In patients with acute respiratory distress syndrome (ARDS), is early application of prone positioning more effective than supine positioning at reducing mortality?

Early Prone Positioning in the Reduction of Mortality

PICOT QUESTION: In patients with acute respiratory distress syndrome (ARDS), is early application of prone positioning more effective than supine positioning at reducing mortality?

 

Over the last two years, prone positioning has been initiated in the ICUs due to the development of acute respiratory distress syndrome (ARDS) because of COVID-19. Prone positioning was unfamiliar to me until the beginning of the pandemic. As we all know, due to the complexity of the coronavirus, there were interventions that were initiated by clinicians that seem to have improved patient outcomes. After briefly researching the benefits of prone positioning in 2019, I realized this intervention has been shown to be beneficial since the 1970’s. Prone positioning consists of placing a patient face down. Prone positioning has been used for more than 40 years to improve oxygenation in patients who require invasive mechanical ventilation for ARDS. The first demonstration of a beneficial effect on patients’ oxygenation was shown in 1974 (Touchon et al.,2021). I chose this PICO question because the initiation of prone positioning is prevalent in ICUs and I thought it would be great to research if early initiation, in fact, does reduces mortality amongst ARD’s patients. As a future nurse practitioner, in a pandemic, determining the effectiveness of treatment plan for ARDS would help me formulate a successful plan of care.

I think it’s essential to understand the physiologic effects of prone positioning before initiation, which I found rather interesting while doing research on my PICOquestion. When an individual with ARDS is supine, the heart compresses the medial posterior lung parenchyma, and the diaphragm compresses the posterior-caudal lung parenchyma. The latter is caused by the abdominal contents displacing the diaphragm cranially, which can be exacerbated by a loss of diaphragmatic tone due to sedation and/or paralysis or increased abdominal pressure. Compression by either the heart and/or the diaphragm may exaggerate dependent lung collapse in the supine position, increasing hypoxemia and ventilator-associated lung injury. During prone ventilation, the heart becomes dependent, potentially decreasing medial posterior lung compression. In addition, the diaphragm is displaced caudally (especially in obese patients and when the abdomen is left unsupported), decreasing compression of the posterior-caudal lung parenchyma (Malhorta, 2021). These effects improve ventilation and oxygenation. Ventilation/perfusion match improves when the patient is moved into the prone position as the previously dependent lung continues to receive most of the blood flow as alveoli reopen, while the newly dependent lung continues to receive the minority of the blood flow as alveoli begin to collapse. In addition, increases in cardiac output have been observed and thought to be because of increased lung recruitment and reduction in hypoxic pulmonary vasoconstriction resulting in increases in right ventricular preload and decreased right ventricular afterload and a decrease in pulmonary vascular resistance (Malhorta, 2021).

It’s evident that the use of prone positioning has been widely adopted now since the pandemic. One common entity between my job and clinical, was that patients with ARDS were placed in prone positioning only if intubated and paralyzed. Initially, I assumed that prone positioning was to only be initiated on intubated patients. But it was noted in many articles that awake prone positioning can be initiated on patients with ARDS while on high flow nasal cannula as well. I’ve come to the realization that there were many studies done on prone positioning in ARDS patients that I was unaware of, therefore I decided to educate myself on this topic. Whether the development of ARDS is related to an infectious or non-infectious process, prone positioning has been proven to have a more successful outcome than with supine positioning. Overall, this paper will educate me on the effectiveness of prone positioning and help me better manage patients with ARDS in my career as a nurse practitioner.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Malhorta, A. (2021). Prone ventilation for adult patients with acute respiratory distress syndrome. UpToDate. Retrieved from https://www.uptodate.com/contents/prone-ventilation-for-adult-patients-with-acute-respiratory-distress-syndrome/print#!

Touchon, F., Trigui, Y., Prud’homme, E., Lefebvre, L., Giraud, A., Dols, A.-M., Martinez, S., Bernardi, M., Begne, C., Granier, P., Chanez, P., Forel, J.-M., Papazian, L., & Elharrar, X. (2021). Awake prone positioning for hypoxaemic respiratory failure: Past, COVID-19 and Perspectives. European Respiratory Review30(160), 210022. https://doi.org/10.1183/16000617.0022-2021

 

 

How did the alphabet (rather than writing in general) develop?

Description 6 pp. double-spaced (1500 words) + images + references due Apr 8 In this paper, which is addressed to a non-academic audience, you describe the history, development, structure, logic, and main uses of one visual communication medium. Imagine your reader: a younger, college-bound sibling, or your parent(s) or a friend–someone who wants to know what you learn in college and is not themselves into communication. You answer: “Here is one thing I learned, how one of these old communication media came into existence that we completely take for granted. It’s a really interesting story. I’ll tell you about its history, how it functions, what it does for us, and where we would be without it.” In other words, you write for a curious, non-academic audience and try to keep their attention, but you also give them solid (scholarly) information. And you make your choice of communication studies as your major or of a communication class look worthwhile. Like any informative paper of this kind, your paper should include illustrations (images with captions, however many you think it needs). The medium can be one of those that the class covers (see the syllabus) or one that it does not (in which case you should clear your choice with the TA or professor). If your medium of choice is discussed in class after the due date of the paper, you will be provided with course materials (slides etc.) once you begin work on your paper. While you should explain the medium as a whole and in general, your paper should be centered around one specific version of the medium: What can we learn from punk fashion about fashion? How did the alphabet (rather than writing in general) develop? What design problems do stove control panels pose and how have designers solved them? Your paper should have this structure: Introduction: which medium your paper is about, why it is interesting, and what importance it has for human societies History: how did the medium first come into existence, what prior medium did it build on (if any), in what context, and what problems did it solve? How did it change over time, if at all? (This could also be included in section 4.) Include one or two specific stories that illustrate this history. ‘Logic’: How does the medium function? What kinds of meanings does it communicate, and how? Use examples! Conclusion: Where would we be without the medium? References: in MLA format.

Select ONE of the concepts highlighted and describe how you could use that new knowledge in a leadership career.

Select ONE of the concepts highlighted by your classmate and describe how you could use that new knowledge in a leadership career. (Citation only as required.)

 

 

 

 

Noah

  1. Leadership Theories: 

Fundamental to understanding leadership is a body of theories that should be studied to develop an individual framework for what leadership is or is not. Leadership, on the outset, appears to be straightforward and complements other elements such as organizations and followers. However, each of these theories produces a more complex premise about leadership that often vary significantly from other theories on this topic. (Malos, n.d., pg. 413-414) Therefore, it is essential to analyze these theories to understand this discipline better and practice it effectively.

  1. Leadership Competencies:

Beyond the theoretical debate, “Is a leader born or made?” are actual competencies leaders need to successfully contribute to their roles and communities. These competencies consist of abilities one naturally possesses complemented by skills that can be learned. Leaders should inventory their competencies, compare them to what the leadership position requires, and work to fill any gaps with education and coaching. Leaders need to be sufficiently skilled in their current and future positions.

  1. Strategic Thinking Skills:

One of the most vital leadership competencies is strategic thinking. Every leader thinks, but strategic thinking is a critical skill that requires development and practice. Strategic thinking can be a logical, creative, or combined process used to generate thoughts and create a future for a person or organization. (Bradford, 2020, para. 1, 2) Strategic thinkers exercise their ability to see beyond the horizon of possibilities and bring a vision closer to fruition.

  1. Culture of Innovation:

Culture and innovation are two buzz words in today’s leadership lexicon. Individually, these concepts are essential to any organization, but together they are a powerhouse duo. Most companies have a vision statement or set of priorities that include growth but are stifled by a rigid culture that discourages innovation. An organization that sees failure as mistakes of enthusiasm and flattens decision-making to the lowest level possible will foster a vibrant culture that embraces innovation and exponential growth. (Biro, 2020, paras. 6, 9)

  1. Emotional Intelligence:

Another emerging factor shaping leadership effectiveness is emotional intelligence. Emotional intelligence is one’s ability to perceive, understand, and manage the emotions of oneself and others. (Cherry, 2020, paras 11-14) A leader who applies emotional intelligence has a greater sense of self-awareness, empathizes with others better, and is prone to slowing down and thinking prior to making an emotional decision. (Cherry, 2020, paras 17-19) In other words, this is a relational skill that helps build an emotional connection between ourselves and others.

  1. Followership:

Though leadership is the main focus of this discussion, followership is an essential component of the conversation. Followers make up one-third of an organizational triade, including context and leadership. (Harvard Kennedy School, 2009) Followership brings relevance to leadership in a symbiotic relationship; one cannot exist without the other. The power of followers derives from their collective strength in numbers, ideas, skills, and experiences.

  1. Crisis Leadership:

Leadership is easy when everything is going well; however, when a crisis strikes, leadership is tested, and character is revealed. The ability to manage unexpected circumstances is key to being a crisis leader. Though crisis leadership skills can be taught, development often comes from experience. A crisis leader must be able to decisively solve problems, navigate a quickly shifting landscape, provide timely communication, and sift through a flood of information to find relevant and actionable intelligence. (The Wall Street Journal, 2015, paras. 8-14)

References:

Biro, M. (2020, July 24). 6 Ways Leaders Can Build a Culture of Innovation. TalentCulture. Retrieved April 6, 2022, from https://talentculture.com/6-ways-leaders-can-build-a-culture-of-innovation/

Bradford, R. (2020, November 12). Critical Strategic Thinking Skills. Center for Simplified Strategic Planning. Retrieved April 6, 2022, from https://www.cssp.com/CD0808b/CriticalStrategicThinkingSkills/

Cherry, K. (2020, June 3). How Emotionally Intelligent Are You? Verywell Mind. Retrieved April 6, 2022, from https://www.verywellmind.com/what-is-emotional-intelligence-2795423

Harvard Kennedy School. (2009). Barbara Kellerman on FollowershipYouTube. Retrieved April 6, 2022, from https://www.youtube.com/watch?v=kgLcAF5Lgq4.

Malos, R. (n.d.). The Most Important Leadership Theories. learn.umgc.edu. Retrieved April 6, 2022, from https://learn.umgc.edu/content/enforced/347722-001034-01-2192-OL1-6381/The%20Most%20Important%20Leadership%20Theories.pdf?_&d2lSessionVal=kNEXf7PlBbLLRGEAVOijT0Wuo

The Wall Street Journal (Ed.). (2015, July 6). Crisis Leadership: Five Principles for Managing the Unexpected. The Wall Street Journal. Retrieved April 6, 2022, from https://deloitte.wsj.com/articles/crisis-leadership-five-principles-for-managing-the-unexpected-1436155352?tesla=y

Williams, S. (2018, April 10). Leadership Competencies. SHRM. Retrieved April 6, 2022, from https://www.shrm.org/ResourcesAndTools/hr-topics/behavioral-competencies/leadership-and-navigation/Pages/leadershipcompetencies.aspx

 

Rebekah

Reflection

  1. Understanding Leadership:It is important to understand the difference between leading and managing. Leading is a person’s ability to build trust, influence, empower, and communicate (University of Maryland Global Campus, n.d.-a). Managing has a greater focus on control and performance. A leader manages the work, leads the people, and understands that their capacity to motivate will garner peak performance.
  2. Leadership Style:A true leader understands that different people need different leadership styles (Aldrin & Gayatri, 2014). All leadership styles have positive and negative attributes, but an effective leader will adjust to best suit the team and environment (Stevenson, 2019). She will evaluate the circumstances and combine styles to ensure optimal results.
  3. Succession Planning:Succession planning is imperative to business sustainability. As absences occur, planned or unplanned, a succession plan will help facilitate leadership transitions and prevent work stoppages. A good plan should include foreseeable vacancies, desired and required leadership competencies, a diverse pool of potential candidates, challenges, and opportunities (Flowers, 2017).
  4. Cultural Intelligence:Cultural intelligence (CQ) is the ability to relate to people from various cultures and have respect for their differences (Verghese, 2013). Influential leaders understand the value of diversity and support an environment that enables team members to be the best version of themselves and share everything from their ideas to their mistakes (Bilimoria, 2012). A culturally intelligent leader will enforce inclusion and fairness, which leads to success for the individual, team, and company.
  5. Self-Awareness:A leader can only lead if they have a good sense of self and understand their strengths and weaknesses. Current and future leaders should measure their personality traits to ensure the right things drive them. Although there is no definition for the perfect leader, it is essential to outline the most critical components of effective leadership and work to personify them (The Ken Blanchard Companies, n.d.). This is the basis for maintaining excellent organizational culture (8.5 Creating and Maintaining Organizational Culture, 2015).
  6. Building and Sustaining Relationships:It is important to build relationships with followers and superiors before you need them to establish trust. Employee relationships built over time and cultivated properly feel authentic and will result in higher productivity and support of the team when facing challenges. While some relationships might not be as significant as others, they will all eventually serve a purpose (Axner, 2018).
  7. Surviving a Crisis:Good leaders adapt during challenging times and have the psychological maturity to deal with adversity (University of Maryland Global Campus, n.d.-b). The best leaders make preparations for potential risks. When dealing with a crisis, a leader should be confident, decisive yet flexible, ensure communication flow and manage the entire crisis lifecycle, not just work to quiet the issue (deloitteeditor, n.d.).

 

References:

8.5 Creating and Maintaining Organizational Culture. (2015, October 27). Umn.edu; University of Minnesota Libraries Publishing edition, 2015. This edition adapted from a work originally produced in 2010 by a publisher who has requested that it not receive attribution. https://open.lib.umn.edu/principlesmanagement/chapter/8-5-creating-and-maintaining-organizational-culture-2/

Aldrin, A., & Gayatri, R. (2014). Leadership Not A Title Nor A Position. International Journal of Current Research and Academic Review2(8), 356–366. http://www.ijcrar.com/vol-2-8/Anitha%20Aldrin%20and%20R.Gayatri.pdf

Axner, M. (2018). Chapter 14. Core Functions in Leadership | Section 7. Building and Sustaining Relationships | Main Section | Community Tool Box. Ku.edu. https://ctb.ku.edu/en/table-of-contents/leadership/leadership-functions/build-sustain-relationships/main

Bilimoria, D. (2012, April 3). Inclusive leadership: Effectively leading diverse teams | weatherhead. Case.edu. https://weatherhead.case.edu/news/2012/04/03/inclusive-leadership-effectively-leading-diverse-teams

deloitteeditor. (n.d.). Crisis Leadership: Five Principles for Managing the Unexpected. Wall Street Journal. Retrieved April 6, 2022, from https://deloitte.wsj.com/articles/crisis-leadership-five-principles-for-managing-the-unexpected-1436155352?tesla=y

Flowers, J. (2017, October 10). 9 Tips for Effective Succession Planning. Council on Accreditation. https://coanet.org/2017/10/9-tips-for-effective-succession-planning/

Stevenson, H. (2019). Leadership Style, Emotional Intelligence, and Organizat ional Effectiveness | Cleveland Consulting Group, Inc. Clevelandconsultinggroup.com. http://www.clevelandconsultinggroup.com/articles/leadership-style-emotional-intelligence-organizational-effectiveness.php

The Ken Blanchard Companies. (n.d.). Sign in to your account. Www.umgc.edu. Retrieved April 5, 2022, from https://learn.umgc.edu/content/enforced/275876-001034-01-2185-OL1-6380/Critical%20Leadership%20Skills%20-%20Key%20Traits%20That%20Can%20Make%20or%20Break%20Today%e2%80%99s%20Leaders.pdf

University of Maryland Global Campus. (n.d.-a). Differences Between Leading and Managing. Umgc.edu; UMGC. Retrieved April 6, 2022, from https://leocontent.umgc.edu/content/scor/uncurated/tlp/2211-tlp610/learning-topic-list/differences-betweenleadingandmanaging.html

University of Maryland Global Campus. (n.d.-b). Leadership Traits. Umgc.edu. Retrieved March 22, 2022, from https://leocontent.umgc.edu/content/dam/equella-content/bmgt365/SBA-Leadership_Traits.pdf

Verghese, Dr. T. (2013). What is Cultural Intelligence? [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=rdjecUD_6Ck

 

Emily

  1. Leadership:The importance of leadership will help a business expand. “Leadership involves many management skills, but generally as a secondary or background function of true leadership” (Aldrin, Anitha, and Gayatri, R. August 2014 Page 358). Leadership is important because it provides a model for the staff to follow and helps promote the business in public.
  2. Risk-taking: The importance behind this factor is that it will help a company grow overtime. “Leaders regularly encounter risks, but they must know when to embrace a challenge and when to take a safe approach” (Indeed Editorial Team March 21, 2022). A good leader knows when to take a risk, that will help benefit the company, and be able to make the correct judgements of a situation.
  3. Strategic Thinking:The importance of strategic thinking is “They are amazingly aware and perceptive. They will recognize internal and external clues, often subtle, to help guide future direction and realize opportunities for them and their companies or organizations” (Center of Simplified Strategic Planning Inc, 2008). This is important because it helps show who is overseeing the differences or problems within the company, and come to an honest concussion.
  4. Understanding that failing is alright: Failing might be a hard thing to admit to but “If you’re never failing, chances are you’re not innovating much. Failure is inevitable when you’re fostering a culture of innovation, and that’s part of the challenge — the reality that there’s almost always a degree of uncertainty” (Biro, Meghan M. August 20, 2019). This factor should be seen more because in order to learn it is sometimes good to fail and make mistakes, it will help a person learn.
  5. Emotional Intelligence:This is important because “Emotional intelligence (EI) refers to the ability to perceive, control, and evaluate emotions” (Cherry, Kendra, June 03, 2020). This factor will help staff members be able to better understand the way people are feeling about certain situations. It will also help provide feed back to the company on what needs to be changed or improved.
  6. Authentic Leadership: This is an important factor “But there is something behind the jargon – ideas and concepts that have been around for centuries that can help leaders lead people by having a sense of self-awareness, identity, honesty and passion” (The Insights Group, LTD). The reasoning behind this being important is that it helps show who the company is through the leaders, and it will help employees by motivation them.
  7. Hire for personality, drive, execution, and accountability:These factors are important because “The value of positive, responsible, and accountable team members who take action cannot be overestimated” (McDowell, Scott 2020). These factors help a company hire the right Person for the job, and to make sure they are the most qualified for the open position.

Resources:

Aldrin, Anitha, and Gayatri, R. August 2014 Page 358,

http://www.ijcrar.com/vol-2-8/Anitha%20Aldrin%20and%20R.Gayatri.pdf

Biro, Meghan M. Talent Culture, “6 Ways Leaders Can Build a Culture of Innovation” August 20, 2019

https://talentculture.com/6-ways-leaders-can-build-a-culture-of-innovation/

Center of Simplified Strategic Planning Inc., “Course and Direction the Path to Strategic Success” “Strategic Thinking: 11 Critical Skills Needed” 2008

https://www.cssp.com/CD0808b/CriticalStrategicThinkingSkills/

Cherry, Kendra, Verywell mind, “What is Emotional Intelligence?” June 03, 2020

https://www.verywellmind.com/what-is-emotional-intelligence-2795423

Indeed, Editorial Team, “10 Traits of High Effective Leaders (and How to Develop Them), March 21, 2022

https://www.indeed.com/career-advice/career-development/top-leadership-traits

The Insights Group, LTD, Authentic 2014

https://www.insights.com/media/1107/authentic-leadership.pdf

McDowell, Scott, Leadership, “Why Flat Organizations Don’t Create Great Leaders (& What to do about it) 2020

https://99u.adobe.com/articles/7123/why-flat-organizations-dont-create-great-leaders-what-to-do-about-it

 

Consider how this event informs media narratives and historical rationalisation of policy both before and after by choosing two events to consider how representations of this event have been reproduced.

Description

“When Holt went on his fateful swim on 17 December 1967, all hopes that the referendum would result in positive change drowned with him” (Foley, 2017, para. 1). The 1967 Referendum is considered a landmark event in Australia’s shared history. The quote above is by Gary Foley who is an academic and activist with a lifetime of scholarly experience and activism regarding analysis of Government and Aboriginal and Torres Strait islander peoples’ relations. Consider how this event informs media narratives and historical rationalisation of policy both before and after by choosing two events to consider how representations of this event have been reproduced. Use the following structure for your essay Introduction: outline your approach to answering the question, making sure to mention each part of the essay. (100 words) Part A: HISTORY (500 words) Select two events from the Australian History Timeline. One event must be pre-1967 (before the Referendum) and the other post-1967 (after the Referendum). You are required to describe and analyse each policy/event in relation to: Goals of each policy or event. How Indigenous Australians are positioned (e.g., do they have a role in decision-making, are their views represented, are they constructed as a ‘problem to be resolved’). The similarities and differences evident in the goals, positioning of Indigenous Australians, and the implied relationship between Indigenous Australians and wider Australian society. Part B – INSTITUTIONS (500 words) Institutions are powerful influences which shape our knowledge (examples include the media, schools, Government). Explain how knowledge about Australian history is reproduced through institutions to reinforce contemporary understandings. You are required to consider: how the discourses and norms associated with the two events continue to inform contemporary understandings of Australian history and culture how racialised power and privilege influence historical and contemporary structures of Australian society and its institutions the role of racialisation in the collective and individual standpoints of Indigenous and non-Indigenous people. Part C – SELF (500 words) Reflect on your own standpoint by considering: the influence of the two policies/ events on your own positioning the social, institutional and historical influences on your understandings Examples of other institutions that you are familiar with (schools, your professions etc) and how they influence your standpoint. Conclusion: Your conclusion should sum up the arguments in your essay and restate and summarise your answer to the question. (100 words

Demonstrate how your leadership practice improves and sustains care quality.

Application of your learning

There are three pieces of work-based evidence required for this module, each with a maximum word count of 500 words (If you go over this word count it will result in a fail).

Evidence of work-based application should be written in the first person. When addressing this assignment, you need to ensure that you demonstrate the following outcomes:

  • Demonstrate a critical understanding of the theories and practice of reflective practice.
  • Apply theories and methods of reflective practice
  • Demonstrate reflexivity in your leadership practice
  • Demonstrate how your leadership practice improves and sustains care quality.

WBA 1:

  • Demonstrate practical skills to embed diversity, equality and inclusion in your leadership practice
  • Demonstrate taking responsibility for aligning the values of individuals and team with those of the organisation in context
  • (500 words. Minimum 6 reference sources)

WBA 1:  Living the Values

In module 3, you undertook a learning activity called Living the Values (Week 1-2: Activity 10, Living the values).

In this activity you watched a video (https://www.youtube.com/watch?v=NDb8WKkjBzw&feature=youtu.be ) and reviewed a number of guides available from the NHSI on putting values into practice. In each of these guides there were questions and activities that helped put values into practice.

For this piece of work based evidence, you need to select the questions and activities (from the NHSI guides) that are most relevant to your service, and work with your team/colleagues to develop an approach and action plan for putting values into practice. Please illustrate how your approach and action plans are seeking to embed equality and diversity into your values in practice. The assignment is a reflective summary of the approach you and your team/colleagues have taken. Please also include your action plan as an appendix.

 

 

 

Writing for application and reflection

  • The purpose of the evidence you provide is to demonstrate how you are putting your learning into practice at work. This ‘application’ might be reflective, practical or it might relate to enhancing or developing your personal qualities.

 

Calculate the estimated cost of the arena construction at completion.

For the purposes of the scenario, you are to assume that you have been appointed as a Consultant Project Manager to the client company undertaking the Grantchester Arena Project.

Your submission should take the form of a high quality consultancy report document. You may create your own corporate identity for the consultancy firm (name, logotype, brand style etc.) and use it to create your report if you wish.

“Grantchester Arena Project”

A specialist entertainment venue management company, Arena Developments, new to operating in the United Kingdom market, is intending to purchase and develop an inner-city brownfield site as a multi-purpose leisure venue.

The exact configuration of the facility is still being developed, but it is planned to comprise an indoor sports arena capable of hosting ice hockey as well as ball sports (depending on the season) with the arena also being capable of ‘dual use’ as a concert venue.

The central arena will be augmented with restaurant, bar and concession areas for patrons to buy food, drink, sportswear and other merchandise. Provision will

also be made for private boxes within the arena for corporate dining and entertainment as well as facilities for press and broadcast media.

Arena Developments have negotiated to acquire a site in the City of Grantchester. The City Council have fully supported the idea in the expectation that the arena will provide employment opportunities and act as a magnet for visitors to the City. Additionally, they expect that there will also be an increase in business activity as a whole and increased council tax revenue.

The City’s ice hockey club, “Ice Storm” have agreed in principle to enter into a lease agreement to use the ice hockey rink together with a dedicated training gym, administrative offices, changing rooms and a ‘fan zone’.

Most of the local community are supportive of the project, in particular sports fans and concert goers. Local restauranteurs and retailers are less enthusiastic and have concerns about loss of customers for their own businesses.

Environmental groups oppose the scheme being concerned, amongst other things, of pollution during the construction phases and noise and anti-social behaviour once the venue is operational. “Blue Light” services also have concerns about safety in and around the venue and their ability to respond to any major incident should one occur.

The consultancy company for whom you work as a senior project manager has just been appointed by Arena Developments as a member of their consultancy team, responsible for the provision of governance and project management services. Your team will be led by a project director, supported by yourself and a project assistant.

Outline Delivery Plan

The client has completed negotiations to acquire the site and have also reached an ‘understanding’ with the local council with regards to scope and context for a planning application to be made.

It is expected that the project will be delivered in a series of phases:

 

The English League ice hockey season is scheduled to start in September 2024 with the first league game for Ice Storm expected to be on either Saturday 28 or Sunday 29 September, the fixture list having not yet been confirmed.

Financial Arrangements

Arena Development’s accounting year runs from 1 January to 31 December.

In accordance with their operating procedures, all costs for the project from 1 January 2022 until launch are regarded as a ‘project cost’ and therefore accounted for in the project budget and considered an expense in the business case.

Costs incurred to the end of December 2021 are not included, they will be funded as a business development expense.

The cost of purchasing the site will be £17.5 million, payable on the last day of March 2022.

Funding

A consortium of investment banks has agreed to fund the project in its entirety. Repayments of £27.5 million fall due on 1 January 2023 and for 4 years thereafter as five equal ‘tranches’.

Consultancy Team

The core consultancy team will be engaged for the duration of the project, commencing on 1 January 2022 until the end of the ‘soft launch’. Their fees will be £63,375 per month inclusive of expenses and disbursements.

In addition, specialist resources engaged via an employment agency will be deployed to the project site as follows:

These staff will be expected to work a 5 day 40 hour week and will have four weeks leave per year, for which they will not get paid.

Staff will receive £150 per week expenses, except for the administration assistant who will receive £50 per week.

Office accommodation for the site team in nearby offices will cost £650 per week inclusive of utilities and other expenses.

Remediation and Construction Costs

Remediation costs including site security and demolition are expected to be £18,500,000.

Arena construction costs, including site security and commissioning are expected to be £76,000,000.

Costs for concession areas will be borne by the retailers / operators concerned.

Operating Income (Revenue) Stream

Whilst there will be a small income resulting from the events to be held during the ‘soft launch’ period, these will be off-set by the small audience numbers involved and the additional costs of test management and evaluation as well as disruption to events such as test evacuation and response exercises. Phase 5, therefore is expected to be “cost neutral” with income equal to expenditure and no impact on the project budget.

Thereafter, incomes are expected to show growth as follows:

Assignment Task One Project Planning

1a. Using the data in the scenario, prepare a Gantt chart for the entire programme from inception to the end of the ‘soft launch’. You may assume the project start date is Monday 10 January 2022.

1b. Compile a detailed network diagram and Gantt chart for the Arena construction phase (phase 3). You should allow in your programme for a two week shutdown of construction activity over the year-end holiday period.

1c. Identify the critical path for the construction phase.

1d. Re-present key data in Table 3 to show task durations using Eli Goldratt’s Critical Chain approach. Show also the safety buffer for the phase as a whole. Determine how buffer time should be used either at key milestones within the construction phase or only at the end clearly stating the reasons for your choice.

1e Present a simple Gantt chart to show the critical chain approach and the buffer distribution you have selected to use.

20 marks

Assignment Task Two Budgets and Cost Planning

2a. Using the data in the scenario, prepare a fully itemised cost plan for the project to include the provision of contingencies.

2b. Determine a basis for the provision of contingency within the cost plan (for example, adopting a flat rate for the entire project or risk-related rates for different elements or phases). Make a clear recommendation, stating your reasoning.

10 marks

Assignment Task Three Project Appraisal

3a. Using the budget you prepared in task two with the income streams provided in the scenario, prepare an itemised cash flow for the project for the period 2022 to 2029 inclusive. You should consider the payment profiles for both the remediation phase (phase 2) and the main arena construction phases (phases 3 and 4). You will also need to include an estimate for the revenue receipt in Q4 2024, stating your reasoning for the figure you have chosen.

3b. Using the cash flow data, prepare an initial project appraisal and identify the Payback Period; Return on Capital (RoC); and Net Present Value of the project to support a business case for presentation to the client’s Board. Use a discount rate of 4% per annum.

3c. State any assumptions made and the commercial implications of the results presented including an accept / reject recommendation for the project as a whole

15 marks

Assignment Task Four Resource Management

As the arena construction phase nears completion in Q4 2023, the professional team have re-focussed attention on the logistics and management of phase 4 – the arena fit-out, concession areas and commissioning.

With the main contractor having left site, additional site management resources will be required to co-ordinate and control the fit-out works for each retail and food unit as well as specialist equipment to be installed in hospitality areas, the TV Studio and Media Centre.

It has been decided to recruit a number of assistant project managers to support the construction manager and safety manager plus another administration assistant.

The assistant project managers will cost £300 per day plus £100 per week expenses.

The projected breakdown structure and resource need is as follows:

 

4a. Prepare a resource budget for the assistant project managers and administration assistant (assume that no additional office accommodation is required).

4b. Develop a week-by-week resource histogram (column chart) showing the number of assistant project managers required.

4.c It would be desirable to limit the peak assistant project management resource to a maximum of three as the recruitment agency have expressed concern about their ability to source enough suitable candidates. Suggest how the programme might be revised to achieve this constraint and identify any consequences and the resource budget saving.

15 marks

Assignment Task Five Project Evaluation

The project director to whom you report fears that the main contractor’s schedule to construct the arena is too optimistic. Nevertheless, it is essential that the arena is complete by the end of 2023, so that there is sufficient time for the 6- month phase 4 fit out and commissioning and the 3-month ‘soft launch’ phase.

You and your project assistant have looked at the contractor’s programme and, together, determined optimistic and pessimistic durations for each activity:

5a. Analyse this data and, using the PERT technique, assess the probability of the arena construction works being completed before the end of December 2023.

5b. What conclusions do you make as a result of your findings?

10 marks

Assignment Task Six Earned Value

A progress meeting with the arena main contractor was held in February 2023 and the consultant quantity surveyor tabled a financial report on the budget expended to date (to 31 January 2023):

Using the Earned Value approach determine the following:

6a. Calculate the estimated cost of the arena construction at completion.

6b. Calculate the estimated total duration of the arena construction and identify the estimated completion date.

6c. Comment upon the results.

10 marks

Assignment Task Seven Project Monitoring and Reporting

The main contractor’s progress report, presented at the February meeting identified progress made as follows:

Analyse this information with respect to the project plan you prepared in response to task one and prepare a “traffic light” progress report indicating the status of each task on the following basis:

Red Stage in progress falling more than 5% behind plan
Amber Stage in progress (broadly in line with plan) or not yet started

Green Stage completed or at least 5% ahead of plan

7a. What conclusions do you draw?

10 marks

 

 

Compare the various groups in terms of the characteristics you observed portrayed for each in the advertisements. What generalizations about age and gender do these portrayals convey?

Description

In this project, you will investigate gender and age stereotypes in magazines. Look at one widely circulated magazine and evaluate how ads depict males and females of various ages (adolescence, early, middle, and late adulthood). You should evaluate physical appearance, personality, and behaviors as they are depicted in the magazine ads. You can use the attached data sheet to help organize your impressions. After completing the data collection, write a brief report that answers the following questions. Make sure to include a literature review concerning the importance of media influencing gender stereotypes. Are all age groups represented in advertisements? Who is underrepresented and overrepresented? Why do you think that is so? Compare the various groups in terms of the characteristics you observed portrayed for each in the advertisements. What generalizations about age and gender do these portrayals convey? Compare your findings to those obtained by someone who looked at a different magazine. Are your findings similar or different? What do you conclude if they are similar? Different? If they are different, do the differences sensibly relate to differences in the apparent purpose or style of the magazines?

Identify development needs in relation to leadership practice

Summary:

Application of your learning

There is one piece of work based evidence required for this module with a word count of 500 words (If you go over this word count it will result in a fail).

Evidence of work-based application should be written in the first person. When addressing this assignment, you need to ensure that you demonstrate the following outcomes:

  • Apply theories and methods of reflective practice
  • Demonstrate practical skills in leadership practice at individual, team and organisational levels.
  • Undertake a critical reflection to demonstrate selfawareness, selfreflection, and management of self
  • Identify development needs in relation to leadership practice
  • Demonstrate confidence and ability to challenge poor behaviours and performance

In module you undertook a learning activity called Peer Consulting – task (Week 1: Understanding leadership repertoire, Activity 6 – Peer consulting – task)

For this piece of work based evidence, you need to demonstrate your learning about the process and impact of receiving peer consultation. This needs to include:

  • What you learned about yourself as a leader; and
  • Outline how you will sustain any behavioural changes you may choose to make as a leader

Writing for application and reflection

  • The purpose of the evidence you provide is to demonstrate how you are putting your learning into practice at work. This ‘application’ might be reflective, practical or it might relate to enhancing or developing your personal qualities.
  • Each piece of work based evidence will need to be separately uploaded onto Turnitin

 

Peer Consulting Exercise

 

Peer consulting – task

Peer consulting

Form a pair

Select a peer from any of the participants within your cohort on the programme. It does not necessarily have to be from within your ALS or tutor group. Together you will form a peer consultancy ‘pair’. As peer consultants, you will each give and receive mutual support and challenge to help make progress with a specific leadership issue at work. In other words, you will consult to each other.

If pairing is logistically difficult, you may consider working in a trio to provide each other with peer consultation.

The focus of the peer consultancy is to deepen your understanding of your own leadership behaviours and the impact you have as a leader.

Identify a leadership issue

Each of you needs to identify a leadership issue at work where you would benefit from some peer support. The way you provide peer consultancy to each other is for you to decide and negotiate. It will be important to consider issues such as logistics, communication and expectations as well as ways of working and what sort of approach each of you wishes to take in your role as peer consultant. You are advised to work together over a period of 3-4 weeks.

Be creative! It may or may not be practical to observe each other in practice. If this is possible, it might be in the form of, for instance, shadowing each other or observing each other in a particular work context (eg. a meeting or event). If you do this, be clear about what specific leadership behaviours or skills you wish to focus on.

Alternatively, you may decide to ask your peer participant to interview some of your team to gather feedback on a particular aspect of your leadership work. You might even invite your peer participant to facilitate a session where this feedback is shared back with you and your team. How you approach any of this is up to you.

The peer consultation does not have to be face to face, although it is likely to be more effective if at least some of the time is direct contact. Skype/FaceTime or phone are all options to consider if distance or logistics are an issue.

Define and develop the role

You do need to be clear about the role of the peer consultant and set clear boundaries and expectations. To glean the most learning, dedicate some time together as a pair/trio to de-brief not only on the leadership issue being explored, but also about the process of working together as peer consultants.

You will need to do some background reading to help you consider which skill sets you need to develop or practise to be an effective peer consultant. In addition, use the resources suggested and read around the subject to ensure that you are demonstrating relevant skills, learning and understanding to your work based assignment, which will be based on this activity.

 

 

Intake 16 Module 6 – Evaluating my leadership behaviours and impact

Peer consulting – resources

Peer consulting

This adapted extract from Schein (2005) is a helpful introduction to your role as a process consultant:

 

‘There are several models of helping – the expert model, the doctor-patient model and the process consultation (PC) model. The key to effective helping, both for the manager and the consultant, is the ability to be a process consultant and not to succumb to the temptations of being the expert or the doctor except where that is appropriate.

 

Process consultation puts the emphasis on helping others to help themselves, not on solving their problems for them or giving them expert advice. If the person being helped just accepts expert advice, he may solve his immediate problem but he may not learn anything about how to solve problems of this nature; skills that would enable him to solve a similar problem in future.’

 

Knowing how to be an effective process consultant is probably more relevant in today’s complex world than it might have been in times past. Even in medicine, specialists are finding themselves in complex relationships with their patients where they are helping their patients to make a beneficial decision rather than just ‘ordering’ a given procedure.

 

A more realistic model of management as well as consulting is to see the process as one of intervening facilitatively. The more managers think about their role, the more they will come to recognise how much they might increase their own effectiveness if they learned some of the philosophies, concepts and skills that process consultants use.’

 

(adapted from Schein 1987, p.8-9)

 

Tips

 

Some tips for your role as peer consultant

 

Your colleague must own and continue to own their own problem. Your goal must be to provide help without taking the problem onto your own shoulders.

Use active, interested listening – without this, the process of consulting will deteriorate rapidly.

See the uniqueness of what your colleague is talking about, develop empathy and try to understand the issue from your colleague’s perspective.

Look for patterns in how the problem manifests itself, how your colleague perceives it, what role he or she takes in it and what their own diagnostic insights are.

Feedback to your colleague is most likely to be beneficial if it is solicited, timely, concrete and balances honesty with empathy.

Core reading

 

Block, P. (2000) Chapter 2: ‘Techniques are not Enough’ in Flawless Consulting: A Guide to Getting Your Expertise Used (2nd edition), San Francisco: Jossey-Bass Pfeiffer (Available here)

 

De Haan, E. & Burger, Y. (2014) Chapter 1: ‘A Wide Scope for Conversations’ in Coaching with Colleagues 2nd Edition: An Action Guide for One-to-One Learning Basingstoke: Palgrave Macmillan (Available here)

 

Gibbs, G. (1988) Learning by doing: a guide to teaching and learning methods. London: Further Education Unit. (Available here)

 

Kline, N (2010) More Time to Think, Pool-in-Wharfedale: Fisher King pp186 – 189 (Available here)

 

Further reading

Schein, E (1987) Process Consultation Vol II: Lessons for managers and consultants Addison-Wesley Publishing Company, Wokingham (Available here)

Identify the study’s key findings and their implications. Analyse the study’s methods (e.g. sample size, number of replicates, choice of statistical analysis); do these influence your conclusions about the study’s importance or implications?

 

  • Title
  • Introduce the topic of the paper, why it is important, and why you have chosen it.
  • Outline the study’s hypotheses and methodological approach. You do not need to give fine details of the methods, but provide enough detail so that any discussion of the paper can be understood.
  • Identify the study’s key findings and their implications. Analyse the study’s methods (e.g. sample size, number of replicates, choice of statistical analysis); do these influence your conclusions about the study’s importance or implications?
  • Conclude with an indication of the overall significance of the paper, based on your analysis of its methodology and findings. Summarise any shortcomings or particular attributes of the paper that have influenced your conclusion.

It is encouraged to use figures or tables in this section (e.g. to show a study’s results), this is part of the grading criteria to demonstrate you can use select figures to support your analysis, ensure they are properly referenced.

 

Paper 1: Isolation of Novel Probiotic Lactobacillus and Enterococcus Strains From Human Salivary and Fecal Sources

https://doi.org/10.3389/fmicb.2020.597946

 

Paper 2: Indigenous Probiotic Lactobacillus Isolates Presenting Antibiotic like Activity against Human Pathogenic Bacteria

https://doi.org/10.3390/biomedicines5020031

 

Paper 3: In Vitro and In Vivo Evaluation of Lacticaseibacillus rhamnosus GG and Bifidobacterium lactis Bb12 Against Avian Pathogenic Escherichia coli and Identification of Novel Probiotic-Derived Bioactive Peptides

https://link.springer.com/article/10.1007/s12602-021-09840-1

 

 

Paper4: A Systematic Approach to Identify and Characterize the Effectiveness and Safety of Novel Probiotic Strains to Control Foodborne Pathogens

 

https://www.frontiersin.org/articles/10.3389/fmicb.2019.01108/full

What are the barriers and facilitators to effective nursing practices regarding obesity management at primary care?

Chapter One: Introduction

Study Background

Chronic diseases are a major source of burden to the United Kingdom’s healthcare system. The Office for National Statistics (2020) indicates that more than 40% of people aged 65 and above in England suffer from different types of chronic diseases like cardiovascular diseases, diabetes, hypertension, stroke, and cancer, with obesity and overweight being major risk factors not only in the UK but also worldwide (Pearce et al., 2019; McHale et al., (2020), hence, a significant public health concern. An adult is considered obese if they have a body mass index (BMI) of 30 kg/m2 or more caused by an excessive accumulation of body fat, usually 20% beyond the limits of physical requirement leading to an increase in body weight to the degree that it might adversely affect wellbeing (Agha and Agha, 2017; WHO, 2021; House of Commons, 2021). In many cases, it affects the person’s ability to perform many of the tasks required for physical activities due to strain on their body. Likely causes of obesity range from genetics, physical inactivity, unhealthy diet, emotional and mental health problems (Public Health England, PHE, 2017).

Statistics show that over 39% of adults are overweight globally, while more than 13% suffer from obesity (WHO, 2021). In England, cases of obesity and overweight went up by 23%, from 711,000 in 2018 to 876,000 in 2019 (House of Commons, 2021). Moreover, McHale et al. (2020) found out that obese patients consult primary care more frequently than individuals suffering from other illnesses. It is estimated that there was a 17% increase in hospitalisations linked to obesity in 2019/2020, with over one million people being admitted to hospitals across the UK. Increasing prevalence is directly linked to increasing healthcare costs, and it is projected that the NHS will incur 9.7 billion pounds annually by 2050 (PHE, 2017).

Research strongly points out that obesity is linked to reduced quality-adjusted life expectancy, prompting the development of guidelines for identification and management of obesity (NICE, 2014), policies and campaigns such as Sport England (SE) and recently DOH (2020) ‘call to action campaign’ and Public Health England’s Better Health campaign (PHE, 2021). Furthermore, the NHS (2017) guidelines require that the preventive care integrated with treatment or control of obesity-related diseases be accessible to everyone regardless of health status or age. Concurrently, the WHO (2021) stresses the importance of obesity prevention to reduce the prevalence of non-communicable diseases. Practices aimed at preventing obesity and overweight and those intended to achieve weight loss among the overweight individuals cumulatively contribute to an overall decrease in obesity prevalence (Pearce et al., 2019). As such, nurses should care for patients with obesity through preventive measures and by helping overweight individuals lose weight in the population. Nurses form a critical part of primary care as they coordinate with a multidisciplinary team to care for obese people in the community and hospitals (Braga et al., 2017). Obesity management and care involve health promotion to prevent obesity and treat or control obesity-related diseases (Zhu et al., 2013; Kelly et al., 2016).

Furthermore, nurses educate and counsel patients on the importance of weight management and healthy living (RCN, 2021). Various studies postulate that nurses can also advocate for policies that encourage weight management and obesity prevention (Kelly et al., 2016). Such policies may involve government funding of activities such as gym subscriptions or rewarding health outcome goals such as weight loss (Braga et al., 2017). Other roles of nurses in obesity management may involve advocating for the government, insurance companies, and professional bodies to formulate more policies that remove barriers to obesity management services access. Therefore, nurses are an integral part of obesity management in hospitals and within the community. The current integrative literature review explores the role nurses play in obesity management at the primary care level in the UK.

Focus and Scope of the Study

Obesity management involves nurses, but it entails a multidisciplinary effort within the healthcare system. However, this integrative literature review will focus on nurses’ role in promoting obesity management practices at the primary care level. Equally, the study will not focus much on the patient’s role although, it may mention the role of the patient-nurse relationship in obesity management. Accordingly, the study will explore the nurses’ attitudes and perspectives on obese people and other factors influencing their role in obesity management and control.

Significance of the Study

Obesity and overweight management are a priority in the UK due to the high obesity prevalence, especially among adults and adolescents. This reality highlights the crucial role nurses and other healthcare professionals play in the healthcare system. However, much of the existing literature on the role of nurses in obesity management does not give special attention to the UK health system (Braga et al., 2017). Besides, most of the studies generalise the role played by healthcare providers in obesity management and prevention without a specific focus on nurses (Pearce et al., 2019). One of the studies examining healthcare providers’ perspectives and beliefs on weight management in the UK revealed that they were less enthusiastic about obesity management practices (McHale et al., 2020). As a result, there is an urgent need to focus more on the obesity management practices in the UK and how nurses handle them. The current study adds to the existing literature by integrating previous research on hospital practices in obesity management, with a specific focus on the role of nurses in primary care.

Consequently, the study is significant to the nursing profession as it will provide more insights into the facilitators and barriers to quality obesity management service provision. It will also help the relevant stakeholders understand the attitudes and perceptions of nurses towards obese individuals and how they affect service provision. In addition, policymakers and professional bodies like NICE may find this study helpful in formulating the relevant guidelines for nurses to promote obesity management practices. The study may further benefit scholars and students who may want to explore the topic in future.

Research Questions

The study applied the PICO (Population, Intervention, Comparison, and Outcome) framework to formulate a focused research question. Studies indicate that using PICO to frame a research question enhances conceptual clarity and specificity of the clinical problem (Eriksen and Frandsen, 2018). In addition, Aveyard and Bradbury-Jones (2019) posit that the PICO framework enables the researcher to identify the keyword, thereby aiding in the literature search by generating more precise results. Therefore, the framework was essential in this review to help formulate a clear and precise research question regarding current nursing practices around obesity management. The table below shows how the PICO framework developed the research question.

Population Intervention Comparison Outcome
Obese patients Current nursing practices at primary care Null Obesity management

Table 1: PICO framework for the research question (Source: Researcher)

Consequently, the main research question is: what are the current nursing practices around obesity management at the primary care level in the United Kingdom? Therefore, the study will seek to address the following specific research questions:

  1. What are the barriers and facilitators to effective nursing practices regarding obesity management at primary care?
  2. What are the primary care nurses’ perceptions and opinions on caring for people living with obesity?
  3. How do primary care nurses identify and care for people living with obesity in hospitals?

Research Aim and Objectives

The study aims to explore the current nursing practices for managing obesity at primary care in the UK. Accordingly, the study seeks to achieve the following objectives:

  1. To find out the factors influencing primary care nursing practices concerning obesity.
  2. To explore primary care nurses’ attitudes towards people living with obesity.
  3. To determine how nurses identify and manage patients living with obesity in primary care.
  4. To identify what primary care nurses are doing to support people living with obesity.