UNIVERSITY OF THE SOUTHERN CARIBBEANP.O. BOX 175, PORT-OF-SPAINTRINIDAD AND TOBAGOAssignment 6.2Instructor: Mr. Val TobiasCOURSE: NURS331CRITICAL THINKING & DECISION MAKING (CTDM) By:Members of Group two (2)Compilation of group assignmentsGroup members include:1.Cornibert, Kelly-Ann (Group leader)2. Dyett-Crooks,Leah3. Dubay- Ramrattan, Jaya4. Deterville, Eliah5. Dumar, Jacqueline6.Rachael, Constantine
Group workDecide on a topic of interest among group members. Applying the ‗ten (10) Steps to Teaching Others‘ from the reading for this unit,in Alfaro-LeFevre‘s book, develop a teaching plan.Topic of interest:Stress management in amongst registered nurses at the Victoria Hospital.Expected outcomes:At the end of this teaching plan workers will be able to:1) Define stress.2) Identify factors which may influence stress at the work place.3) Identify signs and symptoms of work related stress.4) Identify strategies to deal with the stress factors identified.5) Identify coping mechanisms to deal with work related stress• Assess patient‘s knowledge of stress management by utilizing the following questions:o What do you know about stress and its management among nurses?
o What have you been told about stress management in nursing?o How have you managed stress in the past?o What stress management strategies have you utilized recently to help relieve your WRS?o How will you say you manifest WR stress?o In your estimation, what do you consider as the triggers?o What situation triggers your greatest stress levels?o Of all the coping measures you have tried, which one seems to be the best to relieve your stress?o You have c/o WRS, how is it affecting you and your family?o When highly stressed, and in your attempt to cope with stress, are there attending problems that you have difficultyhandling?This assists in understanding the nurse‘s areas that are of greatest concerns to be identified and addressed.
o Question the learner‘s preferred learning styles. The method by which the learner prefers to be taught is evaluated itmay be doing, observing, listening or reading. Ask the nurse the following questions, these questions have beenadopted from the AHEC Clear Health Communication Program, Ohio State University(2007): What‘s your preferred method of learning? For example, Reading? Listening? Doing? Reflect on the last time that you learned a new skill, operated new equipment, or learnt a new hobby). Inwhat way did you learn it? What was the best way for you? Observe and note if the nurse explain things in intellectual or tangible terms.o Identify barriers to learning: Are there any problems that would prevent you from learning at this time? (within one, two, four weeks, etc)(Lieb, 1991). Do you think that the stipulated time for the teaching session is sufficient facilitate a comprehensiveunderstanding of stress management? (Lieb, 1991). Are you confident enough to implement the various strategies taught to cope with stressful situations in yourlife (Lieb, 1991)? Do you have sufficient information about opportunities to learn about stress management to make changes inyour life (Lieb, 1991)?
Do you experience scheduling problems when using stress management techniques (Lieb, 1991)? Do you lack of motivation to utilize effective stress management techniques (Lieb, 1991)? Are there institutional policies that hinder you from utilizing effective stress management techniques (Lieb,1991)?Ensure that the learner is encouraged to engage in the teaching session: Please feel comfortable to ask questions, seekclarifications on all information about stress management that is being offered. Also this teaching session continuously centerson your preferred stressful areas thus appropriate stress management techniques will be discussed with you.Provide supportEveryone experiences factors which contribute to stress at the work place, you can now identify them and we will discuss waysto manage stressful situations. Here are some coping mechanisms for stressful situations according to the Mayo Clinic (2013): Scale back. Reduce on your obligations when probable. Evaluate your daily, weekly and monthly schedule and findmeetings, activities, dinners or chores that you can cut back on or delegate to someone else. Prepare. Prepare for meetings or trips, scheduling your time better, and setting realistic goals for tasks both big andsmall in advance to reduce stress. An unaccounted situation causes stress to build up. Reach out. Make or renew connections with others. Surrounding yourself with supportive family, friends, co-workers,or clergy and God fearing spiritual persons have a major positive effect on your mental well-being and your ability to
cope with stress. Go to church services as the assembling together is good for your spiritual and mental wellbeing andvolunteer your services in your church and community. Take up a hobby. The time spent engaging in enjoyable activities soothes and calms your restless mind. Attemptexploring nature, sewing, reading, gardening, crafts, tinkering with electronics, fishing, carpentry, music — things thatyou dont get competitive or more stressed out about. Relax. Physical activity, meditation, yoga, massage and other relaxation techniques can help you manage stress. Thegoal here is to center your attention on calming and relaxing your mind and body thus freeing your thoughts fromstressful thoughts. Get enough sleep. Your immune system is weakened when it does not receive sufficient sleep thus you feel moreirritable and less focused. Most people need seven to eight hours of sleep a day. Get professional help. If whatever method(s) you have deemed appropriate to reduce your stress levels does notalleviate it, consult your doctor for appropriate referrals. Chronic, uncontrolled stress can lead to a variety of potentiallyserious health problems, including depression and pain.Conducive environmentThe teaching session will take place in the nurse‘s lounge at 10:00am on Monday 20thMay, 2013. This location is conducive,as it is located in a quiet area of the hospital. The time chosen is convenient for persons coming from home and those whoworked the night shift which ended at 7am, where they are able to rest before attending the teaching session, allowing the
learners to be comfortable and rested. However if persons are not able to attend the session at the abovementioned timedifferent more appropriate arrangements can be made. There will be two (2) booths in the conference rooms to complete thesession before the teaching commences.IllustrationsIn the teaching session, there will be use of two assessment tests, diagrams, discussions through use of scenarios, pamphletsand simulations and this will enhance comprehension as we cater for all individuals present who learn through theory andvisual aids.Mental imagesVarious comparisons and representations are utilized to explain terms, concepts, prescribed regimens to the learner. Individualsunderstand concepts more clearly when they are taught using terms, words, situations that are personalized to their everydayexperiences.TriggersFor increased compliance, remembering and understanding of the concepts being taught it is effective to utilize words thatpersons are familiar with.Keep it simple
The information provided during the teaching session will be given in simple terms for the benefits of every individualunderstanding.Learners responsesLearners are given time to ask questions to clarify misconceptions during the teaching session.SummaryA summary of all key points in the teaching plan will be repeated. A handout will be given to allow learners to review andrefresh their memory.Topic: Stress management in the work environmentDate and time: 20thMay, 2013, 10AMLocation: Nurses lounge, Victoria HospitalObjectives / expectedoutcomesData / Information provided to learners Aids used forillustrationEvaluation1) By the end of 15- 20 minuteslearners will beAccording to Davis (2001), stress is any physical,physiological or psychological force that disturbs the body‘sequilibrium.Factors that influence stress includes:At the beginningof teachingsession, learnersBy the end of 20minutes learnersdefine stress as events
able to definestress andidentify factorswhich mayinfluence stressat the workplace.Being OverworkedMost obvious stress factor where one has too much work todo, insufficient time to perform it (Aynilists, 2013).Being UnderworkedAn individual don‘t wants to be caught doing nothing andbeing paid on the company‘s time. This is particularly hard ifyou have no control over your workflow (Aynilists, 2013).Job SecurityLayoffs are made with little hiring. Not having job securitycan be seriously magnified (Aynilists, 2013).ProgressionNo one wants to remain in the same position, on the same payfor an extended period of time, but many careers are currentlystifled by a market where little hiring or promotion is beingdone. Even though you may have a job, not being able to getto your next level can make you feel bored and trapped, whichcan be stressful (Aynilists, 2013).Having the Wrong JobHaving a job that you have insufficient skills or experience tohandle, you‘re going to feel like you‘re sinking. When youcan‘t ask for training or help because you don‘t want to admityou‘re not right for it, the stress increases (Aynilists, 2013).will be givenhandout ―WHEREARE YOU NOW‖for assessment andquestioning.A Skit acted outby presenterswhich indentifiedthe different stressfactors in whichthe learners had tospot / identifythem from the skitand personalexperiences.which lead tonegative effects onone‘s body. Thelearners identifydifferent stressfactors, namely:Job securityBeingoverworkedBeingstagnant, notbeingpromotedPoor workenvironmentPoor
Blame cultureIn the workplace people adapt to cultures, if someone cannotconfess to errors there are implausible to progress and learn.If no one can acknowledge the error, blaming becomescommon, producing an environment of fear and lack of trustthat is actually stressful to deal with in the workplace in everyday basis. (Aynilists, 2013).Bad ManagementA lack of strong and effective management can leave a teamdirectionless, and individuals in a state of disorganizedconfusion that is very stressful. Conversely, over-managementand micromanagement are claustrophobically stressful foremployees and leave no room for creativity or growth(Aynilists, 2013).Bullying by co-workersUnfortunately, workplaces can bear a striking similarity toplaygrounds when the pressure is on and bullying by acolleague or manager can make life very difficult taking theirproblems and worries out on their team or colleagues(Aynilists, 2013).No Support NetworkmanagementGenerally the learnersvoiced that having asubstantial amount ofwork with little timeto complete it is oneof the most stressfulfactors in the workenvironment.
Workplaces with weak, or non-existent, human resourcesstructures, and a lack of proper procedures for makingcomplaints or dealing with problems, mean that employees areleft to handle situations on their own. This can cause a hugeamount of stress and a sense of fear and isolation (Aynilists,2013).Poor Working EnvironmentCompanies may not have procedures in place for regularhealth and safety. Poor work environment would consist ofold or broken equipment, poor lighting, uncomfortablefurniture, excessively high levels of noise can make for anextremely stressful working environment (Aynilists, 2013).2) By the end of10-15 minuteslearns willidentify signsand symptomsof work relatedstress.An individual who is experiencing work related stress mayexperience the following:Feelings of anxiety, irritability, depression, loss ofinterest at work, insomnia (inability to sleep), troubleconcentrating, social withdrawal, loss of sex drive, useof alcohol or drugs to cope with stress factors (Segal,Smith & Robinson, 2012).Active discussionbetween learnersand presenters.By the end of 5minutes learnersidentify the followingsigns of work relatedstress:Anxiety, depression,use if alcohol anddrugs.
3) By the end of 10minutes learnerswill identifystrategies todeal with thestress factorsidentifiedEscapeRemove self physically and mentally from the stressfulsituation. This can be done by: going for a walk, listening tomusic, meditation (Stress Management Workshop Handout).Physical relaxationThis will assist in decreasing cortisol levels which leads tostress, increasing confidence. This can be accomplished by:jogging, yoga, sporting activities, dancing, swimming (StressManagement Workshop Handout).Self careTo increase energy levels one should care for self. This isdone through adequate sleep, balanced diet, drinking sufficientwater, reduce intake of caffeine, sugary foods, alcohol,nicotine, recreational drugs (Stress Management WorkshopHandout).Use of pictures(see below).Handouts given atend of teachingsession. Multisessions may beneeded, andscheduled at theend of thisteaching session.By the end of 10minutes the learnersidentify the followingas ways to deal withthe stress factorsidentified earlier:escape, physicalrelaxation, self care,time management,having a supportnetwork. Somevoiced that havingparticipating in theseactivities occasionallywill act asprophylaxis to stress
Time managementMuch pressure is caused by feeling you have too manydemands and too little time. Sometimes individualsprocrastinate. This can be reduced if individuals prioritize, donot procrastinate, and do not cut out sleep. Cut down on socialtime when necessary, during long periods of work take a 5minute break and move around (Stress ManagementWorkshop Handout).Build a support networkFind individuals and support groups where you can talk tovent (Stress Management Workshop Handout).management.Near the end ofteaching a summaryof the valid pointswill be re-enforced.Learners will beasked questions toevaluate theirunderstanding andamount ofinformation retained.A handout will begiven to learners atthe end of teaching
session to allow forreview and to refreshmemory
Diagrams used to illustrate strategies for stress management.
References:Aynilists, (2013) Top 10 causes of stress in the work place retrieved on 18/05/2013 fromhttp://allyouneedislists.com/world-business/online-business/top-10-causes-of-stress-in-the-workplace/Davis, F.A. (2001), Taber‘s Cyclopedic Medical Dictionary (20thed) F.A. Davis Company, Philadelphia, PA19103.How can you manage stress diagram retrieved on 18/05/2013 from http://stressmanage.net/wp-content/uploads/2012/08/Stress-Management.jpgLieb, S. (1991) Adult learning principles. Retrieved May 31, 2013, fromhttp://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm.Ohio State University,(2007); Clear health communication program Retrieved May 31, 2013, fromhttp://medicine.osu.edu/sitetool/sites/pdfs/ahecpublic/Learning_Assessment.pdfSegal, J., Smith, M., Robinson, L., & Segal, R., (2012) stress at work retrieved on 18/05/2013 fromhttp://www.helpguide.org/mental/work_stress_management.htmStudent Counseling Service, Stress Management Workshop Handout retrieved on 18/05/2013 fromhttp://www2.lse.ac.uk/intranet/students/supportServices/Handout.pdfStress management diagram retrieved on 18/05/2013 from http://stressmanage.net/wp-content/uploads/2012/08/Stress-Management-Tips.jpgASSIGNMENT 5.1DEVELOPING A CTDM BUILDING BLOCK 3
Assignment 5.1Use the same grouping that was used for the group assignment in Unit 4 to complete this assignment. Choose one of the decisionmaking models and processes that were found in your reading. By following the steps of the model or process, show how you willensure that the staff on the ward where you work comply with the directive given by the Nursing Administrator to have the nursingprocess (patient classification, work load index, and nursing care plan) implemented and maintained in the hospital.The Model chosen by the group is the DECIDE Model. This Model aids health care managers in making more quality decisions.Decisions that will in due course, result in success in the clinical setting (Guo, 2008).According to Guo, (2008), the DECIDE model is the acronym of 6 particular activities needed in the decision-making process, whichincludes:(1) D = Define the problem,(2) E = Establish the criteria,(3) C = Consider all the alternatives,
(4) I = Identify the best alternative,(5) D = Develop and implement a plan of action,(6) E = Evaluate and monitor the solution and feedback when necessary.Define the problem:Based on the situation given, the Nurses are not using the Nursing Process (patient classification, work load index, and nursing careplan) to administer care. The problem stems from the Registered Nurses not complying with the Nursing Administrator willingness toincorporate the use of the Nursing Process in the patient‘s care. It is important that the nursing process be utilized for superior qualityof care to be administered. If the Nursing Process is used, the care provider would have enhanced patient outcome, meet the patient‘sneeds holistically, improve their job satisfaction (Clement, 2007).Establish the criteriaUtilization of the Nursing Process would;Enhanced patients care outcome (Clement, 2007).Any RN can follow up patient care (Clement, 2007).Meets the needs of the patient, family and community (Clement, 2007)
Creates opportunities for patients to be directly involved in their care (Clement, 2007)It provides job satisfaction for nurses, by allowing nurses to determine what interventions based on accurate identification ofthe patients problems, hence preventing trial and error nursing. (Clement, 2007)In having the staff utilize to nursing process in administering care, the quality of care administered to the patient is preserved andachieved with this decision, therefore avoiding the inability to meet patients needs, job dissatisfaction for nurses (clement, 2007). Theeffective use and implementation of the nursing process in health care delivery would ensure quality patient care across the life span.C- Consider all the alternativesHold a ward meeting, asking the staff for their opinions, on how to achieve the goal of having nursing staff utilize the Nursing Processin providing care.Alternatives to meet the criteria above include:Delegating staff to be responsible for the patient classification.Use and ensure the nurse to patient ratio, according to patient classification (AACCN, 2013)Hire more staff to facilitate nurse – patient ratio.Train staff through workshops, on how to use the Nursing Process and it benefits.
Motivate staff by recognizing them at staff meetings for good performance, give good appraisals when deserved.Use of the Nursing Process.Creation of suggestion boxes on various unitsEngage nursing staff in weekly self reflection exercises and collegial dialogue on their experiences with the implementation ofthe nursing process.Formulate or revise admission forms to include forms for proper documentation of nursing care plans.Use Maslow‘s hierarchy of needs to fulfill this goal allowing optimal patient care.Use of most alternatives stated above should allow the use of the nursing process by Registered Nurses as an instrument used toprovide optimal care. Getting the staff actively involved will avoid staff resistance to the decision or change.I - Identify the best alternatives.At this phase the alternatives gained from the previous phase are reflected on, and the best are identified to be utilized. The bestalternative can be obtained through analyzing past experiences, intuition and research evidence (Guo, 2008)."An alternative that satisfies all the criteria gets the highest rating (ie, a rating of a 10) and becomes the best alternative. Thisapproach, known as maximizing, develops the one best solution by comparing all the alternatives against all the criteria until one
solution emerges. The maximizing method leads to the one best solution, which is the only acceptable one" (Guo, 2008, (I = identifythe best alternative), para. 4).The best alternative would include:Training staff through workshops, on how to use the Nursing Process and it benefits towards quality patient care.D- Develop and implement a plan of action.Having workshops to train staff will require resources including personnel to do the training, a physical structure, equipments, cost.The workshop will be held on the 8thJune, 2013 at 9am, in the Staff Lounge at the Victoria Hospital. The workshop will include whatis required of the manager and staff, the importance and benefits of using the nursing process as an instrument when providing care.Goals such as by the end of one week, the manager will see improvement with the use of the nursing process and patient care will beinstituted. At the end of the week the manager reviews the notes to assess nursing care plan. A schedule will be made assigning staffmembers days in which to do the patient classification, in order to determine the nursing resources needed to administer quality
nursing care. The manager is to ensure that this is done. These workshops will be held biannually to ensure staff stays on par and theutilization of the nursing process as an instrument of care is maintained.E- Evaluate and monitor the solution.At this phase the plan is analyzed for defects. A meeting is held with staff who will voice concerns, queries and gains about thechange. Staff voice not having adequate time to do care plans due to the amount of work or number of patients providing carefor. Nursing care outcomes is evaluated through the use of data acquision (patient satisfaction tool, given to patients on discharge torate the care received), and questioning of inconsistencies allowing for revision of actions and goals.In conclusion, decision making requires skills, knowledge, experience and understanding. The decision-making process and modelintends to assist managers improve their decision making to result in more effective decisions and become better equipped to act invarious situations that require decisions to be made. The DECIDE model is used in this scenario to help the manager make aninformed decision, with the assistance of staff, which will promote cooperation and implementation of the change. Monthly themanager will monitor and evaluate the implementation of plan, whether principles are being followed, quality of care improved andjob satisfaction among staff is obtained, making the relevant changes where necessary (Guo, 2008).
ReferencesAmerican Association of Critical Care Nurses (2013), retrieved on 7/6/2013 from http://www.aacn.org/wd/practice/content/nurse-staffing-ratio.pcms?menu=Clement, I. (2007). Basic concepts on nursing procedures. Jaypee Brothers Publishers.Guo, L., (2008); DECIDE: A decision making model for more effective decisions making by health care managers. The health caremanagers, Volume 27 Number 2, p.118-127.