinical protocols, and most importantly communication. Although a successful collaborative practice model has is a planned event. According to (Evans, 1994), it is important to realize that a collaborative relationship cannot be legislated, dictated, or mandated by anyone.

It must be agreed upon and accepted by individuals who share responsibility for patient care outcomes. The third step in the process would be to empower the nursing staff with beliefs that fulfill their higher order of needs such as achievement, self-actualization, concern for others, and affiliation. Because of nursings normative behavior as passive, caring, and subservient the staff must learn to overcome expectations to identify with this role expectation. The nurse manager must support, coach, and instill a sense of empowerment into her staff in order for them to depart from those stereotypes.

The idea is to fill the nursing staff with a sense of self-confidence and to lose thoughts of self-doubt, inequality, and subservience. To implement this new paradigm of nurse empowerment can be a challenge for the nurse manager within any typical hospital beaurocracy. That is why it is important to choose the correct style of leadership to guide the staff through this process of empowering or transforming. The leadership model best suited for this type of task and the most congruent with empowerment is the transformational model. Transformational leadership is a process in which leaders seek to shape and alter the goals of followers.

Cassidy & Koroll (1994) describe the process as incorporating the dimensions of leader, follower, and situation. The leader motivates followers by identifying and clarifying motives, values, and goals that contribute to enhancing shared leadership and autonomy. Transformational leaders are usually charismatic so they enhance energy and drive people towards a common vision and shifting the focus of control from leaders to followers. It is the transformational nurse manager that will be able to empower her workers to facilitate nurse-physician collaboration, for the common good of the patient.

The nurse manager using transformational leadership would set the direction for the rest of the unit to follow. She would be able to charismatically appeal to the medical staff as well as the nursing staff and create collaboration beyond the daily frustrations of arguing about to which domain a certain patient care issues belong. Further more the nurse manager would have to work hard at decreasing the seeds of distrust and disrespect that have been planted between our colleagues in medicine, and vice versa with nursing.

Corley (1998) described several behaviors that the transformation nurse manager would need to exhibit in supporting her staff in such a role transition. The behaviors are as follows: stimulate creativity, establish an environment that facilitates team work and learning, implement change, motivate staff to assume increased responsibility, help develop employees” awareness of organizational goals, delegate responsibility appropriately, communicate openly and directly with staff, and collaborate with peers. The significance of these behaviors in facilitating empowerment is seen as fundamental to creating collaborative practice environment.

The final step in the process is to evaluate its effectiveness. In order to provide a clear and concise evaluation of the collaborative process one must look at all structural elements and all indicators of collaboration as previously discussed. Once accurate measures are identified and assessed the collaborative practice committee can discuss their outcomes and effectiveness. Over time, nurses and physicians may be able to articulate more clearly the changes in their practice and beliefs that have been affected by collaborating on patient care.

Several of these key areas to examine would be: length of stay, patient and provider satisfaction, number of return visits, and changes in supply costs. Improvements in any of these areas could be due to favorable results from collaborative practice between nurses and physicians. In conclusion, many problems related to nurse physician collaboration are typically blamed on physicians. However the reality is that many of the barriers can be traced back to nursing as well. Collaboration is a process by which members of various disciplines share their expertise.

Accomplishing this requires that these individuals understand and appreciate what it is that each professional domain contributes to the “whole”. The nurse manger plays a pivotal role in establishing an environment that is conducive to collaboration among the disciplines. Although it is a difficult road to follow the benefits of an effective collaborative unit out-weigh the difficulties of establishing such a practice. However, the nurse manager has an excellent vehicle for which to begin her journey and that is the use of transformation leadership, an empowering tool for change.

The purpose of this essay is to describe an incident which occurred with a patient while in the clinical placement. This paper will attempt briefly to describe an encounter with a patient on the ward in terms of the use of effective communication skills. This essay will also provide two definitions of communication. In addition, this paper will describe how i used verbal/non verbal and other communication skills on the above encounter as well as explain what went well and my weaknesses on that occasion.

For the purpose of preserving confidentiality, patients’ name will be changed. ? Describe incident with patient My current placement is in a geriatric ward, designed to deliver health care for old age. Mr. Black is a 64 year old patient diagnosed with personality disorder and paralysis. I approached Mr. Black after he had called for help. I addressed Mr. Black and asked him what i could do for him.

As he started speaking, i used colloquialism, as Miller (2002) stated was part of verbal communication, yet i could not understand what he was saying, although i knew he was from the West Indies since i saw how his daughter looked and dressed the day before, his speech was not clear, he spoke low, stumbled over the words and could not articulate the sounds because of the paralysis. Although I asked him to speak louder so i can understand what he was saying, he continued speaking in an unclear manner.

After few attempt i felt helpless as the patient was not making sense and there were other patients calling for attention. Suddenly, frustration and distress was appeared on Mr. Black’s face, this indicated the urgency of what he was trying to tell me. I observed his surrounding area and notice that there was no catheter anywhere near Mr. Black’s bed although i noticed he always had it around. This indicated that he must be wearing a pad. As i lifted the blanket off the patient to see if the pad needed to be changed, i realised what he was trying to tell me.

The patient’s blanket,bedsheets and clothes were completely wet. That is when he started crying of relief. With assistance from a staff nurse we changed all that was wet on Mr. Black’s bed. He Introduced me to his daughter the next day and i told her he was telling me this morning that she lived near Kilburn. ? Two definitions of communication According to TVU (2005), communication is a personal interactive system where exchange and transmission of information and meanings take place.

Similarly, Miller (2002), believed that communication is the act of giving and receiving information. However there are two types of communicate: verbal and non verbal. ? Describe the use of verbal/non verbal and list communication skills used on occasion In the above incident, i used verbal communication techniques such as use of language/words to communicate with Mr. Black when asking him to tell me what he needed. Although i did not understand what Mr. Black was saying, i felt his frustration through his tone and facial expression.

I also bent over the patient’s bed to reach his eye level, looked directly at him and touched his hand to show interest and patience so he would not feel rushed. ? Explain what went well and weaknesses on occasion In my opinion, i handled the indicated incident in a professional manner with good use of verbal and non verbal communication techniques. I did not pretend to understand what Mr. Black was trying to say or even ignore him. However, Miller (2002) stated that I could have asked him questions about the few meaningless words that i heard him say to allow him feel capable of conveying his message.

Conclusion

In conclusion, efficient communication skills must be developed and improved for the safe delivery of care. Health care professionals need to be aware of the type of communicate style used while dealing with patients with various age group, backgrounds and mental state as well as overcome the barriers that affect and hinder communication such as sensory, psychological and language.

References

Miller L (2002) Effective communication with older people. Nursing Standard. 17, 9, 45-50

Christine Jorgensen Biography Christine Jorgensen (May 30, 1926 – May 3, 1989) was the first widely known person to have sex reassignment surgery – in this case, male to female. She was born George William Jorgensen, Jr. , the second child of George William Jorgensen Sr. , a carpenter and contractor, and his wife, the former Florence Davis Hansen. She grew up in the Bronx and later described herself as having been a “frail, tow-headed, introverted little boy who ran from fistfights and rough-and-tumble games”. She graduated from Christopher Columbus High School in 1945 and shortly thereafter was drafted into the Army.

After being discharged from the Army, Jorgensen attended Mohawk College in Utica, New York, the Progressive School of Photography in New Haven, Connecticut, and the Manhattan Medical and Dental Assistant School in New York City, New York. Jorgensen briefly worked for Pathe News. Returning to New York after military service and increasingly concerned over (as one obituary called it) her “lack of male physical development”, Jorgensen heard about the possibility of sex reassignment surgery, and began taking the female hormone ethinyl estradiol on her own.

She researched the subject with the help of Dr. Joseph Angelo, a husband of one of Jorgensen’s classmates at the Manhattan Medical and Dental Assistant School. Jorgensen intended to go to Sweden, where the only doctors in the world performing this type of surgery at the time were to be found. At a stopover in Copenhagen to visit relatives, however, Jorgensen met Dr. Christian Hamburger, a Danish endocrinologist and specialist in rehabilitative hormonal therapy. Jorgensen ended up staying in Denmark, and under Dr.

Hamburger’s direction, was allowed to begin hormone replacement therapy, eventually undergoing a series of surgeries. According to an obituary: “With special permission from the Danish Minister of Justice, Jorgensen had his [sic] testicles removed first and his still-undeveloped penis a year later. Several years later Jorgensen obtained a vaginoplasty, when the procedure became available in the U. S. , under the direction of Dr. Angelo and a medical advisor Harry Benjamin. Jorgensen chose the name Christine in honour of Dr. Hamburger.

She became a spokesperson for transsexual and transgender people. Famous Asked Questions for Women Famous Women and Their Contribution Abby Kelley Foster Year Honored: 2011 Birth: 1811 – Death: 1887 Born In: Massachusetts, Died In: Massachusetts, Achievements: Humanities Educated In: Rhode Island Schools Attended: Providence Friends School Worked In: Massachusetts, New York, Pennsylvania, Connecticut, Ohio, Indiana, Michigan During her lifetime, Abby Kelley Foster followed the motto, “Go where least wanted, for there you are most needed.   A major figure in the national anti-slavery and women’s rights movements, she spent more than twenty years travelling the country as a tireless crusader for social justice and equality for all. Foster was born into a Quaker family in Pelham, Massachusetts in 1811, and raised in Worcester, Massachusetts at a time when society demanded that women be silent, submissive and obedient. After attending boarding school, she held teaching positions in Worcester, Millbury and Lynn, Massachusetts.

In Lynn, she joined the Female Anti-Slavery Society, where she became corresponding secretary and later, a national delegate to the first Anti-Slavery Convention of American Women in 1837. The following year, Foster made her first public speech against slavery, and was so well received that she abandoned her teaching career and returned to Millbury. There, she founded the Millbury Anti-Slavery Society and began lecturing for the American Anti-Slavery Society. During the next two decades, Foster served as a lecturer, fundraiser, recruiter and organizer in the fight for abolition and suffrage.

In 1850, she helped develop plans for the National Women’s Rights Convention in Massachusetts. There, she gave one of her most well-known speeches, in which she challenged women to demand the responsibilities as well as the privileges of equality, noting “Bloody feet, sisters, have worn smooth the path by which you come hither. ” In 1854, Foster became the chief fundraiser for the American Anti-Slavery Society, and by 1857, she was its general agent. Through the American Anti-Slavery Society, Foster continued to work for the ratification of the fourteenth and fifteenth amendments.

In her later years, once slavery was abolished and the rights of freedmen were guaranteed, Foster focused her activism primarily on women’s rights. She held meetings, arranged lectures, and called for ‘severe language’ in any resolutions that were adopted. In 1868, she was among the organizers of the founding convention of the New England Woman Suffrage Association, the first regional association advocating woman suffrage. Foster’s efforts were among those that helped lay the groundwork for the nineteenth amendment to the U. S. Constitution. Lilly Ledbetter Year Honored: 2011

Birth: 1938 – Born In: Alabama, Achievements: Humanities Educated In: Alabama Schools Attended: Worked In: Alabama, District of Columbia For more than a decade, Lilly Ledbetter fought to achieve pay equity. It was in Alabama, where Ledbetter was born and raised, that she began a crusade that would eventually lead her all the way to the nation’s capital. In 1979, Ledbetter took a job at the Goodyear Tire & Rubber Company in Gadsen, Alabama. Although she was the only woman in her position as an overnight supervisor, Ledbetter began her career earning the same salary as her male colleagues.

By the end of her career, however, Lilly was earning less than any of the men in the same position. Although she signed a contract with her employer that she would not discuss pay rates, just before Ledbetter’s retirement an anonymous individual slipped a note into her mailbox listing the salaries of the men performing the same job. In spite of the fact that Ledbetter had received a Top Performance Award from the company, she discovered that she had been paid considerably less than her male counterparts.

Ledbetter filed a formal complaint with the Equal Employment Opportunities Commission and later initiated a lawsuit alleging pay discrimination. After filing her complaint with the EEOC, Ledbetter, then in her 60s, was reassigned to such duties as lifting heavy tires. The formal lawsuit claimed pay discrimination under Title VII of the Civil Rights Act of 1964 and the Equal Pay Act of 1963. Although a jury initially awarded her compensation, Goodyear appealed the decision to the United States Supreme Court. In 2007 the Supreme Court ruled on the Ledbetter v. Goodyear Tire & Rubber Co. ase. In a 5-4 decision, the court determined that employers cannot be sued under Title VII of the Civil Rights Act if the claims are based on decisions made by the employer 180 days ago or more. Due to the fact that Ledbetter’s claim regarding her discriminatory pay was filed outside of that time frame, she was not entitled to receive any monetary award. After that decision, Ledbetter lobbied tirelessly for equal pay for men and women. Her efforts finally proved successful when President Barack Obama signed the Lilly Ledbetter Fair Pay Act into law on January 29, 2009.

Ledbetter said of her continuous and persistent efforts, “I told my pastor when I die; I want him to be able to say at my funeral that I made a difference. ” Loretta C. Ford Year Honored: 2011 Birth: 1920 – Born In: New York, Achievements: Science Educated In: New Jersey, Colorado Schools Attended: Middlesex General Hospital; University of Colorado, School of Nursing, Boulder; University of Colorado, School of Nursing, Denver; University of Colorado, School of Education; Evergreen Institute Worked In: New Jersey, Colorado, Washington, New York, Japan

An internationally renowned nursing leader, Dr. Loretta C. Ford has transformed the profession of nursing and made health care more accessible to the general public. In 1942, Ford received her Diploma in Nursing from Middlesex General Hospital in New Jersey and began her professional career as a staff nurse with the Visiting Nurses’ Association. She went on to serve as a First Lieutenant in the U. S. Army Air Force from 1943-1946. In 1949, Ford received her B. S. from the University of Colorado, School of Nursing, and in 1951, she obtained her M. S. from the same university. From 1948-1958, Dr.

Ford held several different roles at the Boulder City County Health Department, and from 1955-1972 she held various teaching positions at the University Of Colorado Schools of Nursing. In 1961, she earned her Ed. D. from the University of Colorado School of Education. In the early 1960s, Dr. Ford discovered that, because of a shortage of primary care physicians in the community, health care for children and families was severely lacking. In 1965, she partnered with Henry K. Silver, a pediatrician at the University of Colorado Medical Center, to create and implement the first pediatric nurse practitioner model and training program.

The program combined clinical care and research to teach nurses to factor in the social, psychological, environmental and economic situations of patients when developing care plans. When the program became a national success in 1972, Dr. Ford was recruited to serve as the Founding Dean of the University of Rochester School of Nursing. At the university, Dr. Ford developed and implemented the unification model of nursing. Through the model, clinical practice, education and research were combined to provide nurses with a more holistic education. Dr.

Ford is the author of more than 100 publications and has served as a consultant and lecturer to multiple organizations and universities. She holds many honorary doctorate degrees and is the recipient of numerous awards, including the Living Legend Award from the American Academy of Nursing and the Gustav O. Lienhard Award from the Institute of Medicine of the National Academies. Today, it is estimated there are 140,000 practicing nurse practitioners in the United States and close to 9,000 new nurse practitioners are prepared each year at over 325 colleges and universities. Oprah Winfrey Year Honored: 1994 Birth: 1954 –

Born In: Mississippi, United States of America Achievements: Arts, Business, Philanthropy Educated In: Tennessee Schools Attended: Tennessee State University Worked In: Illinois, Tennessee, Maryland, District of Columbia, California, New York At the heart of everything Oprah Winfrey does, there is a consistent message – that individuals should take personal responsibility for their lives, and to improve the world. Winfrey is the first African-American woman to own her own production company; a talented actress nominated for an Academy Award in her first movie; television’s highest-paid entertainer; producer and actress n her own television specials; and the successful host of a syndicated television talk show that reaches 15 million people a day. She does all that she can to eradicate child abuse. As a victim herself, Winfrey knows the damage abuse does to young lives, and she was a major force in the drafting, lobbying and passage of the National Child Protection Act, signed into law by President Clinton in 1994. The Act establishes a national registry of child abusers to help employers and those working with children to screen out dangerous people.

Winfrey is also a committed philanthropist, providing significant assistance to schools (Morehouse College, Tennessee State University, Chicago Academy of Arts) as well as to the Chicago Public Schools. She also funds battered women’s shelters and campaigns to catch child abusers. Billie Holiday Year Honored: 2011 Birth: 1915 – Death: 1959 Born In: Maryland, Died In: New York, Achievements: Arts Educated In: Maryland Schools Attended: Worked In: Maryland, New York, Missouri, California, Illinois, Canada

Considered by many to be one of the greatest jazz vocalists of all time, Billie Holiday triumphed over adversity to forever change the genres of jazz and pop music with her unique styling and interpretation. Holiday was born in Baltimore, Maryland, and moved to New York City with her mother at a young age. There, she began work as a maid. However, in 1931, she left that employment to pursue work as a dancer in Harlem nightclubs. At one of those clubs, she was asked to sing. She quickly began singing in many of the Harlem nightclubs and soon established a following of admirers, despite having had no formal musical training.

Holiday’s career began to grow, thanks in part to the interest of John Hammond of Columbia Records, who organized her first recording with Benny Goodman in 1933. She debuted at the Apollo Theatre in 1935, and began recording under her own name in 1936. Holiday toured extensively in 1937 and 1938 with the Count Basie and Artie Shaw bands. While on tour, Holiday was often subjected to discrimination. Perhaps Holiday’s most notable collaborations were with legendary saxophonist Lester Young, who gave Holiday her moniker “Lady Day. Together, they created some of the most important jazz music of all time. Of her groundbreaking vocal style and delivery, Holiday once said, “I hate straight singing. I have to change a tune to my own way of doing it. That’s all I know. ” As both a vocalist and a songwriter, Holiday penned God Bless the Child and Lady Sings the Blues, among others. Her interpretation of the anti-lynching poem Strange Fruit was also included in the list of Songs of the Century by the Recording Industry of America and the National Endowment for the Arts.

Holiday’s autobiography, Lady Sings the Blues, was written in 1956. She won five Grammy Awards and was inducted into the Rock and Roll Hall of Fame in 2000 and the Nesuhi Ertugan Jazz Hall of Fame in 2004. Holiday, known for her deeply moving and personal vocals, remains a popular musical legend more than fifty years after her death. In spite of personal obstacles, Holiday inspired many with her vocal gifts and continues to be recognized as a seminal influence on music.

The project is registered with the care inspectorate in accordance with the regulations of care (Scotland) act 2001. There are 5 flats with 5 rooms in each with 2 bathrooms and a communal kitchen/dining area. The service users are all different with various problems within their own lives there are there are many different nationalities within the project. ‘We provide the accommodation to meet your personal and support needs. ” Placement handbook page 22 Each flat has 2 keywords assigned and they are responsible for the service users within their flat.

The service users can talk to any of the staff within the Project at any time. There is a minimum of 2 staff present at any time 24 hours per day 7 days per week.. My role within he unit is to assist the service users with various different aspects of daily life I. E. Making sure that the service users sign on go to any appointments that is required of them I. E. Doctors, Nurse and if they have to attend any other agencies they require. I am also required to do flat and welfare checks which is carried out on an hourly basis to make sure all service users are k.

If there are any outings within the unit I am required to go along to assist the service users, also sort any mail that comes in and put it into the correct file for each service user and any general duties that is asked of me. I am also out at service users who are living in the outreach flats to talk to them about where they are wanting to do for their future, help with independent living skills also help with services users gain access to mental health services and alcohol and drug addiction services.

Service users might also need the assistance of a sexual clinic in which we will put them in contact with. Some service users want to go to college or enroll in projects which could be to do outdoor work, or working in voluntarily organizations. At the start of each day will read both the communications book and log book. This tells me hat has happened within the project since have last been in and if there is anything which is of great importance to watch out for. The project also has an outreach programmer which helps to house the service users within their own tenancy with the council.

At present I have been assigned to helping within the outreach programmer. The outreach workers help the service users when out in the community, I am helping service users with budgeting of money and any problems they might have with both in the tenancy and there personal life I have also been involved with service users moving into the outreach flats and when ready to move onto their own tenancy, in extreme circumstances the evicting of service users from the outreach flats.

Risk Assessments and reviews can change very quickly and these must be kept up to date at all times these are filled out on paper and onto computer, copies are kept in service users file which is kept in a locked filing cabinet with only the staff having access to these. When service users are moving on to the outreach flats their file is passed on to the staff there and they will then have a chat to the service user to see if the Risk Assessment is accurate and if any changes are needing to be made.

The service user whom am going to discuss is male aged 24 years and at present has moved from the project unit into 1 of the outreach flats and for the purpose Of confidentiality and the Data Protection Act 1 998 1 am going to call him Barry “Bag” Bag has been in the care system since he was a young child, he has 4 sisters 2 of which are older and 2 younger he also has 2 brothers 1 older and 1 younger. His mother has had mental issues over the years,. Due to this his 2 younger sisters were taken into care and eventually been adopted to another family out with his own family.

The family were in poverty due to his mother Ewing dependent on alcohol and drugs such as Amphetamines and Cannabis. “Downtrend’s definition, poverty of income does not stand alone but is attached to a network of lost resources, activities and opportunities the experience of being less equal. ” HEN in Social Care page 128. His younger brother at present is in prison, he is due to be released in a few months. Bag has 2 sons of his own aged 3 & 4 years old but at present has no contact with them due to a breakdown in the relationship with their mother. Bag is hoping to be in contact with his 2 sons in the future.

Bass’s mother is also in a omelets unit and under medication for mental health problems, this has been ongoing for a number of years. Bag has had own tenancy in the past, he lost the tenancy when he was incarcerated for 6 months due to him hitting a police car with a foreign object. He lost the tenancy due to no one living there and was declared abandoned. When Bag was released he turned to drink and drugs to cope. This is when Bag became homeless and lost all contact with his sons and siblings. He was “Sofa Surfing” for a number of months with friends or family, before arriving at the Project.

Conflict perspective could be linked to Bag as he is competing o keep his tenancy but because he was in jail this could not happen “According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others. ” Bag*s care plan has been quite complex as he has depression and is on medication on a daily bases, he also finds it hard to sleep at times which his medication helps with. Bag regularly attends his GAP and has been in contact with a CAP in the past for 8 months, also on Bass’s care plan is about his past drinking and the taking of drugs. A care plan is an action plan in working with service users. As plans are written down and shared with users, they emphasis the contractual nature of the service provided. ” Care in Practice for Higher page 253. The aim of producing care plans within my placement is to promote independence and help service users realist the potential in which they have, and help move on to gain their own tenancy with the council and to help promote their independent living. The care plans are achieved through communication with the service users. A warm, mutually satisfying relationship with clients is built on the foundation of good listening and talking. ” Care Practice for S/NV 3 page 95. Through care planning all individuals are treated with privacy, dignity and choice and agree on goals which are realistic to each service user. All service users have different needs and beliefs and these are recognized through the care plans made and regularly updated if any changes arise. The service users are referred to the project with their needs and a brief explanation of their background along with any other needs they might have.

The service user is then invited along too pre assessment interview and if required an interpreter will be called in to translate to anyone who might need it. The support workers within the reject explain about the accommodation that is offered and if everyone is happy with this then the tenancy will begin on a set date agreed on with both staff and service user. A file is then created with all the relevant information which is agreed by both parties. The service user will be assigned a flat and room which has 2 keywords attached to it.

The service user will then be told when their keynoters will next be on shift to meet them and arrange their first key work with the keynoter who will work with each service user within their “flat” to build up a relationship with and will at all times respect heir privacy, confidentiality, dignity and beliefs. At the time of filling out the forms each service user is asked to read over and sign their tenancy agreement accordingly in line with “The Housing Scotland Act 2001” this will safe guard both workers and service user.

The staff within the project all hold an HEN is Social Care or Q.V. level 3, some of the staff hold other qualifications all within the care sector 1 has a degree in alcohol and substance abuse and another is a qualified nurse which can be quite helpful as if anyone falls ill they can help until the ambulance or doctor arrives. The knowledge and skills which they have contribute to achieving the best possible care plan associated to each service user. “Communication is defined as the imparting conveying, or exchange of ideas, knowledge etc. ” Care in practice for higher.

As long as the service user is feeling comfortable and in a relaxed setting away from other service users and staff they will feel comfortable and open up. Good eye contact and body language is a must as well as the way the seating is arranged. Verbal communication should be in a relaxed manner and environment between the service user and support worker. Once all the information has been taken the staff member will type up the information that was discussed to ensure the care plan is accurate this is to avoid any misunderstandings which might have arose during discussion.

When both the serviced user and staff member is happy with the care plan this will be signed by both staff member and service user and put in the service users file and locked in filing cabinet as stated by the Data Protection Act (1998) The service user could be involved with other outside agencies which will have to be contacted in order to make sure that the service users re receiving the best possible care for their specific needs and continuity is achieved.

Review meetings are also held and all relevant workers from project and outside agencies are invited along the service user is informed in advance about the meeting and if they require to have someone present they can. At times the keyword will access various agencies in which the service user is interested in such as voluntary organizations to help with work experience, college courses or with their C.V. to help apply for jobs. The project also has a Bridging Team who come in weekly with helping service users with innumeracy ND literacy skills.

The project also has a group which meets twice a week to help with reading skills and teamwork, they will do cooking exercises, shopping trips and various other group activities which the service users would like to address. At the centre of good practice is Anti-Discriminatory practice as this is a positive way to help staff examine their own values and practice. ” Anti- Discriminatory Practice is not about treating everyone the same its about recognizing the differences, negotiating with service users how best to meet their needs, assert their rights and challenge the inequalities they face.

Care in practice for higher page 57. There is training with the company that examines Ant-Discriminatory practice within the workplace “Equality & Diversity” 1 day training. At the project they implement Anti-Discriminatory practice can be implemented within the care planning by promoting independence, maintain dignity, valuing others and their opinions and respecting beliefs in all. Miller states “A care worker is someone who respects you as a person someone you will trust who will be honest with you. Forming and nourishing a caring relationship is the most effective immunization between a service user and a support worker, if the care workers don’t have this then there will be no mutual respect and the service user wont open up to the support worker. In return the needs of the service user wont be met. When communicating with service users we must show the willingness to help and what the support workers role is and to help them understand that we want to guide them and achieve their goals. If a service user speaks in another language an interpreter will be called in to help translate.

Any care plans and forms that the service user will need to read an be brought into the project or using a translator app on the computer Listening to the service user is also a big part within the project. The staff must listen to the service user carefully and respond to them and if needs action then they need for this to happen. Everyone must be listened to and spoken to age appropriately and not spoken at. To establish and maintain an accurate care plan the service user must be consulted at all times as they are the one that knows themselves the best.

Bag meets the outreach staff on a weekly bases at his flat as its more private their for him to talk to the support worker. Bag also attends a programmer called Venture Scotland 2 days per week the programmer offers young people a structured 12 month programmer of adventure, conservation and personal development activities. This will help Bag with making positive relationships and team work. The staff their will also have 1 to Xi’s with Bag and if the staff at Venture Scotland then they will contact Bass’s support worker at the project with Bass’s permission.

If the support worker feels it’s relevant they will discuss this with Bag and reassess his care plan. Person centered planning is a process for continual listening and learning, sousing on what is important to someone now and in the future, and acting upon this in alliance with their family and friends. Bass’s situation is that he was estranged from his family, slowly he is starting to integrate with his 2 older sisters, his mother and 1 of his older brothers. Bag has had drink and drug issues in the past he has got mental health problems and at time has anxiety attacks.

I would apply Erosion’s psychosocial theory as one of the main elements of Erosion’s psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others. “Hope is both the earliest and the most indispensable virtue inherent in the state of being alive. If life has to be sustained hope must remain, even where confidence is wounded, trust impaired HEN Social Care page 78.

The homeless unit is important to the homeless as it’s a place they can start to call home and for many this could be the 1st place they have ever called home or for a very long time. The service will help the service users to live within society as independently as they can. We will work as a team to set out the goals and objectives that are specific to each service user, we will provide them with the correct tools which they require to live within their own life in the community.

The goals and objectives will continue to be re-evaluated as the person grows or if they have relapse or any other issues they require help with arises. The main objective of gaining a tenancy of their own is always achieved, however some service users need a longer time to gain their tenancy and to move on. This is where the support worker comes in and helps the service user to overcome to gain the tenancy they require. Bag was in the project for 3 months before he moved onto the outreach flat.

He has settled into the flat fine but is still needing some help from the support workers within the outreach team. Bag isn’t ready to gain his own tenancy yet as he feels it would be to much to handle at the moment. He is hoping to be over his fears within the next 6 months, by this time he is also hoping to be in contact with his 2 children by then. The project is to help others who are unfortunate to find themselves homeless and the staffs purpose or goal is to help each service user with the issues they have about their life.