Best Practice and High Commitment HRM

Introduction
What is high commitment HRM?
It is a set of HR practices that has the potential to contribute towards organisational performance. They are mainly to increase labour turnover, reduce absenteeism, improvise employees behavior and attitude, improve quality and customer service. This has been argued by a set of US academics that there are a set of hr practices which can increase the productivity and organisational performance, these practices are good for the workers and the companies perspective, because it improves on employment security, training and development and the from the companies end it improves on the quality and the overall organisational performance.
The best practices according to Pfeffer J (1998):

Employment security and internal labour markets
Selective hiring
Extensive training, learning and development
Team working
High compensation contingent on performance
Performance review appraisal and career development
Reduction of status differentials/ harmonisation
Work life balance
Employment security and internal labour markets.

This practice says that the company cannot ask everything from its employees without some expectation of employment security, which as a major concern over the employees future, but the author argues that how much of employment security the company can provide, the company cannot allow its employees to stay for their rest of their life nor they can sack the employees when required. The author considers this has one of most vital principles of high commitment
Selective hiring and sophisticated selection
“Recruiting and retaining outstanding people and capturing a stock of exceptional human talent ” (Boxall 1996 , p 66-67)
The author says that the most of the companies want to recruit those who can show commitment, team working skills and trainability in them. The company should be careful while defining the job profile in the advert so as to reduce the number of applications. The company should use precise techniques to recruit. The company should make use psychometric tests, structured interviews and work simulator in order to select the best. This process should be conducted by professional individuals. The author also points out the best key point about best practice selection is that the process of selection should be integrated and systematic, the company should make use of the techniques which are appropriate for the position and the organization.
Extensive training, learning and development
(kersley et al, 2005, p.84) says extensive training is to those companies who emphasis more on quality and customer service, where it is perceived to be crucial for organisational success.
This practice says that the company having selected the best, the company should ensure they train their employees to be forefront in their field of work, the author also states, their has been a growing importance of individual and organisational learning to gain competitive advantage.
(wright and gardner 2003, p312)says the word learning is very crucial as it demonstrates employer willingness to encourage and facilitate employee development rather than providing training to cover short term crisis.
Employee involvement and participation and workers voice
(Marchington and Wilkinson, 2005) say that there are numbers why EIP is an essential component of the high commitment. Firstly there should be communication about the company financial performance, strategy and operational matters. The message should be conveyed that they are to be trusted and treated in a positive manner. Secondly team working will provide a platform for workers to offer their suggestions and contribute towards organisational performance. Thirdly the management will consider the participation of workers to put across their ideas before decisions are ultimately made. EIP appears in prescription foe best practice or high commitment HRM, this may include downward communications, upward problem solving groups, all of which are designed to increase the involvement of individual employees in their workplace. The author also argues that it is difficult to compare results across studies and arrive at any firm conclusions about the importance of EIP to high commitment HRM. EIP is often little more than a cascade of information from management. The objective of such schemes such as team briefing is to reinforce the supervisor as an information disseminator.

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Self-managed teams/Team working
(Marchington, 1999) says, team working as been identified by many employers as a fundamental component of organization success. Pfeffer, 1998, p76) says, team working is seen as a platform to make a better decision-making and the achievement of more creative solutions. The author also states that there is evidence that the employees who work in teams, generally report higher levels of satisfaction than their counter parts who work under the traditional regime.
High compensation contingent on performance
(Pfeffer 1998) says, that there are two elements to this practice, higher than average compensation and performance related reward, both these elements say that the employees are to be awarded for their superior contributions. The author says the pays should be competitive, to retain and to attract high quality labour. It should reflect different levels of workers contribution like being paid as regular bonus or through profit sharing schemes. (Huselid 1995) says two measures for this factor. One being the proportion of the workforce who have access to company incentive schemes, and the proportion, whose compensation is determined by performance appraisals.
Performance review, appraisal and career development
Performance review, appraisal and career development as key element in high commitment HRM, they help in defining performance expectations and in providing employees with their targets to aim for. There should be regular team meetings between the staff and the managers to review and feedback to the staff through performance appraisals. Performance review is concerned, that the current levels of performance are acceptable, and instigating action if they fall below expectations, it is also important in helping the workers to plan their future in the organization and in determining any further learning and training needs. Employers should be able to communicate clearly through the appraisal process, so as to link between the organisational performance and hr practices.
Reduction of status differences /harmonisation
This practice states that the companies which employ manual workers, should convey message to these workers and the lower level staff that they are also valuable assets and deserve to be treated in a similar way to their senior colleagues. This practice allows the employees to offer ideas within an open management culture. This practice can be achieved by having staff uniforms, shared canteens and car parking facilities. This helps to break down artificial barriers between different groups of staff, which will in turn encourage and support team working and flexibility. The company should extend share ownership to the workforce and by doing this status difference can be reduced.
Work life balance
Most of the companies are emphasizing on work life balance. Mainly women employees because they have to work and take care of the family too. many of the companies are changing their policies to attract and retain those women employees who have responsibility.(Houston 2005, CIPD 2006)
After briefly explaining the best practices of high commitment HRM, I can understand that each of these practices is important in improvising on the organization growth. Most of the authors say that these practices cannot be implemented in isolation, but they should implemented in a package (Mac duffie 1995) most of the literature says that these practices support and mutually reinforce each other, for example workers are more positive if there is employment security and status free, workers show more interest in team working if their efforts are rewarded with performance related pay, work life balance, access to training opportunities and share ownership. We can understand if there was a formal way of a selection and induction employees are more likely to adopt flexible practices and to training opportunities. All these practices will pay of only if there is strong organisational culture. This is argued that these practices form a synergetic bundle which helps the organization to enjoy success.
A research was conducted by john Purcell, this study was basically to check the link between hr practices and people management and how hr practices impact on performance. This research was carried on 12 organizations in different sectors of the industry. The research was done by interviewing front line employees and line managers, at the initial stage most of the companies had a “big idea” which the company is trying to achieve. Most of the companies which had an big idea, it was not just a mission statement but it was the values which was spread throughout the organization so that they are embedded in their policies and practices, so these organization had strong practices to improve on the organizational performance. The research also said it’s important to have good front line managers who can implement the practices, it’s not enough to have good hr policies but there should be someone that makes sure that these policies are followed. It is important that these practices are followed, so that the employees feel good and take that extra mile at work. We can say that if a company as good line managers who can implement these practices in a right way so to bring the best in the workers, so that they can help on improvising on the overall perspective of the organization.
On the contradictory these practices will show good results only if they are followed together,
Various authors have found out the drawbacks of these practices, (wood and de menezes 1998:487) note that most of the studies indicate the lack of consistency, reporting fragmentation, a “pick and mix” approach of human resource they even found out short termism packages of HRM, rather than deploying integrated, consistent and long term packages of HRM.
(Truss et al) say that they hardly found out evidence of any deliberate or realized coherence
Between hr practices, in their research one of the Hr officer said the company would recruit one employee and sack another from another department, then where is the practice called employment security. (pfeffer) says that most of the smart companies often “do dumb things”, failing to learn from examples. They say that there is support for the notion that HR practices do operate more effectively when combined together. They also say that the precise number and mix of these is more open to debate, for example extensive training is an essential requirement for self managed teams to run effectively, higher than average rewards are more to impact on the numbers of applications for the job and to the consistency of selective hiring practices. The provision of financial and performance information to all employee is likely to be part of a wider harmonisation package. Any employer is willing to show more employment security if there is effective selective process; self managed teams are more extensive though the organization and compensation is based on performance. (Huselid1995, Dyer and reeves1995) say that marginal changes on practices have little or no effect on productivity.
Employers may make employee security a guarantee, condition only on an agreement that pay can be substantially adjusted in order to maintain employment in lean times. Few employees are offered security but with a price that they have to flexible, to move jobs and locations to maintain employment, they should be flexible to undertake retraining and to adjust in working hours.
(Pfeffer) also said “eliminating layers of management by instituting teams saves money”.
He says that self managed staff can also take on tasks, which was done by specialized personal, by doing this company can reduce the numbers of levels in the hierarchy and thus making senior managers more visible and more accessible.
Some of the key methodological issues faced by the researchers was that there was inconsistencies between the studies, where one research ignored one factor and including the other, practice like employment security by pfeffer was not included in the list of Delaney and Huselid 1996, Youndt 1996, Patterson et al 1997, wood and de Menezes 1998. Some authors include some measure of employee voice rather than achieved by employee involvement.
Pfeffer says, he is uncertain why researchers have included or excluded certain HR practices. He says the list can be developed on the basis of the other researchers have used or by constructing groups of practices on the basis of factor analysis. (Huselid 1995 645-647) identified two groups of practices namely ’employee skills’ and organisational structures’ they include job design, enhanced selectivity, formal training, various forms of participation and profit sharing.
(Patterson et al, 1997) also emerged with two groups of practices ‘job design’ and ‘acquisition and development of employee skills’. Guest says that there must be strong empirical base and a clear theoretical specification of hr practices that have to be included. Pfeffer says that the closer the organization gets towards the best practices the better, the better the performance. Guest points out that there may be room for variations between organization and practices which they follow in specific to external and internal circumstances.
Conclusion
The main focus of this study was check that can organization performance can be improved by following a set of Hr practices. The study led to suggestions that there is one way in which HRM should be delivered , moreover that these practices have an positive impact on the organization. This remains an idea that a bundle if hr practices and policies is capable of making major contribution towards organization success in all work places. On the contradictory side, weather this set of practices will suitable or which make a difference to lower line performance organizations.
 

Define Evidence Based Practice Health And Social Care Essay

Evidence based practice is a buzzword that appeared in healthcare settings in last decade. Pressure from government agencies on healthcare providers to deliver excellent clinical practice increases importance in implementation of evidence based practice. In order to sustain effective outcome in rehabilitation, is essential for clinician to manifest evidence-based practice into clinical made decision. The aim of essay is to define evidence based practice (EBP) and implementation of paradigm, EBP into occupational therapy process in Peter’s case. In order to understand Peter’s case paper draws information about his condition, multiple sclerosis (MS). Essay will explore evidence-based practice through range of researches in occupational therapy (OT) intervention, identifying possible benefits for Peter’s well-being.

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Evidence-based practice is one of most debatable process of last few decades. EBP developed and arouse from evidence-based medicine defined by Professor David Sackett and other scholars, as an attempt to find best evidence to assist healthcare professionals with making best decisions for patients (Bailey et al, 2007). EBP is process where gathered best available evidence and clinical expertise assists clinical decision-making. Decision process is understandable for client, justifiable to other healthcare professionals, where gathered evidence (through research process) allows clinician to assess current practice. Collaboration between patient satisfaction, clinical judgment, and up to date information throve EBP to become powerful toll to underpin clinical intervention (Taylor, 2000). Definition of EBP is based on best evidence, clinical expertise, patient values, and circumstances where clinician takes under consideration all those elements in practice settings. Clinician is expected in EBP process to apply criticism, educational skills and to recognise system of values meaningful for client (Hoffman et al, 2009). When applying evidence into intervention clinician is proved to use skills upon which he or she could judge and recognise best evidence for practice. Hierarchy of evidence to recognise best evidence to underpin intervention guides clinician (Taylor, 2000). Author as the strongest and most valid elevates systematic reviews and meta-analyses from all, through which clinician has access to publish and unpublished evidence. Taylor (2000) recognises ‘gold standard’ evidence in randomize control trials (RTC); they are to be considered by healthcare professionals as effective in intervention. Limited credibility is given to non-experimental studies, non-randomized trials, opinions or experts discussion where level of validity is low.
EBP takes form of several steps to address information to relevant intervention: asking the question, searching for evidence, critically appraising evidence, collaborate evidence with clinical expertise and client personal values and finally evaluate. The form of question could determine information about certain patient. Clinical question includes several components: P – patient and/or problem, I – intervention, C – comparative intervention (optional, include if relevant), O – outcome (PICO). For example, in Peter’s case clinician through formulated clinical question determines valid information about him: P -middle age male with multiple sclerosis, I – occupational therapy, C- physiotherapy, vocational therapy and O- benefit in patient well being (Hoffmann et al, 2009). Evidence research for PICO is a next step for clinician. Valid information gathered through steps of EBP process needs reliable source, where materials and references are found. Key aspect of EBP is for clinician to have access to books, journals, conferences, RCT, systematic reviews, and databases. Clinician is aided by nowadays technology in journey to find best evidence; allied tool is internet where most of databases are placed. AMED, BNI, EMBASE, HMIC, MEDLINE, PsycINFO, CINAHL, HEALTH BUSINESS ELITE, The Cochrane Database, and OTseeker are databases that assist and guide evidence based therapist to develop sufficient and explicit evidence in clinical intervention (Hoffmann et al, 2009).
Best evidence is determined by evidence-based clinician on validity of evidence through hierarchy of research (Lin et al, 2010). Critical appraisal of evidence clinician bases on RCT, where RCT could be best choice to underpin treatment options. EBP process is tailored to patient’s needs and beliefs, so client could feel empowered and included in rehabilitation process. For example, in Peter’s case client-centred occupational therapist would concentrate on Peter’s priorities, which are employment and his knowledge about MS. Although clinician in rehabilitation process manifests EBP, implementation of EBP could be a challenge for both parties (Lin et al, 2010). Process can be time consuming due to large amount of researches available. High demand to understand researches for both parties is seen as an obstacle. Therapist could have limited knowledge to conduct particular research or lack of understanding patient’s goals. However evidence based therapist could seek help from current employer in ongoing training, communicate arouse issues with other health professionals and client or collaborate to conduct small group evidence based project (Lin et al, 2010).
Peter diagnosis is relapsing- remitting form of multiple sclerosis. According to National Institute for Clinical Excellence (NICE, 2004) multiple sclerosis is chronic, progressive disease of the central nervous system, which affects young and middle-aged adults. MS causes damage to myelin, which is fatty substance surrounds the brain and spinal cord. Scare tissues within the brain or spinal cord replace myelin. Damage leads to disruption in ability of nerves to conduct electrical impulses. Individuals affected by MS experience functional loss, including weakness, fatigue, spasticity and impairments of cognition, vision, speech, swallowing, bowel, and bladder function. MS occurs with an episode from which individual recover full, after that, disease develops in certain form. NICE (2004) statistics shows that 80% individuals with MS are diagnosed with relapsing- remitting form of disease. Relapsing – remitting disease occurs when patients experience relapse, which can last from 1 day to several months. Relapse occurs in loss of mobility, loss in function of bladder, loss of vision, general paralysis of the voluntary muscles. There is no progression between relapses.
Multiple sclerosis is long-term condition with complex problems, which requires wide range of healthcare professions input: nurses, doctors, physicians, occupational therapists and many more. At the present, there is no cure for disease (NICE, 2004).
Turning now to discuss evidence-based practice occupational therapy interventions, which could be beneficial for Peter.
Peter expresses symptoms of anxiety, he does not know much about his condition, he developed negative stereotype of doctor due to insufficient amount of information about his illness.
Evidence based practitioner could build therapeutic relationship with Peter, for example by effective communicated information about his condition. Evidence based therapist would inform patient about his condition appropriate to his knowledge abilities. Ongoing support, access to information and advice on treatment could have positive influence on patient experience during rehabilitation process (Köpke et al, 2010). Köpke et al (2010) protocol highlights sufficient and adequate information through different channels (leaflets, internet and education programs) allows patient to understand illness, to develop management strategies and to avoid unrealistic expectation from rehabilitation process. Occupational therapist could develop collaborative relationship with Peter through engagement in making decisions, medical interventions, and new technological aids tailored to individual needs. For example, information process is tailored and designed for Peter’s level of understanding, Consequently Peter’s main expectations are reassured by occupational therapist – to be included in rehabilitation process, fell heard and understood. Furthermore, patient can understand complexity of disease has choice in various treatment options and feels empowered (Reynolds, 2005).
MS has impact on many areas on people life, where employment status concern individuals, many may struggle to remain in work role. Sweetland et al (2007) undertook study, where participants were tape recorded to show expectations and implications for patients with MS in vocational market. Paper demonstrated demand in MS workforce population access to vocational rehabilitation, support performance in work place, management of anxiety and fear from discrimination. Peter well-being is influenced by fear, uncertainty about employment status, insufficient money income, and deteriorating health condition. Define employment legislation to patient and employment rights, as a disable person and provide vocational support (Disability Employment Advisers and the Access to Work Scheme), could guide Peter to understand his status in work field (Sweetland et al, 2007). Evidence based practitioner could introduce Peter to legislation act. For example, Disability Discrimination Act (1995) could show Peter his rights as an employee. Information about eligibility to social benefits allows service user to feel reassured about financial aspect of life (Johnson et al, 2004). To help in employment service occupational therapist could liaise with Job Centre and local government authorities (council) to achieve financial grant for adaptation in work environment according to progression of illness. However, therapist has to be mindful about patient condition at work. Peter complains about fatigue (overwhelming tiredness) and muscle spasm. Peter is a forklift truck driver, remain in same working environment could put on risk himself and others. MS exposes individuals to risk of injury because fatigue could lead to nausea, disorientation, and loss of balance. Ongoing assessment of work conditions is important for individuals to present problems as they arise. Management of fatigue symptoms, support from employer and work colleagues, flexible work schedule, knowledge development about social benefits could have positive impact on employment performance. Informing employer about illness would be important due to health and safety issues, furthermore to set up solutions in working environment. Taking into account Peter’s expectations and needs evidence based practice therapist could develop intervention where Peter could sustain effective employment (Johnson et al, 2004).
Young and middle age adults are affected by Peter’s condition (MS). Various aspects of individual life are affected by illness. Disturbance occurs in education, employment, physical functioning or disability and important to many sexual life. Clinically effective therapist applying intervention in sexual life filed should take sensitive approach. Peter’s condition would have impact on his sexual performance, therefore therapist should concentrate on client-centred approach, adapt actions to fulfil patient needs and expectations. Often patients exhibit needs, but they do not express them, where upon that evidence based therapist should apply observation skills and intuition in rehabilitation process (Reynolds, 2005). Insufficiency in therapeutic understanding of biographical disruptions such as relationship breakdown due to poor or absence of sexual activities can be a barrier between patient and therapist. Effective communication has a significant role in active participation into rehabilitation where issues of sexual dysfunction arise. Although, sexual life is meaningful need of many individuals, embarrassing nature of issue for patient and therapist may influence patient’s adherence to long-term treatment (Reynolds 2005). Evidence based practitioner acknowledges complexity of sexual dysfunction advising patient to seek advice in collaborative services like counselling. In Peter’s case, client- centred therapist through sensitive approach could address problems with erectile dysfunction or is prepared for remark from patient side. Evidence based practitioner could address Peter with pharmacological help (Viagra); offer to see specialist in sexual problems and advice how to use sexual aids or adapt sexual position (NICE, 2004).
Multiple sclerosis is long term neurological condition. According to World Health Organization (WHO, 2008), there is no treatment that can cure MS. Evidence shows that cost of medical treatment can be expensive and it is only limited to slow down progression of disease. WHO document (2008) highlights importance of rehabilitation process in MS. For example evidence, based therapist could draw attention to management strategies for illness. Occupational therapist could show Peter how to manage fatigue through keeping daily diary of activities, regular exercise and implement schedule of brakes between activities. Evidence based therapist could liaise with other healthcare professions to promote client centred approach to MS. Result of collaboration between multidisciplinary team could be beneficial for Peter. For example, evidence-based occupational therapist could collaborate with psychologist, where psychology session could help Peter adjust to, and cope with MS. Finally yet importantly, rehabilitation process could improve quality of his life (WHO, 2008).
This overview of studies is focused on efficiency of occupational therapy for Peter, who suffers from MS. Key aspect for evidence based practice therapist is to enable Peter to remain independent and provide him with achievable goals. Occupational therapy for Peter could have problem-solving approach. Critically evaluating their practice evidence based occupational therapist would create opportunities where Peter could enhance his life quality. Evidence based therapist would seek advice from other health care professions and government agencies, local authorities to promote effective and sustainable employment status. Effective communication between occupational therapy and Peter would build profession relationship, which could be a bridge to engage patient in lifetime rehabilitation journey. Empathic, client centred occupational therapy process would be perceive as allied tool to help Peter to understand his difficult and complex illness. However, occupational therapist would not be able to treat his condition, nevertheless evidence-based occupational therapist could help Peter sustain his independence and enable Peter to regain feeling of ‘normality’.
REFERENCES:
Bailey, D., M., Bornstein, J., & Ryan, S. (2007). A case report of evidence-based practice: From academia to clinic. American Journal of Occupational Therapy, 61(1), 85-91.
Disability Discrimination Act 1995. (1995) London: HMSO
Hoffmann, T., Bennett, S., Del Mar, C. (2009). Evidence-Based Practice Across the Health Care Professions. Australia: Elsevier.
Johnson, K., L., Amtmann, D., Yorkston K., M., Klasner, E., R., Kuehn, C., M. (2004). Medical, Psychological, Social, and Programmatic Barriers to Employment for People with Multiple Sclerosis. Journal of Rehabilitation. [Online] Available at: http://proquest.umi.com/pqdweb?Ver=1&Exp=10-27-2015&FMT=7&DID=577472521&RQT=309&cfc=1 [Accessed 28 October 2010]
Köpke, S., Solari, A., Khan, F., Heesen, C., Giordano, A. (2010). Information provision for persons with multiple sclerosis. Cochrane Database of Systematic Reviews, Issue 10. Art. No.: CD008757. DOI: 10.1002/14651858.CD008757.
Lin, S., H., Murphy, S., L., Robinson, J., C. (2010). Facilitating Evidence-Based Practice: Process, Strategies, and Resources. The American Journal of Occupational Therapy, 64(1), 164-171.
National Institute for Clinical Excellence and the National Collaborating Centre for Chronic Conditions (2004) Multiple Sclerosis: National clinical guideline for diagnosis and management in primary and secondary care. London: Royal College of Physicians.
Reynolds, F. (2005). Communication and Clinical Effectiveness in Rehabilitation. London: Elsevier.
Sweetland, J., Riazi, A., Cano, S., J., Playford, E., D. (2007). Vocational rehabilitation services for people with multiple sclerosis: what patients want from clinicians and employers. Multiple Sclerosis. [Online]Available at: http://proquest.umi.com/pqdweb?Ver=1&Exp=11-09-2015&FMT=7&DID=1370288031&RQT=309[Accessed on 10 November 2010]
Taylor, M., C. (2000). Evidence- based practice for occupational therapists. Oxford: Blackwell Science.
World Health Organisation (2008). Atlas multiple sclerosis resources in the world 2008. [Online] Available at: http://www.who.int/mental_health/neurology/Atlas_MS_WEB.pdf [Accessed on 28 October 2010]
Student number: 1041133
Discuss the strengths and limitations of the educational leaflet that you developed within a small group during HH1103 seminars.
The aim of this essay is evaluation of educational and communicational material in form of leaflet based on Helen case, who suffers from Juvenile Chronic Arthritis (JCA). Essay draws definition of condition and determines how leaflet is presented and why. Moreover, paper demonstrates leaflet limitations and strengths and how well meets it purpose. The purpose of the leaflet was to inform Helen and her parents, in simple form and manner, about her condition-JCA. Furthermore, leaflet is designed to pass message about available services, form of rehabilitation, and management of JCA.
Leaflet main topic is concentrated around solutions in life style and rehabilitation for 14-year-old girl Helen. Leaflet is designed upon Helen personal experience and her illness JCA. JCA is condition, which affects joints in children, age under 16 years old. One in 1000 children in United Kingdom is affected; in relation to gender, females are impacted more than males. Skin rush, joint swelling, fever, change in mood are symptoms associated with JCA. Rehabilitation process has successful rate in majority cases; it enables individual to preserve normal rate of growth and psychological development (Arthritis Care, 2010).
The leaflet is composed in simple form where colourful scheme would attract Helen’s attention. Choice of the colours is not patronizing, it is modern and does not have significant impact on cost of producing the leaflet (Department of Health, 2003). When it comes to graphics, pictures suggest activities in which Helen could engage and introduce to the rest of the family importance of active lifestyle. For example, picture of the family in swimming pool displayed on the front of the leaflet, illustrates meaning to rehabilitation process. Furthermore, it encourages Helen and her family to participate in activity. Swimming sessions could motivate family to spend quality time together and empower Helen in her illness. The National Health Service (NHS) logo could be discouragement for Helen, making leaflet to official. However, it could be invitation point for her parents, where it could be a source of credibility (Department of Health, 2003).
The font size is readable and information flow through the leaflet. Information is arranged in small intersections to make more understandable for children. It was important to implement bullet points where possible so leaflet draws attention and it is not boring, but has patient friendly-text aspect. Identify source of information is distinguished where it proved leaflet to be honest guide to JCA (Department of Health, 2003).
It was priority to locate information about medical treatment. Helen compliance with medication is insufficient. Information introduced in leaflet could persuade her to follow guidelines from GP related to her medical treatment. There is some evidence, where written information about medication has benefits on patients’ outcomes: like knowledge or compliance (Nicolson et al, 2009). Compliance with medication could be beneficial for Helen by reducing level of pain; subsequently medication would reduce swelling of the joints and enable Helen in active participation in physical form of treatment. The area where leaflet informs patient about medication could be less informative. Information about medications could be to formal for Helen by putting her off. However, leaflet could guide Helen into different source of information (internet or other leaflets), where medication is explained in simple language, and details possible side effects (Nicolson et al, 2009).
It is a challenge to develop leaflet for the patient with low readability and those who expect information that is more specific. Determine whether the leaflet language is comprehensible and suitable for majority of population is based on Reading Ease score (Reynolds, 2005). Language used in leaflet is readable to average 13-14 year old child. Simple and plain language could be easy to remember. Verbal information could be easily forgot or misunderstood during patient consultation session. Written information could hence patient participation in rehabilitation (Dixon-Woods, 2001). Medical jargon is reduced to minimum when explaining JCA. Adequate knowledge about condition explained in plain language could be a form of education. Available treatment options for Helen’s condition could empower her parents in decision-making process (Dixon-Woods, 2001). However, if patients who would like to explore condition in more details, leaflet should provide more adequate information in last section of leaflet.
Overall, concept of the leaflet is good. Leaflet is not only about patient information, but has numerous advice and solutions for Helen and her family. Therefore, it seems sensible that leaflet guides reader to seek advice in additional services. Group could implement few improvements in some areas. Where needed team could concentrate on board public and made it leaflet less official. Moreover, would be beneficial if leaflet explore more about occupational therapy and physiotherapy rehabilitation for Helen. Nevertheless, leaflet achieved it main purpose: to communicate information about Helen’s condition to her and family.
 

Literature Review Strategy for Evidence Based Practice (EBP)

Introduction
Evidence based practice (EBP) is an approach to health care in which health professionals use the most appropriate information available to make clinical decision for providing high quality patient care (McKibbon, 1998). EBP has shifted the focus of health care professionals from a traditional approach on authoritative opinions to a stress on facts extracted from previous research and studies (Sackett et al, 1997). It has been suggested by that nursing practice based on evidence enhances patient care, as compared to traditional practices (Majid et al, 2011). In addition, as nurses are increasingly more involved in clinical decision making, it is becoming essential for them to make use of the best evidence in order to make effective and justifiable decisions (Majid et al, 2011).

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To discuss the evidence for a clinical skill, this essay will investigate the antiseptic preparations for surgical site antisepsis. The rationale for selection of this topic is its significance for the clinical nursing practice as nurses are frequently involved in the surgical site preparation (Dizer et al, 2009). Surgical site infection (SSI) is a type of healthcare-associated infection in which a wound infection occurs following an invasive (surgical) procedure. It has been suggested by National Institute of Health and Care (NICE, 2004) that surgical site infections account for almost 20% of all of healthcare-associated infections. It has been further highlighted that nearly 5% of patients undergoing a surgical procedure develop a surgical site infection antiseptic preparations. NICE (2008) has recommended that aqueous or alcohol based solution with chlorhexidine or iodine can be used for prevention of SSI. However, it does not favour or recommend one solution over the other. This essay will explore the literature for evidence about efficacy of these preparation in comparison to one another. It is important for the nurses to be aware of the best available evidence regarding antiseptic preparations to minimise the risk of surgical site infection.
Research Question and Literature Search
The research question for the current essay will be formulated on the PICO framework as suggested by Sackett et al (1997):

P

Population or problem

Clean-contaminated surgical procedures

I

Intervention

Chlorhexidine gluconate

C

Comparison or comparator

Povidone-iodine

O

Outcome

Surgical site infection

The question formulated for the current essay using PICO framework would therefore be:
“In surgical procedures, is chlorhexidine gluconate more effective in comparison to povidone-iodine in reducing surgical infections?”
To answer the question, literature search for the available evidence for was done. The author identified a list of key search terms and synonyms that can result in a large number of hits and combined these with Boolean terms AND/OR. Terms made up of of two words were looked for by making use of speech marks so that they were are not searched for separately, and truncation was used for terms identified to have multiple endings. The key words used were “surgical site infection” “anti-septic preparations” “iodine” and “chlorhexidine”. In order to make sure that an in-depth search was done, which would elicit the largest number of studies more than one academic search engines were searched by the researcher.
Cinahal: Contains an index of nursing and allied health literature and is helpful for use in a thorough search (Glazsiou, 2001).
Medline: Suggested to be used in healthcare systematic reviews (Glazsiou, 2001).
NHS Information Resources and NHS Evidence: Is a widely used database resource containing evidence-based reviews and specialist research from reliable sources. NHS evidence was searched separately.
Cochrane Library: Provides a list of systematic reviews and RCTS that have been published or are in a process of publishing (Glazsiou, 2010).
Pubmed: It is a commonly used internet resource for healthcare professionals with a large international coverage.
The results of the search generated a large number of article however these had to be reduced in order to generate an appropriate research article which can answer the question formulated. Therefore, an inclusion and exclusion criteria was set to narrow down the large number of articles generated.
The guidelines from NICE (2008) in which both preparation have been recommended in 2008 hence the research was done for studies published after that. Only randomised controlled trials (RCTs) have been included as they provide the best evidence. The articles which were not in English and published before 2009 were therefore excluded. Also, the studies in which preparations for a particular type of surgical procedure were studied were also excluded as the evidence for general surgical procedures was being looked for.
Abstracts of the studies generated from the search of different data bases engines were thus read so that the articles which do not satisfy the inclusion criteria of this essay can be excluded. This resulted in selection of one article which satisfied the inclusion and exclusion criteria of the current work.
The study by Darouiche et al (2010) is a RCT which compared the efficacy of two surgical preparations i.e. chlorhexidine–alcohol with that of povidone–iodine for preventing surgical site infections. In order to achieve this, preoperative skin preparation was done for adults undergoing clean-contaminated surgery in six hospitals with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint in a random way. The primary outcome was any surgical-site infection within 30 days after surgery. This study will be critically analysed to identify its strengths and weaknesses. It has been suggested by Burls (2009) that critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. The critical skills appraisal programme (CASP) tool (Appendix 1) for randomised controlled trials (RCTs) will be used as the selected study is a randomised controlled trial.
Screening questions
1. Did the trial address a clearly focused issue?
Yes, the study addressed a clearly focused issue with clear problem to be explored, comparison groups and outcomes being investigated using a PICO framework to formulate the research question thereby increasing the rigour of the study (Huang et al, 2006).
2. Was the assignment of patients to treatments randomised?
Yes, the assignment to treatment and placebo group was carried out randomly in a ratio of 2:1. This will increase the validity of the study. Literature suggests that random allocation of patients to study groups help to minimize both the selection bias as well as the impact of any confounder present (Cormack, 2000). It has also been observed in the study that in order to match the two groups and deal with possible inter-hospital differences, randomization was stratified by hospital by using computer-generated randomization numbers without blocking. This is a strength of the study as stratified randomisation can help to attain maximum balance of significant characteristics without compromising the benefits of randomisation (Altman and Bland, 1999).
3. Were all of the patients who entered the trial properly accounted for at its conclusion?
Yes, the trial was not stopped early and the patients were analysed in the groups to which they were randomised. The study has done both intention-to-treat analysis for both groups as well as per protocol analysis. This accounts for the drop outs in the study an also been reported thus accounting for these drop-outs which may decrease the internal validity of the study. According to the Cochrane Collaboration (2014) intention-to-treat analysis minimised the presence of bias which may exist due to loss of participants, thus upsetting the baseline similarity attained by randomisation.
Detailed Questions
The study by Darouiche et al (2010) does not explicitly mention whether the personnel involved in the study were blind to the treatment groups. However, it has been mentioned in the study that the operating surgeon became aware of which intervention had been assigned only after the patient was brought to the operating room. In addition, both the patients and the site investigators who diagnosed surgical-site infection on the basis of standard criteria stayed unaware of the group assignments. This minimises the bias in the study and increases its validity as differential treatment or evaluation of participants can possibly introduce bias in the study at any phase of a trial (Karanicolas et al, 2010). Hence, it is a strength of the study.
According to Berger (2006), in addition to randomisation, it is important to keep the baseline variables of the study groups similar at the commencement of the trial as it is essential for a RCT to compare groups that differ only with reference to the treatment they receive. The baseline characteristics of both groups have been reported in the study and did not show any significant difference between the two intervention groups reflected by their insignificant p values. It appears from the study that both chlorhexidine and iodine groups were treated the same way other then intervention.
In order to determine the treatment effect, clear pre-defined primary end point has been given by Darouiche et al (2010). The primary outcome was defined on the basis of a standard criteria given by the CDC hence it increases the reliability of study.
The results of the study found that the overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%; P = 0.004). In order to find the results, the study undertook multiple statistical considerations and tests. The study increased its statistical power by increasing the sample size in each group which gives the study 90% power to identify a significant difference in the frequency of surgical-site infection between the two groups, at a significance level of 0.05 or less. In addition, as mentioned above intention-to-treat and per protocol analyses were performed which further increases study validity. The study also carried out a pre-specified Breslow–Day test for homogeneity to find whether the results were consistent across the six participating hospitals. This was also a strength of the study as literature suggests that involvement of multi-centre patients can compromise the external validity of the RCTs (Rothwell, 2010). This is due to potential effect of differences between health-care systemswhich result in different treatment affects, values and confidence intervals have also been reported where required.
Regarding the application of the results in the settings in UK, it has been highlighted by that the study by Darouiche et al (2010) was done in the US and used an aqueous solution of iodine. However, in the UK, the most widely used skin preparations are alcohol-based solutions of 0.5% chlorhexidine or 10% iodine (Tanner, 2012). This is because aqueous-based solutions are thought to be less effective than alcohol-based solutions. Hence, to make the study applicable to the UK settings, 2% chlorhexidine in alcohol should have been compared with 0.5% chlorhexidine in alcohol or 10% povidone iodine in alcohol.
The benefits of the study are definitely superior to the harms as SSI not only causes significant unwanted outcomes and distress for the patient but also results in increased costs for the patient, the healthcare and the wider economy (Tanner, 2012).
Thus, a number of factors increase the external validity and internal validity of the study including stratified randomisation, blinding of study personnel, intention-to-treat analysis, keep the baseline variables of the study group’s similar, sample size and a number of statistical tests. In addition, clear pre-defined primary end point increased the reliability of the study. The study thus has very low risk of bias and can be therefore rated as 1++ according to NICE hierarchy of evience (NICE, 2004). Hence, alcoholic chlorhexidine solution is significantly more effective in reducing SSIs than povidone iodine. However, the results should be applied to UK settings with caution.
References:

Altman, D.G. and Bland, J.M. (1999) How to randomise BMJ. 11;319(7211), pp. 703-4.
Berger VW. (2006) A review of methods for ensuring the comparability of comparison groups in randomized clinical trials. Rev Recent Clin Trials. 1(1), pp. 81-6.
Burls, A. (2009) What is critical appraisal? London, Hayward Group.
Cochrane Collaboration (2014) Glossary, [Online] Available from: http://www.cochrane.org/glossary [Accessed 29 January 2014]
Cormack, D. (2000) The research process in nursing, 4th ed., Wiley-Blackwell: Oxford.
Crookes, P.A. & Davies, S. (1998) Research into Practice. London: Balliere Tindall.
Darouiche, R.O., Wall, M.J. Jr, Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., Miller, H.J., Awad, S.S., Crosby, C.T., Mosier MC, Alsharif A, Berger DH. (2010) Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. . N Engl J Med. 362(1), pp. 18-26.
Dizer B, Hatipoglu S, Kaymakcioglu N, Tufan T, Yava A, Iyigun E, Senses Z. (2009) The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery. J Clin Nurs. 18(23), pp. 3325-32.
Glasziou, P. (2001) Systematic reviews in health care: a practical guide, Cambridge; Cambridge University Press.
Huang, X., Lin, J. and Demmer-Fishman, D. (2006) Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc, pp. 359-63
Karanicolas, P.J., Farrokhyar, F., Bhandari, M. (2010) Practical tips for surgical research: blinding: who, what, when, why, how? Can J Surg. 53(5), pp. 345-8.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.L., Chang, Y.K., Mokhtar, I.A. (2011) Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. J Med Libr Assoc. 99(3), pp. 229-36.
McKibbon, K.A. (1998) Evidence-based practice, Bull Med Libr Assoc. 86(3), pp. 396–401.
NICE (2004) Reviewing and grading the evidence [Online] Available from: http://www.nice.org.uk/niceMedia/pdf/GDM_Chapter7_0305.pdf [Accessed 9 February 2014]
NICE (2008) Surgical site infection – Prevention and treatment of surgical site infection, London: NICE.
Rothwell, P.M. (2006) Factors That Can Affect the External Validity of Randomised Controlled Trials, PLoS Clin Trials. 1(1): e9.
Sackett D.L, Richardson W.S, Rosenberg W.M.C, Haynes R.B.(1997) Evidence-based medicine: how to practice and teach EBM.Edinburgh, UK: Churchill Livingstone.
Tanner J (2012) Methods of skin antisepsis for preventing SSIs. Nursing Times; 108: 37, 20-22.

 

Third Wave Developments in Cognitive-Behavioural Approaches to Theory and Practice

Describe the central elements of the cognitive-behavioural approach, including reference to some third-wave developments in theory and practice.

In this essay, the central elements of the cognitive behavioural approach and third wave developments will be reviewed. The central elements will be referred to as the claims of the approach, as research is continuous and has changed through time. CBT alters the cognitive process to resolve maladaptive behaviours and psychological distress. These alterations change cognitive thinking patterns and behavioural reactions. (Stallard, P. 2002)The CBT approach claims that a behavioural reaction to a situation is determined by our perception of them, not the situation itself. CBT benefits from the client-therapist relationship through genuineness, empathy and understanding while changing this perception. It claims to enable the client to become his or her own therapist to monitor and address their own maladaptive processes through behavioural or philosophical (third-wave) coping techniques. This essay will explore these elements (claims) through CBT’s approach to treatment and associated research through critical discussion.

Treatment

CBT addresses the client’s treatment objective and has a structured approach to assessing, treating, monitoring and evaluating the client. The treatment aims to alter perceptual thinking patterns, and this process is formulated with clear definitions and frequent reviews. Moreover, CBT is not time -consuming as the treatment only takes 16 sessions with a therapist, therefore it actively encourages the client to become independent and make use of self-help coping techniques. These can include journaling, cognitive-restructuring, relaxed breathing and many more. It is also not distressing, as these techniques promote relaxation; therefore, it can be considered a universal treatment for children and adults.

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Spitzer created the Diagnostic and statistical manual of mental disorders as a framework for diagnosis which details how CBT should be implemented. The DSM claims to be methodologically meticulous in over ‘12,000 clients and 550 therapists in 212 facilities’(Spitzer,1980), yet there is no evidence for this impressive claim. DSM guidelines allow psychologists to investigate individual cases and coordinate self-help coping techniques which will fulfil the treatment needs of the patient which is useful. (Barlow et al.2017). But, by promoting a positive ‘fulfilment’ at the end of the treatment process, CBT often oversells itself which leads patients to expect a universal approach and an ‘off the shelf’ type treatment. Moreover, by classifying mental illness in terms of ‘coping’ CBT does not focus on the cause of the issue, it only poses maintenance mechanisms. The lack of long-term effectiveness and research support means that CBT has become diluted, therefore critics (Binnie.J., Spada.M.M., 2018) question it as a method of psychotherapy

Through semi-structured interviews, clients can reflect on their own thoughts and express their incongruence through self-talk which can be formulated from the age of three in an interview setting (Hughes, 1988). This is useful as it poses the CBT approach has the potential universality. Yet, Whitaker, (2001) suggest a child’s mind is still developing, therefore the cognitive behavioural tasks need to be expressed at the appropriate level. This can be done by using simplified language, visual information and presenting abstract concepts as concrete ones. Not only would this make CBT better for children but those with cognitive and behavioural disabilities. This is not a complete limitation as it poses a direction for cognitive behaviour research. It highlights the possibility of universality within treatment, even for those most vulnerable. Interview questions should promote thought and increase understanding rather than demanding a ‘correct’ response. (Neenan.M & Palmer. S 2018) Therefore, a pre-planned defined session, with a ‘correct’ response before the problems are explained and identified is over simplistic. (Goldfried, 1995).

A modern CBT approach poses that the treatment outcome, factors in session processes (DeRubeis et al. 2017) and by implementing these factors into testable models, it enables a better understanding of how CBT treatment devices work for the patient and the therapist. This is true with Kazantzis’ (2017) research on the initial Cognitive Therapy Scale’s interpersonal items.  These items: feedback, collaboration, interpersonal effectiveness and guided discovery are useful for classification, and they have multimodality. For example, guided discovery could be induced through a client-therapist relationship or by self-help techniques, which makes treatment adaptable. This contradicts Goldfried (1995’s) criticism, so within the approach, what is scientific fact and what is a claim is ‘muddled’.

Research

More recently CBT, claims a holistic approach which tailors’ therapeutic techniques to the needs of the client. Research support meets the rigorous criteria of an empirical treatment through strong comparative conditions. In Cuijers (2016) study he found that 17 % of depression and anxiety trials were of high quality. Most psychotherapy approaches are far from these numbers in current trials and study quality therefore cognitive behavioural therapy can be considered the gold standard of psychotherapy. (David.D., et al 2018) CBT is considered ‘gold’ as it is well researched and systematically innovative, and its theoretical models align with the contemporary paradigms of cognition and behaviour. Moreover, there is room for advancement in the CBT process, by making their theories more adaptable it could turn this ‘holistic’ claim into a testable treatment process.

CBT still has the most research support to validate its underlying theoretical claims. Whereas some psychoanalytical treatments are controversial, lack research support and some are only emerging e.g. interpersonal psychotherapy. CBT is the ‘go-to’ treatment by the National Institute for Health and Care Excellence’s guidelines and American Psychological Association. Yet, Boyle and Johnstone (2014) suggest that CBT’s current paradigm for diagnosis (DSM-5) has failed and that psychologists should develop a new research focus on individual experiences and context. By addressing experiences, a diagnosis is not necessary as the client’s psychological distress is resolved. Reassurance, normalisation and explanation of problem behaviours and their lifestyle effects is a form of therapy itself (Ezzamel, et al 2015), one which does not require the distress of CBT or the label the DSM provides. This questions whether CBT is even needed, maybe what one needs is someone to listen, which may explain the effectiveness of the client-therapist relationship.

 Happy canines shake their tails. Through observation, unhappy canines do not shake their tails. We deduct that if unhappy canines shook their tales then we predict they would become happy. Treatment research develops to teach unhappy canines to shake their tails. Once taught and they choose to carry out this action, their unhappiness will be cured (Dalal, 2018). This is precisely how maladaptive behaviours and psychological distress resolution is comprehended and implemented in society today. CBT and society view mental illness in terms of dichotomy: you are ‘content’ and mentally stable or ‘discontent’ and mentally unstable. Moreover, Seligman’s ethically ambiguous study (1967) gave electric shocks to dogs to show his concept of ‘learnt helplessness’. He shocked the dogs continuously until they no longer attempted to escape the shocks and lay down on the ground whimpering. He anthropomorphised that there was a similarity between depression and learnt helplessness in humans, resulting in future negative schema of the self, the world and the future. This rigid behaviourist outlook CBT still holds, can explain why there are no further developments in implementing their ‘holistic claims’. There is no exploration of external influences on psychological distress and behavioural interactions, instead, the problem is placed upon the individual refuting their ‘holistic’ claim. The conflict within the rigid approach itself means that it is incomplete and needs further development.

CBT claims it reduces symptoms; amplifies the duration of improvement, the effects of symptom reduction as well as the number of people it helps. CBT holds a hyper-rationalist outlook, that only claims with evidence that are accurate and reasonable.  Hyper rationalists seek to control the cognitive and behavioural reactions we produce. If you are unable to do this you are classified as ‘CBT resistant’ (Otto & Wisniewski, 2012) So in this regard, it could be seen that CBT has remained the best therapy in the field as it has manipulated the rules to its own advantage.

Waves

Behaviourism took the form of CBT’s first wave, the second wave hinged on cognition. It emphasised the control of thought and emphasised that one could transform their thoughts of negativity into ones of positivity. Beck (1976) identified three levels of cognition: Core beliefs, dysfunctional assumptions and negative automatic thoughts. He also constructed the negative triad: negative views on the self, the world and the future. In contrast, the third wave accepts internal angst and uses meditative techniques from philosophy (Hinduism, Buddhism) as coping mechanisms. For the qualification of these to count as CBT treatments, they need to be moral and directive, tested and manualized if efficacious. (Dalal.F, 2018) Some of these treatments include: Acceptance and Commitment Therapy, Functional Analytic Psychotherapy, Compassion focused therapy, metacognitive therapy and Dialectical Behavioural therapy. The philosophies initial function required a meditator to dissolve the self, whereas, within CBT, the focus is on self-reinforcement, which shows how these ancient techniques have been adapted for widespread uneducated human consumption.

Treatment

Before CBT diagnosis, the client is introduced to the Work and social adjustment scale (WSOS), General Anxiety Disorder Test (GAD 7) and the Patient Health Questionnaire (PHQ 9). Treatment within CBT focuses on the event, cognitive processing surrounding that event and the emotional effects of the event. The CBT approach presumes that two clients will respond to the same event in the same way; If they do not they are considered to have irrational cognition.

Holistic treatments are being replaced with phone calls and labelled as ‘low-stress treatment’ and claim it is acceptable to clients. Richards and Whyte, (2011) discovered that therapy is prescribed in the form of phone calls and internet dialogue to cut costs. Yet, CBT claims to be person-centred, and holistic, moving away from the reductionist behaviourist approaches it was founded on. This means the actions being implemented for CBT contradict the approach claims. This further supports Ezzamel, et al’s (2015) suggestion that CBT may not be needed at all. These ‘low-stress treatments’ create a de-personalised mutation of the client-therapist relationship and having a friend to listen may be just as effective.

Furthermore, Wiles et al., (2013) paper discovered that ‘two out of ten’ people felt better after a CBT treatment process. This means that it may not work for the remaining eight. The two also only declared a 50% symptom reduction which means that the benefits may not last. Even this declaration is subjective, this finding comes from patient’s completion of the Clinical Outcomes in Routine Evaluation form (CORE), therefore the finding is subjective in the eyes of the researcher. CBT claims and presents itself as an inflated cure and one that lasts, and from this evidence, this is not the case.

Evidence-based treatments claims seem overpowering, but the research support is underwhelming. For example, DBT’s (Dialectical Behaviour therapy) treatment support consists of small sample groups of 20 in DBT and 22 in the TAU group. Furthermore, the 25 research paper authors were the researchers in the initial research team. This means that there was a singular experiment, but 25 research papers based on it. (Driessen, E., et al .2010). This shows the conclusions that the treatment draws upon, are not reliable or valid. Furthermore, health agencies ignore negative research findings. For public use, only two concurring studies are needed (Davies, 2014). For example, NICE permitted ‘Mindfulness-Based Cognitive Therapy’ due to a study replication of the same findings. Therefore, the central elements should be referred to as claims as they were created from corrupt concepts and support.

In conclusion, CBT research is continuous, and still has a long way to go before it can be officially classified as a ‘gold standard of psychotherapy’. More attention needs to be placed on the individual and understanding of external influences rather than forcing a client to fit into a textbook case. Especially when the textbook is based on ambiguous concepts. In the attempt to cut costs, the holistic claim of CBT has disintegrated, and the economic pressure for results produced an uneducated venture into third wave philosophies to cope. CBT claims genuineness, empathy and understanding, yet what the client gets is the complete opposite. This approach needs to rename ‘central elements’ into ‘central claims’ until research support has a clear direction.

Barlow. D.H, Farchione. T.J, Bullis. J.R, et al (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared with Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 74 ,875–884.

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. Oxford, England: International Universities Press.

Binnie.J., Spada.M.M., (2018). Let’s put the ‘T’ back into CBT. Mental Health Review Journal. 10.110

Boyle, M. & Johnstone, L. (2014). Alternatives to psychiatric diagnosis. The Lancet Psychiatry, 1, 409-411.

Cuijpers, P., Cristea, I. A., Weitz, E., Gentili, C., & Berking, M. (2016). The effects of cognitive and behavioural therapies for anxiety disorders on depression: A meta-analysis. Psychological Medicine, 46(16), 3451-3462.

Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal psychotherapy for mental health problems: A comprehensive meta-analysis. American Journal of Psychiatry, 173(7), 680-687.

Dalal, F. (2018). CBT: The cognitive behavioural tsunami: managerialism, politics and the corruptions of science. London: Routledge.

David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioural Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry, 9, 4. doi:10.3389/fpsyt.2018.00004

Davies,J.(2014). Cracked: Why Psychiatry is doing more harm than good. London: Icon Books.

DeRubeis, R.J., & Lorenzo- Luaces. L. (2017). Recognising that the truth is unattainable and attending to the most informative research evidence. Psychotherapy Research, 27, 33-35.

Ezzamel, S., Spada, M. M., & Nikcevic, A.V. (2015). Cognitive- behavioural case formulation in the treatment of a complex case of social anxiety disorder and substance misuse. In M.H. Bruch (Ed.), Beyond Diagnosis: Case formulation in Cognitive -Behavioural Psychotherapy. London, UK: Wiley.

Goldfried, M. R. (1995). Springer series on behaviour therapy and behavioural medicine. From cognitive-behaviour therapy to psychotherapy integration: An evolving view. New York, NY, US: Springer Publishing Co

Hughes, J. N. (1998) Cognitive behaviour therapy with children in schools. Pergamon Press, New York.

Kazantzis, N., Dattilio, F. M., & Dobson, K. S. (2017). The therapeutic relationship in cognitive-behavioural therapy: A clinician’s guide. New York, NY, US: Guilford Press.

Neenan.M. M., & Palmer.S., (2001). Cognitive Behavioural coaching. 13. 15-18.

Otto.M.W. and Wisniewski, S.R. (2012). ‘CBT for treatment resistant depression’. The Lancet, 381: 352-3.

Richards, D. and Whyte, M. (2011). ‘IAPT Reach out – National Programme Student Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions. 3rd ed. London: Rethink Mental Illness.

Seligman, M. E., & Maier, S. F. (1967). Failure to escape traumatic shock. Journal of Experimental Psychology, 74(1), 1-9.

Stallard, P. (2002). Think good, feel good: A cognitive behaviour therapy workbook for children and young people. Chichester: Wiley.

Whitaker, S. (2001) Anger control for people with learning disabilities: a critical review. Behavioural and Cognitive Psychotherapy, 29,277-93.

Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., Lewis, G. (2013). Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care-based patients with treatment resistant depression: Results of the CoBalT randomised controlled trial. The Lancet, 381(9864), 375-384.

 

Critical Evaluation of Change Managed in Practice

The Government has clearly outlined the need for nurses to develop leadership skills at all levels within the workforce in order to deliver the NHS modernisation programme (DH  1998; DH 1999). The leadership role expected of community practitioners is evident in ‘Shifting the Balance of Power’ (DH 2001a) and ‘Liberating the Talents’ (DH 2002) with the expectation that health visitors will lead teams which will deliver family-centred public health within the communities they work (DH 2001b).

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The change I was to lead however was not initiated primarily to support clients, but instead to protect staff working in the community to ensure they were safe and supported in their public health work as a large proportion of the time is spent working alone. The issue of lone worker safety is particularly topical after the recent murder of a mental health support worker during a home visit (BBC News 2006).
To support this proposal, Baulcomb (2003) asserts that any change management initiative should not only yield benefits for patients but also for staff and the wider organisation.
The Health and Safety Executive (HSE 2005) reports that nurses and other health care workers are 2.8 times more at risk of an injury  than clerical workers and the vulnerability of health care workers increases significantly if they are working alone  (Chappell and Di Martino 2000). It was a particularly pertinent time to examine mechanisms for risk reduction as they had still not been reviewed despite a member of staff being off sick  due to an adverse incident involving lone work. As health visiting frequently requires lone work, it was clear that lone working practices needed reviewing to reduce the likelihood of a similar or more serious incident recurring.
Further drivers for change were identified as a result of observations of workers in practice. I noted the following areas of concern: up-to-date whereabouts of staff not always provided (or out of date) and a lack of a reporting-in system which would identify whether staff had finished work safely for the day. I discussed these issues with the community nursing manager who wholly supported any attempts to introduce mechanisms that would improve lone worker safety. A further driver for change was the obligation to implement health and safety legislation. Due to limitations in report length, this information has been provided in Appendix One.
If changes are to be implemented which lead to increased worker safety, this will have a positive (although indirect) effect on clients because if staff feel safer and more supported in their roles, they will be less likely to be off sick with stress or injuries (Mahony 2006) which would impact on the team’s ability to deliver the public health agenda. As workers who contribute to the implementation of health and safety measures are known to be healthier and safer than those who do not (HSE 2005), it was felt that this would be an appropriate area for the team to examine and implement change.
It was after consideration of these anteceding factors that the need for change was established and a vision created:
To improve the safety of lone workers within the health visiting team.
Implementing the change was a dynamic and multidimensional process with many facets too abundant to detail fully here, however pertinent examples will be selected and analysed. The following study will detail a reflective evaluation of my application of leadership and management theory to effect a change in practice. The successes and difficulties encountered will be given throughout with reference to the literature.
Change management requires well-developed leadership and management skills (Marquis and Huston 2000). A combination of these skills is necessary to ensure that the job is done not only efficiently, i.e. new mechanisms are put in place and embedded into the team’s practice (the management dimension) (Stewart 1996) but that it is achieved in such a way that motivates and inspires staff to change their practice- the leadership dimension (Stewart 1996). To guide the changes, a change management model was selected. Deegan et al (2004) report that such models provide a theoretical sequence, which will be instrumental in helping the change manager to choose, develop, and order activities which are required during planned change episodes.
As the change was planned (as opposed to emergent), a suitable model was Lewin’s three-stage model of planned change (Lewin 1951)  . The use of this model in the National Health Service (NHS) is widely documented and has underpinned the successful changes in many of the research papers read  . It is also a simple model which is not overly prescriptive and so does not restrict individual practitioner creativity (Cameron and Green 2005). The three stages of planned change according to this model are: unfreezing the existing equilibrium (Unfreezing); moving to a new point (Movement) and refreezing the changes into practice so that they become embedded in practice (Refreezing). My change management project is currently part way through the ‘Movement’ stage as the change has not been fully implemented or evaluated yet I continue to lead this project  .
Lewin (1951) suggests that in the change’s preliminary stage, factors which will drive or resist the change should be identified. This process is known as Force Field Analysis (FFA) and will identify the change enthusiasts, the potential objectors and the undecided (Turner, 2001) (see Appendix Three for the FFA carried out at this stage). Lewin (1951) asserted that change occurs as a result of a shift in the equilibrium between the opposing forces (those which resist change) and the driving forces and is thought to be more likely to occur successfully if restraining forces are removed rather than by simply increasing the driving forces. Hussey (1998) exercises a word of caution at this juncture warning that an increase in the driving forces may lead to an increase in the restraining forces, however if the driving forces outweigh the restraining forces, there is a positive climate for change (Cameron and Green 2005). After analysing the force field I could see that the driving forces outweighed the resisting forces and so confirmed that the change was needed and realistic.
Leaders motivate their staff by inspiring vision and encouraging followers to share in that vision (Bennis 1997, Davidhizar 1993) and like in Kassean & Jagoo’s study (2005), the unfreezing stage was initiated by facilitating people’s thoughts on the current situation (Greaves 1999)- stimulating ideas for how to change the current situation  . As people can only be empowered by a vision that they understand (Sheldon and Parker 1997), it is paramount that strategies are used to foster inclusion and participation so that all team members are fully aware of the impetus for change. For change to be successful and enduring, Kouzes and Posner (1987) say that it is imperative that the leader encourages team ownership of the vision by encouraging their participation in the project. Without participation failure is likely to result due to resistance from team members. It is vital to the success of the change that it is perceived to be needed by those that will be affected by the change (Marquis and Huston 2000) and so to raise awareness of the issue and create dissatisfaction with the current state (Lewin 1951), I introduced my ideas at a team meeting. On reflection, I can identify aspects of transformational and situational leadership in how I shared my ideas and interacted with the team.
Most team members agreed that risks to lone working needed to be reduced and willingly offered their ideas (see Appendix Four). Encouraging team input and facilitating problem solving are key features of the supportive behaviours exhibited by the situational leader (Northouse 2004). Situational leadership was developed by Hersey and Blanchard (1977) and assumes the leader adapts their style according to a given situation  . This style has two main types of intervention: those which are supportive and those which are directive. The effective situational leader is one that adjusts the directive and supportive dimensions of their leadership according to the needs of their subordinates (Northouse 2004). As most team members were highly motivated in the project, freely offering suggestions and ideas, a directive role was not needed. The supportive behaviours I employed encouraged a participative approach characterised by the use of finely tuned interpersonal skills such as active listening, giving feedback and praising (Marquis and Huston 2000) which can be likened to a Skinnerian approach of positive reinforcement.
In retrospect I can identify my correct use of this leadership style by looking at a later development of this model which introduced a further dimension to the leadership style: the developmental level of the participants. This is ascertained by assessing worker’s competence and commitment to completing the task. The member of staff that appeared to take little interest and was not able to offer ideas displayed a lower developmental level compared to other team members and hence I directed her more using the coaching behaviours advocated by Hersey and Blanchard (1977). This coaching promoted inclusion and participation by: giving encouragement, soliciting input and questioning the participant on what they thought of the proposals and the changes they would like to see. This was done to increase levels of commitment and motivation (Northouse 2004) and thus integrate that team member into the change process. On reflection this can also be identified as an example of reducing the resisting factors to the change within the force field as by adapting to the needs of that team member, she was encouraged to take part and share ideas rather than hinder progress and potentially thwart the change.
A model which places great importance on the needs, values and morals of others is transformational leadership (Northouse 2004; RCN 2005) and elements of this could be identified in my leadership. The needs of staff could be regarded as the need to stay safe, and values may be their desire to get home to their families at the end of the day. I was aware that on face value, looking at improving safety for lone workers would perhaps not appear to be an issue that would provoke much excitement, or according to Kotter (1999) ‘light a fire’. However, I articulated my vision in terms of getting people to consider the impact of what the consequences could be if we were to be a victim of an adverse incident. When discussing the impact of this with staff and getting them to consider the impact of not changing practice, of how their lives and their families lives could potentially be affected, I created motivation within the team to examine working practices. This was confirmed to me as many of the staff showed their interest by their offering of ideas to meet this challenge. By tapping into the moral dimension of a proposed change i.e. promoting the need to contribute in order to protect the safety of not just themselves but also the wider team, the transformational leader further inspires staff to change by motivating followers to transcend their own self-interest for the sake of the team and organization (Bass 1985).
Once the vision had been shared and accepted by the team, several strategies were discussed that could contribute to risk reduction (Appendix Four). At this stage it was realistic to focus on a single change. A reason for this was because McIntosh (2000) highlights that many changes focus on the needs of the organisation (e.g. to provide certain services or to implement Government policy) and often overlook the needs of the employees. Applied to this case, there was an organisational need to manage risk but this had to be balanced with not overwhelming the team with too many changes at once  .
At the meeting it was decided by the team members present  that the simplest intervention to implement would be to phone into the clinic base administrators when finishing their shift to notify that they had finished work for the day and were safe  . Although the proposed change would not eliminate the risk of an adverse incident occurring, it would ensure that should an incident occur, it would be identified and acted upon as swiftly as possible and thus the risk would be managed more effectively.
Vroom and Yetton (1973) propose five types of considered decision-making ranging from that which may be expected of an autocratic manager i.e. a decision is made by the leader entirely alone, through to a democratic approach whereby the matter is discussed with the whole team and a consensus decision is made. When analysing my own management stance it was clear that my style had been distinctly democratic as I had sought to include everyone and promote consensus decision-making. I demonstrated sensitivity and appreciation of the pressures that others were under by ensuring that those not present at the meeting were included in the decision-making process as open consultation with key stake holders often leads to the successful introduction and adoption of change (Phair and Good 1998, cited in Deegan et al 2004). This contributed to creating a climate of a learning organisation. A learning organisation is one where all members are encouraged to increase their capacity to produce results they care about (Karesh 1994) and one which promotes the exchange of information between members in order to create a knowledgeable workforce. I was determined that those who could not attend the meetings still be part of the decision making process. However there were difficulties with this as due to being in practice just two days a week meant that it was unrealistic to consult each absent worker individually and so I emailed out meeting minutes from the meeting and invited feedback  . Although the use of email to communicate ideas is one of the least popular ways to receive information, it was one of only a few methods available to me and hence justified its use. Without using this medium, communication with the team would have been compromised and could have led to some team members feeling they had been excluded from the decision-making process. Further analysis of this point reveals my own concern that all the follow up and meetings needed to be done by myself when perhaps this could have been delegated to someone else. With regard to situational leadership, if team members are motivated and committed to the change, the leader can assume a more passive role where they let team members take responsibility for doing the job and refrain from giving unnecessary support (Northouse 2004). This perhaps reveals ‘Theory X’ management style traits (McGregor 1960) whereby the manager feels the need to keep a tight grip on staff perceiving them to need coercion to achieve tasks, deeming them to possess little capacity to explore and solve problems spontaneously without direction. This approach may convey distrust of the team (McGregor 1960) and was therefore not an ideal management style in the actual situation I was in. Rather than viewing this as a weakness however, it must be viewed as an opportunity to explore my assumptions of the team, assessing whether my assumptions had any grounding in reality or whether this style was assumed due to my inexperience leading and hence insecurities about the role.
Reaching a consensus on the change to implement was an example of how in situational leadership, decision-making can be shared between the leader and motivated followers (Hersey and Blanchard 1977). From a management point of view, this participative approach facilitates the process of completing the task but it is also an example of how leaders empower their teams by transferring some of their power to the follower to enable them to be active participants in the decision-making process. After confirming the change intervention, the safety plan was devised (see Appendix Six). This was a contingency plan detailing the steps to take should a team member fail to report in. The team agreed that I should draw this up due to my previous experience of using one. As the manager is responsible for ensuring a task is completed on time and is done efficiently (Stewart 1996) there was no reason for this task to be delegated elsewhere as this would have taken up time and hence been an inappropriate use of resources.
During the movement stage, I positively reinforced the importance of the change by acting as a role model. Role modelling is a key feature of transformational leadership whereby the leader demonstrates specific types of behaviours that they want their followers to adopt (Northouse 2004). Stewart (1996) also reports that the ‘greatest power as a leader is the example that you set’ (p.25) and so I did this by ensuring that I implemented the proposed changes i.e. I always reported into base on finishing work even before the agreed implementation date. The change is currently in the latter stages of the ‘Movement’ phase with implementation and evaluation still required to complete the phase  . Refreezing is the final stage of Lewin’s model and involves the change agent (myself) supporting staff to integrate the change into practice so that it becomes part of the ‘status quo’ (Marquis and Huston 2000) ensuring that over a period of time everyone’s practice changes and there is no chance of reversion to former ways.
A strategy for the future development of the change and to conclude the refreezing stage would be to carry out an evaluation to determine the change’s effectiveness. A summative (or outcome evaluation) could be conducted to investigate: whether the intervention is effective in reaching planned goals; what happens to the participants as a result of the change and whether it is worth continuing with the change intervention (Robson 2003).
The first question could be assessed by carrying out a risk assessment of the hazards faced by lone workers including strategies in place to reduce risk. The HSE (2005) detail a five-step risk assessment guide that can be carried out to assess the extent of risk post-intervention. Ideally a risk assessment should have been carried out in the unfreezing stage and thus provide a baseline to compare against.
Another strategy to obtain objective data would be to keep a copy of all reporting-in records which should identify those failing to report in  . Although this appears to be a policing measure which may imply distrust for staff (typical of a ‘Theory X’ manager, McGregor 1960), it may be the only way of conclusively being able to tell if people are actually putting the new change into practice. If an audit of these records revealed certain team members were not engaging in the process and were having to be chased by administrators to ascertain whether they had finished work safely, I would use responsive leadership skills incorporating effective interpersonal communication to work with these staff members to identify what the problems and issues were. It is vital that this is done as if ignored these resisting factors could impede the change and failure could result (Hussey 1998). A key goal of refreezing is supporting those involved so that the change remains in place (Marquis and Huston 2000) and so this audit may reveal those who need further support  .
The change detailed in this case study has first and foremost considered the needs of the employees (i.e. to be safe in their lone work) yet has many benefits for the wider organisation and staff: potentially decreased litigation due to decreased adverse incidences affecting staff, increased recruitment and retention due to the organisation’s increasing attractiveness as a supportive employer and many more. This highlights effective use of a combination of leadership skills to inspire and motivate staff coupled with the ability to function in a management capacity by directing changes necessary in order to meet the organisation’s requirements (Marquis and Huston 2000).
Change management requires well-developed leadership and managerial skills (Marquis and Huston 2000). However as a student health visitor many of these skills were far from being well developed and rather than use and manipulate models as I went along, elements of models such as transformational and situational were recognised retrospectively. However in doing so my knowledge of the theoretical underpinning has been developed and consolidated arming me with a plethora of skills to draw on in future.
Northouse (2004) states that leadership style refers to the behaviours shown by an individual who attempts to influence others. I felt this was a daunting task as in my student role I felt very much the subordinate as opposed to the leader. However, Government papers such as ‘Making a Difference’ (DH 1999) stress for the need to develop leadership at all levels meaning it is not an activity reserved for the upper echelons of an organisation (Garvin 1996).
I found it hard at times to reconcile the requirement to develop leadership skills with the need to embrace evidence-based practice as the two often clashed due to the fact that there is little empirical evidence of the effectiveness of many leadership models (Northouse 2004) including those I used. To further illustrate this point Wright and Doyle (2005) conclude ‘it is impossible to say how effective transformational leadership is with any degree of certainty and it is not possible to say here that another approach would have been more effective without trying it’. Northouse (2004) also criticises other models of leadership including situational leadership, and questions their validity commenting that they are under-researched and with few published research findings.
I had not viewed myself as a ‘born leader’ and coupled with my student status, I felt nervous embracing a leadership role. Marriner-Tomey (1996) however asserts that leadership skills can be developed over time, indicating that skills can indeed be learnt, dispelling the myth that leaders are born not made. This provides me with reassurance that with further experience of leading in practice, along with a deeper knowledge of leadership theory, I may become a more effective and inspiring leader.
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Appendices
APPENDIX ONE Health and Safety Legislation in Practice.
The Lone Worker Policy (SYPCT 2006) in my practice area is heavily influenced by the Health and Safety at Work Act (HSE 1974) and the Health and Safety at Work Regulations Act (HSE 1999 cited in SYPCT 2006) which stipulate the duties of the employer  and the employee  . The more recent legislation requires employers to assess the nature and scale of any workplace risks to health and ensure there are proper control measures to reduce or eliminate risk. Although the policy encompasses the relevant legislation and raises awareness, its aims are particularly broad and apart from indicating particular training, there are few suggestions of good practice to help staff understand exactly how they can take ‘reasonable care’. It was also evident that although Lone Worker safety training was mandatory, fewer than half of the members of the team had accessed this within the l
 

Theory and Practice of Industrial and Organizational Psychology

Introduction

Industrial and Organizational Psychology, or IOP, is a section of science that deals with a specific area of human behavior: the area of their work lives. The goal is to better understand and optimize the effectiveness of both the workforce and the organization (Rogelberg, 2017).

This is done through researching and consulting in several different main areas:

Team and organizational effectiveness;

Employee recruitment, retention and promotion;

Measuring and testing individual differences and abilities;

Training and development;

Performance management;

 Workplace health;

Employee attitudes, motivation and satisfaction;

Compensation and benefits;

Effective communication;

Change management

Employee discipline (Rogelberg, 2017).

Industrial and Organizational Psychology is both a science and a practice, meaning that  Industrial and Organizational Psychologists research for better understanding of the above topics, then they  put new methods into place to achieve certain goals within the organizational setting (Rogelberg, 2017).

The intent of this paper is to discuss the current beliefs, assumptions, and understandings about Industrial and Organizational Psychology, and how they tie into the topic of work life balance and work life conflict. This will more clearly define this area and outline where areas for future research and understanding lay (Rogelberg, 2017).

Industrial and Organizational Psychology

 Industrial and Organizational Psychology can be traced back as far as 1913 when Hugo Münsterberg advocated that the purpose of a new applied psychology was to connect laboratory science with the problems of business. During the late 19th and early 20th century, the main objectives were to improve efficiency, increase productivity, and decrease costs through standardization and simplification (Rogelberg, 2017). Therefore researchers such as Frederick Taylor and Frank and Lillian Gilbreth addressed these objectives by investigating and designing work to improve efficiency. Through the use of time and motion studies, a precedent was established for scientists to enter organizations creating the concept of Industrial and Organizational Psychology (Rogelberg, 2017). In 1915 Lillian Gilbreth was the first individual to complete a doctoral dissertation on the application of psychology to the work of classroom teachers (Rogelberg, 2017). Today, the field has grown and gained extensive recognition. Membership in the Society for Industrial and Organizational Psychology (SIOP), the principal professional organizational of Industrial and Organizational Psychologists, has increased more than 65% since 1991. Attendance at the annual SIOP conference has increased 400% in the last 20 years and is now approaching 4,000 attendees. Arguably, I/O is the fastest growing area of psychology (Rogelberg, 2017).

 As the concept of maximizing worker efficiency and productivity is further recognized as one of the most cost effective was of achieving organizational success, Industrial and Organizational Psychology will continue to grow over the next space of time.

Figure 1. History of Organizational Psychology (gradschools.com)

 As stated above, there are roughly eleven areas that Industrial and Organizational Psychologists focus on when practicing and studying Industrial and Organizational Psychology. The first of those involves working with groups or teams. When employees work in teams, challenges can arise. The goal of Industrial and Organizational Psychology is to help groups be cohesive (Rogelberg, 2017). Aside from a concern with what leads group members to remain with a group, the interest in group cohesiveness is also inspired by the assumption that more cohesive groups function better, at least in part because members of more cohesive groups presumably are more willing to exert themselves on behalf of the group. Evidence for this proposition is mixed, however. To address this issue, Brian Mullen and Carolyn Copper (1994) integrated the results of many studies on the relationship between group cohesiveness and group performance. Their conclusion is that group cohesiveness may better be viewed as a construct with different aspect, and that the aspect of cohesiveness that has to do with group members’ commitment to task performance and goal achievement is the most important in predicting group performance (Mullen & Copper, 1994).

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 As employees are often considered the heart of the organization, another goal of Industrial and Organizational Psychology is to help with employee recruitment, retention and possible promotion. Although in simpler terms, these are technically Human Resource tasks, Industrial and Organizational Psychologists are able to help with areas such as defining effective selection and assessment processes, and also employee succession planning (Rogelberg, 2017). The next stage in this process is a keener awareness that leaders are critical, but there are other pivotal talent pools that must be acquired, developed, and managed proactively to achieve and sustain competitive advantage in a dynamic, global economy (Fulmer & Congers, 2004). In fact, a whole new Human Resource decision science is beginning to emerge that provides theory and tools for tying business strategy to talent pool identification, development, and investment (Fulmer & Congers, 2004).

Individual differences are overall a good thing for an organization. Mixing and maximizing the various abilities of the employees in the most efficient way is what Industrial and Organizational Psychologists seek to assist with. Teams, groups and organizations can be diverse. This diversity must be harnessed to make it a benefit. Diversity is overall a benefit to teams. Diversity works well when there is a high sense of cognition (Kearney, Gerbert, & Voelpel, 2009). However, if there is a lot of diversity in the form of age, or education level it can cause issues within teams. When teams can achieve cognition, the idea production can increase however as a benefit (Kearney, Gerbert, & Voelpel, 2009). This is what Industrial and Organizational Psychologists seek to assist with.

 Training and Development is another area of Human Resources that Industrial and Organizational Psychology deals with. Training and Development deals with areas that reach from on the job training, to diversity training, to performance feedback and appraisals to training need analysis (Rogelberg, 2017). Performance feedback is critical in Industrial and Organizational Psychology. In their Job Characteristics model, Hackman and Oldham (1980) propose that the key to employee motivation lays within the specific job tasks themselves. However, the model also proposes that there are five core job features that serve as motivating factors in a job: “task variety, identity, significance, autonomy and feedback (Hackman & Oldham, 1980).” Feedback should be positive, but it will allow employees to feel involved and give them the direction they need in a positive way (Oldham & Fried, 2016). Performance feedback is a critical component in the area of training and development.

 Leadership management is an important area of Industrial and Organizational Psychology. Industrial and Organizational Psychology recognizes several modern leadership theories such as Transitional Leadership, Servant Leadership and Contingency Leadership. Understanding these leadership styles and theories and teaching leaders to become more effective is one goal for Industrial and Organizational Psychologists (Rogelberg, 2017). In addition, it is important that Industrial and Organizational Psychologists not only teach leaders how to be good leaders, but that Industrial and Organizational Psychologists are good leaders. Industrial and Organizational Psychologists should be Transformational Leaders (Rogelberg, 2017). Transformational leadership moves past meeting the current needs s of a group or organization and pushes them towards achievement and growth (Stewart, 2006). It is about constant growth and improvement (Stewart, 2006). Therefore, when Industrial and Organizational Psychologists are working with an organization, this is exactly what Industrial and Organizational Psychologists are trying to help the organization do. Transformational Leaders are commonly associated with the characteristics of creativity, vision, and passion (Stewart, 2006).

 Employee wellbeing, attitudes and motivation are fairly interrelated in the study of Industrial and Organizational Psychology. Boredom, burnout, and morale can all affect commitment and productivity (Rogelberg, 2017). The concept of the motivation of the workforce is explained by a simple fact: the motivation of the workforce is directly linked to a human. This means that an organizations productivity and efficiency is controlled ultimately by complex being which creates, consumes, feels, yearns and suffers. Therefore when the workforce is composed of healthy, happy, motivated workers, it can be more productive, and, as such, sustainable over the long term period (Bošković, 2017). In Bošković’s study (2017) he showed that once income is satisfied, these other psychological factors are a company’s best opportunity to increase productivity by increasing job satisfaction. This area is the heart of what makes Industrial and Organizational Psychology, Industrial and Organizational Psychology. Understanding why people do what they do and feel what they feel, in the workplace.

 Industrial and Organizational Psychologists are often used to help an organization better define or design their Organizational Structure. This is an important aspect of communication as communication is a key element of an organization design (Kottke & Agars, 2007). Organizational structure refers to the formal and informal manner in which people, job tasks, and other organizational resources are configured and coordinated (Kottke & Agars, 2007). Although organizational structure sounds like a singular characteristic, it is composed of a number of dimensions, because there are multiple ways the employees within an organization and the job tasks that are carried out can be structured. Industrial and Organizational Psychologists are often tasked with consulting on the Organizational Structure because facilitating the communication throughout the organization can be the most challenging aspect (Kottke & Agars, 2007).

 While much of Industrial and Organizational Psychology deals with growing and developing and protecting employees and leaders in one aspect or another, Industrial and Organizational Psychologists also assist in the issue of undesirable employee behavior (Rogelberg, 2017). Again, Industrial and Organizational Psychology deals with why employees do what they do at work. So, undesirable employee behavior needs more than discipline, it needs understanding and prevention. Prevention cannot be attained without understanding. Undesirable behavior spans from absenteeism to bullying to theft. Prevention is key however, discipline is often needed as well. Undesirable behavior can be dealt with in a positive manner that hopefully will lead both the employee and the organization through a growth and learning experience (Rogelberg, 2017).

 Employee wellbeing is a crucial aspect of Industrial and Organizational Psychology. As burnout can affect motivation, keeping employees healthy mentally and physically is an important task for organizations wanting to maximize efficiency (Rogelberg, 2017). In addition, absenteeism as discussed above can be prevented by simply increasing overall employee wellbeing. According to the American Psychological Association–commissioned annual Stress in America survey, in 2014, work was the second leading source of stress reported by 60% of all qualified respondents (Sharp, 2017). A wide variety of work-related environmental conditions and occupational stressors affect the well-being of employees. These work-related factors trigger a stress response characterized by the activation of the body’s physiological systems that prepare it for fight or flight (Sharp, 2017). Some occupational stressors may be intrinsic to the job, such as excessive workload and work pace, abnormally long work hours, shift work, or harmful environmental and ergonomic conditions. This stress can have physiological, psychological and behavioral consequences on employees (Sharp, 2017).

 Another aspect of well-being that Industrial and Organizational Psychologists seek to protect is security at work (Rogelberg, 2017). That may be job security or it may be physical safety and protection from workplace bullying.  Although security can be considered a subjective term, employees need security, it is a basic human need and if it is unmet in the workplace, there will be consequences to employee commitment and productivity (Rogelberg, 2017).

 Wellbeing is a broad area that Industrial and Organizational Psychologists deal with. It is also an area that provides a lot of room for future research and understanding. Industrial and Organizational Psychologists are not medical doctors, however they do seek to protect the wellbeing of employees in the workplace in as many ways as possible. In addition, they seek to protect the organization from the consequences that follow along with not protecting that employee wellbeing (Rogelberg, 2017). Burnout, as a prime example of something that can massively affect wellbeing, can be managed and prevented when it is well understood. One reason employees experience burnout, and leave their workplace, is due to their inability to achieve work life balance (Major, 2017). This is an area where there is still room for future research and understanding, if organizations can more effectively help their employees achieve a positive work life balance they will in turn maximize their own productivity by ensuring they have happy, healthy, motivation and committed workers on staff (Rogelberg, 2017).

Work Life Balance in Industrial and Organizational Psychology

 Work and family are considered the primary domains in a person’s life. The interface between the work and family domains of life is studied across psychology subfields but Industrial and Organizational Psychologists are interested primarily in how interactions between work life and family life, or more broadly the non-work aspects of one’s life, influence important individual and organizational outcomes (Major, 2017).

 Work life conflict has become an increasingly discussed issue as the need for dual income households has risen in the past several years. Dual-career couples have been increasing in number, particularly in industrialized nations, over the past several decades (Major, 2017). Part of this increase can be attributed to societal shifts in gender roles, in that traditional families in which the husband is the breadwinner and the wife is the homemaker are becoming less common (Major, 2017). Another contributing factor is the increase in the number of women entering the workforce and the increase in the number of women pursuing advanced degrees. Dual career families are more common and there are some implication of this trend that are affecting organizations as well as their employees (Major, 2017).

 One of the most widely noted challenges for dual-career families is that it can be mentally and physically draining if both partners are pursuing careers and also managing family and life role obligations. The theoretical concept describing this phenomenon is work-family conflict, in which role pressures from work and family roles are mutually incompatible in some respect, and this incompatibility leads to decreased performance (Major, 2017). Work-family conflict can be time based, when the time spent in one role decreases the time available for another domain; strain based, when strain felt as a result of one role is negatively affecting performance in another domain; or behavior based, when behaviors transferred from one domain to another hinder performance in the other domain (Major, 2017).

 The alternative to work life conflict is work life balance and this balance is the state workers seek to achieve. Work life balance applies to all workers not just dual income households and not just workers with families at home. However, research has shown that these factors make it harder for workers to achieve work life balance (Laurijssen & Glorieux, 2013). Although there is widespread agreement on the desirability of work–life balance, scholars are not consistent in the way they define it. Early conceptualizations of work–life balance treated it as the absence of work–life conflict, a perspective less popular today. Researchers have also treated work–life balance as indicative of equally high involvement in work and non-work roles. At present, the notion of equal role investments has been supplanted by the idea that what constitutes balance is more individually determined (Major, 2017). In other words, work life balance isn’t a science, it’s a perception. Each individual defining their own concept of this balance.

 Numerous antecedents of work–life conflict have been studied. Research shows that work stressors, lack of control or unpredictability in work routines or scheduling, long work hours, high work demands, and job stress are all associated with greater work–life conflict (Major, 2017). Work–life conflict also tends to be greater for those who have more children, younger children, high caregiving demands such as elderly parents or chronically ill children, little family support, and high family stress. Often, however, antecedents do not have simple direct effects on work–life conflict. For example, although long work hours are generally associated with greater work–family conflict, this is especially the case when an individual is required to work more hours than desired (Major, 2017).

 This is where Industrial and Organizational Psychcologists get concerned with work life balance. When employees have work life conflict, it affects their wellbeing overall. Employee turnover is becoming an increasingly known consequence of work life conflict. Oludayo, Falola, Obianuju, and Demilade (2018) showed that work life balance can predict employee behaviors, one of those behaviors being turnover intention. The study concluded that factors such as work leave arrangement, employee time out, flexible working arrangements, social support and dependent care can all be predictors of behavioral outcomes within the workplace (Oludayo, Falola, Obianuju & Demilade, 2018). The authors concluded their study by suggesting to managers that encouraging and supporting employees in achieving work life balance managers will help inspire acceptable workplace behaviors and decrease turnover rates (Oludayo, Falola, Obianuju & Demilade, 2018). Identifying what will most help managers assist their employees with achieving work life balance is the role of Industrial and Organizational Psychology.

 As work life balance is an objective perception of the individual solutions are not often one size fits all for organizations and employees. This is the area that needs future research in Industrial and Organizational Psychology. We need to better understand the various factors that can affect work life balance for employees, and how altering these factors can make a more positive or negative difference on the employees’ perception of this balance.

Summary

 Industrial and Organizational Psychology is no longer a new area of science. It is fully recognized as a viable and needed study and practice. As society and working trends evolve, the area of Industrial and Organizational Psychology will evolve along with it to meet current needs.

 Employees are the heart of any organization. They are the workforce, therefore maximizing their productivity is the goal of all organizations. This doesn’t need to be a costly endeavor. Simply understanding the employees and what makes them perform as they do, will allow organizations to harness their strength and avoid their weaknesses. Meeting the needs of employees is far less challenging when the needs and the priority of the needs is understood. In addition, familiarization with the consequences of an unsatisfied workforce is pivotal in avoiding undesirable behaviors and effects.

 While, behaviors, communication, retention, training, leadership, compensation, performance and diversity management are all areas Industrial and Organizational Psychologists seek to research and improve practice in, well-being is perhaps the area that needs the most future attention. The work has evolved and it is clearly recognized that workers should be healthy in order to be productive. That health incorporates both their physiological and mental needs.

 Work life balance is not a new concept, however it is becoming more recognized as a key area that must be protected in order for employees to perform in their most productive state while in the workplace.  Existing research has shown how some factors can affect work life balance for employees, but it has also show that balance is not affected equally by these various factors across the board. This is certainly an important area for future research- the continuous defining of these factors and their specific effect on the perception of work life balance.

References

Bošković, M. Ž. (2017). Workforce Motivation as a Factor of Productivity. TEME: Casopis Za Društvene Nauke, 41(2), 503–516. https://doi-org.proxy1.ncu.edu/10.22190/TEME1702503Z

Fulmer, R. M., & Congers, J. A. (2004). Growing Your Company’s Leaders: How great organizations use succession management to sustain competitive advantage. New York: AMACOM Books.

Hackman, J.R., & Oldham, G.R. (1980), Work Redesign, Addison-Wesley: Reading, MA

Kearney, E., Gebert, D., & Voelpel, S. C. (2009). When and How Diversity Benefits Teams: The importance of team members’ need for cognition. Academy Of Management Journal, 52(3), 581-598. doi:10.5465/AMJ.2009.41331431

Kottke, J. & Agars, M. (2007). Organizational structure. In S. G. Rogelberg (Ed.), Encyclopedia of industrial and organizational psychology (Vol. 1, pp. 586-589). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412952651.n225

Laurijssen, I., & Glorieux, I. (2013). Career Trajectories for Women After Childbirth: Job quality and work–family balance. European Sociological Review, 29(3), 426

Major, D. (2017). Work–life balance. In S. Rogelberg (Ed.), The SAGE encyclopedia of industrial and organizational psychology, 2nd edition (pp. 1762-1765). Thousand Oaks, CA: SAGE Publications, Inc doi: 10.4135/9781483386874.n606

Mullen, B., & Copper, C. (1994) The Relation Between Group Cohesiveness and Performance: An integration. Psychological Bulletin115210–227.

Oldham, G. R., & Fried, Y. (2016). Job Design Research and Theory: Past, present and future. Organizational Behavior and Human Decision Processes, 136(Celebrating Fifty Years of Organizational Behavior and Decision Making Research (1966-2016), 20-35. doi:10.1016/j.obhdp.2016.05.002

Oludayo, O. A., Falola, H. O., Obianuju, A., & Demilade, F. (2018). Work- Life Balance Initiative as a Predictor of Employees’ Behavioural Outcomes. Academy Of Strategic Management Journal, 17(1), 1-17.

Rogelberg, S. (Ed.) (2017). The SAGE encyclopedia of industrial and organizational psychology, 2nd edition (Vols. 1-4). Thousand Oaks, CA: SAGE Publications, Inc doi: 10.4135/9781483386874

Sharp, O. (2017). Stress, consequences. In S. Rogelberg (Ed.), The SAGE encyclopedia of industrial and organizational psychology, 2nd edition (pp. 1529-1530). Thousand Oaks, CA: SAGE Publications, Inc doi: 10.4135/9781483386874.n523

Stewart, J. (2006). Transformational Leadership: An evolving concept examined through the works of Burns, Bass, Avolio, and Leithwood. Canadian Journal of Educational Administration and Policy, (54), 1–29. Retrieved from http://proxy1.ncu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ843441&site=eds-live

 

Adapting Conservation Practice In The Face of Climate Change

Adapting Conservation Practice In The Face of Climate Change

Colloff et al., 2017 remark on how lack of stakeholder engagement in many conservation initiatives can setback Transformative Adaptation. There is much literature to support this statement. For example, regarding species reintroduction, many stakeholders fear a radical change to the status quo (Arts et al., 2011) and lacking effective consultation often leads to resentment and feelings of disempowerment (Cairns & Hamblin. 2007). Therefore, rigorous consultation between key stakeholders is paramount. Otherwise, stakeholders could act uncooperatively or even destructively. This is exemplified by the slow progress associated with the Irish Sea Eagle reintroduction, where insufficient initial consultation led to some landowners illegally persecuting the raptors (O’Rourke. 2014). Colloff et al highlight another hindrance to Transformative Adaptation, “insufficient monitoring” of conservation projects. They suggest more rigorous, long-term monitoring is essential for conservation practice in the face of anthropogenic climate change.

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Jordan & Hoffmann. 2017 compliment the sentiments of Colloff et al in proposing Transformative Adaptation, that requires long term follow-up of ecosystem functions, implemented on a large spatial scale. They propose designing “Climate Future Plots” (CF plots), theorized to improve climate resilience of ecosystems, making them “climate ready”. CF plots would help tackle vagaries associated with ecosystem responses to climate change, whilst determining the best conservation methods. Expansion of habitat is integral, facilitating increased genetic diversity of plants, thus improving their resilience to climate change. Colloff et al claim anthropogenically induced ecosystem change is always “unpredictable and irreversible”, however there are select examples which contradict this statement (Terborgh & Estes. 2010). 

The collapse and revival of Yellowstone’s ecosystem proves that the course of habitat change can be understood and reversed (Monbiot. 2013). Wolves were extirpated from the National Park in 1926 and their 69-year absence adversely impacted the ecosystem (Terborgh & Estes. 2010). The resident Elk population increased to unnaturally high levels, resulting in overgrazing. Subsequently, due to lacking tree sapling recruitment, beavers could no longer feed or build dams and declined (Beschta & Ripple. 2006). This reduced Cutthroat Trout populations, because the absence of beaver dams and riparian woodland increased river water velocity, reducing the availability of suitable spawning grounds (Monbiot. 2013). Consequently, trout populations dwindled and species reliant on them, such as Bald Eagles, also declined. This negative process reversed following the reintroduction of wolves in 1995. The ‘landscape of fear effect’ prevented deer from stagnating in certain areas, keeping animals on the move and causing them to completely avoid particular locations (Manning et al., 2009). Resultantly, more trees became available to beavers, which recolonised the park (Beschta & Ripple. 2012). The return of riparian woodland and dams caused rivers to meander again, which increased trout abundancy and consequently, Bald Eagles increased (Monbiot. 2013). Wolves impacted species ranging from small birds to Grizzly Bears, by allowing increased growth of berry producing vegetation (Bridgeland et al., 2010). Through interspecific competition, wolves reduced Red Fox populations, causing increases in ground nesting birds. Ironically, even elk benefited, because wolves essentially reduced intraspecific competition for food between individuals and led to genetically stronger stock due to preferentially hunting weaker deer (Beschta & Ripple. 2012).

Yellowstone illustrates how it is possible to reverse negative ecosystem change in certain circumstances. However, the authors validly emphasise ecosystem changes will become increasingly irreversible due to the combined effects of climate change and other anthropogenic stressors (Colloff et al., 2017). A stark pre-historical example is the Woolly Mammoth extinction. The end of the Younger Dryas 11,500 years ago, heralded rapid global warming, causing tundra to convert into boreal forest and swamps, habitats insufficient for Woolly Mammoths (Nogués-Bravo et al., 2008). However, suitable habitat remained in northern Siberia and Alaska during extinction. Although climate change reduced the mammoth’s tundra habitat, it was the combination of this with hunting by humans, which drove the species to extinction. Equivalent Modern-day examples, such as the rapid decline of Monarch Butterflies (Davis & Dyer. 2015), further emphasise the urgent need for Transformative Adaptation proposed by Colloff et al.  

Word Count (Excluding Title and Bibliography): 654

Bibliography

Arts, K., A. Fischer and R. van der Wal (2012). Common stories of reintroduction: A discourse analysis of documents supporting animal reintroductions to Scotland.

Beschta, R. L. and W. J. Ripple (2006). River Channel dynamics following extirpation of wolves in northeastern Yellowstone National Park, USA. Earth Surface Processes and Landforms 31 1525 – 1539.

Beschta, R. L. and W. J. Ripple (2012). The Role of large predators and trophic cascades in terrestrial ecosystems of the western United States. Biological Conservation 142 2401 – 2414.

Bridgeland, W. T., et al. (2010). A conditional trophic cascade: Birds benefit faster growing trees with strong links between predators and plants. Ecology 91(1) 73-84.

Cairns, P. and M. Hamblin (2007). Tooth and Claw: Living Alongside Britain’s Predators. Dunbeath: Whittles Publishing.

Colloff, M. J., et al. (2017). Transforming Conservation Science And Practice For A Postnormal World. Conservation Biology31(5) 1008-1017.

Davis, A. K. and L. A. Dyer (2015). Long-Term Trends in Eastern North American Monarch Butterflies: A Collection of Studies Focusing on Spring, Summer, and Fall Dynamics. Annals of the Entomological Society of America 108(5) 661-663.

Jordan, R. and A. Hoffmann (2017). Creating resilient habitat for thefuture: Building Climate Future Plots. 1 – 13. University of Melbourne.

Manning, A. D., I. J. Gordon and W. J. Ripple (2009). Restoring landscapes of fear with wolves in the Scottish Highlands. Biological Conservation 142(10) 2314-2321.

Monbiot, G. (2013). Feral: Searching for Enchantment on the Frontiers of Rewilding: Penguin Books.

Nogués-Bravo, D., et al. (2008). Climate Change, Humans, and the Extinction of the Woolly Mammoth. PLOS Biology 6(4) e79.

O’Rourke, E. (2014). The reintroduction of the white-tailed sea eagle to Ireland: People and wildlife.

Terborgh, J. and J. A. Estes (2010). Trophic Cascades: Island Press.

Evidence Based Practice in Nursing Essay

Introduction
Evidence based practice is a complex experience that requires synthesizing study findings to establish the best research evidence and correlate ideas to form a body of empirical knowledge (Burns & Grove 2007). There are many definitions but the most commonly used is Sackett et al (1996). Sackett et al (1996) as cited in Pearson, Field, & Jordon, (2007) describes evidence based practice:
“the conscientious, explicit and judicious use of current best available evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical experience with the best available external evidence from systematic research”. (Sackett et al 1996 page 5).
The author will discuss the importance of evidence for practice, different types and levels of evidence. The research process, dissemination of evidence, barriers and will conduct a critique of two research articles.
The importance of evidence based practice is to enable nurses to provide high quality care, improve outcomes for patient and families and to run a more efficient health service. Therefore other agencies within the health service will benefit when interventions and care is based on research (Burns & Grove 2007). According to the Nursing and Midwifery Council (NMC) code nurses are accountable to society to provide a high quality of care so therefore it is important that nurses reflect, evaluate the care and keep abreast of new knowledge and evidence that is available (Burns & Grove 2007). Providing a streamlined service, which is cost effective and based on current evidence based practice has shown to reduce cost but also to enhances the quality of care the patient receives (Melnyk et al2010). Working in partnership with the nurse the patient is able to participate in decisions about their care. This is not only beneficial for the patient but also increases the satisfaction of the nurse treating the patient (Craig & Smyth 2007). Furthermore Craig & Smyth (2007) suggests evidence based practice is a problem-solving approach to the delivery of health care. In using a problem solving approach the nurse is able to integrate clinician expertise and patient preferences to provide individualized care suitable for the patient.

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To acquire knowledge in the past, nurses have relied on decisions based on trail or error, personal experience, tradition and ritual. Parahoo (2006) suggests learning by tradition and ritual are important means of transferring knowledge, for example learning the ward routine. According to Brooker and Waugh (2007) Students learn from effective colleagues who practice safety and on the basis of best evidence. However, a disadvantage of this method of learning may lead to transmission of invalid information and may put the patient and nurse at risk (Brooker & Waugh 2007). According to Burns and Grove (2007) to generate knowledge a variety of research methods are needed. The two different research methods are quantitative and qualitative. According to Burns and Grove (2007) quantitative research is an objective formal systematic process and demonstrates its findings in numerical data. According Munhall (2001) qualitative research is gathering information to describe life experiences through a systematic and subjective approach and does not use figures or statistics to produce findings. In nursing practice the quantitative approach has been considered to provide stronger evidence than qualitative (Pearson, Field, & Jordon, 2007). Pearson, Field, & Jordon (2007) suggest health professionals and servicer users require a variety of information to facilitate change and to include evidence not only of effectiveness but feasibility, appropriateness and meaningfulness to achieve evidence based health care practice.
Evidence based practice promotes the application of research evidence as a basis on which to make health care decisions so it is important to search for the truth and knowledge logically. Robust research which may draw on expertise and experience represent a higher level of evidence because of the discipline involved (Burns &Grove 2007). There are thirteen steps in the quantitative research process and one step gradually builds on another (Burns & Grove2007). The beginning of the research process starts with a problem which usually highlights a gap in knowledge (Melnyk & Fine-Overholt 2005). The next step is the purpose of the research. This is produced from the problem and identifies the aim of the study (Burns & Grove2007). To build a picture up of what is known or not known about the problem a literature review is conducted. This will provide current theoretical and scientific knowledge about the problem and highlight gaps in the knowledge base (Burns & Grove 2007). This is followed by the study framework and research objectives, questions and hypotheses. This continues to the end till all the steps are covered. The final step is the research outcome.
Hierarchy of evidence is generated from the quality of information from different evidence. Practitioners are able to use the hierarchy of evidence to inform them on which information is most likely to have the maximum impact on clinical decisions (Leach 2006). Leach (2006) suggests hierarchy of evidence may be used to discover research findings that supersede and invalidate earlier accepted treatments and change them with interventions that are safer, efficient and cost-effective. If findings from a controlled trial are inadequate, choices should be guided by the next best available evidence (Leach 2006).
According to Scottish Intercollegiate Guidelines Network (SIGN 2009) the revised grading system is planned to place greater weight on the quality of the evidence supporting each recommendation, and to highlight that the body of evidence should be considered as a whole, and not rely on a single study to support each recommendation. The grading system currently in use with the SIGN guidelines starts with 1++ and ends in 4. For the evidence to be rated at 1++ it must include a high quality meta-analyses, systematic reviews of random controlled trails (RCT) or RCT with a low risk of bias. Level 4 is based on expert opinion (SIGN 2009).
There are many barriers to implementing evidence based practice. One of the common barriers is staff information and skill deficit. Health professionals lack of knowledge in regarding results of clinical research or current recommendations may not have the sufficient technical training skill or expertise to implement change (Pearson, Field, & Jordon 2007). Nurses have also highlighted lack of time as a barrier in applying research to practice. As the number of patients increases nurses face the challenge of providing safe, high-quality care within a short time frame. Nurse educators and researchers have developed a “toolkit” to ease the implementation of evidence based practice into nursing (Smith, Donez & Maghiaro 2007).
According to Gerrish and Lacey (2006) dissemination is a process of informing people about the results of a particular research. There are many ways to present results, video, seminars and the most accepted is through professional journals. However with the internet being more assessable the researcher is able to post details on the website hosted by NHS trust or university. One disadvantage in using the internet is that it provides no guarantee of quality (Gerrish & Lacey 2006). SIGN guidelines are circulated free of charge throughout Nation Health Service (NHS) Scotland. For this to happen they must be made widely available as soon as possible to facilitate implementation. Furthermore guidelines on their own have proved ineffective and more likely if they are disseminated by active educational intervention and implemented by patient-specific reminders relating directly to professional activity (SIGN 2009).
Critique 1
Rydstrom I, Dalheim-Englund A, Holritz-Rasmussen B, Moller C, Sandman P-O (2005). Asthma – quality of life for Swedish children.Journal of Clinical Nursing 14, 739-749. Blackwell Publishing Ltd.
As the title suggests this was a research to find out how Swedish children with asthma experience their quality of life and to look for potential links between their experience of quality of life and some determinants. This study was accomplished by using a quantitative research approach which adhered to the aims and objectives. Quantitative research is formal, objective, systematic inquiry that involves numerical data (Burns & Grove 2007). The two stages used in the quantitative research were correlation and quasi-experimental (Burns & Grove 2007). This is an acceptable method to use as the study was trying to explore the relationship between two variables and the findings were produced in a numerical format.
In previous literature it was noted investigations in children with asthma around the world all had similar experiences (Rydstrom et al2005).It also highlighted that girls and boys perceived asthma in a different way and girls were more likely to include asthma in their social and personal identities where boys would exclude the condition (Williams 2000). The researchers wanted to ask the children how they experience their life living with asthma. Also to look at possible links between children’s quality of life and determinants such as age, sex, pets, siblings, location and social status (Rydstrom et.al. 2005).
Some common types of sampling used in quantitative research are random and non-random samples (Burns and Grove 2007). In the article for the purpose of this study all hospitals and clinics were used and fifteen were chosen randomly for the study (Rydstrom et al2005). Both children and parents were asked to participate in the study but children had to meet the inclusion criteria before being selected (Rydstrom et al2005). By using a random sample the general population becomes representative of the larger whole (Parahoo 2006).
Validity was established by cross-matching Paediatric Asthma Quality of life Questionnaire (PAQLQ) with About my Asthma (AMA), by Mishoe et.al.(1998). Warschburger (1998) recommended that PAQLQ was a reliable instrument and Reichenberg & Brogerg (2000) found that there was no difference concerning reliability between the Swedish and the original PAQLQ.
The study was approved by The Ethics Committee at the Medical Faculty of Umea University in Sweden and consent was received from parents and children. Burns and Grove (2007) define sampling as a process of selecting groups of people who are representative of the population.
Data was collected through self administration questionnaires. There advantages and disadvantages in using questionnaires. Advantage firstly, the data is gathered is standardised and therefore easy to analyse. Secondly, respondents can answer anonymously which may produce more honest answers. A disadvantage is the responses may be inaccurate especially through misinterpretation of questions in self completing questionnaires. (Gerrish & Lacey 2006). Children age seven to seventeen were required to fill in Paediatric Asthma Quality of life Questionnaire (PAQLQ) which was used to measure the children’s quality of life in different domains. Parents were required to fill in Paediatric Asthma Caregivers Quality of life Questionnaire (PACQLQ) (Rydstrom et al2005). Children and parents filled in questionnaires separately and a nurse was on hand to help children who could not manage on their own.
The researchers clearly identify what statistical tests were undertaken. However the results are presented in a complex manner. The results showed the majority of children estimated their quality of life at the positive end of the scale. Children reported impairment in the domain of activities than emotions and symptoms for example not being able to run around. Living in the south of Sweden and being a boy were reported to have a better quality of life. Furthermore children living with a Mum over forty or with cohabiting parents had a better quality of life (Rydstrom et al2005).
The researchers brought to the attention of the reader the laminations within the study. Children view friends and their social environment being important to them however there were no questions relating to this and also it did not take into consideration the child’s stage of development (Rydstrom et al2005). Also the research was done within a week, therefore would the results be different if it was done over a longer period. This was not a controlled research so there is a possibility that some data may be missing as nobody was checking to see if the children had filled in all the questions.
The findings highlight it is important for the nurse to look at all aspects of the child development. Furthermore caring tends to focus on the patients’ limitations, another important issue for nurses is to try to discover those aspects in a child’s daily life that contribute to a high QoL in order to improve and maintain the child’s wellbeing.
Critique 2
Lyte, Milnes, Keating & Finke 2007. Review management for children with asthma in primary care: a qualitative case study.Journal of Nursing and Healthcare of Chronic Illness in association with Journal of Clinical Nursing 16, 7b, pp123-132
As the title suggests this research article will focus on review management for children with asthma within a primary care setting. This study was accomplished by using a qualitative case study design. In using a qualitative case study design it can provide much more comprehensive information than what is available through other methods, such as surveys (Neale, Thapa & Boyce 2006). Neale, Thapa & Boyce (2006) suggest case studies also allow one to present data collected from multiple methods (i.e., surveys, interviews, document review, and observation) to provide the complete story. Qualitative research is systematic, subjective approach (Burns & Grove 2007) which describes life experiences, meanings, practices and views of those involved (Craig & Smyth 2007).
In the UK one in eight children suffers from the effects of asthma and the majority of cases are now being managed in the primary care setting (National Asthma Campaign 2001). With improvement in management of asthma over the years there is still a high level of morbidity and mortality (Lyte et al2005). Out of Sight, Out of Mind (Asthma UK 2005) agrees with Lyte et al(2005) that death rates are high. In Scotland the death rates due to asthma vary each year. Furthermore inquires have shown at least 90% of those deaths could have been avoided. However child admissions to hospital due to asthma have fallen slightly (Out of Sight, Out of Mind Asthma UK 2005). Furthermore it was highlighted through a systematic review of literature published at the time of research that it was unknown whether primary care based asthma clinics were effective. Additionally it concluded that patients’ views on asthma clinics were also unknown (Fay et al2003). One cannot ignore the fact that there are evident gaps in generic knowledge of primary care asthma services for children in the UK (Lyte et al2005). Therefore the aim of the study is to investigate current review management of children’s asthma in one primary care trust and to consider the views of children, their parents/carers and the role of the practice nurse in asthma care in one primary care trust (Lyte et al2005).
For the purpose of this research Lyte et al(2005) used purposive sampling to gather information. Craig & Smyth (2007) suggests there are various methods can be applied to data collection. Lyte et al(2005) used interviews, observations and reviews of available documentation regarding asthma (Artefactual). In using this type of sampling the researchers can be specific on the groups they wanted to target. However they may be an element of bias as the practice nurse selected the parents and children for this research. To strengthen the research the researchers used triangulated methods for data collection. According to Craig & Smyth (2007) the theory behind triangulation if multiple sources, methods, investigators or theories provide similar findings their creditability is strengthened.
The study was approved by the Local Research Ethics Committee and the University’s Senate Ethics Committee. Throughout the research during the data collection consent was treated as an ongoing process. However there was difficulty in communicating with children. To solve this problem, when meeting with the children the researchers would go through the informed consent and voluntary participation again. Confidentially of all participants were protected and guaranteed by the Data Protection Act.
Children expressed a wish to participate and share information in the research (Lyte et al 2005). However some children felt through the research of not being involved. Lyte et al (2005) suggested it is the child’s personality that determines how much response the practice nurse receives. It is often said good communication in nursing is crucial and is the foundation of building trust and encourages children to seek advice. It is important to communicate with children appropriately to match the stage of development (The Common Core of Skills & Knowledge 2010). Ultimately effective communication allows for the exchange of information, needs and preferences of the patient between herself and the patient (The Common Core of Skills & Knowledge 2010). However Hobbs (1995) suggests that some practice nurses may not have the training in regarding complexities of caring for children and their families. One cannot deny that it is important for practitioners to have the appropriate training (Alderson 2000) because children have equal rights to contribute to their care as well as adults (Save the Children 1997).
It was noted that children did not have sufficient knowledge about asthma. Furthermore parents and children highlighted that there was insufficient information on asthma in the primary care setting. For children and adults to make informed choices regarding their asthma they require having up to date information to help them in making decisions. Equally in one practice it was identify that the practice nurse lack confidence in caring for children with asthma and Hobbs (1995) confirms this lack of confidence and points out that practice nurses deal with arrange of illnesses.
Parents and children in the study both agreed that one area for improvement was the waiting room (Lyte 2005). Some children may find going to the doctor a very frightening experience. The first expression needs to be reassuring and non-threatening. (Making Your Waiting Room Kid-Friendly 2006). The waiting room should be child friendly and also have books, television/video for older children. With today’s technology many children use computers in the classroom. Some computer programs are touch-screen driven, making them friendly to all levels. Providing a computer in the waiting room may be ideal opportunity to encourage children to show off their technical skills by accessing the computer for health-related information (Making Your Waiting Room Kid-Friendly 2006).
It might be concluded from this research the strengths outweigh the weaknesses, despite the research being conducted in one primary care trust. The most satisfactory conclusion that can come from this, to facilitate children and parents a comprehensive package of care needs to be put in place in order to manage their asthma effectively.
References
Burns N, Grove S, (2007). Understand Nursing Research, Building an Evidence-BasedPractice. Fourth Ed
Craig J V, Smyth R L (eds). (2007). The Evidence-Based Practice Manual for Nurses. China: Churchhill Livingstone Elsevier.
Leach M J (2006). Evidence -based practice: A framework for clinical practice and research design. International Journal of Nursing Practice. 12, pp 248-251
Lyte, Milnes, Keating & Finke 2007. Review management for children with asthma in primary care: a qualitative case study.Journal of Nursing and Healthcare of Chronic Illness in association with Journal of Clinical Nursing 16, 7b, pp123-132
Melnyk, Mazurek , Fineout-Overholt, Ellen, Stillwell, Susan, Williamson, (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing: January 2010 – Volume 110 – Issue 1 – pp 51-53
Mishoe SC, Baker RR, Poole S, Harrell LM, Arrant CB & Rupp NT (1998). Development of an instrument to assess stress levels and quality of life in children with asthma.Journal of Asthma 35, 553-563.
Munhal (2001) cited in Burns N, Grove S, (2007). Understand Nursing Research, Building an Evidence-BasedPractice. Fourth Ed
Questionnaires – a brief introduction [online]. (2006) [Accessed 15th March]. Available from: .
Reichenberg K & Broberg AG (2000) Quality of life in childhood asthma: use of the paediatric Asthma Quality of Life Questionnaire in a Swedish sample of children 7-9 yearsold. Acta Paediatrica 89, 989-995.
Roberts P et al(2006). Reliability and Validity in research. Nursing Standard. 20,44, 41-45
Rydstrom I, Dalheim-Englund A, Holritz-Rasmussen B, Moller C, Sandman P, (2004). Asthma – quality of life for Swedish children. Journal of Clinical Nursing, 14, pp739-749.
Sackett et al (1996) pp 5 cited in Pearson A, Field J, Jordan Z (eds). (2007). Evidence-Based Clinical Practice in Nursing and Health Care. Singapore: Blackwell Publishing.
Williams (2000) cited in Rydstrom I, Dalheim-Englund A, Holritz-Rasmussen B, Moller C, Sandman P, (2004). Asthma – quality of life for Swedish children. Journal of Clinical Nursing, 14, pp739-749.
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History and Changes of the Policy and Practice Towards Rape Investigations

The topic of rape has often been at the forefront of controversy as there are many different views on the subject. According to the Sexual Offenses Act (2003) the definition of rape is if a person does not consent to the intentional penetration of the vagina, anus or mouth by another person and that person knows that they did not consent. However, the policing of rape investigations has faced many criticisms, for example, Tempkin’s (1999) qualitative research into rape victims showed that many victims were displeased with police investigations into their rape due to the way they were treated by male police officers, however others argue that the police working in partnership with support agencies is beneficial. Therefore, the purpose of this essay will be to look at the legislation surrounding rape, the different policies and procedures when dealing with rape, whilst also looking at the history and how the policing of rape has evolved over time. Finally, this essay will address the organisational learning that took place after a specific incident happened and how these lessons were implemented.

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When looking at the history of rape, it is clear that the laws surrounding the offence have definitely changed for the better over time. Changes were made when the Sexual Offences Act 1967 was replaced with the Sexual Offences Act 2003. This new act defined the word ‘consent’ to mean that a person consents if they agree by choice and have the freedom and capacity to do so (Sexual Offenses Act 2003). This means that the new law sets out evidential and conclusive presumptions about consent, which helps to clarify the law and strengthen the legislation. The recent act also provides a clear definition and sets the responsibility of the defendant to prove he had reasonable grounds to believe their partner consented. This compares to earlier legislation, where consent was never really defined and there was no clarity or consistency about the meaning of consent, which meant the jury had to decide whether the rape was consensual, or consent was presumed (Sjölin 2015). The act is also more specific when it states that rape is the penetration by the penis of the mouth, anus or vagina. This compares to previous Sexual Offences Acts such as the act in 1956, which stated that a man will be guilty of rape if he impersonates a woman’s husband and induces her into sex or to have sex by means of intimidation or threats. This shows that by replacing these acts in 2003, the wording of the law is a lot clearer and it provides greater protection to woman or vulnerable people and it also considers men that are raped not just women. Another benefit of the law reform is that the wording has changed from being outdated and based on a Victorian era to reflecting the attitudes and values of today’s society whilst also offering protection against crimes that didn’t happen in previous years.

In the year 2000, there were 28,473 incidences of rape and sexual assaults on females, however there were only 2780 convictions, meaning that there is a 10 percent conviction rate (Garside and McMahon 2006). This suggests that there was either a failure within the police or the investigation, or women just aren’t reporting the crime anymore. There are numerous reasons why woman don’t report rape, these are; some women feel like they might not be believed by the police due to the fact the conviction rate is low, and some woman do lie, making it hard to distinguish liars from real cases. Another reason might be that they are scared or blame themselves so choose not to report it, especially as the court process can be very intimidating. Some women who have come forward later on in life have found that they couldn’t get a conviction due to lack of evidence or its too hard to prove, so this could be another reason why woman choose not to report their crime because they might feel like they have left it too late. And finally some women who are raped by their partner, might not want to report it because they are either afraid of their partner or still love them, so these reasons show that there are numerous women who don’t report their rape, meaning that it’s hard to accurately analyse the statistics (Kaithwas and Pandey 2018). However having said this, the number of convicted rapists has risen since the year 2000 from 2780 to 2822 which isn’t a huge difference considering it has been 18 years, and if you look at the figures from previous years it actually shows the conviction rate is lower now then the year 2010 which was at 3387 charges per year, even though there is an increase in the number of reported incidents (Crown Prosecution Service 2019). Despite there being numerous reason why women don’t report rape, there are also many reasons why the number of reported rapes has increased, for example, there was the rise of feminism in the 1970’s that saw the downfall of a patriarchal society and woman gained more equal rights. This also encouraged numerous practical developments such as the creation of rape crisis centres and women’s refugees across the UK, with the first refuge set up in 1971 and by 1978 there was 150 (Newburn 2017), however this decreased to 32 in 2006 due to the lack of funding, despite the increase in cases. Another reason why more women are reporting rape could be that the facilities when supporting victims has improved, for example women could be medically examined away from police interview rooms and this overall meant woman were more satisfied with how they were dealt with by female police officers. However, their attituded towards male police officers weren’t satisfactory due to the fact that they were treated unsympathetically (Heidensohn 2003). This has always seemed to be a complaint that women have had, because even in the 1980s women were told not to get things out of proportion, or do not go out at night and do not take short cuts, which implies that there is a restriction on women’s freedom, so this is something the police need to consider in present day policing in order to encourage women to report it. Moreover, new terminology is coming into practice with terms such as ‘survivor’ instead of ‘victim’, being used in order to not re-victimise them. Finally, the last reason why more women are reporting rape could be due to the rise of technology and the media. In recent moths there has been the ‘#MeToo’ movement on Twitter which looks at encouraging women to speak up about their sexual assault stories whilst bringing a community of survivors together to encourage each other with love and support (metoo.org 2018). This increase in media attention has encouraged more women to report their incidents, which in turn has raised the statistics of reported rapes. With more media sources criticising the police’s policies and procedures regarding rape, this could mean that new policies are being considered when it comes to the treatment of victims.    

One case that has shaped new policies and procedures within rape investigations is the Rochdale case, where five victims were trapped in a grooming ring and endured countless rape and sexual abuse. Several Pakistani men would entice girls in with the idea of free food, alcohol and cigarettes but would later ask for sex in return. Most of the girls were underage and it is believed that there are over 40 victims and over 100 men involved in the sexual abuse rings. However this is a case that led to a massive failure from police because, one victim had come forward and reported the abuse she was enduring, however, the Crown Prosecution Service reviewed the case and decided that the victim would not be a credible witness so the case never progressed. This led to the victim enduring more abuse for many more months until another victim came forward with a similar story and it was then that ‘Operation Span’ was launched. It was admitted that there was a lack of understanding of the exploitation happening and a failure to recognise the scale of it, with police chiefs ‘distracted’ by achieving targets for other crimes. As a result of the police failure, seven officers were given misconduct notices and it was recognised that there was a failure to record the crimes properly because they were described as sexual activity with a child even though it should have been called rape (Airey 2012) Police have now received more training when dealing with these types of cases and they are ensuring the continued use of ‘Project Phoenix’ which is a multi-agency approach to child exploitation. However, two more recommendations have been made to the police, where they must monitor and review safeguarding cases and they are to commit to maintaining an exploitation team that works with the Rochdale council (Syal 2013). This case suggests that better leadership is needed within the police to reduce the number of untrained police officers being sent out. This would provide the public with more trust in the police and encourage more victims to come forward especially as big media stories on police failings will more likely reduce the number of reported rapes.  

To conclude, it is evident that the legislation had to change from previous acts to a more modern view of rape due to the fact that we are living in a completely different era then when the acts were passed. The way men treated woman in general such as owning them as property suggests that it was vital that the law changed because we no longer live in a society where woman are controlled, meaning the law around rape had to be more specific in order to get more convictions, based on facts rather than presumptions. These changes are down to social attitudes, public perceptions, the rise of feminism and media influences. In regards to the policing of rape investigations, it is clear that a lot has to change in order for women to feel more confident about coming forward and reporting their rape, such as victim blaming, but also there needs to be more female officers in the police ready to deal with any reported rape cases, as this might make woman more likely to approach the police if it wasn’t so patriarchal. Although it would seem like there is a long way to go before substantial changes are made in the police to increase conviction rates, the use of partnership working with agencies such as the Sexual Assault Referral Centres (SARC) and other movements in the media such as the Me Too movement, helps to regain public confidence and helps victims to feel more supported if the police can’t always provide that.

References

Airey, T., 2012. Rochdale grooming case: Victim’s story. [Online] Available at: https://www.bbc.co.uk/news/uk-england-manchester-17914138

Crown Prosecution Service, 2017. Key facts about how the CPS prosecutes. [Online] Available at: https://www.cps.gov.uk/publication/rape-prosecutions-key-facts

Heidensohn, F. (2003) Gender and Policing, Handbook of Policing, Cullompton: Willan. :642

Manish Kaithwas, N. P., 2018. Incompetency and Challenges of Police in Rape Cases. Social Work Chronicle, 7(1), pp. 52-54.

MeToo, 2018. About: History and Vision. [Online] Available at: https://metoomvmt.org/about/

Newburn, T., 2017. Criminology. 3rd ed. Oxon: TAYLOR & FRANCIS.

Richard Garside, W. M., 2006. Does criminal justice work? The ‘Right for the wrong reasons’ debate. Crime and Society Foundation, Volume 3, pp. 19-20.

Sexual Offenses Act 1956, C.69, Available at: http://www.legislation.gov.uk/ukpga/1956/69/pdfs/ukpga_19560069_en.pdf

Sexual Offenses Act 2003, C.1, Available at: https://www.legislation.gov.uk/ukpga/2003/42/contents

Sjölin, C., 2015. Ten years on – Consent under the Sexual Offences Act 2003. 1(1), pp. 1-3.

Syal, R., 2013. Rochdale sex-grooming gangs able to flourish due to police errors says report. [Online] Available at: https://www.theguardian.com/uk-news/2013/dec/19/rochdale-sex-grooming-gangs-police-errors

Tempkin, J. (1999) Reporting Rape in London: a qualitative study, Howard Journal, 37(4):507-10

 

Application of Marketing Theories to Practice

Introduction
This report shows the different field of businesses and the methods that our company was using in SimVenture comparing with theories.
Marketing and Sales
Our company’s main marketing tool was advertising but we were using different like direct marketing, exhibitions and our website. However, digital marketing is limited only to website in the game, although this is getting more popular these days (Pittsburgh Post-Gazzette, 2006). Digital marketing defined by Jobber, 2007: “The application of digital technologies that form channels to market (the Internet, mobile communications, interactive television and wireless) to achieve corporate goal through meeting and exceeding customer need better than the competition.” Digital marketing is almost completely missing from the game, it is only limited to website. Network theory studies relationships of all sorts, whether between people, animals or things. Social network analysis is an overlapping tool for learning about patterns that develop within social networks and how they influence behaviour. Digital marketing channels such as Facebook, Twitter, Foursquare and Instagram are useful in this regard, as they allow marketers to listen to what consumers are saying, and they allow marketers to leverage the power of influential users to spread messages throughout their networks (Harvard Business Review, 2006.). Generational marketing theory holds that consumers born of the same generation — defined as a 20-year period — have common attitudes and behaviours because of shared experiences that influenced their childhoods and shaped their views of the world. The relevance of generational theory to digital marketing is primarily in the ways in which each generation communicates and the online places where marketers can reach them (Zickuhr, 2010.). The customer research in the game is only limited to where the customers heard about but nothing who they are (age, gender, education, etc.). All in all the game had good opportunities in traditional marketing channels like direct marketing and advertisement but digital marketing part is really limited which makes it less realistic.
Operations
Efficient operations management is a key element to make a company successful. Without supply network a company cannot exist. A supply network perspective means setting an operation in the context of all the other operations with which it interact some of which are its suppliers and its customers. Materials, parts, other information, ideas and network of customer-supplier relationships formed by all these operations (Slack, Chambers, Johnston, 2004.). The supply network view can also help in decision making about the design. The design activity in operations has one overriding objective: to provide products, services and processes which will satisfy the operation’s customers. During the game our company used ‘Just in time’ method for the production because if there was more order then our organisation was able to produce then we contracted some out when it was financially possible. Furthermore, in the meanwhile of last year in the game, all of our production was contracted out because the four employees weren’t enough to build the product and to handle other task that were essential to run the company at the same time. High dependency theory is one of the explanation of the ‘Just in Time’ approach to operations management. With high inventories insulating each stage in the production process, the dependency of the stages on one another was low. Take away the inventory and heir mutual dependency increases. The ‘Just in Time’ practice of empowering ‘shopfloor’ staff makes the organisation dependent on their actions (Slack, Chambers, Johnston, 2004.). However, this theory perfectly suits with SimVenture, thus it is realistically show the opportunities and limitations of ‘Just in Time’ delivery and production because in the first year when financially it was not a possibility to contract out some of the production we bumped into some limitations according to the ‘Just in Time’ manufacture technique.
Finance
All investments carry with them some degree of risk. In the financial world, individuals, professional money managers, financial institutions, and many others encounter and must deal with risk. Investors can either accept or try to mitigate the risk in investment decision-making (Baker & Filbeck, 2015.).
However, the game is limited to only two choice of grants and family and bank loans. Decision parameters are: amount, period, interest rate. The game also offers an opportunity to set bank overdraft which can be really useful especially in the beginning of the game when the company has to buy the products’ component and has to wait until the clients paying. The payback period can be up to 3 months.
According to Deakins and Freel (2009) our company’s stage of finance is at young stage, due to we paid back our only £3000 loan from friends and family, although the company is owed 100% by the founders. Business angels capital, internet crowd funding
Michael Jensen and William Meckling, in ‘Theory of the firm: management behavior, agency costs and ownership structure’ (1976), note that ‘agency costs arise in any situation involving cooperative effort’ and that, as the firm is essentially ‘a nexus for a set of contracting relationships among individuals’, agency problems are endemic to it. Their analysis focuses on how agency problems can help to explain such questions as:

The degree to which a firm is financed by debt or equity;
Why firms in some industries are usually owner-operated;
Why firms would voluntarily supply shareholders and lenders with accounting reports and have them independently audited.

The last point is of most interest for our purposes. Essentially, firms will voluntarily provide shareholders and lenders with independently audited accounting reports because this reduces the monitoring costs associated with contractual relationships with these parties. In the game there is opportunity to make the finance reports in house or to ask an agency to do it for extra costs per each months.
Setting up the right price for the product is a key element for running a successful company. Our gross profit per unit is 43% of the whole price which is around average in this industry (Stefan, 2015.).
Organisation and growth
“SimVenture is a game which is run on a managerialist philosophy not an enterprising one” (Grant, 2015.). Theories of the small business life cycle have been heavily criticised in recent years for being reductionist and ‘speculatively normative’, relying on formalistic, deductive approaches rather than inductive heuristic methods (Gibb and Davies, 1990). In particular, it is the ‘deterministic assumption that all firms grow through a series of predictable series of preordained stages’ (Merz et al, 1994; p49). Small business growth is characterised by a number of predictable, discrete and consistent stages (Churchill and Lewis, 1983; Hanks et al., 1994; Kazanjian, 1988; Steinmetz, 1969). These stages are sequential in nature and occur as a hierarchical progression not easily reversed (Dodge and Robbins, 1992; Quinn and Cameron, 1983). An important aspect of theorising on the organisational life cycle is that many stage models of small business growth can be conceptualised as ‘metamorphosis’ models (d’Amboise and Muldowney, 1988; Kazanjian, 1988), where the fundamental transition from one stage of growth to another requires considerable change. However, in SimVenture when the firm moved to a bigger office and purchased new equipment for the company the efficiency of the company have been developed to a higher level that also meant that the company is growing. The life cycle literature emphasises that such periodic crises have an important role to play in the development of both the organisation and the individual. (Dodge and Robbins, 1992.). Hiring more employees and train them to be professional in different business fields is also a great method to rise the organisation to a higher level. Upon interpretation, it seems that entrepreneurs have to develop new behaviours and learn to think in radically different ways as a result of managing developmental crises (Greiner, 1972). As Greiner (1972) states, ‘these periods of tension provide the pressure, ideas, and awareness that afford a platform for change and the introduction of new practices’ . From this viewpoint, a key assumption behind life cycle theorising is that for a small business to grow, the owner-manager must adapt and modify their perceptions and actions as a result of these discontinuous events in order to facilitate organisational growth. For instance, in the game when the company was financially able to advertise not only in printed media but use the more expensive although more efficient TV and Radio as a marketing channel, the number of orders rising exponentially. That caused profit and sales growth which helped to increment the firm to a higher level as it displayed in the Figure 1.1 below.

Figure 1.1
Even though such statements indicate a fundamental process of personal learning and development on behalf of the owner-manager, most life cycle theorists do not address this issue in any significant depth. On the other hand, there are opportunities for training and learning for the owner as well, and it is also developing the skills during the game. The important point to draw from this significant recognition is that learning to become an effective small business owner is not always simple, or inevitable for that matter (Burns and Harrison, 1989).
Leadership
Entrepreneurs and small business owners are very different because entrepreneurship can be distinguished from small business ownership by a venture strategy oriented toward growth and innovation (Grant, 2015.). Using Team Role theory the word ‘shape’ indicates to us ‘shaper’, whilst the word ‘vision’ implies ‘plant’. Looking at leadership using Handy’s definition is interesting for vision is certainly important to leadership, but does it have to be unique to an individual? Where it is unique to an individual with a drive to enact it such as a ‘Shaper’, strong Solo leadership is likely to prevail. Vision alternatively may be ‘borrowed’ by a ‘Shaper’ who treats it as a product of the self and similarly will adopt a Solo leadership style. Many organisations have rewarded Solo leadership behaviour by promoting individuals to management and leadership positions, for such individuals have met past organisational needs (Handy, 1992.).