Health Issues for the Aging

Health Issues for the Aging

DNP-810A EMERGING AREAS OF HUMAN HEALTH

Project Assignment

Topic: Health Issues for the Aging

As of 2017, health care expenditures in the United States are near 17.9% of our gross domestic product (GDP), with a major portion of Medicare funding going toward chronic illness and care at the last 6 months of life. The Patient Protection and Affordable Care Act (ACA) has made some initial legislative changes in the U.S. health system, but not sufficient enough to address growing expenditures and caring for the large aging population. In this assignment, learners will synthesize issues in aging with health policy solutions by writing a paper on one health issue for older individuals addressed in the topic and offering a policy solution. Example of issue: In 2014, more than 50% of the costs of institutional long-term care for older persons was paid for with public funds from Medicaid. Health Issues for the Aging

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General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least three additional scholarly research sources related to this topic and at least one in-text citation for each source be included.
  • You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. Health Issues for the Aging

Directions:

Write a paper (1,000-1,250 words) that addresses a health issue for older individuals. Include the following:

  1. Evaluate what the literature suggests as a resolution to your chosen issue.
  2. Discuss any attempts to incorporate the solution into public policy.
  3. Determine the barriers to implementation of the solution.
  4. Analyze the options being discussed for public or private funding.
  5. Propose your own recommendation.

RESOURCES

Howdon, D., & Rice, N. (2018). Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population. Journal of Health Economics, 57, 60-74. https://doi.org/10.1016/j.jhealeco.2017.11.001

Von Wyl, V. (2019). Proximity to death and health care expenditure increase revisited: A 15-year panel analysis of elderly persons. Health Economics Review, 9(1), 1-16. https://doi.org/10.1186/s13561-019-0224-z

 

 

Nursing homework help

Nursing homework help

NURS 621

Guidelines -Culturally Sensitive Population Care Management Plan Paper

Overview of paper’s purpose:It is now time to bring the information together that you have learned over the semester and to develop a culturally sensitive population care management plan to address a specific mental health care disparity for the specific population that you select.

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In this paper, you will begin to bridge the gap between identifying a mental health care disparity and taking an action step forward to design a plan to correct it.  The purpose of this plan is to present to three (3) organizations or leaders for implementation.  In your written plan you will include three (3) possible funding organizations that you will seek to support your plan.  In the future,you will be able to present this plan to organizations and or leaders that you think would be interested in partnering with you to implement the plan and address the mental health care disparity. Nursing homework help

Helpful Tips: Below are some helpful tips and a template for you to use when you develop your paper.  It is very important that you use the template headings and address the specific information under each heading.

  • Make sure to set the paper up in APA format and provided a cover page with the title of your paper, your name, the course number, and your professor’s name
  • Make sure each page has a page number on it Nursing homework help
  • Make sure the reference page begins on a separate page and is double spaced
  • Check your paragraph structure and make sure you have at least 3 sentences in a paragraph and no more than 5-6 sentences

 

Template with section headings:

Assignment # 3: Culturally Sensitive Population Care Management Plan for an Underserved Community(10-12 pages excluding title page and references and appendix with list of organizations and links)

  1. Overview of population: includes RECENT demographic information on the estimated number of individuals in the community, the age range of this population, and a description of the environment they live in; provides 3 examples of cultural values and practices that impact the chosen population when a member seeks mental health care services and follows the health care providers’ instructions; includes 3 information examples on this population’s perceived value of health and access to mental health care; describe if members of this population arewilling to pay for mental health care services or mental health care insurance or if they believe it should be provided to them at no cost.
  2. Mental health disparity that needs to be addressed:describe, using RECENT (not older than 5 years) available peer-reviewed evidence, a specific mental health care disparity in this population; three (3) causes of the disparity, and what initiatives have taken place to address the disparity (including what has worked and what has not worked). Describe what needs to be done now and in the future to address this mental health disparity.
  3. Cultural competency model being applied and cultural considerations when planning care to address the mental health disparity: apply three (3) concepts from the chosen cultural competency model when conducting the assessment for mental health disparities in this patient population. Describe how you conducted the assessment of the cultural values and norms of this population using the cultural competency model.
  4. Strategies for eliminating mental health disparity: describe five (5) evidence-based strategies for eliminating the identified mental health disparity
  5. Proposed care management plan and implementation steps:describe the care management plan and at least six (6) specific steps that need to be taken to implement this plan. Include who will be carrying out the specific implementation steps and the timeline for completing the steps.
  6. Organizations to consider for grant funding:provide three (3) names of organizations that you can apply for grant funding to support implementing your Population Care Management Plan; include information on the title of the grant being applied for and a link to the grant guidelines from each of the organizations in the appendix.
  7. Measuring outcomes on mental health care disparity post implementation of care management plan:describe three (3) specific measurable outcomes to evaluate the plan’s success after implementation; describe who will collect, synthesize, create the outcomes report, and distribute the data. Determine and describe the specific tools that will be used to collect data, who will collect the data, and three (3) distribution channels that you will use to disseminate the findings
  8. Summary: 2-3 paragraphs summarizing each of the prior sections to use as an executive

Additional Critique of Evidence

Additional Critique of Evidence

Unit 5 Assignment – Additional Critique of Evidence 4/7/22 1000w

This is part 3 of your evidence-based practice project.

In this assignment, you will refer back to assignment you completed in week 4/ the previous week, as this assignment will build upon it.

For this assignment, you will re-review your three articles selected from your week 2 and 4 assignment. Then, you’ll write a paper on the following (be sure to include the content from your previous papers in weeks 2 and 4.

For each of the three articles, please discuss the following in your paper: Additional Critique of Evidence

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  1. Research design of the study
  2. Threats to external/internal validity
  3. Potential legal/ethical issues within the article
  4. Data analysis (be sure to elaborate on this more from your paper in week 4, providing specifics about the results)
  5. Implications for evidence-based practice and how this article could be used to make an evidence-based change
  6. Conclusion/summary of the evidence

Remember to support your ideas with the articles you found. These articles should be less than five (5) years old. They should not be from the Web, but from the library databases, and be sure to use a narrative format.

In addition, you must follow APA guidelines, providing a title page, reference page, appendix, and in-text citations, as well as use level headings to match the assignment criteria listed above. Additional Critique of Evidence

Please use, at minimum three scholarly references, and your paper should be 800-1000 words, excluding title and reference pages.

 

 

 

 

 

 

Topic and PICOT Question

“The effects of proning treatment in COVID-19 patients” is the evidence-based practice topic chosen. Respiratory distress is the outstanding and pervasive COVID-19 symptom, thus, the prone position is a typical treatment for such problems. It necessitates practitioners to keep an eye on patients lying on their stomachs for effective proning. The prone posture entails lying on the frontal abdomen to relieve respiratory discomfort. The prone posture contrasts with the supine position, in which people lie horizontally on their backs. In a respiratory crisis, however, the prone position is preferable to the supine position because the supine posture compresses the lungs and inhibits air exchange, resulting in low oxygen levels.

Acute respiratory distress syndrome (ARDS) caused by deteriorating symptoms is of primary importance to the evidence-based issue. Although additional problems such as multi-organ failure andpulmonary edema might occur, ARDS is the most common in severely ill patients, involving around 17% of COVID-19 patients. The chosen evidence-based subject aims to investigate the efficacy of prone treatment in treating COVID-19 individuals experiencing deteriorating symptoms. In addition, it also assesses whether it reduces mortality for COVID-19 patients without access to mechanical ventilators (White & Lo, 2020).

A PICOT question is also created to address the evidence-based topic.Because of its specificity, the PICOT question is a foreground question since the important information required is for making therapeutic judgments. Because it examines whether proning treatment leads to better results for COVID-19 patients, the PICOT question can be categorized as targeting an intervention. The complete PICOT question is; “For COVID-19 positive patients, has the use of proning therapy been effective in reducing mortality and intubation rates?”The separate elements of the PICOT question include:

P: Covid- 19 positive patients in the ICU.

I:Proning therapy

C: supine position

O: Reduced intubation and mortality of COVID-19 patients

T: during hospital admittance.

First Article

The first article is by Ghelichkhani & Esmaeili, 2020 which is a commentary on using the prone position in managing COVID-19. The article’s concept is that prone positioning is the most effective intervention when dealing with acute respiratory distress syndrome (ARDS). Since ARDS is prevalent among COVID-19 patients by about 17%, prone positioning can be used to improve ventilation. However, the article’s authors assert that the efficiency of the prone position is influenced by commencement of therapy, duration of intervention, and patient selection

As a result, it’s critical to pick particular patients for the therapy and keep track of their time in the posture. The authors conclude thatproning be done for a minimum of 12 hours each day to be successful and started early in ARDS patients to reduce mortality.

The study is qualitative and does not collect numerical data. Instead, the authors depend on the available information in already published research articles to arrive at conclusions. The authors depend on historical studies and select primary sources that contain relevant information about COVID-19 and proning. For instance, the article references a meta-analysis that identified mortality rates dropping by about 17% after implementing the prone position for 12 hours a day.

The primary subjects of the article are COVID-19 patients suffering from ARDS. The article does not specify the specific tools that were deployed to select and identify relevant articles, the selection criteria, or database sources. The article is reliable because it is located in a health-related database, PubMed Central, and is created by authors with expertise on the subject. The weakness of the article is its commentary nature. The authors do not specify how they selected their sources of information.

Second Article

The second article is by Rahmani et al.(2020) and is qualitative in design. The article focuses on the outcome of using the prone position in the treatment of COVID-19. The prone position is commonly used to improve oxygenation in patients with ARDS who cannot breath without assistance. According to Rahmani et al. (2020), the prone posture promotes uniform ventilation and lowers patient mortality. Proning as a medical intervention is non-invasive ventilation; however, it is not entirely perfect and contains weaknesses. Of key interest is that it is usuallyeffective and successful when controlled by a healthcare team. COVID-19 patients under respiratory distress need supervision and constant monitoring when applying proning to improve oxygenation.

The method used in the study is a literary analysis of previous works to establish facts. It is qualitative, and thus the authors attempt to assess the effects of proning on COVID-19 patients based on available research. The authors reference multiple studies adapting statistics and other factual information. In addition, the authors also reference present theories on the prone position that illustrate proning results in homogenous ventilation. The article’s primary focus is COVID-19 patients admitted to the Intensive Care Unit (ICU) suffering from respiratory distress.

The article’s authors do not specify the tools used to select the studies referenced in the literature. However, one can infer that the studies selected to align with the main topic and are relevant in helping the authors identify relevant information. The information in the article is credible first because it is located in a recognized medical journal. Second, the article’s authors have competency in the relevant topic and expertise in presenting similar information. The last rationale for the article’s credibility is because it has been cited by other authors and used as a reference point in creating other published peer-reviewed articles.

 

Third Article

The third article is a study by Hallifax et al. (2020) to determine if successful awake proning of COVID-19 patients in need of respiratory assistance is linked to better medical outcomes. The study’s problem of focus is that awake proning promotes oxygenation in COVID-19, despite the lack of data on clinical effects. Its goal is to investigate how effective awake proning is in COVID-19 patients who need breathing assistance. A total of 565 COVID-19 patients were studied in a High Dependency Unit (HDU). According to the authors, awake proning may be beneficial for COVID-19 patients.

The researchers’ methods used for data analysis included logistic regression analysis and multivariate logistic regression. The authors specified criteria for patient admission to the HDU. Patients for the study were transferred to the HDU when their oxygen requirement increased. However, patients with increasingly deteriorating conditions were not enrolled in the study. Respiratory specialists monitored the patients in the HDU and encouraged them to line in the prone position for at least 2 hours daily.

Regarding the study’s validity,it expands on previously unsolved issues; for example, it provides evidence that awake proning improves medical outcomes in patients with respiratory distress. The study’s outcomes are consistent with earlier research, and they add that awake proning is a viable intervention in COVID-19 that needs more research. The study’s findings are consistent with past studies on the issue, and the authors remain cautious in their assertions, instead urging more evaluation and investigation. Nurses may utilize awake proning in COVID-19 patients in the HDU to enhance outcomes, and the findings are immediately applicable in nursing practice.

Conclusion

In conclusion, the prone position has been historically used to address respiratory distress problems, specifically ARDS. Since ARDS is the most common condition in COVID-19 patients with worsening symptoms, it is vital to assess the effectiveness of applying proning to alleviate their respiratory distress. There are specific aspects that should be addressed before using the prone position. For instance, the efficiency of the prone position is influenced by patient selection, commencement, and length of placement in the prone position. Practitioners need to select specific patients capable of benefiting from the intervention. It is also essential for health care practitioners applying the intervention to monitor the patients and ensures they receive a minimum of two hours of proning daily.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/

Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678

Rahmani, F., Salmasi, S., &Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580

White, D. B., & Lo, B. (2020). A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. https://doi.org/10.1001/jama.2020.5046

 

 

 

 

 

 

 

 

Appendix

Matrix Table

Article/Reference (in APA format) Purpose of the Article/Study Question Variables (i.e.; Independent vs. Dependent) Study Design Sampling Methods Instrument Findings/Results
Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/

 

Assessing the management of COVID-19 patients through prone position There are no variables Narrative inquiry Purposeful sampling of COVID-19 patients Selecting previous relevant  articles Document or article analysis The prevalence of ARDS in COVID-19 is 17% and prone position can be used to improve ventilation in this population.
Rahmani, F., Salmasi, S., &Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580

 

The effects of prone position in COVID-19 patients There are no variables Narrative inquiry Purposeful sampling of COVID-19 patients Selecting previous relevant  articles Literature analysis the prone position leads to homogenous ventilation and reduces patients’ mortality rate
Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678

 

Determine if successful awake proning of COVID-19 patients who require respiratory support is linked to better outcomes. Respiratory support.

Ventilation

Retrospective study. COVID-19 patients requiring respiratory assistance in the HDU Selecting patients who require oxygen support for the HDU and performing awake proning at least twice a day for 2 hours. Logistic regression analysis, Multivariate logistic regression, and Firth bias-reduced logistic regression High mortality rate for COVID-19 patients who require respiratory support although awake proning can address this issue.
               

 

 

Qualitative Research Critique and Ethical Considerations

Qualitative Research Critique and Ethical Considerations

Rough Draft Qualitative Research Critique and Ethical Considerations

Assessment Description

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses.

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Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.  Qualitative Research Critique and Ethical Considerations

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. Qualitative Research Critique and Ethical Considerations

Research Critique Guidelines – Part I

Qualitative Studies

Background of Study

  1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

  1. Discuss how these two articles willbe used to answer your PICOT question.
  2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

  1. State the methods of the two articles you are comparing and describe how they are different.
  2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

  1. Summarize the key findings of each study in one or two comprehensive paragraphs.
  2. What are the implications of the two studies in nursing practice?

Ethical Considerations

  1. Discuss two ethical consideration in conducting research.
  2. Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.

 

 

Nursing homework help

Nursing homework help

Episodic/Focused SOAP Note Template

 

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

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Location: head Nursing homework help

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better Nursing homework help

Severity: 7/10 pain scale

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  Denies rash or itching.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis.

O.

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

A.

Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

 

Qualitative Research

Qualitative Research

Conduct a literature search to select a qualitative research study on the topic identified in Module 1. Conduct an initial critical appraisal of the study.

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Respond to the overview questions for the critical appraisal of qualitative studies, including:

  • What type of qualitative research design was utilized to conduct the study?
  • Are the results valid/trustworthy and credible?
  • How were the participants chosen?
  • How were accuracy and completeness of data assured?
  • How plausible/believable are the results?
  • Are implications of the research stated?
  • May new insights increase sensitivity to others’ needs?
  • May understandings enhance situational competence?
  • What is the effect on the reader?
  • Are the results plausible and believable?
  • Is the reader imaginatively drawn to the experience?
  • What are the results of the study?
  • Does the research approach fit the purpose of the study?
  • How does the researcher identify the study approach?
  • Are the data collection and analysis techniques appropriate?
  • Is the significance/importance of the study explicit?
  • Does the literature support a need for the study? Qualitative Research
  • What is the study’s potential contribution?
  • Is the sampling clear and guided by study needs?
  • Does the researcher control selection of the sample?
  • Do sample size and composition reflect the study needs?
  • Is the phenomenon (human experience) clearly identified?
  • Are data collection procedures clear?
  • Are sources and means of verifying data explicit?
  • Are researcher roles and activities explained?
  • Are data analysis procedures described?
  • Does analysis guide directions of sampling when it ends? Qualitative Research
  • Are data management processes described?
  • What are the reported results (descriptive or interpretation)?
  • How are specific findings presented?
  • Are the data meanings derived from data described in context?
  • Does the writing effectively promote understanding?
  • Will the results help me care for my patients?
  • Are the results relevant to persons in similar situations?
  • Are the results relevant to patient values and/or circumstances?
  • How may the results be applied to clinical practice?

Please be sure to answer the questions thoroughly using complete sentences and APA format. Explain responses to yes/no questions in detail by presenting information found in the study to support your response.

Provide a reference for the article according to APA format and a copy of the article.

Nursing Care Plan

Nursing Care Plan

This is a nursing care plan assignment, based on your assessment of Brian Foster. You should identify a nutritional problem for your care plan based on your assessment.  You will see I speak of “Cues” you should find cues in your transcripts of your interview with Brian Foster. For example, if we had a diagnosis of risk for unstable glucose level…what evidence does Brian provide to you that this is a problem? For example during your interview you would identify I just have a lot going on in my life, and I only have space in my mind for so much, you know? It’s a lot easier to stay away from sweets than it is to remember to test my sugar and be pricking my finger all the time and all of that. Anyway, the num Nursing Care Plan

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Identify client’s health goal

1.      Choose a problem-based diagnosis based on the client’s nutritional status assessment with supportive evidence from your interview (20pts).

 

2.      Provide a rationale for your choice (10pts).

 

 

 

Nursing Diagnosis: Iron deficiency anemia

 

 

 

 

Rationale: The client displays the following symptoms: extreme fatigue; pale skin; headache, lightheadedness, and dizziness; brittle nails; shortness of breath; damaged or dry skin; brittle nails; and inflammation of the tongue. All these symptoms are associated with iron deficiency anemia.

3.      Identify two nursing interventions (10pts) based on the client’s identified nursing diagnoses with rationale (10pts) for each intervention (Total = 20pts).

4.      Identify two nursing goals (10pts) based on your client’s identified nursing interventions (10pts) for each intervention (Total = 20pts).

 

 

 

 

 

 

5.      Interventions must be supported by ONE evidence-based practice article within 5 years. The article must be uploaded your assignment in Bb; a full and proper APA format is required in the right column under reference (10pts)

 

 

 

Intervention 1:Iron supplements

 

Rationale: As a nurse, I will advise the patient to take iron supplements (including drops, capsules, pills, etc.) to treat the symptoms of the disease and increase the levels of iron in the body (Cleveland Clinic, 2018)

 

Goal Intervention 1: To replenish iron stores.

 

Reference: Cleveland Clinic. (2018). Oral Iron Supplementation. Retrieved from:  https://my.clevelandclinic.org/health/articles/14568-oral-iron-supplementation

Intervention 2: Treating underlying causes of iron deficiency

 

Goal Intervention 2: To treat the underlying condition or disease

 

Rationale: If iron supplements do not increase the levels of iron in the body, it is more likely that the iron deficiency is a result of bleeding or malabsorption of iron (Mayo Clinic, 2022). Depending on the cause, treatment may include medications (including oral contraceptives) to stop heavy periods; surgery to get rid of a bleeding fibroid, a tumor, or polyp; or antibiotics to treat peptic ulcers.

 

Reference: Mayo Clinic. (2022). Iron Deficiency Anemia. Retrieved from: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040

 

 

6.      Identify how you will evaluate each intervention/goal (with a rationale) that the client will achieve the health goal (20pts)

 

 

 

 

Evaluation of Intervention 1: Assess the symptoms of the disease

 

Rationale: By evaluating the symptoms of the illness, I will determine if iron supplements were effective. The effectiveness of the intervention lies in its ability to reduce the symptoms.

 

Evaluation of Intervention 2: Evaluate the iron levels in the body

 

Rationale: By evaluating the iron levels in the body, I will determine if the medications and antibiotics were effective in treating the underlying condition.

 

 

Assessing the Abdomen

Assessing the Abdomen

Assignment 1: Lab Assignment: Assessing the Abdomen

A male went to the emergency room for severe midepigastric abdominal pain. He was diagnosed with AAA; however, as a precaution, the doctor ordered a CTA scan.

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical assessments and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Assessing the Abdomen

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To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment.

  • About      the Episodic note case study provided:
    • Review       this week’s Learning Resources and consider the insights they provide       about the case study.
    • Consider       what history would be necessary to collect from the patient in the case       study.
    • Consider       what physical assessment and diagnostic tests would be appropriate to       gather more information about the patient’s condition. How would the       results be used to make a diagnosis?
    • Identify at       least five possible conditions that may be considered in a       differential diagnosis for the patient.

Case study

ABDOMINAL ASSESSMENT

Subjective:

CC: “My stomach has been hurting for the past two days.”

HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain.  Assessing the Abdomen

PMH: HTN

Medications: Metoprolol 50mg

Allergies: NKDA

FH: HTN, Gerd,  Hyperlipidemia

Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female

Objective:

  • VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall symmetrical
  • Skin: Intact without lesions, no urticaria
  • Abd: abdomen is tender in the epigastric area with      guarding but without mass or rebound.
  • Diagnostics: US and CTA

Assessment:

  1. Abdominal Aortic Aneurysm (AAA)
  2. Perforated Ulcer
  3. Pancreatitis

PLAN: 

The Assignment

  1. Analyze      the subjective portion of the note. List additional information that      should be included in the documentation.
  2. Analyze      the objective portion of the note. List additional information that should      be included in the documentation.
  3. Is      the assessment supported by the subjective and objective information? Why      or why not?
  4. What      diagnostic tests would be appropriate for this case, and how would the      results be used to make a diagnosis?
  5. Would      you reject/accept the current diagnosis? Why or why not? Identify three      possible conditions that may be considered as a differential diagnosis for      this patient. Explain your reasoning using at least three different      references from current evidence-based literature.Episodic/Focused SOAP Note Template

     

    Patient Information:

    Initials, Age, Sex, Race

    S.

    CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

    HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

    Location: head

    Onset: 3 days ago

    Character: pounding, pressure around the eyes and temples

    Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

    Timing: after being on the computer all day at work

    Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

    Severity: 7/10 pain scale

    Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

    Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

    PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

    Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

    Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

    ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

    HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat.

    SKIN:  Denies rash or itching.

    CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

    RESPIRATORY:  Denies shortness of breath, cough or sputum.

    GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

    GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

    NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

    HEMATOLOGIC:  Denies anemia, bleeding or bruising.

    LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

    PSYCHIATRIC:  Denies history of depression or anxiety.

    ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

    ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis.

    O.

    Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

    Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

    A.

    Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

    This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

    References

    You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

     

The Crisis of Addiction

The Crisis of Addiction

Research Paper Instructions #1

 

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Chemical Dependency: The Crisis of Addiction

 

The research paper must have a minimum of 2000 words – main body (does not include the title page, abstract, or reference pages). Times New Roman, Size 12, and 5 references about that topic (4 of them most be research articles). The criteria exposed in your paperwork must be exclusively based on peer reviewed article, and I will be very fussy in confirming the reliability of your statements. A formal paper using APA format according to Publication Manual American Psychological Association (APA) (6th ed.).2009 ISBN: 978-1-4338-0561-5 will be submitted via Exercise Submission. This paperwork must be submitted on week # 6 (Sunday, 2/13 at 11:59 PM EST), The Crisis of Addiction

Question Guide:

The paper should include the following:

  • What is Chemical dependency?
  • Statistics / Most common abused substance
  • Sociocultural determinants of substance abuse
  • Models of addiction
  • Dynamics of addiction
  • Interventions / Treatments approaches (pharmacological and non-pharmacological)
  • Other considerations in the management of Chemical dependency (including but not limited to management of behaviors, family considerations, challenges in the care of patients with addiction.

Examine evidence-based practice guidelines / research, nursing theories that support the identification of clinical problems, implementation of nursing skills in the care of adults with addiction.

Grading Criteria:

  • What is Chemical dependency? – 2%
  • Statistics / Most common abused substance – 2%
  • Sociocultural determinants of substance abuse – 2%
  • Models of addiction – 2%
  • Dynamics of addiction – 2%
  • Interventions / Treatment approaches (pharmacological and non-pharmacological) – 2%
  • Other considerations in the management of Chemical dependency (including but not limited to management of behaviors, family considerations, challenges in the care of patients with chemical dependency – 2%
  • References: At least 5 reference sources – 4 of them most be research articles – 3%
  • APA style – 3 %

MAXIMUN POINTS – 20%

It accounts for 20% of your final grade

 

Aligning Strategic Goals to People Development

Aligning Strategic Goals to People Development

Volume 12

Issue 1

March 2014

 

Performance Appraisal at Telespazio: Aligning Strategic Goals to

People Development

 

Case1 prepared by Professors Silvia PROFILI,2 Alessia SAMMARRA,3 Laura INNOCENTI4

and Gabriele GABRIELLI5

 

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Part A

 

“Dear colleague,

 

The Telespazio Performance Appraisal is one of the primary tools for human resource development

and management, and its correct use is one of your main responsibilities. Aligning Strategic Goals to People Development

 

Our organization sets important challenges at the transnational level, leveraging on personnel

motivation. Optimal use of the appraisal system is extremely important when it comes to achieving

this. For these reasons, this year, I am looking forward to receiving your full commitment to the

management of the process, which is divided into two phases:

 

– Phase 1: evaluations related to the previous year must be finished by no later than April l5th, 2011.

 

– Phase 2: you are asked to define the 2011 objectives for your subordinates by no later than

April 30th, 2011.

 

Regarding Phase 1, I have to stress the importance of the evaluation, which must be based on fair and

realistic criteria, while also respecting deadlines.

 

I look forward to receiving your full commitment to the appraisal process.”

 

It was January 2011 when Telespazio’s CEO, Carlo Gualdaroni, sent this letter to all of the

company’s managers in order to strengthen their commitment to the appraisal program.

Gualdaroni considered the Performance Management System to be crucial to the organizational

change process undertaken by the company. As a matter of fact, the top management team had

 

____________

1 The authors wish to thank the Telespazio HR team, guided by Giorgio Dettori, for its continuous support. Particular thanks go

to Marta Di Santo, who is in charge of the Organizational Development, Management and Training Function, for her input and

enthusiastic involvement. Without her support, this case study would not have been possible. Special thanks also go to Stefania

Tomassi, who heads the Development Function, for her valuable contributions to the writing of this case.

2 Silvia Profili is an Associate Professor of Management at the European University of Rome, Italy. Aligning Strategic Goals to People Development

3 AlessiaSammarra is an Associate Professor of Organization Theory and HR Management at the University of L’Aquila, Italy.

4 Laura Innocenti is an Adjunct Professor of Organizational Behavior and Human Resources Management at the LUISS Guido

Carli University, Italy.

5 Gabriele Gabrielli is an Adjunct Professor of Human Resources Management at the LUISS Guido Carli University, Italy.

© HEC Montréal 2014

All rights reserved for all countries. Any translation or alteration in any form whatsoever is prohibited.

The International Journal of Case Studies in Management is published on-line (http://www.hec.ca/en/case_centre/ijcsm/), ISSN 1911-2599.

This case is intended to be used as the framework for an educational discussion and does not imply any judgement on the

administrative situation presented. Deposited under number 9 30 2013 010 with the HEC Montréal Case Centre, 3000, chemin de

la Côte-Sainte-Catherine, Montréal (Québec) Canada H3T 2A7.

 

 

been renewed and a new organizational matrix model had been introduced in the fall of 2010.

This re-organization also involved the HR Function. With the change in top management, the

entire HR Management and Development System had been redesigned by the new Organizational Development, Management and Training Function. Marta di Santo was in charge of this, and it had been validated by the senior management team. The CEO, Carlo Gualdaroni, stated: “For the very first time, all of the components of the HR System (Development, Organization, HR Management and Training) fall under a single coordinating structure in the HR Department; this can only provide a new momentum to Telespazio, which will be even more market-driven,

international and based on a matrix model” (Figure 1).

 

The company had become increasingly present on foreign markets, which required a more

articulated structure to manage its global dimension. For this reason, Telespazio undertook a

major reshaping of the group model, adopting a matrix approach in order to produce a

transnational organization that focused on both geographic markets and business lines.

The new organizational model was characterized by:

– Double reporting, both regional and business, with a strong controlling model.

– Responsibilities allocated on a dual basis (central and local).

– Simultaneous control of market and business strategies.

– The opportunity to take advantage of synergies.

 

This new model had several advantages, but also introduced a new challenge, especially related

to HR management, because of the dual line of authority.

.

This organizational model was complicated by the fact that in the last decade, Telespazio had

focused on project teams in an attempt to deal with the constant and rapid innovation required by

the business environment. For example, the company was involved in major international space

programs, including: Galileo, EGNOS, GMES, COSMO-SkyMed, SICRAL and Göktürk. These

programs involved employees from different business units and departments, who would be

temporarily assigned to a project on a full-time basis.

 

The appraisal system could play a strategic role for this organizational change. However, the HR

Department had to make important decisions about how to manage the ambiguity and potential

conflict inherent in the matrix model. Should the responsibility for employees’ evaluations be

shared between two managers, with different views and competencies, or should the

responsibility be allocated to a single supervisor (the Business Unit Manager or the Country

Manager)?

 

Mr. Dettori, Director of Human Resources, was aware that the time had come to review the

appraisal system, taking into account the complexity of this new organizational model.

 

Telespazio: From Its Origins to Its Development into a Leading Global

Company in the Space Industry

Telespazio, a space services company, headquartered in Rome (Italy), has roots dating back to

1961, when Italcable and RAI founded the business under the auspices of the CNR (National

Research Council) and the Ministry of Posts and Telecommunications.

 

From the very beginning, the heart of the firm’s activities was telecommunications using artificial satellites, and it quickly partnered with NASA. The creation of the company opened the horizons of space to Italy, and enabled the country to take part in experiments with new forms of

telecommunication.

 

In just a few years, Telespazio expanded by way of its successful technological developments,

achieving important goals that marked the history of telecommunications, such as the live

television broadcast of the moon landing on July 20, 1969, which was made possible by the

parabolic antennas at Fucino, the Space Centre inaugurated by Telespazio in 1967. The Fucino

Space Centre was, at that time, one of only four such stations on the continent (the others being

PlemeurBodou in France, Goonhilly in the UK and Raisting in West Germany) that were capable of receiving TV signals via satellite from anywhere in the world.

 

Over the course of 50 years, Telespazio quickly became a point of reference in the space

industry, expanding its operations from the design and development of space systems to the

management of launch services and in-orbit satellite control, and from Earth observation services,

integrated communications, satellite navigation and localization to scientific programs.

 

The company’s growth and diversification was accompanied by important changes in its

governance structure through subsequent mergers and acquisitions. The most important transition occurred in 2002, when Telespazio became part of the Finmeccanica Group, the leading Italian manufacturer of high technology, which was ranked among the top 10 global players in the aerospace, defense and security industries.

 

In 2007, Telespazio, along with Thales Alenia Space, was transformed into a joint venture

between Finmeccanica (67%) and the French company Thales (33%) as a result of the new Space Alliance signed by these two giants of the European aerospace industry.

 

In 2010, Telespazio was ranked among the leading global companies in satellite management and Earth observation, satellite navigation, integrated connectivity and added value services.

With437 million Euros in annual revenues and approximately 2,500 people employed in 25 sites

worldwide, the company managed a network of four space centres, including the Fucino Space

Centre, the world’s largest civilian teleport (Figure 2). In Europe, the company was now present

in France, Germany, the United Kingdom, Spain, Hungary and Romania. Worldwide, Telespazio

operated in the U.S. via Telespazio North America and had consolidated its presence in South

America with Telespazio Brazil and Telespazio Argentina.

 

 

 

Performance Appraisal at Telespazio (PAT)

 

A performance appraisal system (PAT) was designed in 2005 to align employees’ efforts with the organizational and the Group’s challenging goals, both locally and in the international arena. The system was conceived as a means to support decisions regarding employee management, such as rewards, compensation, career advancement, mobility, and training. Its aim was to promote the following values:

 

– Transparency

– Sharing

– Joint definition of objectives

– Reference to observable behaviors

– Focus on roles and competencies

 

The evaluation system covers all employees and managers, with the only exception being

executives, who are part of the Finmeccanica management review process.

 

The last, but by no means least important advantage of this system is the fact that it is totally

paperless.

 

What is assessed?

 

The aim of the system is twofold: (1) to ensure that the company achieves positive results, and

(2) to promote the professional development of employees. Accordingly, it focuses on two

aspects of employee performance: goals/objectives and competencies/skills (Figure 3).

Duties/objectives

Technical and

professional skills

Organizational

Goals/objectives

 

The identification of objectives is a crucial phase, as it is considered to be the basis on which

each employee focusses his/her efforts throughout the year.

 

Each objective should: be related to an individual department’s budget plan, be coherent with the

activities planned for an employee’s team, and cover an employee’s development needs. Along

with business related objectives, attention should also be paid to the definition of goals that are

geared towards an employee’s professional development, such as the attainment of an advanced

proficiency in English, or the acquisition of the technical knowledge needed to operate a specific

application.

 

Importantly, in order to ensure joint ownership of, and involvement in, this process, the system

allows middle managers, professionals and specialists to set their own objectives and enter them

directly into the system. Their supervisor can then modify them or add new ones with the

approval of the employee.

 

Objectives should be set and assessed as far as possible on the basis of measurable factors, such

as facts, deadlines and figures. For the system to be effective, it is important to not only achieve

results, but to reach them in the right way. An objective accomplished using inappropriate or

inconsistent conduct is considered to be more harmful to the organization than an unmet goal.

The achievement of each objective is then evaluated through an appropriate rating scale with

three levels:

For middle managers, professionals and specialists,

  1. Not achieved
  2. Achieved
  3. Exceeded

and, for employees and operators,

  1. To be improved
  2. Standard
  3. Outstanding

 

Skills and competencies

 

All of the skills and competencies related to each organizational role have been identified and

included in the Competency Management System, and each manager is asked to communicate

with his/her staff about their role. This enables a thorough communication of the organization’s

expectations for each role in terms of skills and competencies.

The Competency Management System includes both organizational and technical/professional

skills, which are derived from the business drivers. Organizational skills include behaviors and

methods adopted by an employee to deal with specific situations and achieve set objectives.

Examples of organizational skills for middle managers, professionals and specialists include:

‘Value creation’ and ‘Market and Customer orientation’ (Figure 4).

 

Figure 4 – Organizational Skills for Middle Managers, Professionals and Specialists

Examples of organizational skills for employees and operators include: ‘Flexibility and

Interfunctionality’ and ‘Customer Service orientation’ (Figure 5). Technical and professional

skills refer to specific knowledge and competencies required for a particular role.

 

Moreover, each manager can add specific skills or professional experience to the role-specific

skills, selecting them to be included in the list of competencies in the Competency Management

System. These additional skills are not assessed, but can provide useful information on an

employee’s experience.

 

For the system to be really effective, managers are asked to focus on performance and the

behavior exhibited by an employee during the assessment period. They are also required to base

the evaluation of competencies/skills on the observation of concrete facts, adopting a three-level

scale: to be improved, standard, outstanding.

Value creation:

Market and customerinternational

development

Basic steps for effective performance management

 

The appraisal process must be completed by the first quarter of each new year, as employees

must have enough time to plan the activities required to meet their objectives. To set the goals

half way through the year or, even worse, at the end, is considered to be ineffectual or, in many

cases, harmful.

 

The interview as the core of the appraisal process

 

The evaluation process has several steps, which are described in Figure 6. The interview is the

key part of the process. Indeed, it is so central to the process that it should be regarded as the

performance appraisal. Accordingly, particular attention must be paid to preparing for the

interview; both managers and employees need to carefully gather all of the information available

to support their discussions with concrete evidence. During the meeting, the manager should

focus on the results achieved and the gaps between the expected level of skills for the role and

those exhibited by the employees. The manager must see the interview as an opportunity to both

fully explore areas of performance and skills that require improvement and define the appropriate

training.

 

For his/her part, the employee should make a list of his/her achievements and skills, and is also

invited to suggest training activities that could be useful for improving weaknesses. Employees should not regard the meeting as an ‘exam’, but as a relevant and constructive opportunity to get

feedback on both strengths and areas that could be improved.

 

According to the HR development team, the PAT system should be used as a management tool,

and is designed to motivate and develop employees, rather than simply ‘reward’ or ‘punish’

them. In this regard, negative feedback is also relevant, as it should encourage employees to

recognize their weaknesses, face their problems and take appropriate action to improve their

skills.

 

 

 

 

A paperless appraisal

 

The appraisal process is completely electronic. In order to ensure standardized and comparable

analyses, all of the information about employee objectives and skills are gathered on specific

forms made available by SAP-HR (Figure 7), one for middle managers, professionals and

specialists, and another for employees/operators.

 

The forms also serve to collect all of the data related to training needs and improve the

information available with which to evaluate the company’s quality and return on investment in

training. The SAP system collects the information required to prepare specific training plans for

each individual that are coherent with the company’s strategies. The effectiveness of an

employee’s training, in terms of the impact on work performance, during the year is evaluated by

the manager and included.

 

Employees are expected to take an active part in the performance evaluation, writing their

comments in the appropriate section, which includes several questions aimed at encouraging

them to explain their points of view on key aspects of the appraisal. Both managers and

employees are asked to complete this section. If the sections are blank, the appraisal process is

considered incomplete and the system does not accept it.

 

The adoption of the SAP tool enables the HR Function and all managers to have real-time access

to specific and aggregate data that is valuable for managing and developing employees.

 

 

Overall appraisal

 

The evaluation of objectives and competencies flows into an overall assessment of employees

and uses a three-level scale: to be improved, standard and outstanding. The system itself, on the

basis of all of the information obtained, suggests the most appropriate level. The supervisor can

modify this value if an employee’s professional track record suggests a different evaluation.

 

Who is in charge of the appraisal?

 

The performance appraisal at Telespazio is based on the views of one evaluator, the direct

supervisor. Evaluation is a primary responsibility of each manager, which ensures the appropriate visibility of results by the management level immediately above. An exception to this rule occurs when employees are assigned to project teams on a regular basis, with a mix of line and project responsibilities. In these cases, the performance appraisal is completed by both the Project Manager and the Line Manager. More specifically, the definition of the objectives for each new year is the Project Manager’s role, as he/she is responsible for the project’s budget and timing. While the Line Manager is responsible for the performance interview, as this is the core of the appraisal process. This approach has two objectives: (1) the attainment of the team’s project goals and (2) ensuring the employee’s long-term professional growth (Figure 8).

 

The planning and coordination of the entire appraisal process is the responsibility of the HRDepartment, which is also in charge of analyzing and preparing monitoring reports on the overall results

Supporting implementation of PAT through ongoing communication

 

Each year, several means of communication are used to ensure that important information and the values associated with the program go out to all employees. Indeed, both the managers who are in charge of evaluating their staff and the workers who will be appraised must be fully aware of the rules of the game. As stated by the HR team: “transparency and equity are essential to

guaranteeing that the program is successfully implemented.”

 

At the start of each year, the CEO sends out a letter as a way of engaging all of the company’s

managers in the process. This letter is accompanied by the setting-up of a Management Forum for all of the managers involved in the appraisal process, and by a more detailed communication

from the Director of Human Resources, Giorgio Dettori, to all employees. Moreover, a section of

the company’s intranet is dedicated to a PAT description and timeline. There also exists a PAT

brochure which explains the evaluation objectives and process.

 

Assessing the PAT system

 

On April 14th, 2011, Mr. Dettori and Ms. Di Santo met the HR staff to determine the program for

the upcoming Management Forum, the annual workshop where the Human Resources

Department presents the overall results of the performance appraisal process to Telespazio’s

management. The Development Unit had prepared a detailed presentation for the meeting in

which it planned to highlight both the positive aspects of the PAT program as well as critical

issues, with the aim of making recommendations with respect to potential changes.

 

Marta Di Santo said: “After six full years since PAT’s introduction, we have several reasons to

be satisfied. We have gone from a context in which it was necessary to demonstrate the value of a formal performance appraisal process, to an organizational environment that has finally

understood its importance. Today, most supervisors acknowledge that PAT is a useful tool that

allows them to manage structured feedback with their subordinates. Moreover, employees have

begun to appreciate PAT as a tool that ensures a transparent and consensual evaluation process.”

 

Stefania Tomassi added: “Initially we had to ‘chase down’ supervisors to get them to complete

PAT; now, employees themselves pressure their boss to complete the evaluation process. I

realized that we were finally able to bring about a real cultural change when the trade unions

came to ask for our intervention with respect to the supervisors who were not completing the

appraisal process, as they thought that this wasn’t in line with the best practices set by the

company.”

 

Marta Di Santo continued her presentation by illustrating the results of the competence gap

analysis for all of Telespazio’s organizational roles (Exhibit 1). As she noted, the PAT program

provides valuable data when it comes to assessing average competency levels and evaluating

their appropriateness against role requirements. These data were crucial for planning targeted

training programs.

 

Although these results were considered to be extremely positive, Ms. Di Santo did have some

concerns about the program:

The timing of the performance appraisal process. Although the PAT process was deemed

an essential responsibility for managers, delays against the planned schedule were still a

problem; pressing budget deadlines took precedence over performance appraisal.

Equity and selectivity. Although the company made significant investments in targeted

training and coaching for assessors, the analysis of the data generated from the Human

Resources Management System showed that the rating distributions were often biased

towards positive performance and uneven between different business units and

departments (Exhibit 2).

– Some remarks were made regarding the system’s alleged rigidity.

 

Mr. Dettori considered the equity and selectivity issue to be the most critical: “After several years devoted to developing a culture of appraisal, I don’t see many steps forward in the ranking

distribution.” Marta Di Santo added: “Most ratings are inflated, others are not

differentiated…some managers award superior ratings to all of their staff!” Mr. Dettori

continued: “These kinds of appraisal risk having a demotivating effect on those employees who

have been correctly evaluated by their boss, and who come out below the average. Last year, we

were in the same situation and decided that more effort was required in terms of communication

and training. But this wasn’t enough! It’s time to make some changes. Our managers have to be

aware that differentiation among their employees is essential to the system’s effectiveness. We

have to evaluate carefully every possible action that goes in this direction. The revision of PAT

should also address the important organizational change we’re facing. The new organizational

model needs to be assimilated by our colleagues; they still need to feel confident with this new

way of working. We must attain a stronger integration of our operations across the world and

adjust to a multicultural context. The worldwide implementation of the performance appraisal

program will be crucial to communicating the new organizational requirements and sustaining the process of global integration.”

Part B

 

T-PAD. The revised appraisal program

 

At the end of April 2011, the HR development team decided on how to improve the PAT

program. The major revisions included:

  • Revised rating categories: the old numerical, three-level rating scale for the evaluation of

both objectives and competencies was replaced by a new four-level rating scale that is

consistent with the one used for the overall evaluation. This expansion was made at the

request of a number of different evaluators, who expressed the need to have a better

opportunity to differentiate between different performance levels. Figures 9 and 10 set out

the new four-level rating scale introduced for both targets and competencies.

  • More selectivity in the appraisal process: all company managers were advised that in every

department/function, the number of employees with an outstanding performance should not

exceed 15% of the overall number of people working in the unit.

 

 

  • Assessment of new competencies: two competencies were added to support the

implementation of the new model (i.e., international orientation and business orientation).

 

These revisions were communicated to all managers and employees through an email sent by the

CEO during the launch phase of the new appraisal process for 2012. Furthermore, a meeting with

all supervisors was planned, with the objectives being to share the previous year’s evaluation

results and to explain how to handle the new program. The revised PAT, now named T-PAD

(Telespazio Performance Appraisal for Development), was illustrated in an article published on

the intranet. A new brochure was also distributed to all employees.

 

As 50% of Telespazio’s employees work outside Italy, the goal set for the 2012-2014 period was

to ‘export’ the Roles and Competencies System and the updated T-PAD to all of the countries

where the company’s subsidiaries operated. The HR team defined the schedule of the operational

plan for the introduction of the T-PAD program to the company’s sites abroad. The pilot country

would be Telespazio Argentina in 2012, with the objective being to extend the appraisal program

to all of the other foreign subsidiaries by the end of 2014.

 

The situation in 2012

 

On September 24th, 2012, Mr. Dettori met the HR team to take stock of the situation and asked

Marta Di Santo to report on the goals achieved during the year. Ms. Di Santo started her

presentation by illustrating the partial results of the 2012 rating distribution among different

organizational units (Exhibit 3): “I think we’ve made some steps forward. The introduction of a

four-level scale together with the supervisors’ training and coaching activities have paid off. Four

evaluators used the outstanding level for less than 20% of their staff and no one rated his/her

entire staff as outstanding. The assessments now definitely have a more normal distribution

compared to those from 2011. The best cases are represented by units 7, 8 and 10, where the

managers used the entire rating scale. But we are still some ways from having a really selective

evaluation approach.”

 

According to Ms. Di Santo, the T-PAD had other positive outcomes: “These figures are very

important, but we need to go beyond them. We’ve been able to bring about a real cultural shift

among our line managers. Most of them are now fully aware that the T-PAD is a powerful tool

with which to manage their staff effectively and achieve their unit’s goals. All the decisions

regarding employee development (training and career advancement) and economic incentives are

taken exclusively on the basis of the evaluation results.” Stefania Tomassi added: “Last week I

met Francesco Rossi, who has recently been appointed as Operations Manager of the Network

Division, and he told me: ‘It’s a good thing we have the T-PAD! Thanks to this system, I had the

chance to conduct structured interviews with my new staff and to get to know each of them in

greater depth. Moreover, the SAP forms allowed me to easily reconstruct the personal history of

each employee… until a few days ago, I didn’t even know them, but today I feel like I’ve been

working with them for the last 20 years!’ He was very enthusiastic about the appraisal system and its potential.”

 

Ms. Di Santo took the floor again: “We all know that the most important task set by our team in

2012, in line with the company’s expectations, is the extension of the T-PAD to all of the foreign

subsidiaries by the end of 2014. The program’s worldwide extension will be crucial to sustaining

the company’s global integration. We started this year by implementing the system in Telespazio

Argentina, the pilot country, and we didn’t have any problems; we worked well with the local HR Department. The local HR Manager, Camila Beliera, was conscious that the subsidiary really

needed a structured appraisal system and worked hard to bring all 10 of the local supervisors

onboard, making them aware of the appraisal system’s strategic role. Moreover, I know Camila,

as she used to work for a big Italian company in Rome and we have the same people management philosophy…working with her was easy.”

 

Stefania Tomassi added: “By the end of September 2013, we have to complete the

implementation process in Germany and France. These countries’ subsidiaries have very different managerial systems and leadership styles… Telespazio France has nearly 400 employees, a very strong national culture and a well-established local evaluation system. This will make the transfer of our T-PAD not easy at all…I don’t think that French managers will simply accept our program!”

 

The HR team was aware that the international implementation needed to be carefully planned.

 

2014-03-06

 

© HEC Montréal 16