The American Nurses Association (ANA) has developed an informative, practical booklet, Bullying in the Workplace: Reversing a Culture, and an accompanying continuing education module to help nurses understand and deal with bullying and its perpetrators and to counter the culture of bullying in their work environments.
According to the Emergency Nurses Association, in 2009 more than 50 percent of emergency center nurses experienced violence on the job by patients. A study of student nurses reported that 53 percent had been put down by a staff nurse, and 52 percent reported having been threatened or experienced verbal violence at work.
Bullying can range from subtle, nonverbal cues to overt humiliation in front of colleagues. Changes in the work environment and patient care based on input from the direct-care nurses. Appraiser Comments: In the example pertaining to patient care, pre and post data were offered for Falls, HAPU, and HCAHPS. Organization Response: A new example is being provided for TL10EO to describe and demonstrate changes in the patient care based on input from the direct-care nurses. UC Irvine recognizes that direct-care nursing engagement is essential for continuing to improve patient outcomes and in creating a healthy work environment.
Whether through the input of the staff practice councils or the input of an individual direct care nurse, changes to patient care are often initiated or coordinated by the direct care nurse. In the spring of 2011, Rose Posadas RN, Tower 3 direct care nurse, an advocate for patient fall prevention, met with her manager, Angelica Ahonen, MSN, RN and Clinical Nurse Specialist, Khaled Al Eid, MSN, RN to discuss her interest in improving both patient safety and the work environment for her peers through leading a clinical ladder project.
Rose began her project in May 2011 by completing a literature search looking at fall prevention strategies.
To do this, she designed a survey tool to assess the effectiveness of patient education on her unit.
Rose compared the current risk assessment tool to the Johns Hopkins Fall Risk Assessment Tool and queried the staff with a survey conducted on May 19, 2011 to gather their feedback.
An interdisciplinary Patient Falls Prevention team was formed in June 2011 to review and update the overall falls prevention program. Rose then collaborated with leadership and staff to develop additional patient teaching modalities.
In June 2011, Rose then designed a staff education program that detailed the survey results; teach back method and new education tools. Changes in the work environment resulted from the input of a direct care nurse, Rose Posadas and the direct care nurses on Tower 3 during the falls prevention project. Increased staff awareness of availability of CCTV Fall Prevention Visibility provided for additional support for patient education. Changes in patient care resulted from the input of a direct care nurse, Rose Posadas and the direct care nurses on Tower 3 during the falls prevention project.
Patient falls on Tower 3 have significantly declined steadily beginning in June 2011 when the changes to the falls program became a focus and continue to be below the CALNOC benchmark. The VA Nursing Academy is a virtual five-year pilot program with central administration in Washington.  It expands learning opportunities for nursing students at VA facilities, funds faculty development of VA staff for additional faculty positions to competitively selected school partners.
The American Association of Colleges of Nursing has reported that in 2007 more than 36,000 qualified applicants were turned away from entry-level baccalaureate degree programs in nursing schools because of insufficient numbers of faculty, clinical sites, classroom space and clinical mentors.  VA currently provides clinical education for approximately 100,000 health professional trainees annually, including students from more than 600 schools of nursing. VA Nursing Academy enables competitively selected VA-nursing school partnerships to expand the number of nursing faculty, enhance the professional and scholarly development of nurses, increase student enrollment by about 1,000 students and promote innovations in nursing education.
The American College of Nursing is a premier Bay Area, CA vocational nursing college focused on providing quality entry level LVN nursing education and training to students from diverse backgrounds and cultures.
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Kurt Lewin’s (1890-1947) work had a profound impact on social psychology and, more particularly for our purposes here, on our appreciation of experiential learning, group dynamics and action research. His doctorate was undertaken at the University of Berlin where he developed an interest in the philosophy of science and encountered Gestalt psychology. Here we will not enter into the detail of Kurt Lewin’s field theory (it is beyond our remit). Kurt Lewin also looked to the power of underlying forces (needs) to determine behaviour and, hence, expressed ‘a preference for psychological as opposed to physical or physiological descriptions of the field’ (op.
It is not an exaggeration to say that Kurt Lewin had a profound impact on a generation of researchers and thinkers concerned with group dynamics. Kurt Lewin had looked to the nature of group task in an attempt to understand the uniformity of some groups’ behaviour. Both agree that democracy must be learned anew in each generation, and that it is a far more difficult form of social structure to attain and to maintain than is autocracy. One of the most interesting pieces of work in which Lewin was involved concerned the exploration of different styles or types of leadership on group structure and member behaviour. There have been few experiences for me as impressive as seeing the expression in children’s faces change during the first day of autocracy.
To instigate changes toward democracy a situation has to be created for a certain period where the leader is sufficiently in control to rule out influences he does not want and to manipulate the situation to a sufficient degree. There are some elements here that ring a little of Rousseau’s view of the tutor’s role in Emile. In the summer of 1946 Kurt Lewin along with colleagues and associates from the Research Center for Group Dynamics (Ronald Lippitt, Leland Bradford and Kenneth Benne became involved in leadership and group dynamics training for the Connecticut State Interracial Commission. At the start of one of the early evening observers’ sessions, three of the participants asked to be present. Lippitt (1949) has described how Lewin responded to this and joined with participants in ‘active dialogue about differences of interpretation and observation of the events by those who had participated in them’. Thus the discovery was made that learning is best facilitated in an environment where there is dialectic tension and conflict between immediate, concrete experience and analytic detachment. It was this experience that led to the establishment of the first National Training Laboratory in Group Development (held at Gould Academy in Bethel, Maine in the summer of 1947). A central feature of the laboratory was “basic skills training,” in which an observer reported on group processes at set intervals. What we see here is the basic shape of T-group theory and the so-called ‘laboratory method’. The approach was not without its critics – in part because of what was perceived as its Gestalt base. The research needed for social practice can best be characterized as research for social management or social engineering. The approach, as presented, does take a fairly sequential form – and it is open to literal interpretation. Action research did suffer a decline in favour during the 1960s because of its association with radical political activism (Stringer 1999: 9). Action research is a form of collective self-reflective enquiry undertaken by participants in social situations in order to improve the rationality and justice of their own social or educational practices, as well as their understanding of those practices and the situations in which the practices are carried out… The approach is only action research when it is collaborative, though it is important to realise that action research of the group is achieved through the critically examined action of individual group members. Just why it must be collective is open to some question and debate (Webb 1996), but there is an important point here concerning the commitments and orientations of those involved in action research. As this brief cataloguing of his work shows, Lewin made defining contributions to a number of fields.
Picture and diagram credits: Detail of plaque commemorating Kurt Lewin on the house where he was born. A well networked and results focused sales manager who possess proven marketing and leadership skills. Ensuring proper credit checks were completed on customers before products or services released to customers. Administration and data input duties to ensure that all records are kept up to date and accurate. Able to effectively communicate the benefits and value of a companies products or services to partners and potential customers.
Excellent communications skills to build relationships with potential new customers and to reinforce ones with existing clients.
Overseeing the recruitment of new sales and retail staff, as well as their training and induction. There were 2,050 assaults and violent acts reported by RNs that required an average of four days away from work.
Nurses must learn how to protect themselves from bullies in the workplace, and institutions must learn how to address and meet the needs of staff who are ostracized, picked on, talked about, threatened, ignored, and emotionally damaged within the work environment. Support at the administrative level provides opportunities at the unit level to create and support engagement which ultimately improves patient care.
The following describes a change in patient care that was based on input of a direct care nurse, resulted directly from the work of this direct care nurse and included the input of the direct care nursing staff.
Khaled Al Eid, Medical-Surgical Clinical Nurse Specialist (CNS), and Angelica Ahonen, Tower 3 Nurse Manager assisted and supported Rose during this process by providing guidance and suggestions on how to proceed as well as providing her time to work on her project.


Her initial thought was to use the Johns Hopkins Fall Risk Tool, however, after comparison and review, and input from her peers, she concluded that the current tool was effective and there was no need to implement a different tool at this time. Rose wrote a script in May 2011 for an additional patient education video focusing on fall prevention at this organization which was produced, and was available on the closed caption patient education TV channel the beginning of November 2011. The direct care nurses input was collected via a survey conducted May 19, 2011, prior to the education, and repeated November 9, 2011 after the education. The changes in patient care related to falls prevention were driven by the input of Rose, a direct care nurse. It has also launched a successful LVN to RN bridge program by partnering with leading universities.
Kurt Lewin was a seminal theorist who deepened our understanding of groups, experiential learning, and action research.
On this page we provide a very brief outline of his life and an assessment of his continuing relevance to educators. His PhD was awarded in 1916, but by then he was serving in the German army (he was injured in combat). There he continued to develop his interest in social processes, and to undertake research in that area. Any normal group, and certainly any developed and organized one contains and should contain individuals of very different character…. That the particular dangers they faced in many countries makes arguing a general case difficult.
Interdependence of fate can be a fairly weak form of interdependence in many groups, argued Lewin. In the former case one person’s success either directly facilitates others’ success of, in the strongest case, is actually necessary for those others to succeed also… In negative interdependence – known more usually as competition – one person’s success is another’s failure.
He remained unconvinced of the explanatory power of individual motivational concepts such as those provided by psychoanalytical theory or frustration-aggression theory (op.
Allport, in his introduction to Resolving Social Conflicts (Lewin 1948: xi) argues that there is striking kinship between the work of Kurt Lewin and that of John Dewey. The friendly, open, and co-operative group, full of life, became within a short half-hour a rather apathetic looking gathering without initiative. Unfortunately, as Gastil (1994) notes, Lewin and his colleagues never developed their definition beyond this rough sketch. The goal of the democratic leader in this transition period will have to be the same as any good teacher, namely to make himself superfluous, to be replaced by indigenous leaders from the group. Is it up to the leader to manipulate the situation in this way – or is there room for dialogue? They designed and implemented a two-week programme that looked to encourage group discussion and decision-making, and where participants (including staff) could treat each other as peers. By bringing together the immediate experiences of the trainees and the conceptual models of the staff in an open atmosphere where inputs from each perspective could challenge and stimulate the other, a learning environment occurred with remarkable vitality and creativity. By this time Lewin was dead, but his thinking and practice was very much a part of what happened. The skills to be achieved were intended to help an individual function in the role of “change agent”.
Initially the small discussion groups were known as ‘basic skill training groups’ but by 1949 they had been shortened to T-group. Lewin had borrowed the term from electrical engineering and applied it to the behavioural sciences. This particular aspect was drawn from developments in psychoeducational and cognitive-behavioural group therapy.
It is a type of action-research, a comparative research on the conditions and effects of various forms of social action, and research leading to social action. What we can see here is an approach to research that is oriented to problem-solving in social and organizational settings, and that has a form that parallels Dewey’s conception of learning from experience. One of the legacies Kurt Lewin left us is the ‘action research spiral’ – and with it there is the danger that action research becomes little more than a procedure.
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Of these, 1,830 of the victims were injured by patients or residents.  What’s more, from 2003 to 2009, eight RNs were fatally injured at work.
The Medical-Surgical Nursing Director requested that the unit Nurse Manager and nursing staff evaluate the current fall prevention program and determine if there were improvements that could be made. The clinical ladder projects provide one avenue for direct care nurses to directly influence change in the organization, work environment and patient care. The literature review suggested that there were two areas of the current program that needed to be reviewed; the effectiveness of the risk assessment tool and the effectiveness of patient education.
Additionally she surveyed the direct care nursing staff and reviewed nursing documentation to validate the survey results. As a result of the success on Tower 3, the project was disseminated house-wide to all clinical staff at UC Irvine in September 2011.
Rose Posadas submitted her project to the Nursing Quality and Research Review Board, and was successfully promoted to CN III status in December 2011 for completion of a meaningful project with positive results! After your original proof and three revisions submitted, each additionalproof will be $10 each. In 1921 Kurt Lewin joined the Psychological Institute of the University of Berlin – where he was to lecture and offer seminars in both philosophy and psychology.
Significantly, he became involved in various applied research initiatives linked to the war effort (from 1940 onwards). Without knowledge of, and obedience to, the laws of human nature in group settings, democracy cannot succeed. The change from autocracy to democracy seemed to take somewhat more time than from democracy to autocracy. This has left them open to the charge that their vision of democratic leadership contains within it some worrying themes. Research was woven into the event (as might be expected given Lewin’s concern for the generation of data and theory). A change agent was thought to be instrumental in facilitating communication and useful feedback among participants.
In 1950 a sponsoring organization, the National Training Laboratories (NTL) was set up, and the scene was set for a major expansion of the work (reaching its heyday in the 1960s) and the evolution of the encounter group (Yalom 1995: 488). Here it was broadly used to describe the adjustment of a process informed by information about its results or effects. It entailed the provision of models or organizing ideas through the medium brief lectures and handouts (and later things like film clips or video). If this first period of planning is successful, two items emerge: namely, “an overall plan” of how to reach the objective and secondly, a decision in regard to the first step of action. It can also be argued that model itself places insufficient emphasis on analysis at key points.
It is a mistake, according to McTaggart (1996: 248) to think that following the action research spiral constitutes ‘doing action research’. Having a consistent track record in achieving all sales targets set and of improving efficiency, maximize profits whilst minimizing costs. The Chief Nursing Officer, Karen Grimley, RN, BSN, MBA, PhDc gives full budgeted support for the unit and division practice councils as well as for the clinical ladder program. The goal was to conduct a literature review, gap analysis, provide recommendations, and design and pilot new interventions that could be disseminated to other nursing units.
As a result of this, Rose conducted an assessment of the organization’s current Falls Prevention Program looking closely at the above two factors. Rose discovered that 35% of patients who were assessed by the RN as at risk to fall stated they were unaware they were at risk to fall, 47% stated they were unaware of why they were at risk, and 24% could not say what they should do to prevent falling.
Leadership, including Angelica Ahonen, Khaled Al Eid and Susan Christensen BSN, MHA, RN, Medical-Surgical Director as well as the remaining membership of the Patient Falls Prevention Team accepted Rose’s recommendation resulting in the original risk tool remaining the tool of choice. He was starting to make a name for himself both in terms of publishing, and with regard to his teaching (he was an enthusiastic lecturer who attracted the interest of students). These included exploring the morale of the fighting troops, psychological warfare, and reorienting food consumption away from foods in short supply. As Allport in his foreword to Resolving Social Conflict (Lewin 1948: ix) put it, these three aspects of his thought were not separable. One who has grasped this simple idea will not feel that he has to break away from Judaism altogether whenever he changes his attitude toward a fundamental Jewish issue, and he will become more tolerant of differences of opinion among Jews. Subsequently, there has been some experimental support for the need for some elementary sense of interdependence (Brown 1989).
In other words, if the group’s task is such that members of the group are dependent on each other for achievement, then a powerful dynamic is created.


He was able to argue that people may come to a group with very different dispositions, but if they share a common objective, they are likely to act together to achieve it. And without freedom for research and theory as provided only in a democratic environment, social science will surely fail. They looked to three classic group leadership models – democratic, autocratic and laissez-faire – and concluded that there was more originality, group-mindedness and friendliness in democratic groups. In particular Kariel (1956, discussed by Gastil 1994) argued that the notion is rather manipulative and elitist. The trainers and researchers collected detailed observations and recordings of group activities (and worked on these during the event). One other participant agreed with her assertion and a lively discussion ensued about behaviours and their interpretations. He was also to be a paragon who was aware of the need for change, could diagnose the problems involved, and could plan for change, implement the plans, and evaluate the results. Connecting concrete (emotional) experience and analytical detachment is not an easy task, and is liable to be resisted by many participants, but it was seen as a essential if people were to learn and develop.
Perhaps the best known of these was the Johari Window (named after, and developed by, Joe Luft and Harry Ingram).
Elliott (1991: 70), for example, believed that the basic model allows those who use it to assume that the ‘general idea’ can be fixed in advance, ‘that “reconnaissance” is merely fact-finding, and that “implementation” is a fairly straightforward process’. The use of action research to deepen and develop classroom practice has grown into a strong tradition of practice (one of the first examples being the work of Stephen Corey in 1949). He continues, ‘Action research is not a ‘method’ or a ‘procedure’ for research but a series of commitments to observe and problematize through practice a series of principles for conducting social enquiry’. Sixty years on, he still excites discussion and argument, and while we may want to qualify or rework various aspect of his work (and that of his associates) we are deeply indebted to him both for his insights and the way he tried to bring a commitment to democracy and justice to his work.
Presently looking for a suitable sales managerial position with a reputable and successful company. However these curriculum vitae samples must not be distributed or made available on other websites without our prior permission. The clinical ladder program provides the bedside RN the opportunity to be mentored by either a clinical nurse specialist or a clinical nurse educator and to ultimately develop and implement a change in patient care.
Rose Posadas, RN, Tower 3, Clinical Nurse II, a direct care nurse, was deeply interested in fall prevention and volunteered to participate in the project. The nursing staff verbally validated and documented that patient teaching for at risk patients was always completed. The Falls Prevention Team accepted this recommendation based solely on input from Rose and the Tower 3 direct care nurses. His work became known in America and he was invited to spend six months as a visiting professor at Stanford (1930). His social commitments were also still strong – and he was much in demand as a speaker on minority and inter-group relations. What is more, a person who has learned to see how much his own fate depends upon the fate of his entire group will ready and even eager to take over a fair share of responsibility for its welfare.
Dewey, we might say, is the outstanding philosophical exponent of democracy, Lewin is its outstanding psychological exponent. In contrast, there was more aggression, hostility, scapegoating and discontent in laissez-faire and autocratic groups (Reid 1981: 115). What is more there has also been some suggestion that Mao’s mass-line leadership in China, ‘used a model like Lewin’s to mask coercion under the guise of participative group processes’ (discussed by Gastil 1994).
Initially these meetings were just for the staff, but some of the other participants also wanted to be involved. Word of the session spread, and by the next night, more than half of the sixty participants were attending the feedback sessions which, indeed became the focus of the conference. To become an effective change agent, an understanding of the dynamics of groups was believed necessary. There was a concern that organizations, groups and relationships generally suffered from a lack of accurate information about what was happening around their performance.
One must be helped to re-examine many cherished assumptions about oneself and one’s relations to others’ (op.
Yalom (1995: 490) comments, ‘The use of such cognitive aids, lectures, reading assignments, and theory sessions demonstrates that the basic allegiance of the T-group was to the classroom rather than the consulting room. For some there is an insistence that action research must be collaborative and entail groupwork. Rose received approval from the nurse manager to take the lead on this issue and to develop a Clinical Nurse Ladder project proposal related to Patient Fall Prevention.
The post-education survey of the direct care nurses conducted November 9, 2011 validated the decision not to change risk tools as the majority of the nursing staff, 55%, preferred to continue using the original risk tool.
With the political position worsening considerably in Germany and in 1933 he and his wife and daughter settled in the USA (he became an American citizen in 1940).
He wanted to establish a centre to research group dynamics – and in 1944 this dream was realized with the founding of the Research Center for Group Dynamics at MIT. An intrinsic state of tension within group members stimulates or motivates movement toward the achievement of desired common goals (Johnson and Johnson 1995: 175). More clearly than anyone else has he shown us in concrete, operational terms what it means to be a democratic leader, and to create democratic group structure. Lewin concludes that the difference in behaviour in autocratic, democratic and laissez-faire situations is not, on the whole, a result of individual differences. Such a possibility would have been disturbing to Lewin, whose commitments and intentions were democratic. Near the conference’s end, the vast majority of participants were attending these sessions, which lasted well into the night. Feedback became a key ingredient of T-groups and was found to ‘be most effective when it stemmed from here-and-now observations, when it followed the generating event as closely as possible, and when the recipient checked with other group members to establish its validity and reduce perceptual distortion’ (Yalom 1995: 489).
The participants were considered students; the task of the T-group was to facilitate learning for its members’. There were questions around action research’s partisan nature – the fact that it served particular causes. When set in historical context, while Lewin does talk about action research as a method, he is stressing a contrast between this form of interpretative practice and more traditional empirical-analytic research. It was determined that although the patient teaching had occurred, it was not effective as evidenced by the lack of patient comprehension.
At the same time Kurt Lewin was also engaged in a project for the American Jewish Congress in New York – the Commission of Community Interrelations. In his field theory, a ‘field’ is defined as ‘the totality of coexisting facts which are conceived of as mutually interdependent’ (Lewin 1951: 240). He argued that democracy could not be imposed on people, that it had to be learnt by a process of voluntary and responsible participation (1948: 39). The notion of a spiral may be a useful teaching device – but it is all too easily to slip into using it as the template for practice (McTaggart 1996: 249). It made use of Lewin’s model of action research (research directed toward the solving of social problems) in a number of significant studies into religious and racial prejudice. Individuals were seen to behave differently according to the way in which tensions between perceptions of the self and of the environment were worked through.
However, the problem becomes clearer when he discusses the nature of democratic leadership at moments of transition.
However, as Bogdan and Biklen (1992: 223) point out, research is a frame of mind – ‘a perspective that people take toward objects and activities’. The whole psychological field, or ‘lifespace’, within which people acted had to be viewed, in order to understand behaviour.
These two elements combined together to provide the basis for Deutch’s (1949) deeply influential exploration of the relationship of task to process (and his finding that groups under conditions of positive interdependence were generally more co-operative. Once we have satisfied ourselves that the collection of information is systematic, and that any interpretations made have a proper regard for satisfying truth claims, then much of the critique aimed at action research disappears.
He and his associates were able to get funding from the Office of Naval Research to set up the National Training Laboratories in 1947 in Bethel, Maine. Within this individuals and groups could be seen in topological terms (using map-like representations). Individuals participate in a series of life spaces (such as the family, work, school and church), and these were constructed under the influence of various force vectors (Lewin 1952). Lewin and Grabbe 1945) there was a tension between providing a rational basis for change through research, and the recognition that individuals are constrained in their ability to change by their cultural and social perceptions, and the systems of which they are a part.
Having ‘correct knowledge’ does not of itself lead to change, attention also needs to be paid to the ‘matrix of cultural and psychic forces’ through which the subject is constituted (Winter 1987: 48).



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