Perestroika Essay Example | Topics and Well Written Essays - 1500 words

Perestroika - Essay Example The improvement of vital plans overall depends on explicit rules. Most ordinarily, the objectives set must be possible †as far as the assets and the time required †while the potential disappointments should be recognized ahead of time so as to guarantee the constraint of disappointments. Then again, not every single authoritative activity have similar qualities; when the accomplishment of explicit targets is endeavored then the strategies utilized must be deliberately picked †a harmony between the expense of a particular vital undertaking and the normal advantages of this task must be sought after by directors in present day associations. Current paper centers around the assessment of the key plans required for the expansion of the piece of the pie of the firm LG in a specific part: the TVs and audiovideo hardware. The firm’s current valuing technique is surveyed and assessed so as to settle on the fitting of the promoting plans utilized in connection with the p articular advertising plan. It appears that the accomplishment of the particular objective is doable yet explicit estimates will be required particularly if considering the situation of the firm’s contenders yet in addition the difficulties of the particular business in all business sectors globally.

Is the death penalty effective Essay Example | Topics and Well Written Essays - 500 words

Is capital punishment successful - Essay Example The general public is one which requires profoundly and frantically consistently, a death penalty. Notwithstanding the discipline, there would have been an a lot more elevated level of murders over the world. Without the death penalty, the populace would will in general use, ‘mob mentality’ in circumstances where the feelings turn crazy. There are various cases, both basic just as increasingly exceptional where individuals have lost their lives and it is essential to take note of that without the predominance of a capital punishment, there would not be any impediment to kill. In the event that an individual was basically to be secured prison with complete access to food, garments, and sanctuary without winning it, at that point individuals would take this alternative and could never stress over killing anybody (Davis, 1998). In basic terms, our general public is documented with various lawbreakers and isn't sufficiently cultivated to oversee without a reasonable set down hindrance for the wrongdoing. Thus, it is fundamental for capital punishment to be applied to guarantee a more secure society. Various specialists have additionally directed their perspectives toward the ineffectualness of the capital punishments and have likewise drawn out the way that regardless of the death sentences that are being utilized inside the nations, there are as yet various individuals who will in general do the wrongdoing. The way toward giving capital punishment is a long one with the hoodlums living serenely in jail and this, all things considered, will in general diminish the adequacy of a capital punishment. As an obstacle, it is significant that the crooks are not given an opportunity and are executed immediately to make the discipline a fruitful one (Dieter, 1998). Anyway this unmistakably is unimaginable considering the quantity of laws and guidelines that should be considered before giving an individual a capital punishment, in this way making this strategy insufficient and wasteful. I for one accept that the capital punishments are an exceptionally successful strategy for leading the general public and crooks that have submitted murder. This is for the most part in light of the fact that, the

Read Harder A Book By or About Someone That Identifies as Neurodiverse

Read Harder A Book By or About Someone That Identifies as Neurodiverse The 2019 Read Harder Challenge is sponsored by the Read Harder Journal. Created by Book Riot, this smartly designed reading log consists of entry pages to record stats, impressions, and reviews of each book you read. Evenly interspersed among these entry pages are 12 challenges inspired by Book Riot’s annual Read Harder initiative, which began in 2015 to encourage readers to pick up passed-over books, try out new genres, and choose titles from a wider range of voices and perspectives. Indulge your inner book nerd and read a book about books, get a new perspective on current events by reading a book written by an immigrant, find a hidden gem by reading a book published by an independent press, and so much more. Each challenge includes an inspiring quotation, an explanation of why the challenge will prove to be rewarding, and five book recommendations that fulfill the challenge. Neurodiversity is an emerging concept, one which posits neurological differences are the result of normal, natural variation in the human genome. The need for recognizing neurodiversity arises from the often-stigmatized nature of conditions like autism, ADHD, dyslexia, and others. In other words, said differences are simply another piece of what makes humans diverse, interesting creatures. Neurodiverse representation in books is also rising, as authors continue to investigate the lives of characters who identify as such. Excitingly, there is also a great wealth of #ownvoices authors whose work is screaming to be read. What are some of your favorite books featuring or written by neurodiverse individuals? Let us know in the comments! TherE is a Case That I Am by torrin a. Greathouse This slim, punchy volume of poems explores gender identity, existential angst, and every conceivable thing in between. The author, torrin a. greathouse, self-identifies as autistic. Insignificant Events in the Life of a Cactus by Dusti Bowling Aven Green was born without arms, a fact she makes light of by coming up with outrageous backstories for her missing limbs. After moving across the country with her family, Aven befriends a classmate, Connor, with tourette syndrome. As their friendship grows, the pair find comfort in their similarities, even in the face of an unraveling mystery. If I Loved You, I Would Tell You This by Robin Black In this short story collection, the fraught nature of human relationships is laid bare. We meet characters on the verge of great changes: failing marriages; becoming an empty nester; watching someone slowly die. Throughout, the prose is crisp, direct, and breathtaking. In a wonderful essay, Robin Black self-identifies as living with ADHD. Shine Shine Shine by Lydia Netzer Sunny and Maxon are a married couple who have bonded over their eccentricities since childhood. While Maxon is in space on a lunar mission, Sunny is back on Earth to care for their neurodivergent son, as well as take care of her own illness. After a series of accidents leaves Maxon potentially stranded in space, Sunny must contend with the uncertainty of the future, as well as that of the immediate present. Thank You, Mr. Falker by Patricia Polacco This is the illustrated retelling of the authors experience as a child with dyslexia. Other students often teased Patricia Polacco for her struggles with reading, until a teacher recognized there might be something more to the problem than just not trying hard enough. Thank You, Mr. Falker is both a tribute to an extraordinary teacher, as well as a testament to the positive role educators and parents must play in neurodivergent childrens lives. Me, Who Dove into the Heart of the World by Sabina Berman Karen is an autistic, feral child who wanders the beach near the decrepit tuna cannery her family has neglected. When her aunt arrives to take over the facility, she looks after Karen and offers the girl a sense of belonging that she had only previously felt among sea creatures. Karens love of ocean dwellers inspires her to reinvent the family tuna cannerys practices to be more humane, which leads her to unexpected success. The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism by Naoki Higashida Naoki Higashida has autism and communicates via an alphabet grid. In this memoir, he provides insights into the working of his mind: the particular way he lines up his toys; his discomfort making eye contact; why he jumps to collect his feelings. This memoir provides an honest, unfiltered depiction of living with autism, and provides insight into the great mysteries of the human mind. I Tic by Abby Hargrove, Illustrations by Rhema Coleman I Tic is the story of a nine-year-old girl living with tourette syndrome, told in her own words. The young authors charming illustrated tale encourages readers to celebrate their differences. Marcelo in the Real World by Francisco X. Stork Marcelos conditionâ€"described as autism-likeâ€"has never given him any trouble. He attends a special school with other students like him. However, after his father forces Marcelo to take a job working at his law firm, the boy begins to experience the full gamut of human emotions for the first time: anger, desire, tragedy, and hope. All the Weight of Our Dreams: On Living Racialized Autism, Edited by Lydia X.Z. Brown, E. Ashkenazy, Morénike Giwa Onaiwu In this multi-genre, intersectional collection, 61 writers and artists detail their experiences as autistic people of color. Often critical of the systems that fail them, these authors offer insights that are nothing short of revelatory. The Cider House Rules by John Irving Irving is one of the most prolific American novelists of the twentieth century, despite pulling poor grades in English throughout his prep school days. Teachers considered him lazy and stupid for his poor performances. He did not know until adulthood that he was dyslexic. The Cider House Rules finds the writer in top form, telling the coming-of-age of orphan Homer Wells. The Kiss Quotient by Helen Hoang Helen Hoang describes herself as being addicted to romance novels. In adulthood, she was diagnosed with autism spectrum disorder. These two experiences directly inspired her to write The Kiss Quotient, which features a protagonist with Aspergers syndrome diving headfirst into the romantic travails that have eluded her by hiring a male escort to teach her what she has been missing. Subscribe to Events to receive news and announcements about sitewide events, including daylong and weeklong bookish celebrations, as well as announcements of our Best Of and Anticipated  books. Thank you for signing up! Keep an eye on your inbox.

Top 8 Roman Military Defeats

The Physics Of Video Games - 2519 Words

People often question when they would ever use the mathematics they are taught in school during the course of their lives. Unbeknownst to them however, is that many of their greatest joys in life are made possible because of mathematics. Anyone who plays video games or any games may not realize just how large a role mathematics plays in their lives. Without math, video games wouldn t be possible, and board games would be less meaningful. Everything that happens in a videogame is occurring due to mathematical inputs inside the game. Some of these inputs are able to be changed of influenced by the user, others are not and form a pseudo-random number generator, which influences the seemingly random events that occur while playing. Board games often have mathematical solutions to them that guarantee a certain result, or strategies that are more likely to result in a victory. Even if it isn t noticeable at first, mathematics in games is very present for those who care enough to look for i t, and those who find it can use their newly found knowledge to their advantage. One of the largest gaming communities in the world is the Pokemon community. Pokemon, a video game series created by Nintendo, has grown in popularity with all ages since its original release in 1996. Since then, 26 main series games have been released, including two new ones just released on November 18th. The basic premise of the game is that a player travels a world, capturing Pokemon to use in battlesShow MoreRelatedEssay On Applying Physics To Gaming797 Words   |  4 PagesApplying Physics to Gaming Germain Mendoza The article â€Å"Teaching introductory undergraduate physics using commercial video games† talks about a course that was offered to college students at the University of Texas at Brownsville that would last from December 2010-January 2011. Many games were used to demonstrate how developers of the video games used real world physics laws and applied them to the basis of the game. In the article only four were mentioned these were: â€Å"Little Big Planet†, â€Å"ShaunRead MoreFlight Simulators Should Be Made ( 13 )792 Words   |  4 Pagesone individual part of it moves(13). However, the physics system is independent of the plane model representation. So the model doesn’t contain any actual physics logic(13). Simulation-subsystem contains the physics model The result of the model logic is a series of physical effects on the components, such as forces, torques, heating, deformation, and so on(13). These are applied on a per component basis determined by the pane model. The physics engine takes the disparate effects and integratesRead MoreUsing Video Games in the Classroom1407 Words   |  6 PagesVideo Games could be used in the classroom for a wide variety of different subjects, ranging from math, to science, to english and even in foreign language classes as many games that are made in different countries are in that countrys own language. Of Course games are almost always translated into different languages so that people worldwide could play them but a foreign language teacher wouldn’t find it too difficult to get ahold of a copy of a game in a foreign language. Music classes such asRead MoreComputer Science And Medicine Or Art Science1225 Words   |  5 Pagesshe an engineer but she’s one of the best in her field, whether it be through gaming, physics, or mechanics. It’s refreshing to hear about a woman changing the standards so drastically in a male-oriented industry like that of gaming because from my experiences girls who play video games are considered doing it for attention or the male approval rather than the idea that we generally enjoy just playing the game. Knowing that some of the designs that transformed the way gaming is now ran was due toRead MoreThe Physics of Tennis Essay561 Words   |  3 PagesThe Physics of Tennis I. Introduction Background: A friendly game of tennis is being played. Camera: pans away from the game and zooms to Sunne. Sunne: Hello, my name is Sunne. Today, my group, which consists of Ravi, Gramh, Whitney and myself, will portray how physics plays an essential role in one specific aspect of tennis. This aspect is the tennis racquet itself, which can only be mastered when the physics of it is completely understood. In this videoRead MoreEssay On Youtube766 Words   |  4 PagesIf someone had told me five years ago that I would be a YouTube junkie and Facebook addict, I would have told them they were insane! I mean, YouTube used to be mostly used only by people posting embarrassing family videos, as well as by wannabe singers and musicians, posting their latest accomplishments in the far-fetched hope of being discovered. There was absolutely nothing about it that interested me. Similarly, while originally created as a study tool for college students, Facebook has morphedRead MoreMultiple Functions Of Utah Valley University991 Words   |  4 Pagesthe game, not because they were good, but because they had fun playing. Before seeing the world of UCAS, I assumed all the students would be geeky boys who were whizzes at math and played video games late into the night. Of course my picture was skewed, I knew only what my cousin Tanner had told me about when he went years prior. He described a common occurrence during lunch, of students playing videogames hooked onto their computer. He’d created an image in my mind of boys who played video gamesRead MoreDungeon And Dragons, Rock N Roll, And Video Games919 Words   |  4 PagesDungeon and Dragons, Rock N’ Roll, and video games, these are three separate activities that when looked at from afar do not seem to have anything to do with each other. However, they in fact do have something fairly big in common. They each have been blamed with being either bad for you or a negative influence. Whether it be Dungeon and Dragons being satanic and making people lose touch with reality, Rock N’ Roll’s cause of juvenile delinquency, or v ideo games leading to violent and antisocial behaviorRead MoreCase Analysis : Deflategate Scandal1458 Words   |  6 Pageswith the game footballs used in the AFC Championship Game against the Indianapolis Colts in the 2015 season. In this game, the Patriots defeated the Colts 45-7 and went on to to defeat the Seattle Seahawks 28-24 in the 2015 Superbowl. Many people, right away, are probably thinking – â€Å"What is the big advantage of an under inflated football?† A deflated football gives the team using it a huge advantage. A physics professor, Mike Eads, from Northern Illinois University explain in terms of physics why aRead MoreThe Haunting Of Hill House1249 Words   |  5 PagesVery few other animals do this, and only ones with a complex neural network have the desire to complete puzzles for enjoyment. Over 40% of Americans play video games at least three hours a week; 1.2 billion people play video games worldwide. Games have always been a form of entertainment, chess is a melena and a half years old, but video games only arose in the last 60 years. Making their mark on history and are slowly taking over the world, the electronic world is becoming more seductive than the

The Nurse Managers Role Free Essays

The nurse manager is vital in creating an environment where nurse-physician collaboration can occur and is the expected norm. It is she, who clarifies the vision of collaboration, sets an example of and practices as a role model for collaboration. The nurse manager also supports and makes necessary changes in the environment to bring together all the elements that are necessary to facilitating effective nurse-physician collaboration. We will write a custom essay sample on The Nurse Managers Role or any similar topic only for you Order Now Many authors (Alpert, Goldman, Kilroy, Pike, 1992; Baggs Schmitt, 1997; Betts, 1994; Evans, 1994; Evans Carlson, 1993; Keeman, Cooke, Hillis, 1998; Jones, 1994) have indicated that nurse-physician collaboration is not widespread and a number of barriers exist. The following will discuss the necessary ingredients for creating a nursing unit that is conducive to nurse-physician collaboration and supported through transformational leadership. The first important barrier according to (Keenan et al. (1998) is concerned with how nurses and physicians have not been socialized to collaborate with each other and do not believe they are expected to do so. Nurse and physicians have traditionally operated under the paradigm of physician dominance and the physician†s viewpoint prevails on patient care issues. Collaboration, on the other hand, involves mutual respect for each other†s opinions as well as possible contributions by the other party in optimizing patient care. Collaboration (Gray, 1989) requires that parties, who see different aspects of a problem, communicate together and constructively explore their differences in search of solutions that go beyond their own limited vision of what is possible. Many researchers have argued (Betts 1994; Evans Carlson, 1993; Hansen et al. , 1999; Watts et al. , 1995) that nurses and physicians should collaborate to address patient care issues, because consideration of both the professions concerns is important to the development of high quality patient care. Additionally, effective nurse-physician collaboration has been linked to many positive outcomes over the years, all of which are necessary in today†s rapidly changing health care environment. One study by (Baggs Schmitt, 1997) found several major positive outcomes form nurses and physicians working together, they were described as improving patient care, feeling better in the job, and controlling costs. In another study (Alpert et al. , 1992) also found that collaboration among physicians and nurses led to increased functional status for patients and a decreased time from admission to discharge. Along with improved patient outcomes, nurse-physician collaboration has several other reasons why it has become significant in today†s health care environment. Several examples of which are, as identified by (Jones, 1994) the cost containment effort, changing roles for nurses and physicians, the Joint Commission on Accreditation of Health Care Organizations focus on total quality management, and emphasis by professional organizations and investigators have focused attention on this area. The challenge of creating an environment for patient care in which collaboration is the norm can be difficult and belongs to the domain of the nurse manager. In order to create a collaborative work environment several conditions must be achieved and several natural barriers to nurse-physician collaboration must be overcome. In creating this environment for collaborative practice, (Evans, 1994) identified several more barriers to overcome. She expresses that the most difficult to overcome is the time-honored tradition of the nurse-physician hierarchy of relationships, which encourages a tendency oward superior-subordinate mentality. Keenan et al. (1998) found that nurses expect the physicians to manage conflict with a dominant/superior attitude. They also found that nurses are oriented towards being passive in conflict situations with physicians. A second barrier to collaboration is a lack of understanding of the scope of each other†s practice, roles, and responsibilities. Evans (1994) feels that one cannot appreciate the contribution of another individual if one has only limited understanding of the dimensions of that individual†s practice. It is equally true that appreciation of one†s own contribution is blurred if the understanding of one†s own role is limited. A third constraint to collaborative practice might be related to this perceived constraint on effective communication. Although there might be individual differences causing restraint in communication, the organizational and bureaucratic hierarchies of most hospitals hinders lines of communication. Several final factors cited by (Evans, 1994) as barriers to collaborative practice include immaturity of both physician and nurse groups, coupled with unassertive nurse behavior and aggressive physician behaviors. Factors that promoted collaboration between nurse and physicians were identified by (Keenan et al, 1998). She explained that nurse education was sighted as one of the most outstanding variables that promoted collaboration. The more educated a nurse was the more likely they were to take action in disagreements with physicians. Additionally, when nurses expected physicians to collaborate and to not exhibit strong aggressive behaviors or controversial styles, they were more likely to approach and discuss patient conditions with them. Researchers also found that male nurse were more likely than female nurses to confront physicians and not avoid dominant or aggressive behavior. Expectations for physicians to collaborate and to not handle situations aggressively appeared to be a stronger predictor of nurse-physician collaboration than any expected normative beliefs. The first step a nurse manager should take in the process of achieving a practice environment that facilitates collaboration is to conduct an assessment of the presence or absence of barriers leading to collaborative practice. According to (Evans, 1994), the environmental and role variables to assess include role identification and the professional maturity of both the nurses and physicians, communication patterns, and the flexibility of the organizational structure. By assessing the work environment for barriers and facilitators to collaborative practice, the nurse manager can achieve a general idea of how ready the unit is to begin a collaborative practice. The next step would be to plan an effective way to initiate a collaborative practice model of delivering health care on the unit. This can be done by establishing what is called a Joint Practice Committee, and including nurses and physicians to be a part of this work group. Its purpose would be to examine the needs assessment results of the unit†s readiness for collaborative practice, designing, implementing, and evaluating the process of transforming the unit. This step is an integral part of the process of establishing a collaborative practice and was identified by the National Joint Practice Commission (NJPC) as a necessary element in the process. The NJPC began in 1971 and the commission was dissolved in 1981. The commission†s work resulted in the publication of guidelines for collaborative practice in hospitals. The NJPC defines a joint-practice committee with a composition of equal number of nurses and physicians who monitor the inter-professional relationships and recommend appropriate strategies to support and maintain those relationships. The NJPC identifies four other structural elements necessary for a collaborative practice as primary nursing, integrated patient care records, joint patient care reviews, and emphasis on and support of nurse independent clinical decision making. These elements are an important cornerstone for creating a successful collaborative practice unit. In addition, several other factors have been identified by the NJPC as beneficial to maintaining an effective support systems when developing a collaborative practice such as appropriate staffing, committed medical leadership, standardized clinical protocols, and most importantly communication. Although a successful collaborative practice model has is a planned event. According to (Evans, 1994), it is important to realize that a collaborative relationship cannot be legislated, dictated, or mandated by anyone. It must be agreed upon and accepted by individuals who share responsibility for patient care outcomes. The third step in the process would be to empower the nursing staff with beliefs that fulfill their higher order of needs such as achievement, self-actualization, concern for others, and affiliation. Because of nursings normative behavior as passive, caring, and subservient the staff must learn to overcome expectations to identify with this role expectation. The nurse manager must support, coach, and instill a sense of empowerment into her staff in order for them to depart from those stereotypes. The idea is to fill the nursing staff with a sense of self-confidence and to lose thoughts of self-doubt, inequality, and subservience. To implement this new paradigm of nurse empowerment can be a challenge for the nurse manager within any typical hospital beaurocracy. That is why it is important to choose the correct style of leadership to guide the staff through this process of empowering or transforming. The leadership model best suited for this type of task and the most congruent with empowerment is the transformational model. Transformational leadership is a process in which leaders seek to shape and alter the goals of followers. Cassidy Koroll (1994) describe the process as incorporating the dimensions of leader, follower, and situation. The leader motivates followers by identifying and clarifying motives, values, and goals that contribute to enhancing shared leadership and autonomy. Transformational leaders are usually charismatic so they enhance energy and drive people towards a common vision and shifting the focus of control from leaders to followers. It is the transformational nurse manager that will be able to empower her workers to facilitate nurse-physician collaboration, for the common good of the patient. The nurse manager using transformational leadership would set the direction for the rest of the unit to follow. She would be able to charismatically appeal to the medical staff as well as the nursing staff and create collaboration beyond the daily frustrations of arguing about to which domain a certain patient care issues belong. Further more the nurse manager would have to work hard at decreasing the seeds of distrust and disrespect that have been planted between our colleagues in medicine, and vice versa with nursing. Corley (1998) described several behaviors that the transformation nurse manager would need to exhibit in supporting her staff in such a role transition. The behaviors are as follows: stimulate creativity, establish an environment that facilitates team work and learning, implement change, motivate staff to assume increased responsibility, help develop employees† awareness of organizational goals, delegate responsibility appropriately, communicate openly and directly with staff, and collaborate with peers. The significance of these behaviors in facilitating empowerment is seen as fundamental to creating collaborative practice environment. The final step in the process is to evaluate its effectiveness. In order to provide a clear and concise evaluation of the collaborative process one must look at all structural elements and all indicators of collaboration as previously discussed. Once accurate measures are identified and assessed the collaborative practice committee can discuss their outcomes and effectiveness. Over time, nurses and physicians may be able to articulate more clearly the changes in their practice and beliefs that have been affected by collaborating on patient care. Several of these key areas to examine would be: length of stay, patient and provider satisfaction, number of return visits, and changes in supply costs. Improvements in any of these areas could be due to favorable results from collaborative practice between nurses and physicians. In conclusion, many problems related to nurse physician collaboration are typically blamed on physicians. However the reality is that many of the barriers can be traced back to nursing as well. Collaboration is a process by which members of various disciplines share their expertise. Accomplishing this requires that these individuals understand and appreciate what it is that each professional domain contributes to the â€Å"whole†. The nurse manger plays a pivotal role in establishing an environment that is conducive to collaboration among the disciplines. Although it is a difficult road to follow the benefits of an effective collaborative unit out-weigh the difficulties of establishing such a practice. However, the nurse manager has an excellent vehicle for which to begin her journey and that is the use of transformation leadership, an empowering tool for change. How to cite The Nurse Managers Role, Essay examples

The Nurse Managers Role Free Essays

The nurse manager is vital in creating an environment where nurse-physician collaboration can occur and is the expected norm. It is she, who clarifies the vision of collaboration, sets an example of and practices as a role model for collaboration. The nurse manager also supports and makes necessary changes in the environment to bring together all the elements that are necessary to facilitating effective nurse-physician collaboration. We will write a custom essay sample on The Nurse Managers Role or any similar topic only for you Order Now Many authors (Alpert, Goldman, Kilroy, Pike, 1992; Baggs Schmitt, 1997; Betts, 1994; Evans, 1994; Evans Carlson, 1993; Keeman, Cooke, Hillis, 1998; Jones, 1994) have indicated that nurse-physician collaboration is not widespread and a number of barriers exist. The following will discuss the necessary ingredients for creating a nursing unit that is conducive to nurse-physician collaboration and supported through transformational leadership. The first important barrier according to (Keenan et al. (1998) is concerned with how nurses and physicians have not been socialized to collaborate with each other and do not believe they are expected to do so. Nurse and physicians have traditionally operated under the paradigm of physician dominance and the physician†s viewpoint prevails on patient care issues. Collaboration, on the other hand, involves mutual respect for each other†s opinions as well as possible contributions by the other party in optimizing patient care. Collaboration (Gray, 1989) requires that parties, who see different aspects of a problem, communicate together and constructively explore their differences in search of solutions that go beyond their own limited vision of what is possible. Many researchers have argued (Betts 1994; Evans Carlson, 1993; Hansen et al. , 1999; Watts et al. , 1995) that nurses and physicians should collaborate to address patient care issues, because consideration of both the professions concerns is important to the development of high quality patient care. Additionally, effective nurse-physician collaboration has been linked to many positive outcomes over the years, all of which are necessary in today†s rapidly changing health care environment. One study by (Baggs Schmitt, 1997) found several major positive outcomes form nurses and physicians working together, they were described as improving patient care, feeling better in the job, and controlling costs. In another study (Alpert et al. , 1992) also found that collaboration among physicians and nurses led to increased functional status for patients and a decreased time from admission to discharge. Along with improved patient outcomes, nurse-physician collaboration has several other reasons why it has become significant in today†s health care environment. Several examples of which are, as identified by (Jones, 1994) the cost containment effort, changing roles for nurses and physicians, the Joint Commission on Accreditation of Health Care Organizations focus on total quality management, and emphasis by professional organizations and investigators have focused attention on this area. The challenge of creating an environment for patient care in which collaboration is the norm can be difficult and belongs to the domain of the nurse manager. In order to create a collaborative work environment several conditions must be achieved and several natural barriers to nurse-physician collaboration must be overcome. In creating this environment for collaborative practice, (Evans, 1994) identified several more barriers to overcome. She expresses that the most difficult to overcome is the time-honored tradition of the nurse-physician hierarchy of relationships, which encourages a tendency oward superior-subordinate mentality. Keenan et al. (1998) found that nurses expect the physicians to manage conflict with a dominant/superior attitude. They also found that nurses are oriented towards being passive in conflict situations with physicians. A second barrier to collaboration is a lack of understanding of the scope of each other†s practice, roles, and responsibilities. Evans (1994) feels that one cannot appreciate the contribution of another individual if one has only limited understanding of the dimensions of that individual†s practice. It is equally true that appreciation of one†s own contribution is blurred if the understanding of one†s own role is limited. A third constraint to collaborative practice might be related to this perceived constraint on effective communication. Although there might be individual differences causing restraint in communication, the organizational and bureaucratic hierarchies of most hospitals hinders lines of communication. Several final factors cited by (Evans, 1994) as barriers to collaborative practice include immaturity of both physician and nurse groups, coupled with unassertive nurse behavior and aggressive physician behaviors. Factors that promoted collaboration between nurse and physicians were identified by (Keenan et al, 1998). She explained that nurse education was sighted as one of the most outstanding variables that promoted collaboration. The more educated a nurse was the more likely they were to take action in disagreements with physicians. Additionally, when nurses expected physicians to collaborate and to not exhibit strong aggressive behaviors or controversial styles, they were more likely to approach and discuss patient conditions with them. Researchers also found that male nurse were more likely than female nurses to confront physicians and not avoid dominant or aggressive behavior. Expectations for physicians to collaborate and to not handle situations aggressively appeared to be a stronger predictor of nurse-physician collaboration than any expected normative beliefs. The first step a nurse manager should take in the process of achieving a practice environment that facilitates collaboration is to conduct an assessment of the presence or absence of barriers leading to collaborative practice. According to (Evans, 1994), the environmental and role variables to assess include role identification and the professional maturity of both the nurses and physicians, communication patterns, and the flexibility of the organizational structure. By assessing the work environment for barriers and facilitators to collaborative practice, the nurse manager can achieve a general idea of how ready the unit is to begin a collaborative practice. The next step would be to plan an effective way to initiate a collaborative practice model of delivering health care on the unit. This can be done by establishing what is called a Joint Practice Committee, and including nurses and physicians to be a part of this work group. Its purpose would be to examine the needs assessment results of the unit†s readiness for collaborative practice, designing, implementing, and evaluating the process of transforming the unit. This step is an integral part of the process of establishing a collaborative practice and was identified by the National Joint Practice Commission (NJPC) as a necessary element in the process. The NJPC began in 1971 and the commission was dissolved in 1981. The commission†s work resulted in the publication of guidelines for collaborative practice in hospitals. The NJPC defines a joint-practice committee with a composition of equal number of nurses and physicians who monitor the inter-professional relationships and recommend appropriate strategies to support and maintain those relationships. The NJPC identifies four other structural elements necessary for a collaborative practice as primary nursing, integrated patient care records, joint patient care reviews, and emphasis on and support of nurse independent clinical decision making. These elements are an important cornerstone for creating a successful collaborative practice unit. In addition, several other factors have been identified by the NJPC as beneficial to maintaining an effective support systems when developing a collaborative practice such as appropriate staffing, committed medical leadership, standardized clinical protocols, and most importantly communication. Although a successful collaborative practice model has is a planned event. According to (Evans, 1994), it is important to realize that a collaborative relationship cannot be legislated, dictated, or mandated by anyone. It must be agreed upon and accepted by individuals who share responsibility for patient care outcomes. The third step in the process would be to empower the nursing staff with beliefs that fulfill their higher order of needs such as achievement, self-actualization, concern for others, and affiliation. Because of nursings normative behavior as passive, caring, and subservient the staff must learn to overcome expectations to identify with this role expectation. The nurse manager must support, coach, and instill a sense of empowerment into her staff in order for them to depart from those stereotypes. The idea is to fill the nursing staff with a sense of self-confidence and to lose thoughts of self-doubt, inequality, and subservience. To implement this new paradigm of nurse empowerment can be a challenge for the nurse manager within any typical hospital beaurocracy. That is why it is important to choose the correct style of leadership to guide the staff through this process of empowering or transforming. The leadership model best suited for this type of task and the most congruent with empowerment is the transformational model. Transformational leadership is a process in which leaders seek to shape and alter the goals of followers. Cassidy Koroll (1994) describe the process as incorporating the dimensions of leader, follower, and situation. The leader motivates followers by identifying and clarifying motives, values, and goals that contribute to enhancing shared leadership and autonomy. Transformational leaders are usually charismatic so they enhance energy and drive people towards a common vision and shifting the focus of control from leaders to followers. It is the transformational nurse manager that will be able to empower her workers to facilitate nurse-physician collaboration, for the common good of the patient. The nurse manager using transformational leadership would set the direction for the rest of the unit to follow. She would be able to charismatically appeal to the medical staff as well as the nursing staff and create collaboration beyond the daily frustrations of arguing about to which domain a certain patient care issues belong. Further more the nurse manager would have to work hard at decreasing the seeds of distrust and disrespect that have been planted between our colleagues in medicine, and vice versa with nursing. Corley (1998) described several behaviors that the transformation nurse manager would need to exhibit in supporting her staff in such a role transition. The behaviors are as follows: stimulate creativity, establish an environment that facilitates team work and learning, implement change, motivate staff to assume increased responsibility, help develop employees† awareness of organizational goals, delegate responsibility appropriately, communicate openly and directly with staff, and collaborate with peers. The significance of these behaviors in facilitating empowerment is seen as fundamental to creating collaborative practice environment. The final step in the process is to evaluate its effectiveness. In order to provide a clear and concise evaluation of the collaborative process one must look at all structural elements and all indicators of collaboration as previously discussed. Once accurate measures are identified and assessed the collaborative practice committee can discuss their outcomes and effectiveness. Over time, nurses and physicians may be able to articulate more clearly the changes in their practice and beliefs that have been affected by collaborating on patient care. Several of these key areas to examine would be: length of stay, patient and provider satisfaction, number of return visits, and changes in supply costs. Improvements in any of these areas could be due to favorable results from collaborative practice between nurses and physicians. In conclusion, many problems related to nurse physician collaboration are typically blamed on physicians. However the reality is that many of the barriers can be traced back to nursing as well. Collaboration is a process by which members of various disciplines share their expertise. Accomplishing this requires that these individuals understand and appreciate what it is that each professional domain contributes to the â€Å"whole†. The nurse manger plays a pivotal role in establishing an environment that is conducive to collaboration among the disciplines. Although it is a difficult road to follow the benefits of an effective collaborative unit out-weigh the difficulties of establishing such a practice. However, the nurse manager has an excellent vehicle for which to begin her journey and that is the use of transformation leadership, an empowering tool for change. How to cite The Nurse Managers Role, Essay examples