Staffing Evaluation at Hallmark

Analyze the case “Staffing Evaluation at Hallmark”. Answer the following questions.

  1. Critically evaluate Hallmark’s staffing index. What are its pros and cons?
  2. How can Hallmark use technology for tracking applicants and onboarding its new hires to include improving the efficiency and effectiveness of staffing functions?
  3. How can Hallmark use the system to track:
    • company turnover,
    • downsizing, and
    • Retention?
  • 4 How should these be measured? Be sure to explain the different staffing metrics and how each is used.

2 pages 

Hallmark, founded in 1910, is the largest U.S. manufacturer of greeting cards and the owner of Binney & Smith, the maker of Crayola Crayons.71 The company pursues a differentiation and innovation strategy and uses creativity and emotion to help people connect to its products, including its stationery, party goods, photo albums, home decor, collectibles, a cable television channel, and books.72 To hire quality people more consistently, Hallmark needed a tool to help it focus its staffing efforts on what is most relevant to the company—that is, on business-relevant cri-teria that would allow it to more consistently hire quality em-ployees to best execute its strategy.73 However, Hallmark didn’t want the tool to be too complex. To launch the effort, Hallmark created a staffing index to evaluate the quality of the firm’s past hires to source and screen candidates more effectively. Upon hiring a new employee, the person’s line manager

makes an immediate assessment of the employee’s intrinsic abilities and desirability. To avoid using complex formulas that require a specialized background to understand, the rat-ings are simple and focused on measuring the quality and timeliness of Hallmark’s hiring system.74 The possible new hire ratings are as follows:75 1 = Average 2 = Above Average 3 = Good

4 = Very Good 5 = Walk-On-Water Good After 6 months, the hiring manager uses the same five-point scale to evaluate whether its initial expectations have been realized. The data are used to compare new hires who consistently get top ratings with those who don’t to identify any distinguishing factors that can be used to make the hir-ing process more effective.76 According to one expert, Hallmark is on the right track by

keeping its system simple and not getting too wrapped up in the numbers and by focusing on the end result of making good hires. Hallmark views the staffing index only as a means to an end and knows that ultimate staffing success will be gauged not by these metrics but by the organization’s performance.

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Monitoring and Evaluation

Monitoring and Evaluation

Monitoring and evaluation is a tool that is used to assess performance and achieve the set goals of a particular project. The assessment focuses on the present and future management of the outcomes of any project. Monitoring and evaluation, therefore, helps to a great extent to clearly demonstrate the status of a project and thus aid in maintaining the focus of such a project by informing on the general progress of the project. Monitoring and evaluation tools are important for they help improve project rollout as well as ensure better utilization of available fund.

Evaluation for the Campaign for Sustainable Rural Livelihoods is a report which was published by Oxfam, a non-profit firm which operates across several countries of the world (Oxfam, 2013). This report is quite appealing since it has shown the evaluation of its program on rural sustainable livelihoods where it is documented that it has influenced the climate change policy. Climate change is one of the leading factors which have influenced livelihoods in as far as food security and sustainability is concerned (Oxfam, 2013). This report is appealing since it touches on a very crucial topic which is the world’s concern. It, therefore, shows that the program that was rolled out clearly helps to sustain the impacts created by climate change.

Adam Smith International Policy, Planning and Monitoring & Evaluation report are quite appealing and informative. The report seeks to report on policy planning in the education sector (Adam Smith International, 2019).  The report notes that the education sector does not put into consideration the monitoring and evaluation as this is the only way to ensure that the policy and programs which are being implemented are up to standard and are sustainable for a longer span of time.  The monitoring and evaluation strategies which are proposed by this report include the inclusion of a rigorous monitoring framework, management information systems, building capacity among other monitoring strategies which are aimed at improving monitoring and evaluation of education policies and programs. This is intended to ensure that there is sustainability in the sector that will see the allocation of limited resources and realize the results and intended outcomes.

Besides the education sector policy monitoring and evaluation, the Australian Government Department of Foreign Affairs on 31st May 2016 reported on the review of Disability rights in Cambodia (Australian Government, 2016). The review is a joint UN program which brings UNDP, UNICEF and WHO together.  The report is therefore appealing since it focuses on the assessment of the program that seeks to create more opportunities for the people with disability. The findings, therefore, are the outcome of the status of the program and thus help in refocusing of the remainder tenure. In its entirety, the initiative is aimed at ensuring that people living with disability are given equal access to opportunities and thus this bring fairness as they are outcompeted and neglected in other sectors where opportunities are very competitive.

Finally, the report on monitoring and evaluation on Global HIV/AIDS by CDC as published in its website in 2012 is impressive and informative since it gives the update on the commitment of the United States in combating HIV/AIDS (CDC, 2012).  This is because the report documents the activities in which CDC and the United States at large have undertaken including the provision of technical assistance on planning and reporting, processing outcomes and implementation of planning and reporting systems.

Conclusively these reports are focused on the Monitoring and Evaluation as a tool and how it has been used as a tool to aid in the management of the projects, programs, and their outcomes.  Depending on how the M& E has been used in various aspects, it is clear that M&E is very crucial and very useful in the management of any project as it provides reports on the status of such a project and thus helps in an amendment or refocusing to ensure that the goals are attained.


Adam Smith International. Policy, Planning and Monitoring & Evaluation. Retrieved from

Australian Government. (2016). Disability Rights Initiative Cambodia: Mid-Term Review Report and Management Response. Retrieved from

CDC. (2012). Global HIV/AIDS: Monitoring and Evaluation. Retrieved from

Oxfam (2013). Evaluation for the Campaign for Sustainable Rural Livelihoods. Retrieved from

Education for Ethnic Minority Children in Cambodia. (2017). Retrieved from

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Practice Evaluation Findings

In the entire process of Lee’s intervention, there will be various findings that will come up. Firstly, the best method to be used in the intervention will be determined. In this case, Cognitive behavioral therapy (CBT) will be the best. This is a form of treatment that “focuses on examining the relationships between thoughts, feelings, and behaviors. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their thinking patterns to improve coping” (National Alliance on Mental Illness, 2012). CBT usually includes exposing the clients to trauma memories through individual and group processing, imagining, and exposure to real-life situations (Jaycox, Zoellner, &Foa, 2002). A widely used form of treatment, CBT has been used with many populations and for several issues, including with women who have experienced the traumatic event of sexual assault.

The other step, included in the findings, will be choosing participants to be involved in Lee’s intervention.  The rationale used for choosing the individual varies on different factors, as well as reasons. In the case of a religious leader, Marge would respect him and so listen to whatever he says. This will also mean that the influence of the religious leader might in some proportions, surpass that of her best friend whom she has got used to for all the time they have been living together. Rather than take the negative consequences of he abuseas told by her friend seriously, she would listen keenly and consider the advice of a religious leader.

At the same time, there would the involvement of a qualified person to guide the entire process. The person would be most likely a counselor, who is experienced with matters of sexual abuse or molestation. The counselor would be qualified to fit in this intervention because he knows all about sexual abuse and how he can steer the intervention effectively (American Psychiatric Association, 2006). The counselor will benefit Lee in terms of learning how to overcome trauma that she has been undergoing since her ordeal.


Kim, J. Y., & Lee, J. H. (2011). Factors influencing help-seeking behavior among battered korean women in intimate relationships.Journal of Interpersonal Violence, 26(15), 2991-3012.doi:

National Center for PTSD (2013). Understanding PTSD. Retrieved from

Wachen, J. S., Jimenez, S., Smith, K., &Resick, P. (2014). Long-term functional outcomes of

women receiving cognitive processing therapy and prolonged exposure. American

Psychological Association. doi: 10.1037/a0035741

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The cause of conflict and alienation at work and evaluation of the resolution methods


A conflict in an organization occurs when the interests or preferences of various groups or persons are incompatible, and the groups or persons block each other’s efforts to fulfill their objectives. Conflict is the process or a course that commences when a person in the interaction process believes that another person or group is not making proper decisions. It also arises when an individual sees another group or person is in an impediment to achieving his goals or needs. Considering the perspective for imagined or actual frustrations of a person, conflict commonly exists in various organizations. This is a global phenomenon and cannot be avoided due to various perceptions and different views of individuals. There are various causes of conflicts in organizations. To start with, various organizations and companies have employees with divergent perceptions, values, and personalities. Second, in various organizations, employees are given tasks with divergent characteristics that affect imbalanced ranks, and they normally encourage competition among employees (Gratton and Erickson, 2007). Lastly, conflict results from various groups with different views in an organization. The groups with divergent views compete for a resource, and due to the various intentions of each group, conflicts result. As a result, conflict is a bound to happen aspect of social relations, an inescapable consequence of social interactions, and is interdependent between groups and people.

The cause of conflict and alienation at work and evaluation of the resolution methods

The report attempts to analyze the cause of conflict and alienation at work and evaluates the methods of conflict resolution in organizations. The report also critically analyzes the impact of conflict to various organizations. In achieving this objective, the report analyses the effects of changes, employee aspects ranging from relation strategies, policies and practices on employees’ performance. Labor unions roles in conflict management are presented in this report taking UNITE as a case study. Based on Donald (2004) definition and in this context, labor relations are the connections between employees and union management. Labor relations deal with all aspects relating to terms of employment. It is therefore crucial as stated by Stephen and Donald (2004) to understand the capability of a labor union (UNITE) to adapt to technology changes, globalization and political environment in conflict resolution. It is the union members that govern a given labor union. The main objective of a labor union is to represent its members to the employer for welfare of other members. Whitney (2008) states that it is the union leadership to tackle matters in relation to working conditions, disciplinary procedures, privileges, and employment contract and conflict resolutions. UNITE is an international labor union with objectives of protecting its members’ welfare in any organization. As stated by Whitney (2008), UNITE like other labor unions in United States, has statewide and global connections as it operates in the United Kingdom and Irish. The report contains recommendations to UNITE in dealing with conflict resolutions in organizations.

UNITE and conflict resolution

According to Kelloway and Julian (1998), labor union can be defined as group of employees in an company or organization whose aim is to fight other members’ interests, normally salary improvement and better working conditions. UNITE, an example of labor union was formed in 2007, serves both British and Irish.

In the past, working hours and wages were negotiated by employers and personal employees. This was due to the reason that the social-economic and legal environment never favored union formations by employees. As a result of the lack of labor unions, various employees have been abused by the employers, causing conflicts between management and employees in various organizations. This is among the reasons UNITE was formed to fight for employee rights and help resolve conflicts in between employers and employee in various organizations. For harmony in an organization and in attempts to reduce the conflicts, three regulations have been formed by UNITE; labor relations, collective agreements and protective legislation. As confirmed by Hunt and Patricia (1994), the main reason of protective legislation is to set maximum working hours, minimum salary for every group of employees. The protective legislations have been designed to prevent discrimination based on gender or race and hence reducing conflicts. UNITE has fought for the right of employee association and unions formations in addressing their needs. As stated by Whitney (2008), UNITE has encouraged the use of labor unions as the sole bargaining route and elimination of oppressive practices by management of any organization. This has reduced the oppressions by the employers and hence reducing conflicts. It is through the labor unions that employees are allowed to negotiate with one another compared to protective legislations is does not set terms and conditions.

Currently, as stated by Reimold and Reimold (2007), most employees have departments for labor relations to solve problems of negotiations and supervision agreements. UNITE has dealt with daily issues concerning salaries and wages, promotions, discipline and arbitrations (Hunt and Patricia 1994). UNITE has been the mouth piece of its members. In cases where employees are oppressed, UNITE has assisted. Through it, employees get their grievances addressed and it is also responsible for providing education to their members and providing skilled labor to companies (Kelloway and Julian, 1998).  

Labor relations are important tool for a company’s management when dealing with union leadership and this is done through three levels; relations strategies, negotiating contracts and administering contracts. It is through labor relations strategies that organization management can decide either to deal with union or non-union operations. This decision is influenced by forces external to organizations for instance public opinions and competition (Kelloway and Julian 1998). Unions have to either accept new management relationships or fight for change on relationship between unions and the organizations (Gratton and Erickson, 2007). The negotiating contracts entail issues regarding job security, salaries and wages, and working hour’s regulations. The administering contracts entail daily activities between management and employees for instance work rule violations, and disagreements among others.

Cause of conflict and alienation at work

Personality differences

In an organization, each person or group has a different opinion or perception. Normally, this is a psychological problem and so do not have anything to do with their formal interactions or job requirements. As result of divergent perceptions and opinion of individual in an organization, there have been various conflicts.

Different Perceptions

Employees in an organization have different experiences; background, training and education. As a result, people have developed very different perceptions of same occasions. The divergent experiences may result to a conflict. On the contrary, vertical conflicts emerge in various organizations; usually because management tries to have full control on their employees and in some cases when resistance develops, conflict occurs (Kelloway and Julian, 1998). Majority of the employees do resists when they feel the management infringes on their personal sovereignty, make their behavior more boring and predictable to other employees. In some cases when the employer exposes an individual’s personal life, the employee is looked down upon by other colleagues.

Competitive environment

Companies and organizations have various reward schemes. When an employee is rewarded for the good work and as a motivation method, it brings about frustrations to other unrewarded employees and at times this causes conflicts. As asserted by Reimold (2007), in some case the employee not rewarded fee they are never appreciated in that organization and start undermining other colleagues. This mostly leads to interpersonal conflicts among employees and management in the work environment, and also among employees themselves and the management. The other case is where some employees are given salary increments and others of the same job group or rank are left.

Power and status differences

Organizations have various political structures. Organizations work by authoritative distribution and also setting a stage for exercise of authority and power. In organizations where power is distributed, unequal sharing or in cases where other employee are superior that others, this can cause a conflict. For instance, when a less experienced employee gives orders to a more experienced employee or younger to older, conflicts might result (Capozzoli, 1999). Leadership style is also important in any team coordination. Some of the leadership favors other employee for given reasons. In some cases, leaders misuse power and results to conflicts.

Scarce resources

Normally, conflicts result when every person in that organization fights to have a share of a limited resource. The notion that someone is out to clear the whole resource of over utilize it do bring ill intentions between employees. When the shortage is absolute or utter, for instance when the resource cannot be improved, it becomes very intricate to manage or deal with conflicts. The other example is when three qualified people vie for one position in an organization, conflicts may result (Townsley, 2008). The other source of conflict is the unequal distribution of resource among the employees. Thai take when other employees are preferred to other causing conflict.

Stereotype behavior

Stereotyping causes a person to have formed opinion about others or colleagues, and most of the time it is through rushed judgment or judgment based on given notions. Due to this, people tend to have biased judgments or behaviors towards people belonging to other groups or department or even their own colleagues. For instance, in majority of the organizations in the United Kingdom, employees tend to exhibit distorted or skewed behavior and attitude towards other individuals who come from other races. This leads numerous interpersonal problems and issues in organizations.

Communication problems

To resolve a given conflict, management needs to determine the major reason behind the conflict. There are various reasons that can cause conflict and so thorough investigation is vital in finding the root of cause of a given conflict. Among the factors that lead to conflicts is lack of proper communication among employee or between employee and management. The other factor that may lead to conflict in organizations is organizational structure and communication system in an organization. Lack of proper leadership and flow of information is among the factors.

Human beings’ exploitative nature

In organizations, many people always come across a group of individuals who tend to abuse others by virtue of their authority or position. Consequently, they try to take a gratuitous share in the outcome, despite their contributions not being in proportion to that level. Naturally, this would bring about interpersonal conflicts in the long-run. For example, some organizations and departments’ heads may claim an authorship in the scientists’ publications working under them, despite the fact that they did not contribute anything to that work (Capozzoli, 1999). This is a typical example for this kind of interpersonal conflict. Actually, in some organizations, it has become a regulation that the Heads’ names should be included in each and every publication. This has caused various conflicts.

Conflict resolution strategies

There are various approaches that can be used to tackle a given conflict. The strategies employed depend on the nature of conflicts. The team leader ought to approach the members directly, the members who are responsible for the issues, discus their problems and advice them accordingly. In this case, constructive criticism plays a vital role. Suppose a member has a better solution to a given conflict, the team leader has to give the member a chance to propose his ideas (Gratton &Townsley 2007).

There are procedures that ought to be followed when resolving a conflict in an organization. The standard rules assist in making informed decisions. The rules are to be followed by every member and any changes are to be communicated to all members. A team leader for effective conflict resolution should never force an employee to follow a new rule as this can create various misunderstanding and feeling of oppression by the employee (Whitney, 2008). Excessive power can cause the employee to resist the rules or the team leader.

Some conflicts are to be ignored for their resolutions. As stated by Brooks (2001), some problems are minor and should not be mentioned either and use of power in such cases results to destructive results. This indicates that a good leader should not involve him in some problems and allow the members or employee to resolve the problems amongst themselves (Capozzoli, 1995). The team leader only needs to provide an environment for its resolution and at times this makes it easier and convenient when the members come to a mutual understanding than being forced to make a decision (Townsley, 2008).

The other resolution technique is through discussions. The optimal objective in conflict resolution is creating a win-win solution for all parties involved. This outcome is not possible in all cases, and most of the time, the team leaders’ goals have been to manage the conflicts in a less destructive way (Gratton and Erickson, 2007). The team leaders have also been concerned with lessening the perpetual differences that exists between the involved parties. A team leader has to discuss the problems as faced by the employees and design methods of resolving them. It is through discussions that mutual understandings are arrived at. The members and the management also feel that their decisions are taken in so a feeling of togetherness. In team conflict resolution, an emphasis has to be placed on how members perceive themselves (Brooks, 2001). This forms a basis on how a given conflict can be resolved. The mediator or the person resolving the conflict has to be neutral and not connected to any party or its interest. A resolution is reached only when all the party’s issues are properly addressed. Suppose a discussion between two members or between employee and the management does not yield any fruit, then it is advisable to involve a third party before the management makes a ruling. In advanced cases, a whole team may be involved to make a final decision on a given issue (Reimold 2007). Suppose this method does not work also, then it becomes necessary for the management to make a ruling based on the organization rules.

Strategies UNITE may adopt deal with conflict resolution

  1. Formation of various team leaders in organizations

The main responsibility of a team leader is to resolve the conflicts in ways that they are not to affect the actual aim of the team. In the present situations, organizations are facing stiff competitions to manage the project of teams. Making the right decisions is vital in every project and the team leaders should do this. Brooke (2001) also affirms that the main objective of a team leader is to resolve its conflicts and attain its goals. Suppose UNITE increases its team leaders, various people with different experiences, different attitudes and power will reduce conflicts in organizations. Decision makings are affected by conflicts in any team, so the importance of choosing suitable members to be team leaders.

  • Improve employees’ self awareness

UNITE should engage in campaigns to educate employees of their rights as this helps them to develop their personalities. It is through educating the employees that good relationships can be achieved (Capozzoli 1995). The improvement of the employees’ awareness on their rights and obligations can be done through forums and some educative program in an organization. Members are also to be encouraged to join any labor unions where they can freely address their concerns and work related issues.

  • Partnership with various organizations and unions

Through partnership, UNITE can experience a mixture of diverse ages, talents and gender in various organizations. Through partnerships, UNITE will also be able to identify various policies attached to different organizations. Various organizations have employees from different races, ethical backgrounds, countries and cultural back grounds. Understanding each employee based in their beliefs and cultures are essential in their management. Employee relations are significant in a business setting and such information can be availed through an organizations’ management (Capozzoli, 1995). It is through partnership that UNITE can make proper decisions in dealing with a given conflict in a particular organization. This is easily achievable since UNITE will familiarize itself with the organization’s rule and terms of employments. Decisions are essential factors that determine the growth of an organization or even growth of an individual hence good UNITE is supposed to be fit in decision making of various organizations.

Decision making is an aspect that a person can undertake, a group of people or an organization and so the importance of understanding an organization’s rule (Hunt and Patricia, 1994). This means that there is a need to have consent or build consensus among the individuals affected by the decision; this is applicable only to groups or organizations since the individuals usually join forces in implementing conducting their business activities.

A decision is usually made basing on the prevailing conditions affecting the organization; it could be managerial, administrative or even operational (Whitney, 2008). Different problems require different decisions to be taken and thus there is need to define the problem or issue to be solved as either administrative or operational before an effective decision is taken (Hunt and Patricia, 1994). Without proper definition and clarification of the problem, it is definite that the decision to be taken will not be vital as the intended solution to the problem will be difficult achieve (Sabatier, 2007).

The implementation of the decisions is usually done after the establishment of the objectives set and the possible alternatives that may be adopted in case the postulated decisions may not be vital in the attainment of the set goals. Brooks (2001) states that there are certain issues that ought to be solved so as to make it possible for the firm to attain its set goals and also reduce the chances of aggression and misunderstandings among the members. Basing on this assertion, it becomes necessary that the managers and the leaders of the specific departments in the firms endorse the suitable alternatives to be undertakes; this has to be done with the consultations or seeking of consensus from all the concerned parties (Sabatier, 2007). A better understanding of employees and various organizations is therefore vital for conflict resolutions.


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Review the performance dashboard for a health care organization, as well as relevant local, state, and federal laws and policies. Then, write a report for senior leaders in the organization that communicates your analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement.

Review the performance dashboard for a health care organization, as well as relevant local, state, and federal laws and policies. Then, write a report for senior leaders in the organization that communicates your analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement.IntroductionNote: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.In the era of health care reform, many of the laws and policies set by government at the local, state, and federal levels have specific performance benchmarks related to care delivery outcomes that organizations must achieve. It is critical for organizational success that the interprofessional care team is able to understand reports and dashboards that display the metrics related to performance and compliance benchmarks.Maintaining standards and promoting quality in modern health care are crucial, not only for the care of patients, but also for the continuing success and financial viability of health care organizations. In the era of health care reform, health care leaders must understand what quality care entails and how quality in health care connects to the standards set by relevant federal, state, and local laws and policies. An understanding of relevant benchmarks that result from these laws and policies, and how they relate to quality care and regulatory standards, is also vitally important.Health care is a dynamic, complex, and heavily regulated industry. For this reason, you will be expected to constantly scan the external environment for emerging laws, new regulations, and changing industry standards. You may discover that as new policies are enacted into law, ambiguity in interpretation of various facets of the law may occur. Sometimes, new laws conflict with preexisting laws and regulations, or unexpected implementation issues arise, which may warrant further clarification from lawmakers. Adding partisan politics and social media to the mix can further complicate understanding of the process and buy in from stakeholders.How many health care laws can you name that affect your practice in your current or future workplace? How do they impact your daily work? How many regulatory agencies oversee the types of services your health care organization provides? Which regulatory agencies apply to your workplace setting? Are you familiar with the process of complying with those agencies in order to maintain certification? You might be overwhelmed as you consider these broad questions.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 1: Analyze the effects of health care policies, laws, and regulations on organizations, interprofessional teams, and personal practice.Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team.Competency 3: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.Advocate for ethical action in addressing a benchmark underperformance, directed toward an appropriate group of stakeholders.Competency 4: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, for health care policies and law for patients, organizations, and populations.Evaluate dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws.Evaluate a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance.Competency 6: Apply various methods of communicating with policy makers, stakeholders, colleagues, and patients to ensure that communication in a given situation is professional, clear, efficient, and effective.Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.PreparationFor this assessment, you may choose one of the following three options for a performance dashboard to use as the basis for your benchmark evaluation.Option 1: Dashboard and Health Care Benchmark Evaluation SimulationYou may use the data presented in the Dashboard and Health Care Benchmark Evaluation media piece as the basis for your assessment submission.If you decide to use the simulation dashboard for your evaluation, review the dashboard, as well as  relevant local, state, and federal laws and policies. Consider the metrics within the dashboard that are falling short of the prescribed benchmarks.Option 2: Actual Dashboard From a Professional Practice SettingIf you choose an actual dashboard from a professional practice setting for your evaluation, be sure to add a brief description of the organization and setting that includes:The size of the facility that the dashboard is reporting on.The specific type of care delivery.The population diversity and ethnicity demographics.The socioeconomic level of the population served by the organization.Note: Ensure that your data is Health Insurance Portability and Accountability Act (HIPAA) compliant. Do not use any easily identifiable organization or patient information.Option 3: Hypothetical Dashboard Based on a Professional Practice SettingIf you have a sophisticated understanding of dashboards that are relevant to your own practice, you may also construct a hypothetical dashboard for your evaluation, based on that setting. Your hypothetical dashboard must present at least four different metrics, at least two of which must be underperforming the relevant benchmark set forth by a federal, state, or local laws or policies. In addition, be sure to add a brief description of the organization and setting that includes:The size of the facility that the dashboard is reporting on.The specific type of care delivery.The population diversity and ethnicity demographics.The socioeconomic level of the population served by the organization.Note: Ensure that your data is HIPAA compliant. Do not use any easily identifiable organization or patient information.InstructionsStructure your report in such a way that it would be easy for a colleague or supervisor to locate the information they need. Be sure to cite relevant local, state, or federal health care laws or policies when evaluating metric performance against prescribed benchmarks. Cite an additional 2–4 credible sources to support your analysis and evaluation of the challenges in meeting the benchmarks, the potential for performance improvement, and your advocacy for ethical action.You may wish to review the Dashboard Benchmark Evaluation Example [DOC] for additional support in planning and developing your submission for this assessment.Note: The tasks outlined below correspond to grading criteria in the scoring guide.In your report, be sure to:Evaluate dashboard metrics against the benchmarks set by local, state, or federal health care laws or policies.Which metrics are below the mandated benchmarks in the organization? Evaluate weaknesses within the entire set of benchmarks.What are the local, state, or federal health care laws or policies that set these benchmarks?Analyze challenges that meeting prescribed benchmarks can pose for the organization or for an interprofessional team.What are the specific challenges or opportunities that the organization or interprofessional team might have in meeting the benchmarks? For example, consider:The strategic direction of the organization.The organization’s mission.Available resources:Staffing.Operational and capital funding.Physical space.Support services (any ancillary department that supports a specific care unit in the organization, such as a pharmacy, cleaning services, and dietary services).Cultural diversity in the organization.Cultural diversity in the community.Organizational processes and procedures.How might these challenges be contributing to benchmark underperformance?Evaluate a benchmark underperformance in the organization or interprofessional team that has the potential for greatly improving overall quality or performance.Which metric is underperforming its benchmark by the greatest degree?Which benchmark underperformance is the most widespread throughout the organization or interprofessional team?Which benchmark affects the greatest number of patients?Which benchmark affects the greatest number of staff?How does this underperformance affect the community the organization serves?Where is the greatest opportunity for improvement in the overall quality or performance of the organization or interpersonal team—and ultimately in patient outcomes?Advocate for ethical action in addressing the benchmark underperformance that has the potential for greatly improving overall quality or performance.At which group of stakeholders should your advocacy be directed? Which group could be expected to take the appropriate action to improve the benchmark metric?What are some ethical actions that the stakeholder group could take that support improved benchmark performance?Why should the stakeholder group take action?Communicate your findings and recommendations in a professional and effective manner.Ensure that your report is well organized and easy to read.Write clearly and logically, using correct grammar, punctuation, and mechanics.Integrate relevant sources to support your arguments, correctly formatting source citations and references using current APA style.Did you cite relevant local, state, or federal health care laws or policies when discussing the mandated benchmarks?Did you cite an additional 2–4 credible sources to support your analysis, evaluation, and advocacy?Additional RequirementsStructure: Include a reference page.Length: 2–5 pages should be sufficient for presenting a thorough and concise evaluation, not including any pages for presenting your data and your reference page.References: Cite 2-4 current scholarly or professional resources.Format: Use APA style for references and citations.You may wish to refer to the following APA resources to help with your structure, formatting, and style:APA Style and Format.APA Paper Tutorial.APA Paper Template.Font: Times New Roman font, 12 point, double-spaced for narrative portions only.Grading Rubric:1)  Evaluate dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws.Passing Grade:  Evaluates dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the evaluation).2)  Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team.Passing Grade:  Analyzes challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team, and identifies assumptions on which the analysis is based.3)  Evaluate a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance.Passing Grade:  Evaluates a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance; defends reasoning for selecting this benchmark over another with similar potential for improvement.4)  Advocate for ethical action in addressing a benchmark underperformance, directed toward an appropriate group of stakeholders.Passing Grade:  Advocates for ethical action in addressing a benchmark underperformance, directed toward an appropriate group of stakeholders, and recommends criteria for evaluating the effectiveness of the recommended action.5)  Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.Passing Grade:  The evaluation and analysis are professional, effective, and insightful; the content is clear, logical, and persuasive; grammar, punctuation, and spelling are without errors.6)  Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.Passing Grade:  Integrates relevant sources to support arguments, correctly formatting citations and references using current APA style. Citations are free from all errors.

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Nursing Research Utilization Project Proposal (pressure ulcer reduction) Monitoring and Evaluation Phase


Write a paper in implementing a project proposal to reduce pressure ulcers in an acute hospital.
The proposed project to be implemented is by adding an electronic documentation system that recorded harm events and documented initial pressure ulcer risk assessment among all admitted cases. In the new program, staff charge nurses will conduct pressure ulcer assessments in admission. Instead of documenting in paper form, they will directly record these findings on an initial risk assessment electronic form and simultaneously make an e-referral to the wound consult nurse if a patient has a pressure ulcer that is a stage 2 or higher.

Use the attached article as one of the references:
Pittman, J., Beeson, T., Kitterman, J., Lancaster, S. and Shelly, A. (2015). Medical device?
related hospital-acquired pressure ulcers. Development of an evidence-based position
statement. Journal Wound Ostomy Continence Nurse, 42(2), 151-154.
DOI: 10.1097/WON.0000000000000113

The assignment should have 4 main sections. Use the attached example as a template.
Please use subheadings to identify each section (see APA 6.0 for formatting heading levels). Do not forget to include the appendix copy and paste it, do not attach as a separate document.
1) Monitoring

Describe the methods for monitoring solution implementation using the steps of the model you chose.
2) Evaluation

Describe the methods to be used to evaluate the solution.
3) Outcome Measure

Describe an outcome measure that evaluates the extent to which the project objective is achieved. A copy of the measure must be included in the appendix. For example: If your problem is falls or CAUTIs, then your objective would be to reduce the rate/numbers and the outcome measure is the form or graph you track the number of falls or number of CAUTIs. If your problem is the lack of knowledge of your nurses regarding lateral violence, then your outcome measure could be a pre and posttest.
The outcome measure for this propose project is: The expected result of the change implementation in California Health Medical Center (CHMC) is to have a reduction in the incidence of newly acquired pressure ulcers development from the current rate of 15% to 10% in all patients in the hospital within six months.

Describe the ways in which the outcome measure is valid and appropriate for use in this proposed project.

4) Evaluation Data Collection

Describe the methods for collecting outcome measure data and the rationale for using those methods.
Identify resources needed for evaluation.
Discuss the feasibility of the evaluation plan.

Format your paper consistent with APA 6.0 guidelines.
Include a minimum of 4 scholarly references
Minimum word count of 800.

J Wound Ostomy Continence Nurs. 2015;42(2):151-154.
Published by Lippincott Williams & Wilkins
Copyright ? 2015 by the Wound, Ostomy and Continence Nurses Society? J WOCN ? March/April 2015 151
Patient safety and prevention of harm are foundational
principles of healthcare, and nursing in particular, yet patients
continue to develop pressure ulcers while under our
care. Hospital-acquired pressure ulcers (HAPUs) cause pain,
loss of function, and infection, extend hospital stays, and
increase costs. The cost of treating these wounds is approximately
$11 billion a year. In spite of progress in wound
care products, support surfaces, and prevention methods,
occurrences of pressure ulcers persist. 1 Medical device-related
HAPUs are common in both adults and children in
the acute care setting.
Medical Device?Related HospitalAcquired
Pressure Ulcers
Development of an Evidence-Based Position Statement
Joyce Pittman Terrie Beeson Jessica Kitterman Shelley Lancaster Anita Shelly
Hospital-acquired pressure ulcers (HAPUs) are a problem
in the acute care setting causing pain, loss of function,
infection, extended hospital stay, and increased costs. In
spite of best practice strategies, occurrences of pressure
ulcers continue. Many of these HAPUs are related to
a medical device. Correct assessment and reporting of
device-related HAPUs were identifi ed as an important
issue in our organization. Following the Iowa Model
for Evidence-Based Practice to Promote Quality Care,
a task force was created, a thorough review of current
evidence and clinical practice recommendations was
performed, and a defi nition for medical device-related
HAPU and an evidence-based position statement were
developed. Content of the statement was reviewed by
experts and appropriate revisions were made. This position
statement provides guidance and structure to accurately
identify and report device-related HAPU across our
18 healthcare facilities. Through the intentional focus on
pressure ulcer prevention and evidence-based practice in
our organization and the use of this position statement,
identifi cation and reporting of device-related HAPUs
have improved with a decrease in overall HAPU rates
of 33% from 2011 and 2012. This article describes the
development and implementation of this device-related
HAPU position statement within our organization.
KEY WORDS: Evidence-based , Iowa Model , Medical devicerelated
pressure ulcers , Position statement
A pressure ulcer can occur wherever external pressure
impairs circulation to the skin. Pressure ulcers have been
defi ned by the National Pressure Ulcer Advisory Panel
(NPUAP) as ?a localized injury to the skin and/or underlying
tissue usually over a bony prominence, as a result of
pressure, or pressure in combination with shear.? 2(p6) This
defi nition is helpful but many pressure ulcers occur as a
result of external pressure from medical devices that do not
completely fi t this defi nition. The NPUAP addressed devicerelated
HAPUs, which develop on mucosal membranes by
issuing a statement describing the inappropriate use of staging/category
classifi cation due to anatomical differences
between mucosal membrane with skin structures. The
National Database of Nursing Quality Indicators recommends
using the term ?indeterminate? when classifying
HAPUs over mucosal membranes when reporting HAPU. 3,4
However, neither of these recommendations provides a
clear and concise defi nition for all device-related HAPUs.
Hospital-acquired pressure ulcer development is considered
a quality indicator across healthcare systems. 5
Healthcare facilities are required to track and report HAPU
rates. In our large academic healthcare system, prevention
and accurate identifi cation and classifi cation of HAPUs are
a high priority. Monthly skin audits within our facility
found that a high percentage, often more than 50%, of
HAPUs are device related. In addition, the identifi cation,
Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, Indiana University
Health?Methodist, Indiana University School of Nursing, Indianapolis.
Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University
Health- University Hospital, Indianapolis.
Jessica Kitterman, BSN, CWOCN, Indiana University Health- Ball
Hospital, Muncie.
Shelley Lancaster, MSN, CNS, CWOCN, Indiana University HealthWest
Hospital, Indianapolis.
Anita Shelly, MSN, CNS, CWOCN, Indiana University Health- Riley
Hospital, Indianapolis.
The authors declare no confl icts of interest.
Correspondence: Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN,
Indiana University Health?Methodist, Indiana University School of
Nursing, 1701 Senate Blvd, Room B651, Indianapolis, IN 46202
( ).
DOI: 10.1097/WON.0000000000000113
Copyright ? 2015 Wound, Ostomy and Continence Nurses Society?. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00006_LR 151 WOCN-D-14-00006_LR 151 21/02/15 2:01 PM 1/02/15 2:01 PM
152 Pittman et al J WOCN ? March/April 2015
defi nition, and reporting of these types of HAPU are inconsistent
with high variation across this organization?s
acute care facilities. Therefore, a task force was created and
given the directive to explore this issue. The purpose of
this article is to describe the process this task force used to
address this important issue.
? Development of the Project
When examining a practice issue or problem, it is helpful to
use a model that provides a guide to identify areas of clinical
inquiry through synthesis and application of research fi ndings.
6 One such model is the Iowa Model of Evidence-based
Practice to Promote Quality Care (Figure 1). It provides guidance
for nurses to use research fi ndings for improvement of
patient care. Using this model, we fi rst created a task force
that included members of our Pressure Ulcer Prevention systemwide
committee. Task force members represented 4 of
our adult acute care facilities and our childrens? hospital.
Four of the task force members were certifi ed WOC nurses,
3 were also masters prepared and/or a clinical nurse specialist,
and 1 member was doctorally prepared. Using the Iowa
Model of Evidence-based Practice to Promote Quality Care,
the task force identifi ed medical device-related pressure ulcers
as a problem-focused trigger, a clinical problem, and a
priority of the healthcare organization. This was an important
fi rst step because a topic that is aligned with the strategic
goals of the organization and embraced by staff has a
high likelihood of being adopted by those providing care. 6
In addition, connecting the knowledge gained from research
to an organizational initiative that has relevance to both the
organization and the WOC nurse creates an opportunity
and environment for support that might not be available if
the topic were chosen to fulfi ll local interests alone. 7
Developing a well-formulated purpose statement is
benefi cial once the topic or problem is identifi ed. The
purpose statement directs the evidence search, helps focus
reading, and defi nes the boundaries and limits around the
work to be accomplished. Finally, we advocate formulating
a clear and concise purpose statement to assist with
developing an appropriate implementation and evaluation
plan. The task force was charged with developing a
standardized, evidence-based defi nition for device-related
HAPU, which would support appropriate identifi cation
and reporting of these pressure ulcers.
The next step in the Iowa Model is to appraise the evidence
related to the question or purpose statement. In
order to fi nd the most current new knowledge related to
device-related pressure ulcers, a search was conducted of
the current relevant literature. We searched the MEDLINE
electronic database. Key search strategies were: (1) time
frame: 1996 to September 2012; (2) exp *?Equipment and
Supplies?/ (312834); (3) exp *Pressure Ulcer/ep, et
[Epidemiology, Etiology] (851); (4) 1 and 2 (84); (5) limit 3
to (English language and humans) (78); and (6) from 4
keep 2?4, 6, 13, 16?17, 20, 23?24, 26?31, 35?39, 53?54, 64,
69?71, 76?78 (30). This search identifi ed 30 references,
which were reviewed by our team.
The task force identifi ed the defi nition of medical devices
by the Food Drug & Cosmetic Act as integral to developing
a defi nition of device-related HAPUs. The US
Food and Drug Administration defi nes a medical device as
??an instrument, apparatus, implement, machine, contrivance,
implant, in vitro reagent, or other similar or related
article, including a component part, or accessory
which is: recognized in the offi cial National Formulary, or
the United States Pharmacopoeia, or any supplement to
them, intended for use in the diagnosis of disease or other
conditions, or in the cure, mitigation, treatment, or prevention
of disease, in man or other animals, or intended
to affect the structure or any function of the body of man
or other animals, and which does not achieve any of its
primary intended purposes through chemical action
within or on the body of man or other animals and which
is not dependent upon being metabolized for the achievement
of any of its primary intended purposes.? 8(p1)
Another important piece of evidence was that of the
NPUAP and its work surrounding pressure ulcers. The
NPUAP hosted a consensus conference in 2010 and again in
2014 to discuss the complexities of avoidable versus unavoidable
HAPUs. As a result of this work, NPUAP has led
efforts of the wound and pressure ulcer expert community
in identifying key components related to pressure ulcer development
and the complexities surrounding these wounds.
This work is in its initial stages, but a state of the science
article was published recently describing unavoidable pressure
ulcer incidence and the key risk factors that infl uence
them. 9 One of these key risk factors identifi ed is that of medical
devices. Medical device-related pressure ulcers are diffi
cult to prevent as they are necessary for treatment. They are
also challenging to assess due to the inability to remove
them in certain instances, and they may produce compromise
of underlying tissue due to moisture or edema.
Many states are recognizing the importance of HAPUs
and are requiring the reporting of prevalence of HAPUs as
a quality measure. Minnesota used data collected through
mandatory statewide adverse health events reporting system
to identify trends in causative factors for device-related
pressure ulcers. An interdisciplinary team convened
to develop best practices for prevention of pressure ulcers
related to the use of medical devices. 10 Although the fi ndings
from this report are helpful, no defi nitive defi nition
for device-related HAPUs was described.
? Implementation of the Project
Using the US Food and Drug Administration defi nition for
medical devices, evidence-based guidelines, and position
statements from various organizations, and results of an expert
review, the task force defi ned device-related skin injury
to those devices that were medical and external. The task
force identifi ed 2 critical elements to be included in the
Copyright ? 2015 Wound, Ostomy and Continence Nurses Society?. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00006_LR 152 WOCN-D-14-00006_LR 152 21/02/15 2:01 PM 1/02/15 2:01 PM
J WOCN ? Volume 42/Number 2 Pittman et al 153
Assemble Relevant Research & Related Literature
Critique & Synthesize Research for Use in Practice
Yes No
Is Change
Appropriate for
Adoption in
Yes Institute the Change in Practice
Continue to Evaluate Quality
of Care and New Knowledge
Disseminate Results
Problem Focused Triggers
1. Risk Management Data
2. Process Improvement Data
3. Internal/External Benchmarking Data
4. Financial Data
5. Identification of Clinical Problem
Knowledge Focused Triggers
2. National Agencies or Organizational
Standards & Guidelines
3. Philosophies of Care
4. Questions from Institutional Standards Committee
1. New Research or Other Literature
Is this Topic
a Priority
For the
Form a Team
Is There
a Sufficient
Pilot the Change in Practice
1. Select Outcomes to be Achieved
2. Collect Baseline Data
3. Design Evidence-Based
Practice (EBP) Guideline(s)
4. Implement EBP on Pilot Units
5. Evaluate Process & Outcomes
6. Modify the Practice Guideline
Base Practice on Other
Types of Evidence:
1. Case Reports
2. Expert Opinion
3. Scientific Principles
4. Theory
Monitor and Analyze Structure,
Process, and Outcome Data
? Environment
? Staff
? Cost
? Patient and Family
The Iowa Model of Evidence-Based
Practice to Promote Quality Care
= a decision point Titler, M.G., Kleiber, C., Steelman, V.J., Rakel., B. A., Budreau, G., Everett, L.Q.,
Buckwalter, K.C., Tripp-Reimer, T., & Goode C. (2001). The Iowa Model Of EvidenceBased
Practice to Promote Quality Care. Critical Care Nursing Clinics of North America,
13(4), 497-509.
Department of Nursing
University of Iowa Hospitals and Clinics
Iowa City, IA 52242-1009
FIGURE 1. The Iowa Model of Evidence-Based Practice to Promote Quality Care. Reprinted with permission from the University
of Iowa Hospitals and Clinics and Marita G. Titler, PhD, RN, FAAN, Copyright 1998. For permission to use or reproduce the model,
please contact the University of Iowa Hospitals and Clinics at 319-384-9098 or
Copyright ? 2015 Wound, Ostomy and Continence Nurses Society?. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00006_LR 153 WOCN-D-14-00006_LR 153 21/02/15 2:01 PM 1/02/15 2:01 PM
154 Pittman et al J WOCN ? March/April 2015
defi nition of device-related HAPUs: (1) NPUAP defi nition of
pressure ulcers provides the basis of the defi nition and (2)
device-related HAPUs will be limited to external medical devices.
After a thorough review of the evidence and using
clinical practice expertise, an evidence-based device-related
HAPU defi nition for adults and pediatrics was developed. A
device-related HAPU is defi ned as a localized injury to the
skin and/or underlying tissue including mucous membranes,
as a result of pressure, with a history of an external medical
device at the location of the ulcer, and mirrors the shape of
the device. This defi nition provides needed guidance, structure,
and process to assist with prevention, identifi cation,
reporting, and treatment of medical device-related HAPU.
The task force used this evidence-based defi nition to develop
the Medical Device-Related Pressure Ulcer Position
Statement. Following the format example of the Wound,
Ostomy and Continence Nursing Society and other organizations,
a position statement was developed. In order to
improve the content validity of the position statement, experts
in wound management and pressure ulcers were asked
to review the content. Based on their recommendations,
appropriate revisions were incorporated into the document.
The next step in the Iowa Model is to move the evidence
into practice. Effective dissemination of evidence
includes mindful communication among opinion leaders,
change champions, core groups of infl uence, and academic
detailing. Opinion leaders were defi ned as those colleagues
who are viewed as important and respected sources
of infl uence among their peers. Change champions
embrace and demonstrate the persistence necessary to promote
the adoption of evidence.
The task force disseminated the position statement by
informing various systemwide leadership groups involved
in patient quality/safety, systemwide pressure ulcer prevention
committee, facility-specifi c WOC nurse experts,
and facility-specifi c direct-care nurse wound teams.
Dissemination continues as the use of the Medical DeviceRelated
Pressure Ulcer Position Statement is integrated
into the process of conducting our monthly facility-wide
pressure ulcer prevalence surveys.
? Conclusion
A pressure ulcer may occur wherever external pressure impairs
circulation to the skin. Pressure ulcers cause pain, loss
of function, and infection, extend hospital stays, and increase
cost. In addition, pressure ulcer development is considered
a quality indicator across healthcare systems. 5
Increased scrutiny and reduced payment or nonpayment
for HAPU by the Centers for Medicare & Medicaid Services
has made the prevention and early detection of pressure
ulcers a prominent quality improvement initiative of
healthcare systems across the country. A key component in
prevention and detection of pressure-related injury is an
accurate skin assessment. In order to perform an accurate
skin assessment, an evidence-based defi nition for devicerelated
pressure ulcers is crucial. Our Device-Related
Pressure Ulcer Position Statement guides practice, education,
and research within this healthcare organization. This
defi nition is used when identifying, reporting, treating, and
developing prevention strategies for device-related HAPU.
It has proven useful for distinguishing between pressure
ulcers resulting from an external medical device versus
nonmedical device. Through the intentional focus on pressure
ulcer prevention and evidence-based practice in our
organization and the use of this position statement, identi-
fi cation and reporting of medical device-related HAPUs
have improved with a decrease in overall HAPU rates of
33% from 2011 and 2012. This concise and evidence-based
position statement supports appropriate and consistent
identifi cation and reporting of medical device?related pressure
ulcers. Staging of these ulcers continues to follow the
staging recommendations of NPUAP and National Database
for Nursing Quality Indicators reporting instructions.
? References
1. Ayello E , Lyder C . Protecting patients from harm: preventing
pressure ulcers . Nursing 2007 ; 37 : 36-40 .
2. EPUAP/NPUAP . European Pressure Ulcer Advisory Panel and
National Pressure Ulcer Advisory Panel. Treatment of Pressure
Ulcers: Quick Reference Guide. Washington, DC : National
Pressure Ulcer Advisory Panel ; 2009 .
3. Berquist-Beringer S , Davidson J . NDNQI: Pressure Ulcer Training.
2013 . Accessed December 18, 2014 . at https://members.nursing
4. NPUAP. Mucosal Pressure Ulcers: An NPUAP Position Statement
2012. Accessed December 18, 2014 at
Position_Statement_fi nal.pdf
5. Centers for Medicare & Medicaid Services. Hospital-Acquired
Conditions and Present on Admission Indicator Reporting
Provision. Accessed December 18, 2014 at http://www.cms

6. Titler M , Kleiber C , Steelman V , et al. The Iowa model of
evidence-based practice to promote quality care . Crit Care Nurs
Clin North Am. 2001 ; 13 ( 4 ): 497-509 .
7. Stanley T , Sitterding M , Broome M , McCaskey M . Engaging and
developing research leaders in practice: Creating a foundation
for a culture of clinical inquiry . J Pediatr Nurs. 2011 ; 26 : 480-488 .
8. Food and Drug Administration . Is the product a medical device
andGuidance/Overview/ClassifyYourDevice/ucm051512.htm .
Published 2013. Accessed December 16, 2013.
9. Edsberg LE , Langemo D , Baharestani MM , Posthauer ME ,
Goldberg M . Unavoidable pressure injury: state of the science
and consensus outcomes . J Wound Ostomy Continence Nurs.
2014 ; 41 ( 4 ): 313-334 .
10. Apold J , Rydrych D . Preventing device-related pressure ulcers:
using data to guide statewide change . J Nurs Care Qual.
2012 ; 27 ( 1 ): 28-34 .
The CE test for this article is available online only at the journal website,, and
the test must be taken online at
Copyright ? 2015 Wound, Ostomy and Continence Nurses Society?. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00006_LR 154 WOCN-D-14-00006_LR 154 21/02/15 2:01 PM 1/02/15 2:01 PM

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Standards of Evaluation

Standards of Evaluation.


Module 2 Home
Standards of Evaluation
Modular Learning Outcomes
Upon successful completion of this module, the student will be able to satisfy the following outcomes:
? Case
o Identify and discuss the standards by which a health care system may be evaluated.
o Apply the standards of evaluation in comparing and contrasting the U.S. and English system.
o Apply the evaluation standard of quality in the care provided in a primary care setting.
o Identify and discuss strategies to improve the care in certain settings.
? Discussion
o Discuss the impact on the quality of care due to limited access and higher costs.
Module Overview
Access refers to the ability of those in need of health services to obtain appropriate care in a timely manner. Can you get medical care when you need it? If yes, you have access. Note: Access is not the same as health insurance coverage, although insurance coverage is a strong predictor of access. Access has also been defined as the timely use of needed, affordable, convenient, acceptable, and effective personal health services. (Shi and Singh, 2005)
Cost of Care
The term cost can carry different meanings in the delivery of health care services. From the consumers perspective, cost generally means price. From the providers perspective, cost means the cost of producing health care services (including salaries, capital costs, and supplies). From the national perspective, cost refers to how much a nation spends on health care services. This is commonly known as health care expenditures, and is measured in relation to the Gross Domestic Product.
The United States spends a larger share of the gross domestic product (GDP) on health than any other major industrialized country. In 2002, the U.S. devoted 15% of the GDP to health compared with 11% each in Switzerland and Germany and nearly 10% in Iceland, France, Canada, Norway, and Greece, countries with the next highest shares.
According to Health, United States 2005, the major sources of funds for hospital care in 2003 were Medicare (30%) and private health insurance (34%). Physician services were primarily funded by private health insurance (50%) and Medicare (20%).
In contrast, nursing home care was financed primarily by Medicaid (almost 50%) and out-of-pocket payments (more than 25%). The Medicare share of nursing home expenditures has risen from 3% in 1990 to 12% in 2003.
Health Care Cost Factors
There are several factors associated with the rise in health care spending. These factors are apart from general inflation in the economy. Read this Power Point presentation on Health Care Cost Factors associated with rising health care costs.
Quality of Care
Quality” has been overshadowed by the emphasis placed on access and costs of health care delivery. One major factor causing this phenomenon is the difficulty associated with defining and measuring quality.” This difficulty notwithstanding, in recent years quality” has taken center stage primarily due to the growth of managed care and its emphasis on control of utilization and cost containment. The concern is that managed cares focus on utilization and costs has and will continue to adversely impact quality of care.
The Institute of Medicine has defined quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
In its report, Crossing the Quality Chasm, the IOM specifies six guiding aims for principles of change in reforming the American healthcare system: Health care should be safe, effective, patient-centered, timely, efficient, and equitable.
Some excellent articles can be found in the IOM web site click here and input quality as your search word.
Quality Assessment refers to the measurement of quality against an established standard. It includes the processes of defining how quality is to be determined, identification of variables or indicators to be measured, statistical analysis, and interpretation of data. (Shi & Singh, 2005)
Quality Assurance is a step beyond quality assessment, and is defined as the process of institutionalizing quality through ongoing assessment and using the results for continuous quality improvement. Quality Assurance is a system wide commitment to engage in ongoing improvement of quality.
See this Power Point presentation on Quality Implications.
Continuity of Care
Continuity is said to be a multidimensional relationship between the patient and care received. It includes factors such as medical record retention/accuracy, patient tracking, visits with same providers, follow-up appointments generally everything associated with a continuum of care.
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Module 2 Background
Standards of Evaluation
If you cannot locate an article in one set of databases (e.g., EBSCO), try to locate it in ProQuest.
Required Reading

California Department of Managed Health Care (2013). Continuity of care. Retrieved from

Davis, K., et al. (2006). Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patients Lens. The Commonwealth Fund. Retrieved from

Hoeksema, J.. (2011). Taking Steps to Control Costs in the OR. Association of Operating Room Nurses. AORN Journal, 94(6), S79-84; quiz S85-6.

Lasser, K. E., Himmelstein, D. U. and Woodlander, S. (2006). Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey. American Journal of Public Health 96 (7); 1300.

Woolhandler, S., Campbell, T., Himmelstein, D. U. (2003). Costs of health care administration in the United States and Canada. The New England Journal of Medicine 349 (8); pg. 768.

Zallman, L., Ma, J., Xiao, L., & Lasser, K. E. (2010). Quality of US primary care delivered by resident and staff physicians. Journal of General Internal Medicine, 25(11), 1193-7.

The overall goal of the Session Long Project is to examine health care delivery in the United States. In Module 1 we studied the economic realities that may ultimately impact the healthcare industry. However despite the impending bursting of the bubble, we must still implement Obamacare. One of the important aspects of the new law is the connecting the evaluation standard of quality to reimbursement. This is a departure for our industry and might have a significant impact on how we do business. Many experts argue that quality of care is subjective but is ultimately based upon those providing the care. This will be the topic of Module 2s SLP. Please read the article by Zallman, Ma, Xiao, and Lasser entitled ?Quality of US Primary Care Delivered by Resident and Staff Physicians? and respond to the following questions. Briefly summarize the issue being addressed as found in the ?Background section.? Identify and discuss the five categories of quality indicators. Discuss what the researchers found when they analyzed the ?Performance on Quality Indicators.? Where you surprised by their findings? Why are there differences in the quality of outpatient care provided by resident and staff physicians? What are some possible strategies an organization can implement to remedy this problem? SLP Assignment Expectations Use information from the modular home and background pages as well as other credible and peer reviewed sources retrieved from a library or an Internet search. LENGTH: 2-3 pages typed and double-spaced using 12pt Times New Roman font and 1-inch page margins. Please use headers throughout the paper. This will aid you in not overlooking vital elements of the assignment and make the document easier for the reader to follow. Your SLP paper will be further evaluated based on the rubric criteria.

Standards of Evaluation

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Assignment 2 Critical Evaluation of Court Case

Assignment 2 Critical Evaluation of Court Case.



It is important to understand the impact an expert testimony may have in the ultimate decision made by a court. In addition, it is helpful for practitioners of forensic psychology to be able to read and understand legal cases.




Click here to review the case Commonwealth of Virginia v. Allen (2005). (THAT IS ATTACHED DOWN BELOW)


The case describes an appellate legal opinion or court decision involving expert witness testimony. When a case is appealed, it goes to an appellate or to a higher court. The appellate court then reviews the findings of the lower court, which in this case was the trial court. The appellate court offered the following two opinions: The first opinion (Commonwealth of Virginia v. Allen, 2005, pp. 1–24) is the majority opinion and is the one that counts. The second opinion (Commonwealth of Virginia v. Allen, 2005, pp. 24–31) is an opinion filed by a minority of judges who concurred (agreed) in part and dissented (disagreed) in part with the majority of the judges who ruled.

*****After reading the appellate legal opinion, write a 2- to 3-page paper addressing the following: Discuss whether either of the expert witnesses in this case acted unethically. Support your opinion with the relevant APA or specialty ethical guidelines. Indicate whether you agree with the majority decision or the minority concurring or dissenting opinion. Explain why.*****

The paper should be in APA style.



Commonwealth of Virginia v. Allen, 609 S.E.2d 4 (Va. 2005).

Submission Details:Save your paper as M4_A2_Lastname_Firstname.doc. By Wednesday, July 19, 2017, post it to the M4 Assignment 2 Dropbox.Assignment 2 Grading CriteriaMaximum PointsDetermined whether either of the expert witnesses in this case acted unethically.40Justified your response with appropriate ethical guidelines.40Critically evaluated the appellate legal opinion and logically explained your reasons for agreement with the majority or minority decision.12Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.8Total:100

Assignment 2 Critical Evaluation of Court Case

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Stress Management Workshop Evaluation and Descriptive Narrative

Stress Management Workshop Evaluation and Descriptive Narrative.


As a health psychology professional, it is likely that you may participate in the analysis and modification of behaviors and thought-processes to improve responses to stress. The components of the Final Project for this course prepare you to identify the stress management needs of a specific population and provide the most appropriate stress management techniques based on the stressors involved. Another component of the Final Project provides practice in the development of stress management handouts and a stress management workshop presentation. Then in the last component of the Final Project you develop a workshop evaluation to analyze the effectiveness of stress management techniques presented in an engaging learning environment, such as a group workshop. Finally, these components of the Final Project taken together prepare you to assist clients in the adoption of effective stress management techniques to reduce the impact of stress.

Final Project (10–15 total pages)

Your Final Project, which is due in Week 11, must include the following elements: Descriptive Narrative (5–7 pages): Describe the population you selected in Week 3 as the intended audience for a stress management workshop. Synthesize research related to stress management techniques. Include the stressors common to that population. Explain the stress management research techniques you selected for your population. Describe the three original handouts you created on stress management techniques in Week 5. Justify the strategy used for selecting these techniques for the specific population you selected. Describe how your stress management presentation from Week 7 is applicable for future use within health psychology. Explain how the stress management techniques you selected and the stress management workshop you created contribute to social change.

 Information on scholarly writing may be found in the APA Publication Manual (6th ed.), and at the Walden Writing Center website. Also see “Code of Conduct and Academic Integrity,” in the Guidelines and Policies area on the left navigation bar. 

Stress Management Workshop Evaluation and Descriptive Narrative

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evaluation of Suzette’s case. Explain Suzette’s specific stressors and their present and potential effects on her mind and body. Describe the methods you would use to assess her levels of stress. Explain the biological and psychological mechanism

evaluation of Suzette’s case. Explain Suzette’s specific stressors and their present and potential effects on her mind and body. Describe the methods you would use to assess her levels of stress. Explain the biological and psychological mechanism.

evaluation of Suzette’s case. Explain Suzette’s specific stressors, and their present and potential effects on her mind and body. Describe the methods you would use to assess her levels of stress. Explain the biological and psychological mechanisms that describe the effects of stress on her sleep. Assess the effect of Suzette’s ongoing stress and insomnia on her health. Describe possible signs of sleep deprivation. List the follow-up questions you want to ask that could help you develop a prevention strategy. Explain whether or not Suzette has an illness, and what it may be. Recommend strategies for her to achieve greater health and thrive. This is the scenario; Week One Assignment Scenario Suzette is a 47-year old Caucasian female who has been married for 24 years, and has three adolescent children. Her spouse was laid off from his job of 15 years, and she has had to seek part-time work in the retail business. She works 25 hours a week. They own a home, but have been unable to make their mortgage payments for the past 7 months. She states that she always felt they went beyond their means when purchasing this large house. Her spouse has been despondent since his job loss and is having difficulty finding employment in his field, spending most days at home doing very little. He has turned down several jobs, because he considered them “beneath” his skill level, and has started drinking more heavily in recent months. Their children are in school and appear fairly well-adjusted. Suzette has suffered from headaches for many years of her life and their frequency has increased to the extent that she has headaches “more days than not.” In the past year, she has had occasional shortness of breath and difficulty sleeping. She falls asleep within 15 minutes but frequently wakes up “at 2 or 3 a.m.” and is unable to fall back to sleep. This pattern has worsened and she claims she dreads going to bed because of the worries she has and her fear of not sleeping well. She has good medical insurance because of her spouse’s COBRA plan, and she has regular visits with her primary care physician. Her medical history includes breast surgery for benign cysts, and she has a history of tachycardia and chronic lumbar pain. She also has evidence of early menopause. Her current medications include Ativan for anxiety and sleep, hormone replacement therapy, and low doses of Naproxen for back pain. She resists taking the Ativan, because it makes her feel “foggy” during the day. She is of normal weight for her height, and her blood pressure is normal. Her eating patterns are reduced, since she says, “I’m just not very hungry.” There has been no major weight loss or gain in 5 years. She does not use alcohol or other drugs. She does not smoke. Sexual interest and desire have decreased significantly in the past 4 years. Her level of physical exercise is minimal and she states that she used to go to a gym, but finances forced her to quit. She claims that exercise always made her “feel good.” Since then, she spends most of her time at work or home, and has no time to exercise. Her mental status is normal, aside from moderate anxiety. Her level of social support is reduced, because she has few friends and her relationship with her spouse has become distant. Her major complaint is her insomnia. She has significant daytime sleepiness and often falls asleep while watching TV in the evening. She claims that she falls asleep almost instantly when her head hits the pillow at night, but she wakes up three or four times and usually cannot fall back asleep. Format your evaluation consistent with APA guidelines, including at least five scholarly references. One of these scholarly references must be a peer-reviewed journal article

evaluation of Suzette’s case. Explain Suzette’s specific stressors and their present and potential effects on her mind and body. Describe the methods you would use to assess her levels of stress. Explain the biological and psychological mechanism

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