Developing a culture of safety is a core element of many efforts to
improve patient safety and care quality. This systematic review
identifies and assesses interventions used to promote safety culture
or climate in acute care settings. The authors searched MEDLINE,
CINAHL, PsycINFO, Cochrane, and EMBASE to identify relevant
English-language studies published from January 2000 to October
2012. They selected studies that targeted health care workers practicing
in inpatient settings and included data about change in patient
safety culture or climate after a targeted intervention. Two
raters independently screened 3679 abstracts (which yielded 33
eligible studies in 35 articles), extracted study data, and rated study
quality and strength of evidence. Eight studies included executive
walk rounds or interdisciplinary rounds; 8 evaluated multicomponent,
unit-based interventions; and 20 included team training or
communication initiatives. Twenty-nine studies reported some improvement
in safety culture or patient outcomes, but measured
outcomes were highly heterogeneous. Strength of evidence was
low, and most studies were pre–post evaluations of low to moderate
quality. Within these limits, evidence suggests that interventions
can improve perceptions of safety culture and potentially
reduce patient harm.
Ann Intern Med. 2013;158:369-374. www.annals.org
For author affiliations, see end of text.
THE PROBLEM
Developing a culture of safety is a core element of
many efforts to improve patient safety and care quality in
acute care settings (1, 2). Several studies show that safety
culture and the related concept of safety climate are related
to such clinician behaviors as error reporting (3), reductions
in adverse events (4, 5), and reduced mortality (6, 7).
Accreditation bodies identify leadership standards for
safety culture measurement and improvement (8), and promoting
a culture of safety is a designated National Patient
Safety Foundation Safe Practice (9). A search of the Agency
for Healthcare Research and Quality (AHRQ) Patient
Safety Net (www.psnet.ahrq.gov) yields more than 5665
articles, tips, and fact sheets related to improving safety
culture. Although much work has focused on promoting a
culture of safety, understanding which approaches are most
effective and the implementation factors that may influence
effectiveness are critical to achieving meaningful improvement
(10).
Drawing on the social, organizational, and safety sciences,
patient safety culture can be defined as 1 aspect of an
organization’s culture (11, 12). Specifically, it can be personified
by the shared values, beliefs, norms, and procedures
related to patient safety among members of an organization,
unit, or team (13, 14). It influences clinician and
staff behaviors, attitudes, and cognitions on the job by
providing cues about the relative priority of patient safety
compared with other goals (for example, throughput or
efficiency) (11). Culture also shapes clinician and staff perce.
Unit III Annotated BibliographyUsing the CSU Online Library, cho.docxmarilucorr
Unit III Annotated Bibliography
Using the CSU Online Library, choose at least five articles—two of which must be professional, peer-reviewed journal articles—on the effects of accidents on individuals and the importance of safety and health training (including refresher training). After a careful review of these articles, write an annotated bibliography in proper APA format. The annotated bibliography must be around three pages in length.
The CSU Success Center offers a great resource regarding annotated bibliographies. The webinar below is designed to walk you through the process of creating an annotated bibliography. Topics covered will include selecting proper sources, highlighting key points, and summarizing contents of the source.
Annotated Bibliographies:
https://columbiasouthern.adobeconnect.com/_a1174888831/annotatedbib/
Information about accessing the grading rubric for this assignment is provided below.
Relative Effectiveness of Worker Safety and
Health Training Methods
Michael J. Burke, PhD, Sue Ann Sarpy, PhD, Kristin Smith-Crowe, PhD, Suzanne Chan-Serafin, BA, Rommei 0. Salvador, iVIBA, and Gazi Islam, BA
An understanding of how best to implement
worker safety and health training is a critical
public need in light of the tragic events of
September 11, 2001, as well as ongoing ef-
forts to prepare emergency responders and
professionals in related areas to do their jobs
safely and effectively.' The need to gain a
better understanding of the effectiveness of
safety and health training is also apparent in
a broader context given that millions of in-
juries and illnesses are reported annually in
private industry workplaces,^ and health and
safety training is globally recognized as 1
means of reducing the costs assodated with
such events."* Indeed, researchers from differ-
ent fields, including business, psychology, en-
gineering, and public health, have long recog-
nized the need for comprehensive, systematic
evaluations of safety and health training to
address these types of critical public- and
private-sector concerns.''"^
The conclusion from several narrative re-
views has been that most training interven-
tions lead to positive effects on safety knowl-
edge, adoption of safe work behaviors and
practices, and safety and health outcomes.̂ '*'̂
However, these qucditative reviews are specu-
lative as to the specific factors that enhance
the relative effectiveness of safety and health
trsiining interventions in reducing or prevent-
ing worker injury or illness.'°~'^ Notably, a
fundamental question remains unresolved
within the scientific literature: What is the
relative effectiveness of different methods of
safety and health tniining in modifying safety-
related knowledge, behavior, and outcomes?
Attempts to address similar broad-based
questions related to the benefits of work-
related health and safety interventions'^ have
revealed the need for a large-scale, quantita-
tive analysis of the extant literature. Results
from such a ...
Control Mechanisms in Health Services Organizations Analysis.docxstudywriters
Control mechanisms in healthcare organizations help administrators direct resources and identify opportunities for improvement. Understanding how to interpret and modify control mechanisms is an essential skill for administrators. A discussion post should select a control mechanism, like checklists or teamwork, and explain how it could promote a safety culture by preventing errors at a specific healthcare organization. As an administrator, the control mechanism would be applied, like using checklists, to continuously improve safety over time through learning from past issues.
This document discusses implementation strategies for improving healthcare practices. It defines implementation strategies as methods used to promote the adoption of clinical programs. Effective strategies include assessing current performance, analyzing barriers and facilitators, developing an implementation plan, and continuous evaluation. Common strategies discussed include audit and feedback, educational outreach, reminders, and financial incentives. The document notes that no single strategy is clearly most effective and that tailoring strategies to the local context is important. It also introduces several tools for assessing the context, such as the COACH framework which examines multiple dimensions like work culture, leadership, and resources.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxspoonerneddy
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxmccormicknadine86
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that ...
The document discusses patient safety culture and climate. It defines safety culture as the shared values and behaviors regarding safety in an organization. Safety climate refers to perceptions of safety at a point in time and is measurable. The document outlines tools for assessing safety culture, including the AHRQ Hospital Survey on Patient Safety Culture, which measures 12 dimensions of safety culture. It provides guidance on using the survey results to identify strengths and areas for improvement to enhance patient safety.
The document discusses definitions and concepts related to quality, safety, and outcomes in healthcare. It defines key terms like quality, indicators, benchmarking, and outlines the Institute of Medicine's aims for quality improvement which are to be safe, effective, patient-centered, timely, efficient, and equitable. It also discusses measuring outcomes, identifying different types of outcome indicators, the process of outcomes management, and different types of research related to outcomes like outcomes research, comparative effectiveness research, and nursing outcomes research.
This document provides resources and instructions for conducting a root cause analysis of a medical error or safety issue related to medication administration. Students are asked to choose a safety concern from a previous assessment or personal experience and analyze the root cause. They then develop a safety improvement plan using best practices and existing organizational resources. The goal is to demonstrate understanding of root cause analysis and developing plans to improve patient safety regarding medication administration.
Unit III Annotated BibliographyUsing the CSU Online Library, cho.docxmarilucorr
Unit III Annotated Bibliography
Using the CSU Online Library, choose at least five articles—two of which must be professional, peer-reviewed journal articles—on the effects of accidents on individuals and the importance of safety and health training (including refresher training). After a careful review of these articles, write an annotated bibliography in proper APA format. The annotated bibliography must be around three pages in length.
The CSU Success Center offers a great resource regarding annotated bibliographies. The webinar below is designed to walk you through the process of creating an annotated bibliography. Topics covered will include selecting proper sources, highlighting key points, and summarizing contents of the source.
Annotated Bibliographies:
https://columbiasouthern.adobeconnect.com/_a1174888831/annotatedbib/
Information about accessing the grading rubric for this assignment is provided below.
Relative Effectiveness of Worker Safety and
Health Training Methods
Michael J. Burke, PhD, Sue Ann Sarpy, PhD, Kristin Smith-Crowe, PhD, Suzanne Chan-Serafin, BA, Rommei 0. Salvador, iVIBA, and Gazi Islam, BA
An understanding of how best to implement
worker safety and health training is a critical
public need in light of the tragic events of
September 11, 2001, as well as ongoing ef-
forts to prepare emergency responders and
professionals in related areas to do their jobs
safely and effectively.' The need to gain a
better understanding of the effectiveness of
safety and health training is also apparent in
a broader context given that millions of in-
juries and illnesses are reported annually in
private industry workplaces,^ and health and
safety training is globally recognized as 1
means of reducing the costs assodated with
such events."* Indeed, researchers from differ-
ent fields, including business, psychology, en-
gineering, and public health, have long recog-
nized the need for comprehensive, systematic
evaluations of safety and health training to
address these types of critical public- and
private-sector concerns.''"^
The conclusion from several narrative re-
views has been that most training interven-
tions lead to positive effects on safety knowl-
edge, adoption of safe work behaviors and
practices, and safety and health outcomes.̂ '*'̂
However, these qucditative reviews are specu-
lative as to the specific factors that enhance
the relative effectiveness of safety and health
trsiining interventions in reducing or prevent-
ing worker injury or illness.'°~'^ Notably, a
fundamental question remains unresolved
within the scientific literature: What is the
relative effectiveness of different methods of
safety and health tniining in modifying safety-
related knowledge, behavior, and outcomes?
Attempts to address similar broad-based
questions related to the benefits of work-
related health and safety interventions'^ have
revealed the need for a large-scale, quantita-
tive analysis of the extant literature. Results
from such a ...
Control Mechanisms in Health Services Organizations Analysis.docxstudywriters
Control mechanisms in healthcare organizations help administrators direct resources and identify opportunities for improvement. Understanding how to interpret and modify control mechanisms is an essential skill for administrators. A discussion post should select a control mechanism, like checklists or teamwork, and explain how it could promote a safety culture by preventing errors at a specific healthcare organization. As an administrator, the control mechanism would be applied, like using checklists, to continuously improve safety over time through learning from past issues.
This document discusses implementation strategies for improving healthcare practices. It defines implementation strategies as methods used to promote the adoption of clinical programs. Effective strategies include assessing current performance, analyzing barriers and facilitators, developing an implementation plan, and continuous evaluation. Common strategies discussed include audit and feedback, educational outreach, reminders, and financial incentives. The document notes that no single strategy is clearly most effective and that tailoring strategies to the local context is important. It also introduces several tools for assessing the context, such as the COACH framework which examines multiple dimensions like work culture, leadership, and resources.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxspoonerneddy
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxmccormicknadine86
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that ...
The document discusses patient safety culture and climate. It defines safety culture as the shared values and behaviors regarding safety in an organization. Safety climate refers to perceptions of safety at a point in time and is measurable. The document outlines tools for assessing safety culture, including the AHRQ Hospital Survey on Patient Safety Culture, which measures 12 dimensions of safety culture. It provides guidance on using the survey results to identify strengths and areas for improvement to enhance patient safety.
The document discusses definitions and concepts related to quality, safety, and outcomes in healthcare. It defines key terms like quality, indicators, benchmarking, and outlines the Institute of Medicine's aims for quality improvement which are to be safe, effective, patient-centered, timely, efficient, and equitable. It also discusses measuring outcomes, identifying different types of outcome indicators, the process of outcomes management, and different types of research related to outcomes like outcomes research, comparative effectiveness research, and nursing outcomes research.
This document provides resources and instructions for conducting a root cause analysis of a medical error or safety issue related to medication administration. Students are asked to choose a safety concern from a previous assessment or personal experience and analyze the root cause. They then develop a safety improvement plan using best practices and existing organizational resources. The goal is to demonstrate understanding of root cause analysis and developing plans to improve patient safety regarding medication administration.
Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Pra...Marion Sills
Kwan BM, Sills MR, Graham D, Hamer MK, Fairclough DL, Hammermeister KE, Kaiser A, Diaz-Perez MJ, Schilling LM. Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Practice-Based Research Network. JABFM. In Press.
By administering assessments and analyzing the results, targeted aTawnaDelatorrejs
By administering assessments and analyzing the results, targeted and individualized interventions can be determined to best serve the needs of students with disabilities. The actual implementation of the interventions provides teachers opportunities to collect data and gauge the effectiveness of the interventions in addressing documented student needs. Teachers can also gain important skills and knowledge on how to best advocate for practical classroom interventions. Teachers will also be able to collaborate with colleagues and families in mentoring students to take ownership of learning strategies.
Allocate at least 2 hours in the field to support this field experience,
Part 1: Assessment and Interventions
Select at least one student to whom you will administer the informal RTI assessment created in Clinical Field Experience A. Score the assessment and share the results with the student to increase understanding of his or her strengths and areas for improvement.
Collaborate with the certified special education teacher and the student to develop 2-3 interventions based on the student assessment data to support the student’s progress in the classroom. In addition, detail one intervention that can be incorporated at home with family support.
Use any remaining field experience hours to assist the teacher in providing instruction and support to the class.
Part 2: Reflection
In 250-500 words, summarize and reflect upon the following:
· Describe each intervention, including teacher, student, and family roles, where applicable.
· Your experiences administering the assessment, analyzing the results, and providing the student feedback on his or her performance.
· Explain how you expect the interventions you developed to meet the needs of the student, incorporating his or her assessment results in your response.
· Explain how you will use your findings in your future professional practice.
APA format is not required, but solid academic writing is expected.
This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
6
Annotated Bibliography
Student’s Name
Course
Instructor’s name.
Institutional Affiliation
October 7, 2021.
Annotated Bibliography
Ali, H., Ibrahem, S. Z., Al Mudaf, B., Al Fadalah, T., Jamal, D., & El-Jardali, F. (2018). Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2960-x
The researchers conducted a cross-sectional study in 16 public hospitals in Kuwait using the Hospital Survey on Patient Safety Culture (HSOPSC). The study aimed to assess patient safety culture in public hospitals as perceived by hospital staff and relate the findings similar to regional and international ...
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
This document discusses the efforts of Partners HealthCare, a large integrated health care system, to develop a common patient safety strategy across their network.
Key elements of their approach include appointing a central Patient Safety Officer to coordinate efforts. This officer formed an Advisory Group of local experts and a Patient Safety Leaders Group of representatives from each institution. The Leaders Group meets monthly to coordinate projects and share results.
Early milestones include implementing executive leadership rounds to discuss safety, developing accountability principles, creating a common incident reporting system, and agreeing to implement computerized physician order entry across all hospitals. This work has increased awareness of patient safety issues within the network.
This study evaluated the association between leadership walkrounds (WRs) and caregiver assessments of patient safety climate and risk reduction across 49 hospitals. WRs involve hospital leaders visiting clinical units to openly discuss safety issues with staff. The study found that units where ≥60% of caregivers reported exposure to at least one WR had significantly higher safety climate scores, greater reported risk reduction, and more feedback on actions taken compared to units with <60% exposure. Higher rates of WR participation at the unit level were positively associated with more favorable caregiver assessments of patient safety culture and outcomes.
This document summarizes 27 grants funded by the Agency for Healthcare Research and Quality (AHRQ) through their Translating Research into Practice (TRIP) program in 1999-2000. The grants targeted a wide range of healthcare providers, settings, and patient populations. Most studies used a randomized controlled trial design. Common interventions included education, and about half aimed to reduce medical errors or use information technology. The TRIP projects encompassed diverse approaches to translating research evidence into practice to improve healthcare quality and outcomes.
RESEARCH ARTICLE Open AccessAn organizational perspective .docxronak56
RESEARCH ARTICLE Open Access
An organizational perspective on the long-
term sustainability of a nursing best
practice guidelines program: a case study
Andrea R. Fleiszer1*, Sonia E. Semenic1,2, Judith A. Ritchie1, Marie-Claire Richer1,2 and Jean-Louis Denis3
Abstract
Background: Many healthcare innovations are not sustained over the long term, wasting costly implementation
efforts and often desperately-needed initial improvements. Although there have been advances in knowledge
about innovation implementation, there has been considerably less attention focused on understanding what
happens following the early stages of change. Research is needed to determine how to improve the ‘staying
power’ of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in
nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was
sustained over a long-term period in an acute healthcare centre.
Methods: We conducted a qualitative descriptive case study to examine the program’s sustainability at the nursing
department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada.
The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three
BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following
program initiation through 14 key informant interviews, document reviews, and observations. We developed a
framework for the sustainability of healthcare innovations to guide data collection and content analysis.
Results: Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization,
and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These
factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing
program sustainability and characteristics of program sustainability accounted for how the program had been
sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership
actions and both institutionalization and development; and a reflection-and-course-correction strategy and
development.
Conclusions: Study findings indicate that the successful initial implementation of an organizational program does not
automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of
committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders
should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or
program benefits. The development of an organizational program may be necessary for its long-term survival.
Keywords: Sustainability, Program, Organizational change, Innovation, Cl ...
HS410 Unit 6 Quality Management - DiscussionDiscussionThi.docxAlysonDuongtw
HS410 Unit 6: Quality Management - Discussion
Discussion
This is a graded Discussion
. Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.
Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:
1.
What are the steps in the quality improvement model and how is benchmarking involved?
2. What are the stages in which data quality errors found in a health record most commonly occur?
3. What is the definition of risk management?
4. What are the parts of an effective risk management program?
5. What is utilization review and why is it important in healthcare?
6. What is the process of utilization review?
Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.
NO PHARGIARISM PLEASE!
This is the Chapter reading for this assignment:
Read Chapter 7 in
Today’s Health Information Management
.
INTRODUCTION
Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient's family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.
This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.
In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY
Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of.
DHA7002 Walden University Improving Healthcare Quality Discussion.pdfsdfghj21
The Quality of Care Committee (QCC) at Arrowhead District Hospital implemented several strategies to improve quality of care, including crew resource management, rounding, and a just culture approach to errors. As a result of these efforts, the hospital demonstrated significant improvements such as a 25% reduction in mortality and improved core measure scores. Key strategies that helped drive quality included engaging physicians in quality goals, overseeing credentialing, and adding a family member to the QCC.
The study evaluated the effectiveness of a safety simulation program involving a standardized patient for operating room nurses compared to a control group that received a lecture on safety. The simulation program was found to significantly improve nurses' safety attitudes and compliance with safety management procedures, though it did not affect their awareness of the importance of safety management. Correlations were observed between variables such as awareness, compliance, and safety attitudes.
This document reviews the literature on patient safety culture in hospitals. It identifies 7 key subcultures that define safety culture: leadership, teamwork, evidence-based practice, communication, learning, justice, and patient-centered care. Leadership is seen as essential for establishing a culture of safety. The review develops a conceptual model and typology that categorizes properties of each subculture identified in the literature. The model and typology are intended to help hospital leaders understand and develop an organizational culture of safety.
The Quality of Care Committee (QCC) at Arrowhead District Hospital implemented several strategies to improve healthcare quality, including:
1) Educating leadership and staff on quality initiatives, metrics, and processes.
2) Adopting best practices from other high-performing facilities through site visits and conferences.
3) Implementing crew resource management, rounding, and a just culture approach to reduce errors and improve safety.
As a result, Arrowhead saw a 25% reduction in mortality, improved scores, and shared their successes in publications.
Soraya Ghebleh - Clinical Integration and Care CoordinationSoraya Ghebleh
Here is a simple slidedeck of research done that examined which systemic care coordination practices should be maximized according to the literature to improve clinical integration within and between healthcare organizations.
Reflective Journal Week 5Topic Philosophies and Theories for Ad.docxsodhi3
Reflective Journal Week 5
Topic: Philosophies and Theories for Advanced Nursing Practice
Course objective:
1. Examine disciplinary influences on nursing inquiry such as biology, medicine, psychology, sociology, and philosophy, among others.
2. Evaluate the application and adaptation of borrowed theories to nursing practice.
Discussion Question: 5 DQ 1
Learning theories have implications for advanced practice nurses outside the classroom. Share an example describing the application of learning theory or theories to develop a program targeting change to a specific organizational issue, patient lifestyle, or specific unhealthy behaviors.
Nursing education is essential to equip professionals with appropriate skills and competencies in line with the changing demands. In this regard, learning theories offer important guidelines for planning of an educational system within the clinical training. Two important areas highlighted in any theory include a change of behavior and talent development. Overall, the stimulus and responses emanating from clinical training should be aimed at improving the skills of clinical professionals. Health professions also need to show the regular use of theories and clear reasoning in educational activities, interactions with patients and clients, management, employee training, continuing education and health promotion programs, especially in the current health care structure.
For example, behaviorists underscore that learning should be a continuous process: the process should aim at achieving the needs that arise in the course of time. DeCoux (2016) observes that regular training of clinical workers is appropriate at all times as the latter reinforces positive behaviors. For instance, poor work relations and productivity among the clinical workers can be enhanced through training. The process also offers practical skills that are not normally taught in the classroom environment. Moreover, such a training program is created with great consideration of the specific needs and organizational interests. The trainers are given an opportunity to understand the needs of workers in a manner that influences the formulation of tactical human resource strategies.
In the same vein, clinical training is critical in talent development. The move allows administrators to assign duties according to the skills and qualifications of an individual. The process is helpful to enhance productivity and positive performance among the workers. Hessler & Henderson (2013) recognize that learning for nursing professionals should be interactive where their participation is paramount. Through this form of training, workers develop a better way to relate and connect with one another. It is also noteworthy that the clinical environment is changing by the day with new needs and dynamics that different approaches to offering to the right interventions. Therefore, clinical administrators need to promote continuous practical training among the staff.
Learni ...
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
This document discusses evidence-based decision making in healthcare. It explains that over the past decade, healthcare workers have increasingly used scientific research evidence to guide clinical practice. While the concept of evidence-based healthcare has been adopted into healthcare systems, its implementation is uneven in actual practice. The paper aims to explore the methods used to make evidence-based decisions in healthcare, and their application to clinical practice. These methods include systematic reviews, clinical practice guidelines, and qualitative studies to measure outcomes. Evidence-based healthcare aims to ensure patients and practitioners are guided by the strongest available research evidence.
This second interactive webinar in the series will draw upon Dr. Ian Graham's Knowledge to Action cycle and focus specifically on the central role of developing and synthesising evidence of what to implement and which knowledge translation and implementation strategies are most effective for promoting implementation, and developing the knowledge infrastructure to make best use of evidence.
Discussion questions – Twain, The Man That Corrupted Hadleyburg.docxduketjoy27252
Discussion questions – Twain, “The Man That Corrupted Hadleyburg”
Mark Twain wrote this story in 1898, toward the end of his career, and long after publishing his masterpieces
Tom Sawyer
and
Huckleberry Finn
. However, “Hadleyburg” reflects one concern that interested Twain throughout his entire career: the sarcastic skewering of middle-class morality and mannerisms. We will examine Twain’s critique of the false righteousness and hidden hypocrisies of common, civilized life as an example of Realism.
1. Hadleyburg prides itself on the honesty of its citizens. However, this focus on honesty has allowed other, less moral attitudes to take root and grow among the people. Find 2 passages that reveal at least two different sinful attitudes shared by the citizens of Hadleyburg.
2. The stranger’s plot is perfectly designed to attack the one source of pride of the townspeople. Focus on the scene describing the night the owner of the sack of gold is to be revealed. Explain what Twain to saying about human nature through the behavior of Wilson the lawyer. Find 1 passage that supports your interpretation. (Hint: Does Wilson tell the truth?)
2a. Also, Dr. Harkness ends up buying the sack of (fake) gold. Why does he do this, and what is Twain trying to say about politics and morality through that subplot? Find 1 passage that supports your interpretation. (Hint: Harkness creates a fake story about the gold. Also, why is he desperate to win the election?)
3. The Richardses were spared the humiliation the other nineteen families experienced. They even receive a reward for $38,500! However, their lives end miserably. Their miserable end is related to the one moral weakness that Richards consistently exhibits throughout the story. What is this weakness (it’s not greed) and explain how it causes a terrible ending to the Richardses’ lives. Find 1 passage that reveals this weakness.
.
Discussion Questions The difficulty in predicting the future is .docxduketjoy27252
Discussion Questions
: “The difficulty in predicting the future is that the outcomes are unreliable, due to the occurrence of wild-card events that distort the relatively well-understand trends for the near to mid-future.” Offer an example of such a “wild-card” event and some ways in which the security professional might address it in an effective manner. Regarding the need for the security industry as a whole to maintain the professionalism and competencies needed to address emerging threats and hazards, what do you feel are its primary areas of weakness and what proposals could you offer to address them?
The Future of the Security
When considering what awaits the security profession in the years to come and those that will operate within it, developments and forecasts related to security science will in large part be impacted by what has occurred in the past and in present day. What
might
occur, what is most
plausible
and
feasible
given current and expected occurrences, and what has proven to be effective (or not) will all need to be considered in determining those issues that will remain relevant or change. So predicting the future (not in the form of Nostradamus or similar prophets) as it relates to security is a technique that considers probable or desirable outcomes in the face of known or anticipated risks. So given this backdrop, where is security heading?
Physical Security
As long as there are structures that people operate within and house various assets, there will continue to be a need to offer needed protection related to them. All of the topics discussed in this course related to walls, fencing, sensors, alarm systems, guards, locks, and other such issues will be needed in some form or fashion. Whether through manual or technological means, these will remain a constant for the security administrator in providing appropriate defensive measures for the material, tangible assets they oversee. Concerning technology, the same trend will continue in serving as a needed aid in providing security moving forward. Mobile devices of various types, functions, capabilities, and their ability to access data, the ever-increasing use of robotics and the functions they can carry out, sensors that will be able to gain more intelligence regarding detection, and high frequency security cameras that will have the capability to verify the chemical compound of an object at a distance are just some of the many technical innovations on the horizon. Yet, just as technology has taken on a greater role in providing these efforts, so too does technology represent ever-increasing concerns to the security manager.
Cyber Security
As society becomes connected on an ever-increasing basis, attention must be directed towards what implications this environment has related to not only security, but related privacy concerns as well. In
Future Scenarios and Challenges for Security and Privacy
(2016, Williams, Axon, Nurse, & Creese), the researchers took a ver.
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6
Annotated Bibliography
Student’s Name
Course
Instructor’s name.
Institutional Affiliation
October 7, 2021.
Annotated Bibliography
Ali, H., Ibrahem, S. Z., Al Mudaf, B., Al Fadalah, T., Jamal, D., & El-Jardali, F. (2018). Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2960-x
The researchers conducted a cross-sectional study in 16 public hospitals in Kuwait using the Hospital Survey on Patient Safety Culture (HSOPSC). The study aimed to assess patient safety culture in public hospitals as perceived by hospital staff and relate the findings similar to regional and international ...
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Abstract
Background: Many healthcare innovations are not sustained over the long term, wasting costly implementation
efforts and often desperately-needed initial improvements. Although there have been advances in knowledge
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power’ of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in
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sustained over a long-term period in an acute healthcare centre.
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department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada.
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sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership
actions and both institutionalization and development; and a reflection-and-course-correction strategy and
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committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders
should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or
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HS410 Unit 6: Quality Management - Discussion
Discussion
This is a graded Discussion
. Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.
Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:
1.
What are the steps in the quality improvement model and how is benchmarking involved?
2. What are the stages in which data quality errors found in a health record most commonly occur?
3. What is the definition of risk management?
4. What are the parts of an effective risk management program?
5. What is utilization review and why is it important in healthcare?
6. What is the process of utilization review?
Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.
NO PHARGIARISM PLEASE!
This is the Chapter reading for this assignment:
Read Chapter 7 in
Today’s Health Information Management
.
INTRODUCTION
Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient's family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.
This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.
In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY
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DHA7002 Walden University Improving Healthcare Quality Discussion.pdfsdfghj21
The Quality of Care Committee (QCC) at Arrowhead District Hospital implemented several strategies to improve quality of care, including crew resource management, rounding, and a just culture approach to errors. As a result of these efforts, the hospital demonstrated significant improvements such as a 25% reduction in mortality and improved core measure scores. Key strategies that helped drive quality included engaging physicians in quality goals, overseeing credentialing, and adding a family member to the QCC.
The study evaluated the effectiveness of a safety simulation program involving a standardized patient for operating room nurses compared to a control group that received a lecture on safety. The simulation program was found to significantly improve nurses' safety attitudes and compliance with safety management procedures, though it did not affect their awareness of the importance of safety management. Correlations were observed between variables such as awareness, compliance, and safety attitudes.
This document reviews the literature on patient safety culture in hospitals. It identifies 7 key subcultures that define safety culture: leadership, teamwork, evidence-based practice, communication, learning, justice, and patient-centered care. Leadership is seen as essential for establishing a culture of safety. The review develops a conceptual model and typology that categorizes properties of each subculture identified in the literature. The model and typology are intended to help hospital leaders understand and develop an organizational culture of safety.
The Quality of Care Committee (QCC) at Arrowhead District Hospital implemented several strategies to improve healthcare quality, including:
1) Educating leadership and staff on quality initiatives, metrics, and processes.
2) Adopting best practices from other high-performing facilities through site visits and conferences.
3) Implementing crew resource management, rounding, and a just culture approach to reduce errors and improve safety.
As a result, Arrowhead saw a 25% reduction in mortality, improved scores, and shared their successes in publications.
Soraya Ghebleh - Clinical Integration and Care CoordinationSoraya Ghebleh
Here is a simple slidedeck of research done that examined which systemic care coordination practices should be maximized according to the literature to improve clinical integration within and between healthcare organizations.
Reflective Journal Week 5Topic Philosophies and Theories for Ad.docxsodhi3
Reflective Journal Week 5
Topic: Philosophies and Theories for Advanced Nursing Practice
Course objective:
1. Examine disciplinary influences on nursing inquiry such as biology, medicine, psychology, sociology, and philosophy, among others.
2. Evaluate the application and adaptation of borrowed theories to nursing practice.
Discussion Question: 5 DQ 1
Learning theories have implications for advanced practice nurses outside the classroom. Share an example describing the application of learning theory or theories to develop a program targeting change to a specific organizational issue, patient lifestyle, or specific unhealthy behaviors.
Nursing education is essential to equip professionals with appropriate skills and competencies in line with the changing demands. In this regard, learning theories offer important guidelines for planning of an educational system within the clinical training. Two important areas highlighted in any theory include a change of behavior and talent development. Overall, the stimulus and responses emanating from clinical training should be aimed at improving the skills of clinical professionals. Health professions also need to show the regular use of theories and clear reasoning in educational activities, interactions with patients and clients, management, employee training, continuing education and health promotion programs, especially in the current health care structure.
For example, behaviorists underscore that learning should be a continuous process: the process should aim at achieving the needs that arise in the course of time. DeCoux (2016) observes that regular training of clinical workers is appropriate at all times as the latter reinforces positive behaviors. For instance, poor work relations and productivity among the clinical workers can be enhanced through training. The process also offers practical skills that are not normally taught in the classroom environment. Moreover, such a training program is created with great consideration of the specific needs and organizational interests. The trainers are given an opportunity to understand the needs of workers in a manner that influences the formulation of tactical human resource strategies.
In the same vein, clinical training is critical in talent development. The move allows administrators to assign duties according to the skills and qualifications of an individual. The process is helpful to enhance productivity and positive performance among the workers. Hessler & Henderson (2013) recognize that learning for nursing professionals should be interactive where their participation is paramount. Through this form of training, workers develop a better way to relate and connect with one another. It is also noteworthy that the clinical environment is changing by the day with new needs and dynamics that different approaches to offering to the right interventions. Therefore, clinical administrators need to promote continuous practical training among the staff.
Learni ...
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
This document discusses evidence-based decision making in healthcare. It explains that over the past decade, healthcare workers have increasingly used scientific research evidence to guide clinical practice. While the concept of evidence-based healthcare has been adopted into healthcare systems, its implementation is uneven in actual practice. The paper aims to explore the methods used to make evidence-based decisions in healthcare, and their application to clinical practice. These methods include systematic reviews, clinical practice guidelines, and qualitative studies to measure outcomes. Evidence-based healthcare aims to ensure patients and practitioners are guided by the strongest available research evidence.
This second interactive webinar in the series will draw upon Dr. Ian Graham's Knowledge to Action cycle and focus specifically on the central role of developing and synthesising evidence of what to implement and which knowledge translation and implementation strategies are most effective for promoting implementation, and developing the knowledge infrastructure to make best use of evidence.
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Discussion questions – Twain, “The Man That Corrupted Hadleyburg”
Mark Twain wrote this story in 1898, toward the end of his career, and long after publishing his masterpieces
Tom Sawyer
and
Huckleberry Finn
. However, “Hadleyburg” reflects one concern that interested Twain throughout his entire career: the sarcastic skewering of middle-class morality and mannerisms. We will examine Twain’s critique of the false righteousness and hidden hypocrisies of common, civilized life as an example of Realism.
1. Hadleyburg prides itself on the honesty of its citizens. However, this focus on honesty has allowed other, less moral attitudes to take root and grow among the people. Find 2 passages that reveal at least two different sinful attitudes shared by the citizens of Hadleyburg.
2. The stranger’s plot is perfectly designed to attack the one source of pride of the townspeople. Focus on the scene describing the night the owner of the sack of gold is to be revealed. Explain what Twain to saying about human nature through the behavior of Wilson the lawyer. Find 1 passage that supports your interpretation. (Hint: Does Wilson tell the truth?)
2a. Also, Dr. Harkness ends up buying the sack of (fake) gold. Why does he do this, and what is Twain trying to say about politics and morality through that subplot? Find 1 passage that supports your interpretation. (Hint: Harkness creates a fake story about the gold. Also, why is he desperate to win the election?)
3. The Richardses were spared the humiliation the other nineteen families experienced. They even receive a reward for $38,500! However, their lives end miserably. Their miserable end is related to the one moral weakness that Richards consistently exhibits throughout the story. What is this weakness (it’s not greed) and explain how it causes a terrible ending to the Richardses’ lives. Find 1 passage that reveals this weakness.
.
Discussion Questions The difficulty in predicting the future is .docxduketjoy27252
Discussion Questions
: “The difficulty in predicting the future is that the outcomes are unreliable, due to the occurrence of wild-card events that distort the relatively well-understand trends for the near to mid-future.” Offer an example of such a “wild-card” event and some ways in which the security professional might address it in an effective manner. Regarding the need for the security industry as a whole to maintain the professionalism and competencies needed to address emerging threats and hazards, what do you feel are its primary areas of weakness and what proposals could you offer to address them?
The Future of the Security
When considering what awaits the security profession in the years to come and those that will operate within it, developments and forecasts related to security science will in large part be impacted by what has occurred in the past and in present day. What
might
occur, what is most
plausible
and
feasible
given current and expected occurrences, and what has proven to be effective (or not) will all need to be considered in determining those issues that will remain relevant or change. So predicting the future (not in the form of Nostradamus or similar prophets) as it relates to security is a technique that considers probable or desirable outcomes in the face of known or anticipated risks. So given this backdrop, where is security heading?
Physical Security
As long as there are structures that people operate within and house various assets, there will continue to be a need to offer needed protection related to them. All of the topics discussed in this course related to walls, fencing, sensors, alarm systems, guards, locks, and other such issues will be needed in some form or fashion. Whether through manual or technological means, these will remain a constant for the security administrator in providing appropriate defensive measures for the material, tangible assets they oversee. Concerning technology, the same trend will continue in serving as a needed aid in providing security moving forward. Mobile devices of various types, functions, capabilities, and their ability to access data, the ever-increasing use of robotics and the functions they can carry out, sensors that will be able to gain more intelligence regarding detection, and high frequency security cameras that will have the capability to verify the chemical compound of an object at a distance are just some of the many technical innovations on the horizon. Yet, just as technology has taken on a greater role in providing these efforts, so too does technology represent ever-increasing concerns to the security manager.
Cyber Security
As society becomes connected on an ever-increasing basis, attention must be directed towards what implications this environment has related to not only security, but related privacy concerns as well. In
Future Scenarios and Challenges for Security and Privacy
(2016, Williams, Axon, Nurse, & Creese), the researchers took a ver.
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Discussion questions – Dunbar
Paul Lawrence Dunbar was a pioneering African-American literary artist. He was among the first black writers who achieved fame among predominantly white audiences with the accurate use of black vernacular and realistic depictions of the attitudes of African Americans while using the literary styles and conventions familiar to white writers. Only within the past twenty years have literary critics begun to appreciate the subtle and perceptive criticism of racial relations he provides beneath the smooth artistry of his works.
1. Dunbar’s “Mr. Cornelius” is extremely naturalistic, with Cornelius struggling against, and eventually losing to, large forces. What are the forces that are arrayed against him (2)? Find a passage that describes each force.
(Hint: Economics, discrimination, as well as emotional weakness are some examples of large forces.)
2. Dunbar was well aware of the story of the slave’s flight north to freedom, a traditional African-American narrative made famous by such works as Frederick Douglass’s
Narrative
and Harriet Beecher Stowe’s
Uncle Tom’s Cabin
. How is Dunbar’s story an ironic, inverted version of the flight-to-freedom story? What is Dunbar trying to say about the status of African Americans in a society newly changed by slavery’s end?
(Hint: Cornelius is from the south. Washington D.C. is north. Does going north mean freedom for him? He must return south at the end—what does going south mean for him?)
.
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Discussion Questions:
Identify the top three threats to the homeland and describe why you chose those as the primary threats. Considering specific terrorist tactics that have been or could be used in the homeland, which do you consider to be the most intimidating and which do you see as the most likely to be used?
.
Discussion questions – Hurston
Zora Neal Hurston attended Howard University, then Barnard College, and studied anthropology while becoming a popular figure of the Harlem Renaissance. Her studies earned her a post-graduate fellowship to study Southern black folktales. These folktales become the basis for her fiction. During her life, Hurston’s writing, while popular with general audiences, was not well-received by critics, particular black literary reviewers who wanted her to focus more on racial inequality. After being wrongly accused of a crime, Hurston finished her career in poverty and obscurity. She has recently become an extremely important writer for her depictions of black women, particularly in the now-acclaimed
Their Eyes Were Watching God
(1937).
2. Hurston’s “How It Feels to Be Colored Me” is a modernist-style literary montage—a series of (loosely organized) images, impressions, memories, observations on experiencing life as a black woman. The montage is quite humorous since she often states that she doesn’t know what “colored” is. The montage can be broken down into a diverse set of themes. Find 1 passage for each theme:
a. earliest memories of life before she knew what “race” was
b. the idea of “race” is imposed on her by others
c. moments where she recognizes her racial identity emerging suddenly
d. she lives a life that is bigger than what “race” tells her she must be
Please use the Answer Sandwich method to answer each question. The passages you add to your answer should be around 2-4 sentences long. Please include a page reference.
Keep in mind that I may select any of these questions to be the upcoming quiz question. Also, I use these discussion questions to create the exams and the major paper assignment. So do your best on each question.
https://bucket-hozzify.storage.googleapis.com/wp-content/uploads/2021/02/08211149/Robert-S.-Levine_-Michael-A.-Elliott_-Sandra-M.-Gustafson_-Amy-Hungerford_-Mary-Loeffelholz-The-Norton-Anthology-of-American-Literature-Volumes-C-D-E-W.-W.-Norton-Company-2016.pdf
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Discussion Questions Compare and contrast through a critical an.docxduketjoy27252
Discussion Questions
: Compare and contrast through a critical analysis of the following laws and strategies with an emphasis on how they enhance port maritime operations: Maritime Transportation Security Act of 2002, The SAFE Port Act, and The Small Vessel Security Strategy.
Response must be 400 words or more in APA style format.
.
Discussion questions (self evaluation)
Examine nursing roles that meet the emerging health needs of individuals, families, communities and populations.
Explore historical, legal, social, cultural, political, and economic forces that influence the client, nursing practice, and the health care system.
Evaluate strategies that can be used by public and community health nurses to improve the health status and eliminate health disparities of vulnerable populations.
Predict trends in lifestyles that will affect the health of communities and the future challenges for nursing.
Plan, analyze, implement and evaluate public health surveillance and outbreak investigation
Develop strategies to deliver nursing care in the preparedness, response, and recovery phases of disaster management.
Initial should have 400 words. Reference in APA format 7th edition.
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Discussion QuestionReflecting on what you have learned abou.docxduketjoy27252
Discussion Question:
Reflecting on what you have learned about the social determinants of health, SDOH, how can nurses work collaboratively with physicians and other health care professionals to improve primary care, reduce overutilization and improve underutilization of healthcare services? Include in your response how fostering an environment of diversity and cultural awareness among healthcare providers builds a stronger healthcare team and improves care delivery to healthcare consumers.
Initial 400 words. Reference APA format 7th edition.
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Discussion questionMotivation is the all-ensuing mechanism t.docxduketjoy27252
Discussion question
Motivation is the all-ensuing mechanism that determines how much and how well a student will learn. Treating it as strictly an internal mechanism, explain how learners; needs, goals, beliefs, interests, and emotions can influence their motivation to learn.
RESPOND TO THESE STUDENTS POSTS
Tashi post
Motivation is something that looks different in everyone. When we look at what motivates one person and assume we can teach based on that, we will not be successful in reaching all students. Looking at motivation strictly from an intrinsic lens, meaning a student’s needs, goals, beliefs, interests and emotions, teachers need many resources. I think that one of the biggest tools that teachers need is relationships. Understanding where a student’s motivation is coming from, or not coming from, can lead to engagement. For example, if a student’s basic needs are not being met, they will not be motivated to learn their math facts because they have greater needs. This is where the relationship and understanding of where students are at is so important for a teacher. They have the ability to create goals with these students. However, on the flip side, a student that knows they want to go to college may be motivated based on their goals for themselves and will engage because they want to do well and achieve a goal in the future.
Motivation can create opportunity as well as hinder progress. It is so important in education. A student’s belief in themselves can create these opportunities or hinder their progress as well. Understanding how a teacher can use motivation through an intrinsic lens can help all students in their class.
Jasmine post
Motivation is defined as the processes that initiate, direct, and sustain behavior. Motivated students put out more effort, persist longer, learn more, and score higher on tests (Lazowski & Hulleman, 2016). Intrinsic motivation is the natural human tendency to seek out and conquer challenges as we pursue personal interests and exercise our capabilities. When we are intrinsically motivated, we do not need incentives or punishments, because the activity itself is satisfying and rewarding (Anderman & Anderman, 2014; Deci & Ryan, 2002; Reiss, 2004). When I think of intrinsic motivation I don't associate it with younger children as much as I would with older children. I can relate to intrinsic motivation myself because just learning something new motivates me to learn more. Also, seeing those A's and B's keeps me wanting to learn more. I feel the more I learn the more I'll be able to teach someone in the future. That is motivation enough for me to keep going. The students I currently work with get excited when they are able to identify numbers and letters and this motivates them to keep learning. You can see the excitement on their faces when they answer something correctly.
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Discussion QuestionHow much, if any, action on ergonomics in th.docxduketjoy27252
Discussion Question:
How much, if any, action on ergonomics in the work-place should rely on the voluntary actions of employers (as favored by George W. Bush) and how much should be mandatory on the part of managements. Explain.
Read the following:
Chapter 9 – Institutional Issues under Collective Bargaining
Chapter 10 – Administrative Issues under Collective Bargaining
Chapter Summaries
Chapter 9 – Institutional Issues under Collective Bargaining
The rights and duties of the employers, employees, and unions are the institutional issues of collective bargaining. On occasion, they can be more troublesome than the economic questions involved with wages and benefits. Some of the longest and most bitter strikes have resulted from conflict over the institutional questions of labor relations.
One of the most controversial issues is union membership as a condition of employment. Labor organizations seeking greater security have negotiated a number of compulsory union membership devices, the most common being the union shop. The closed shop, maintenance-of-membership arrangement, agency shop, and the preferential shop are other security measures that appear less frequently. The growth of the union shop is best explained by the Taft-Hartley prohibition of the closed shop in firms engaged in interstate commerce. The goal of each of these measures is to establish and maintain the institutional security of the union. Such devices are present in about 82 percent of today’s collective bargaining contracts.
There are elements of morality, labor relations stability, and power in this area. Union security may provide stability in industrial relations, but is it moral to compel a worker to join a union? Are these ideological and philosophical issues a mere disguise for the real goal, increased power and influence? Some twenty-two states now have legislation that bans any form of compulsory union membership. These “right-to-work” laws are formidable obstacles in the path of union institutional security. Although Congress has preemptive power in the field of interstate commerce, this state legislation is likely to be allowed to stand.
More than 95 percent of current contracts contain a checkoff procedure by which the employer collects union dues, and often other fees, by deduction from the worker’s paycheck. The advantage to the union is a savings of time and money. The checkoff also can benefit the employer, which explains why it is not a crucial issue of negotiation. Taft-Hartley requires the written authorization of the employee for such an arrangement, which is irrevocable for one year, or the duration of the contract, whichever is shorter. Usually the individual has an annual opportunity to rescind his authorization. If he or she does not, the checkoff remains in force for another year.
The obligations of the union are typically set down in one or more provisions of the contract. The most important is a pledge by the union not to strik.
Discussion QuestionConsider a popular supplement you andor y.docxduketjoy27252
Discussion Question:
Consider a popular supplement you and/or your family and friends take.
Can you think of a supplement that is commonly taken that could easily be replaced by eating more of a certain food or type of foods?
Is there a population group that would find it more difficult to get the recommended amount of vitamins and minerals through diet changes?
.
Discussion QuestionDiscuss opportunities for innovation and en.docxduketjoy27252
Discussion Question
Discuss opportunities for innovation and entrepreneurship in emerging global markets, particularly those with a growing middle class, or those where harsh economic conditions dictate the need for innovation if basic human needs are to be met.
What steps must be taken to encourage innovation in these markets?
Will the same incentives and techniques be effective in all emerging markets?
What can be done in instances where government does not encourage or is even hostile to entrepreneurship?
Design and present a list of talking points you might use when you meet with industry and government leaders in one of these markets as you attempt to build a creative mind-set among local civic leaders, businesses, and citizens.
The final paragraph (three or four sentences) of your initial post should summarize the one or two key points that you are making in your initial response.
Your posting should be about 1 page (400 to 500 words) in length.
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Discussion Question(s)Im interested in the role of women-- in t.docxduketjoy27252
Discussion Question(s)
I'm interested in the role of women-- in the colonial family, in colonial society, etc. Based on what you've read in the book (and in lecture), how much power do you think women had in colonial Latin America? what kind of control were they able to exert? (keep in mind two things: the patriarchal system, and the fact that patriarchy does not equal one-sided dominance.)
Lecture 9
Your author for this course, Burkholder (et. al.)*, states from the outset of the chapter we are reading this week that the Family is the foundation of colonial society (p. 216). That is a bold statement, especially since so much of colonial Latin America is built on violence, religion, labor, and the construction of Spanish political structures once Spaniards started settling in the Americas. However, he states it more clearly than I can when he says, "while race, wealth, occupation, and gender all helped to identify an individual's position in the social structure,
these elements were usually evaluated in the framework of a broadly defined family
" (p. 216).
Think about some of the issues that we talked about last week concerning race (which I know is still fresh in your mind!). Among the issues that the lecture, the reading, and all the rest of us in this class discussed was how race was a bit more slippery than we usually think about it in the United States (this of course does not make it any less harmful, just different). Nonetheless, if we think about all the moves that some people were able to make racially-- up or down the ladder/hierarchy, depending on the situation-- a lot of those moves were not only based on the ideology of the family, but they were also decided on those terms as well. In other words, the ideology of the family helped organize colonial Latin American societies-- not just husband, wife, kids, grandparents, etc. Families were more than blood relations, but rather a collective of biological and fictive relationships that offer a means for people navigate colonial society both economically and politically.
Family meant a lot of different things, but most of all, it is important to remember that being a member of a family was certainly about marriage and blood relations, but it was also kind of like being a member of a "crew" (is that a word that people use these days? Yes? No? I'm a little old, so maybe there is a new word). Anyway, marriages, parentage, god-parentage, and even simply being close enough to a family to be considered part of it almost always had political implications. Like I said, it was how people made their moves.
Let's take marriage as an example. Because the population of colonial Latin America was diverse from the beginning (marriages or coupling between native folks and Spaniards in the early years of conquest and settlement started the ball rolling on a rather mixed population), people in different
castas,
(or "racial castes"-- people who were of mixed descent/race) would use marria.
Discussion Question(s)Why do you think that Native Allies and Af.docxduketjoy27252
Discussion Question(s)
Why do you think that Native Allies and African Conquistadors were not mentioned in European accounts of the conquest? Do you think it was intentional or unintentional? Why?
Portrayals of Malintzin have been unfair to her, historically. My question is this: why do you think the stories have been so unfair to her, while Cortes and other conquistadors are either rewarded or ignored for actually carrying out the conquest?
How do your readings connect to either of these questions?
Lecture 3- Steamrolling?
"Malintzin was the indigenous woman who translated for Hernando Cortés in his dealings with the Aztec emperor Moctezuma in the days of 1519 to 1521. "Malintzin," at least, was what the Indians called her. The Spanish called her doña Marina, and she has become known to posterity as La Malinche. As Malinche, she has long been regarded as a traitor to her people, a dangerously sexy, scheming woman who gave Cortés whatever he wanted out of her own self-interest.
The life of the real woman, however, was much more complicated. She was sold into slavery as a child, and eventually given away to the Spanish as a concubine and cook. If she managed to make something more out of her life--and she did--it is difficult to say at what point she did wrong."
Actually, that is a good question: what did she do wrong? Not much, it turns out-- having been sold by her family, and again by the subsequent owners, exactly what kind of loyalty was she supposed to have? Who was it that she was supposed to not "sell out?" No one, it turns out. Historians today know that she was doing her best to stay alive, and make a life for herself, and given her situation and life experiences, it is hard to expect anything more.
For me, at least, this raises a simple question: why are people in such a hurry to blame Malintzin for the conquest, when, in fact, they should be blaming the Spanish? Why did the blame shift to her, instead of where it should have been-- on Cortes and his men? Just curious.
The Indigenous Allies:
Check out this Prezi presentation! Short and sweet! Think about it alongside your readings! (Links to an external site.)
ñ
Spanish, Slavery, and Encomiendas (Early Colonial Period)
In U.S. History, people debate quite a lot about the plight of Native Americans. Some people believe that Native Americans were given a chance to be a part of the developing American culture, others say they were not. Still others, citing the diminishing numbers of Native Americans and the active role that the U.S. government and its white citizens took in killing and displacing Native Americans, call it genocide. In Latin America, it is a little more complicated.
The removal, displacement, and murder of Native Americans is undeniable in U.S. history, but such actions did not take place in Mexico, or other parts of Latin America, at least not on the same scale. The reason for this is that the goals of the British and the Spanish were different wh.
Discussion Question(This post must be at least 200 words.)What d.docxduketjoy27252
Discussion Question(This post must be at least 200 words.)
What do you think of the tone of "Orders Given to the Twelve"? What
was
the tone? Do you think it is appropriate for the kind of document it is, given when it was written, and why it was written? Why or why not? How does that contrast to the tone in the second document (The Holy Men Respond...)?
Lecture, Week 4
Lecture------
Here is an excerpt from a historian (Camille Townsend) who talks about some of the myths surrounding Cortes's arrival in Mexico (keep an eye out for what I put in bold):
"In 1552, Francisco López De Gómara, who had been
chaplain
and secretary to Hernando Cortes while he lived out his old age in Spain, published an account of the conquest of Mexico. López de Gómara himself had never been to the New World, but he could envision it nonetheless. "Many [Indians] came to gape at the strange men, now so famous, and at their attire, arms and horses, and they said,
'These men are gods!' "
The
chaplain
was one of the first to claim in print that the Mexicans had believed the conquistadors to be divine. Among the welter of statements made in the Old World about inhabitants of the New, this one found particular resonance. It was repeated with enthusiasm, and soon a specific version gained credence: the Mexicans had apparently believed in a god named Quetzalcoatl, who long ago had disappeared in the east, promising to return from that direction on a certain date. In an extraordinary coincidence, Cortes appeared off the coast in that very year and was mistaken for Quetzalcoatl by the devout Indians."
Of course, Townsend continues by saying that no educated person really believes this story. In fact, it was largely fabricated by a chaplain who had never been to the Americas, but rather was taking care of Cortes in Spain during his last years.
Much has been made about the role of the church during the early years of the conquest, and I think that much of what has been written in recent years has been fair, even if they have been criticizing the church for many years. The truth is, the Catholic church (or its representatives back in the colonial period in Latin America) were quite rough on the indigenous people throughout Latin America, calling it a "spiritual conquest."
You will also remember from last week's lecture, when we talked about the ways in which encomiendas were being used, and how Antonio de Montesinos basically called out all of the
encomenderos
and called them bad Christians for not preaching to them while they were essentially enslaving indigenous folks on the land that the Spanish crown granted them.
I bring up this point because it is often forgotten that the military conquest and the "spiritual conquest" of Latin America go hand in hand.
A few years ago, Pope Francis admitted as much (not quite), when he apologized for all of the things that the Catholic Church and its representatives did to the indigenous people in Latin America durin.
Discussion Question(s)What were the colonial misgivings about m.docxduketjoy27252
Discussion Question(s)
What were the colonial misgivings about "monarchy-wide
cortes
in February of 1810 (p. 350). What do you think of the relationship between the monarchy (or the Central Junta) and the colonials in Spanish America? Do you think that the
criollos
were waiting for independence the whole time? Why or why not?
Lecture 13
Over the last two weeks, we talked about the Caroline and Bourbon Reforms in Spanish America, and I am sure that after reading Chapters 9 and 10, you feel like movements for Independence in colonial Latin America were only days away from happening (maybe only a week, since I post these on Sunday). But no!
As upset as the
criollos
might have been by the dramatic economic and political changes that occurred (not the least of which the fact that the power that they had worked for generations to gain was being taken away by
peninsulares
), the
criollos
still remained loyal to the Spanish Crown. Independence was certainly something that was whispered about in dark corners, but only by the bold, and perhaps the stupid. If we start during this era of Independence in the Americas, we
have
to start with the American Revolution--
Hey-- I'm not happy about it either (this is
Latin American History
darn it!)!
But the American Revolution was the first war for independence in the Americas, so it certainly played an important role.
Kind of.
I mean, your book is kind of right-- the French Revolution definitely played a much bigger role, but keep in mind:
1) The American Revolution was fought from around 1775 to about 1783
2) The French Revolution was fought from 1789 through the 1790s.
Just because the American Revolution was first does not mean that it had a bigger influence than the French (it did NOT). However, keep in mind that the movements for independence throughout Latin America were just as much about ideas as they were about economics-- ok, they were
almost
as much about ideas as economics-- and thus, knowing that there was a neighbor to the north that was able to shrug off colonial power certainly had a psychological effect, if not quite a political one.
The truth is, the eventual movements of independence throughout Latin America was really a combination of things, but one of the largest factors was
time--
time was needed for these ideas to sink in, and time was needed for things to totally unravel in Europe.
And it really did start with the French Revolution, and Napoleon's rise to power:
No, not that Napoleon, THIS Napoleon:
Also happening in the late 18th century (the late 1700s) was the Haitian Revolution, which, if the world wasn't turned upside down already, it definitely was by then. Check out the generally informative Powerpoint I put together about the Haitian Revolution (via your email), and connect it to your text.
Freedom was happening everywhere, and it was happening in many different ways (and in Spain, it was happening largely in the context of Napoleon's at.
Discussion Question(s)The reading for this week was a grab bag o.docxduketjoy27252
Discussion Question(s)
The reading for this week was a grab bag of different perspectives on life under colonial rule, or "living in an empire." They talked about the city and the countryside, religious life and secular life, popular culture, education, and intellectual development, and so on. Which of these sections struck you as being most interesting? Which struck you as being most important for the study of colonial (and perhaps modern!) Latin America? Why?
Lecture 10
What does it mean to live in an empire?
No, that's probably not what you were thinking. Instead, were you thinking something like this?
Maybe. Star Wars, for people who might not know (I don't know what college students are into these days), looks like a simple tale of good against evil. The evil empire fighting against a scrappy band of rebels intent on overthrowing their evil masters. In a sense, this might be the way that you see colonial Latin America, too-- the evil Spanish against the good indigenous people of the Americas. I wouldn't blame you, either-- after weeks of learning about the conquest, encomiendas, the mita system (under the Spanish) and the doings of the Catholic church (especially during the conquest), it would be easy to think of the Spanish empire (or the Spanish) as evil. In fact, I don't think I am going to try and convince you otherwise.
However, it might be worth remembering that we are looking at this history right now, in 2015-- not in the period itself. Therefore, whereas today you might think of the Spanish as evil, as time passed during the colonial era in Latin America, for the poor, the castas, and yes the indigenous folks, the Spanish and the Spanish colonial system was simply a way of life. It was something that they lived with, adjusted to, and yes, even sometimes rebelled against (locally, of course, not on a large scale. That happens later).
Therefore, to stretch the Star Wars metaphor even further (yikes), I would say that even though most of you might think of Spanish colonialism like this--
-- it is more likely that it was much more like this:
In other words, we can all agree that in hindsight that colonial Latin America was oppressive, but for most people, instead of plotting rebellion in their basements or back rooms, most people just tried to find a way to survive in the middle of it all, and make the best life they could for themselves despite the horrible conditions. So we can think about how nice and pure life would have been without the invasion of the Spanish, but since that was a luxury that the poor, the castas, and the indigenous people living in colonial Latin America did not have, we might instead think about the ways in which colonial society forced adjustments upon how various groups of people lived, as the colonial empire itself expanded and became more and more complex.
Spain asserted its control through urban planning. Cities were laid out in grids, centered on the most important government buil.
Discussion Question(s)Could Latin American reactions to the Bour.docxduketjoy27252
Discussion Question(s)
Could Latin American reactions to the Bourbon (Caroline era) Reforms be attributed to intellectual change (Enlightenment), religious changes (expulsion of the Jesuits, for instance), economic change (taxes), or political change (taking criollos off their prestigious jobs and replacing them with Peninsulars)? Was it any one of these specifically? All of them? (and if you are going to say "all of them," do you think one might have had more influence than the others?) Why?
Lecture 12
This is where things start to get serious, because Spain isn't playing around anymore. Yes, we are still talking about the Bourbon Reforms- but more specifically, the Caroline Reforms (which happened during the reign of King Charles III, from 1759-1788). The reason that this is so important is because there was a lot of stuff happening during this period: rebellions, revolts, the expulsion of the Jesuits (a specific Catholic order of priests) from Spanish America and Spain, and perhaps most of all, more political reorganization.
But the question is the same as it was last week: why? Well, as we noted last week, there were a lot of conflicts in which Spain had found itself on the wrong side. Take, for example, The Seven Years' War: this particular war is known these days as the first true World War, but for a long time it was called the French and Indian War.
Oooh!!!!--- why was it called the "French and Indian War"? Because the people who named it that (British and British colonists in North America) believed that the world revolved around them. "we are fighting the French and the Indians-- let's call it the French and Indian War!" Of course, when you call it that you are ignoring the fact that it wasn't just the French, Indians, and British fighting one another. In fact, here is who was fighting:
1) France
2) Native Americans (on both sides in North America)
3) Britain
4) Saxony
5) Sweden
6) Russia
7) Prussia (basically Germany)
8) Hanover (basically more Germany)
9) Spain (later)
10) Portugal (later)
And this war (the fighting), with all these people involved, took place in:
1) Europe
2) Africa
3) North America
4) Philippines
5) India
6) Central America
The war was happening everywhere, it seems. And yet, people in the United States called it The French and Indian War. Dorks. I kind of want to tell the British and their colonists in North America this:
But that's why they called it the French and Indian War for so long.
In any case, Spain-- as noted above-- came late to the party, and joined the war on the French side in 1762.
As you might have predicted, this did not go well. France lost, but more importantly for our purposes, Spain lost by extension. And they lost big! First and foremost, they lost Cuba (albeit temporarily), they lost Florida-- gone forever in the Spanish empire (however, considering what it turned into in the 21st century,
maybe they dodged a bullet (this link is not for the faint of heart.
Discussion Question(s)Clearly there is potential for major probl.docxduketjoy27252
Discussion Question(s)
Clearly there is potential for major problems as the Bourbon Reforms are enacted over much of the 18th century. What were those problems? In what way do you think the Spanish crown could have lessened the pain of these reforms while still maintaining control over the Spanish colonies? Or was there no hope? (and if there was no hope, why do you say that?)
Lecture 11
Wen I was a young undergraduate (at a community college in southern California that will remain nameless-- I will give you all one guess in our discussion forum), I remember the week that my class was to discuss The Bourbon Reforms.
Sadly, it was not about what I was hoping.
Sigh.
Nonetheless, I remember being really interested in what was happening, because it was at this point in the class that I started to see the long chain of events that led to independence throughout most Latin American countries.
See, before I learned about the Bourbon Reforms, I was under the impression that the Independence movements (and wars) in Latin America happened from the bottom-up, which is to say that I thought they were led by Mestizos, Castas, and indigenous folks. For example, think of Mexico: Father Hidalgo, a priest and a champion of the peasant classes in New Spain (Mexico), he brings all these different people together-- people who have been stepped on for too long by colonial powers, and he issues "El Grito,", which was a unified cry of the underrepresented people for independence! Together, they would finally throw off the yoke of Spanish oppression and lead their own country to INDEPENDENCE! Yaaaaaayyyyy!
Sadly, it didn't happen like that.
Yes, Father Hidalgo did issue "El Grito de Dolores," but the conditions that led to the independence movement in New Spain (and the changing of its name to Mexico) didn't hit the peasants the hardest (the peasants were already being hit pretty hard), and the Independence movement was not led by peasants, the working classes, nor the indigenous people-- even if they did spark it. In fact, some say that Father Hidalgo and the people following him didn't want independence...they just wanted a better king.
But let's save that disappointment for later.
See, when I took that class and learned what the Bourbon Reforms were, I started to understand why independence happened throughout much of Latin America in the early 19th century (1800s).
The Bourbon Reforms (and the Caroline Reforms within them) were a set of political, economic, and administrative changes that came from Spain.
Now, speaking quite generally, one of the biggest changes was one that happened gradually, then suddenly: the termination of the sale of
audiencia
positions. See, up until this point, much of Spanish Latin America operated on that old saying that I have brought up a few times, "
obedezco pero no cumplo
", which roughly translated means, "I obey but I do not comply." (you may have a better translation-- give it a shot in the forum!)
.
Discussion Question Week #1· Discover which agencies, in.docxduketjoy27252
Discussion Question Week #1
· Discover which agencies, in your state, are responsible for public health of citizens.
· Research if there are centralized or decentralized management of state responsibilities?
· Determine minimum 3 key indicators of health.
· Review the agency sites and upload the links to the Moodleroom, week #1
· Be prepared to discuss in class, week #2
STATE IS FLORIDA!!
.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
How to Download & Install Module From the Odoo App Store in Odoo 17Celine George
Custom modules offer the flexibility to extend Odoo's capabilities, address unique requirements, and optimize workflows to align seamlessly with your organization's processes. By leveraging custom modules, businesses can unlock greater efficiency, productivity, and innovation, empowering them to stay competitive in today's dynamic market landscape. In this tutorial, we'll guide you step by step on how to easily download and install modules from the Odoo App Store.
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...
Developing a culture of safety is a core element of many efforts t.docx
1. Developing a culture of safety is a core element of many efforts
to
improve patient safety and care quality. This systematic review
identifies and assesses interventions used to promote safety
culture
or climate in acute care settings. The authors searched
MEDLINE,
CINAHL, PsycINFO, Cochrane, and EMBASE to identify
relevant
English-language studies published from January 2000 to
October
2012. They selected studies that targeted health care workers
practicing
in inpatient settings and included data about change in patient
safety culture or climate after a targeted intervention. Two
raters independently screened 3679 abstracts (which yielded 33
eligible studies in 35 articles), extracted study data, and rated
study
quality and strength of evidence. Eight studies included
executive
walk rounds or interdisciplinary rounds; 8 evaluated
multicomponent,
unit-based interventions; and 20 included team training or
communication initiatives. Twenty-nine studies reported some
improvement
in safety culture or patient outcomes, but measured
outcomes were highly heterogeneous. Strength of evidence was
low, and most studies were pre–post evaluations of low to
moderate
quality. Within these limits, evidence suggests that
interventions
can improve perceptions of safety culture and potentially
reduce patient harm.
Ann Intern Med. 2013;158:369-374. www.annals.org
2. For author affiliations, see end of text.
THE PROBLEM
Developing a culture of safety is a core element of
many efforts to improve patient safety and care quality in
acute care settings (1, 2). Several studies show that safety
culture and the related concept of safety climate are related
to such clinician behaviors as error reporting (3), reductions
in adverse events (4, 5), and reduced mortality (6, 7).
Accreditation bodies identify leadership standards for
safety culture measurement and improvement (8), and
promoting
a culture of safety is a designated National Patient
Safety Foundation Safe Practice (9). A search of the Agency
for Healthcare Research and Quality (AHRQ) Patient
Safety Net (www.psnet.ahrq.gov) yields more than 5665
articles, tips, and fact sheets related to improving safety
culture. Although much work has focused on promoting a
culture of safety, understanding which approaches are most
effective and the implementation factors that may influence
effectiveness are critical to achieving meaningful improvement
(10).
Drawing on the social, organizational, and safety sciences,
patient safety culture can be defined as 1 aspect of an
organization’s culture (11, 12). Specifically, it can be
personified
by the shared values, beliefs, norms, and procedures
related to patient safety among members of an organization,
unit, or team (13, 14). It influences clinician and
staff behaviors, attitudes, and cognitions on the job by
providing cues about the relative priority of patient safety
compared with other goals (for example, throughput or
efficiency) (11). Culture also shapes clinician and staff
perceptions
about “normal” behavior related to patient safety
in their work area. It informs perceptions about what is
praiseworthy and what is punishable (either formally by
3. work area leaders or informally by colleagues and fellow
team members). In this way, culture influences one’s motivation
to engage in safe behaviors and the extent to which
this motivation translates into daily practice.
Patient safety climate is a related term—often inadvertently
used interchangeably with culture—that refers specifically
to shared perceptions or attitudes about the norms,
policies, and procedures related to patient safety among
members of a group (for example, care team, unit, service,
department, or organization) (11). Climate provides a
snapshot of clinician and staff perceptions about the observable,
surface-level aspects of culture during a particular
point in time (10, 15). It is measured most often using a
questionnaire or survey. Clinicians and staff are asked
about aspects of their team, work area, or hospital, such as
communication about safety hazards, transparency, teamwork,
and leadership. Because climate is defined as a characteristic
of a team or group, individual responses to survey
items are usually aggregated to form unit-, department-, or
higher-level scores. The difference between culture and climate
is often reduced to a difference in methodology.
Studies involving surveys of clinicians and staff are categorized
as studies of safety climate, and ethnographic studies
involving detailed, longitudinal observations are categorized
as studies of safety culture. The terms are often used
interchangeably in practice, but it is important to remember
that there are conceptually meaningful differences in
their scope and depth. For the purpose of this review, studies
of both patient safety culture and climate were included.
We use the term patient safety culture in discussion
only to simplify the reporting of results.
Given that safety culture can influence care processes
and outcomes, efforts to evaluate patient safety climate
See also:
Web-Only
CME quiz (Professional Responsibility Credit)
4. Supplement
Annals of Internal Medicine Supplement
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over time are being widely implemented (16). Measurement
and feedback are necessary—although likely
insufficient—means to effectively promote a culture of
safety. One previous systematic review found strong face
validity for interventions to promote safety culture in
health care, but heterogeneity among studies, measures,
and settings limited conclusions about intervention
effectiveness
(17). Results suggested possible positive effects
for leadership walk rounds and multifaceted, unit-based
interventions on survey measures of safety climate. However,
the review did not assess effects on patient outcomes
or care processes. Another review done by the Cochrane
Collaboration (18) examined organizational culture–
change interventions designed to improve patient outcomes
and quality of care. Only 2 studies were identified
for inclusion, both of which evaluated different outcomes,
and results were inconclusive. We attempted to address
these gaps by conducting a systematic review of the
peerreviewed
literature to identify interventions used to promote
safety culture in health care, assess the evidence for
their effectiveness in improving both safety culture and
patient outcomes, and describe the context and implementation
of these interventions.
PATIENT SAFETY STRATEGIES
Promotion of patient safety culture can best be conceptualized
as a constellation of interventions rooted in
principles of leadership, teamwork, and behavior change,
rather than a specific process, team, or technology. Strategies
to promote a culture of patient safety may include a
single intervention or several interventions combined into
5. a multifaceted approach or series. They may also include
system-level changes, such as those in governance or reporting
structure. For example, team training, interdisciplinary
rounding or executive walk rounds, and unit-based
strategies that include a series of interventions have all been
labeled as interventions to promote a culture of safety.
Team training refers to a set of structured methods for
optimizing teamwork processes, such as communication,
cooperation, collaboration, and leadership (19, 20). Previous
reviews show that the term has been applied to a range
of learning and development strategies, but the critical de-
fining element is a focus on attaining the knowledge, skills,
or attitudes that underlie effective teamwork (20).
Executive walk rounds is an interventional strategy
that engages organizational leadership directly with frontline
care providers. Executives or senior leaders visit frontline
patient care areas with the goal of observing and discussing
current or potential threats to patient safety, as well
as supporting front-line staff in addressing such threats (21,
22). Walk rounds aim to show leadership commitment to
safety, foster trust and psychological safety, and provide
support for front-line providers to proactively address
threats to patient safety. However, walk rounds have been
operationalized in diverse ways, making comparison across
studies difficult (21). For example, not all rounding
interventions
use a structured format, and time intervals between
rounds vary widely across studies.
Improvement strategies that combine several intervention
techniques have also been used to promote safety culture.
For example, the Comprehensive Unit-Based Safety
Program (CUSP) is a multifaceted strategy for culture
change that pairs adaptive interventions (such as continuous
learning strategies or team training) with technical interventions
(such as translation and use of best available
evidence-based clinical care algorithms) to improve patient
6. safety and quality (23, 24). The CUSP methodology includes
elements of executive engagement and team training,
along with specific strategies for translating clinical
evidence into practice. Other interventions have combined
unit-based interventions with broader organizational
changes, including restructuring patient safety governance
(25, 26).
REVIEW PROCESSES
This review examines the evidence for interventions
that articulate improvement in patient safety culture as a
primary outcome and intervention goal. We identified relevant
articles through searches of 5 databases from 1 January
2000 through 31 October 2012: PubMed, CINAHL,
Cochrane, EMBASE, and PsycINFO. Key search terms
included patient safety culture, safety climate, and safety atKey
Summary Points
Safety culture is foundational to efforts to improve patient
safety and may respond to intervention.
Bundling multiple interventions or tools is a common strategy
to improve safety culture.
Many programs include a form of team training or
implementation
of communication tools, executive walk rounds
or another form of interdisciplinary rounding, or unitbased
improvement strategies that target clinical microsystems
(for example, teams, units, or service lines) and are
owned by front-line clinicians and staff.
Low-quality, heterogeneous evidence derived primarily
from pre–post evaluations suggests that bundled,
multicomponent
interventions can improve clinician and staff
perceptions of safety culture.
Low-quality, limited evidence derived primarily from
pre–post evaluations suggests that multifaceted interventions
aimed at improving patient safety can also improve
care processes and patient outcomes.
7. Future research should consider investigation of safety culture
as a cross-cutting contextual factor that can moderate
the effectiveness of other patient safety practices.
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titudes (see the Supplement, available at www.annals.org,
for a description of the search strategies, an article flow
diagram, and evidence tables). The searches found 3679
records, all of which were independently screened by 2
reviewers. One hundred sixty-two articles were identified
for full screening. Of these, 33 studies (in 35 articles) were
identified for final inclusion. Two studies each contributed
2 papers to the review (26 –29).
Studies were included if they targeted health care professionals
or paraprofessionals practicing in adult or pediatric
inpatient settings, explicitly indicated that the purpose
of the intervention was promoting or improving a
culture or climate of patient safety, used a psychometrically
valid measure to assess patient safety culture that had previous
evidence of sound psychometric properties published
in a peer-reviewed outlet (15, 30, 31), assessed culture over
at least 2 time points, and included adequate data to assess
change in patient safety culture or climate. Only
Englishlanguage
studies conducted in the United States, the
United Kingdom, Canada, or Australia were included. Although
a growing number of studies have translated
English-language surveys of culture into other languages,
evidence that their construct validity is comparable across
samples remains limited. Studies were excluded if they
examined
interventions aimed at medical or nursing students,
targeted other aspects or types of culture (for example,
general organizational culture), or were primarily
8. focused on survey development or establishing the psychometric
properties of a culture assessment. Qualitative studies
were also excluded. Each article was abstracted by a
primary reviewer and checked by a second reviewer.
Strength of evidence, including risk of bias, was evaluated
by both reviewers using the Grading of Recommendations
Assessment, Development and Evaluation Working
Group criteria adapted by AHRQ (32). Interventions
and reported outcomes were highly heterogeneous, and
meta-analyses were not done. We present results from thematic
analysis and qualitative summaries of individual
studies.
This review was supported by the AHRQ, which had
no role in the selection or review of the evidence or the
decision to submit the manuscript for publication.
BENEFITS AND HARMS
Study Characteristics
Of the 33 studies reviewed, 24 were pre–post studies;
3 were concurrent control or pre–post with concurrent
control studies; 3 were time-series studies; 2 were cluster
randomized, controlled trials (RCTs); and 1 had a quasistepped
wedge design. The clinical care areas studied
included intensive care, perioperative, labor and delivery,
radiology, and general medical and surgical floors. Twentyone
studies measured patient safety culture or climate with
the Safety Attitudes Questionnaire (33), 10 studies used
the AHRQ Hospital Survey on Patient Safety (34), and 2
studies used the Patient Safety Climate in Healthcare
Organizations
survey (35). Most studies operationalized culture
at the level of the hospital unit or work area; that is,
individual survey responses from clinicians and staff in a
given work area were aggregated to form group-level patient
safety climate scores for each work area surveyed.
Survey sample sizes ranged from 5461 persons working in
144 units in a single hospital to 28 individuals working
9. within a single hospital unit. The response rate—the number
of individuals who complete and return surveys out of
the total invited to complete the survey—is an important
factor influencing the validity of survey results. Survey
response
rates ranged from 23% to 100%.
Intervention Types
Heterogeneity among interventions was substantial.
Most (19 studies) were multicomponent interventions
combining several improvement strategies under a single
overarching initiative to promote safety culture. For example,
Blegen and colleagues (36) used a 3-component approach
that included team training, unit-based safety
teams, and strategies for engaging patients in daily goal
setting. Thematic analysis identified 3 broad categories of
intervention that emerged across multiple studies: 20 studies
explicitly included team training or tools to improve
team communication processes, 8 explicitly included some
form of executive walk rounds or interdisciplinary rounding,
and 8 explicitly used CUSP.
Benefits
Team Training
Twenty studies explicitly examined team training or
tools to support team communication as interventions to
promote safety culture. Of these, 10 were conducted in
perioperative care areas, 5 in labor and delivery or pediatrics,
2 in medical general floors or intensive care, and 3 in
other care areas or a mix of care areas. Seventeen had pre–
post or pre–post with concurrent control designs. One
study was a quasi-cluster RCT; however, only 3 organizations
were randomly assigned to 3 conditions. Sixteen of
the 20 studies reported statistically significant improvement
in staff perceptions of safety culture. In addition, 5
reported improvements in care processes (for example,
decreased
care delays or increased use of structured communication)
10. and 7 reported improvements in patient safety
outcomes (for example, errors resulting in harm or reductions
in adverse outcomes index).
Executive Walk Rounds
Eight studies evaluated walk rounds (either executive
or interdisciplinary), including 1 cluster RCT. All reported
improvement in staff perceptions of safety culture. One
study, however, showed improvement on only 2 of 30 survey
items and did not report domain scores (37). Three
reported improvements in perceptions of care processes
(for example, quality of collaboration) or patient safety
outcomes (for example, improvement in mean number of
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days since last event). One study (27, 28) found that adjusted
care costs were $24.01 lower for intervention work
areas despite an adjusted length of stay that was 0.19 days
longer. However, neither of these indices were statistically
significantly different from control work areas. The study
included only 4 units (2 intervention, 2 control) and was
underpowered to detect differences in these outcomes.
CUSP
Eight studies specifically evaluated the effects of
CUSP. Most used medium- to larger-sample pre–post designs
in intensive care unit settings, although 1 used a
quasi-stepped wedge design. Overall, 6 of the 8 studies
reported statistically significant improvements in staff
perceptions
of safety culture, including perceptions of teamwork.
Two studies reported improvements in care processes,
such as second-stage labor care (38) and timely
resolution of safety concerns (39). Two studies reported
improvements (although statistically nonsignificant or not
statistically tested) in nursing turnover (40, 41), 1 reported
11. a reduction in length of stay (41), and 1 reported greater
reductions in infection rates (although not statistically
significant)
(42). Other studies of CUSP have shown sustained
improvements in infection rates and mortality after
implementation (23, 27).
Outcomes
Regarding effectiveness, 23 of 32 reviewed studies reported
a statistically significant effect of the intervention
on the overall safety culture score, the safety climate score,
or at least half of reported survey domains or items (if
analyzed at the item level). Several studies reported
improvements
in teamwork climate but did not find similar
improvements in safety culture or safety climate (27, 43).
Additional outcomes included changes in care processes,
patient outcomes (for example, indices of harm),
and clinician outcomes (for example, turnover or burnout).
Nineteen studies also reported the effect of interventions
on such outcomes. Statistically significant improvements
were reported in 6 of 11 studies reporting on patient outcomes.
Five studies found reductions in indices of patient
harm (25, 26, 43– 45), and 1 study reported improvements
in length of stay (41). One study found a decrease (0.56 vs.
0.15; P 0.01) in the rate of reported errors that resulted
in patient harm after a multifaceted suite of interventions
that included both cultural (for example, feedback on errors
in the form of posters) and system-focused changes
(for example, medication management protocols) (43). A
cluster RCT that found a marginal increase in teamwork
culture (45) also found that the experimental unit’s
weighted adverse outcome score (an index of patient harm)
decreased by 37% after implementation of a team training
program designed to promote patient safety culture, compared
with a 43% increase in a control unit (P 0.05).
Two studies also reported reductions in nurse turnover after
12. interventions to promote safety culture (40, 41).
Overall, the strength of evidence was low. Risk of bias
was generally high because of study design issues; for example,
we identified only 1 true cluster RCT (22). Core
issues affecting risk of bias for reviewed studies included
low survey response rates and incomplete reporting (not
reporting full results for all units or hospitals where
interventions
were conducted, or not reporting results for all
domains measured as part of culture surveys). Results were
inconsistent, with 56% of studies reporting statistically
significant
findings. Regarding directness, or the extent to
which findings generalize to different organizations or
populations,
few studies discussed the logic model or conceptual
foundation underlying the intervention design. Only 2
studies comparatively evaluated the effects of different
intervention
strategies, and patient safety outcomes were infrequently
and heterogeneously reported. Regarding precision,
many survey instruments were used across reviewed
studies and results were often reported differently.
Harms
We did not identify any data on patient harms.
IMPLEMENTATION CONSIDERATIONS AND COSTS
Studies differed in the characteristics of the organizations
in which they were implemented, the level of leadership
support and engagement reported, and the tools and
strategies used to support implementation into daily care
processes. Thirteen studies were done in academic hospital
settings, 4 in community-based hospitals, 6 in a mix of
academic and community hospitals, and several did not
address the hospital mix in their sample. One study reported
that the gain in safety climate scores was larger for
faith-based hospitals (14%) than for non–faith-based hospitals
13. (8%) but reported no direct statistical test of these
findings (46). Only 1 study (28) examined costs of care
among intervention and control work areas. No statistically
significant differences in mean care costs between control
and intervention work areas at follow-up were found.
DISCUSSION
Our review identified 33 studies in 35 articles that
evaluated interventions to promote safety culture in inpatient
care settings. Although these interventions varied
greatly and often included multiple components, 3 common
types of intervention emerged: team training and
team communication tools, executive walk rounds and
interdisciplinary
rounding, and CUSP. These interventions
were implemented across various care areas in both academic
and community hospital settings. Most were evaluated
in either perioperative or intensive care areas.
Overall, results suggest evidence to support the effectiveness
of such interventions in improving clinician and
staff perceptions of elements of safety culture (for example,
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general perceptions of safety climate and teamwork). A few
studies provide evidence that interventions aiming to improve
safety culture may meaningfully improve clinical
care processes (28, 47– 49) and suggest the potential to
improve aggregate indices of patient harm (29, 45). However,
these conclusions are tempered by the limitations of
the current evidence. Although 1 true cluster RCT was
identified (22), most studies had pre–post designs with
relatively small to moderate samples (particularly at the
unit or work area level of analysis) that did not include
control participants. In addition, few studies examined potential
variation in perceptions of safety culture by care
14. provider type.
Although this review offers a systematic analysis of
strategies to promote safety culture, clear limitations must
be considered. Only studies in acute care settings using
established survey measures were included. Although
qualitative
studies of safety culture may offer insight into nuances
of implementation, they were outside the scope of
this review. Because several studies in outpatient settings
were not included, results may not generalize beyond inpatient
settings. Relevant studies may also have been inadvertently
excluded despite extensive searches. Publication
bias and selective reporting of positive findings also may
limit conclusions about the effectiveness and generalizability
of the interventions evaluated. Finally, traditional criteria
for evaluating the effectiveness of clinical interventions
for individual patients are not well-suited to assessing the
effectiveness of quasi-experimental study designs conducted
at the unit level of analysis. This may have introduced
systematic bias into our ratings for strength of evidence.
As noted by Pizzi and colleagues in the original
“Making Health Care Safer” report (50); “the threshold for
evidence may need a different yardstick than is typically
applied in medicine.”
In summary, this review suggests that evidence to support
the potential effectiveness of interventions to promote
safety culture is emerging. In particular, the best evidence
to date seems to include strategies comprising multiple
components that incorporate team training and mechanisms
to support team communication and include executive
engagement in front-line safety walk rounds. Organizations
should consider incorporating these elements into
efforts to promote safety culture but also robustly evaluate
such efforts across multiple outcomes. Future research
should also consider thorough investigation of safety culture
as a cross-cutting contextual factor that can moderate
15. the effectiveness of other patient safety practices, such as
implementation of rapid response systems. The strength of
evidence for patient safety culture would be improved if
theoretical models (31, 51, 52) were meaningfully used in
the development of interventions for improvement and
those interventions were robustly evaluated. Finally, work
is needed to better understand the contextual role that
safety culture plays in implementation of other patient
safety practices, as well as how efforts to promote safety
culture can best be implemented to enhance the effectiveness
of complementary or supplementary interventions for
safety and care quality.