The Care Clinic Improvement Project University Essay Example


A Care Clinic, hereinafter known as CC is a healthcare facility operating in Summerville, Florida. As part of the management and improvement of the said facility, the administrator and investors established the Executive Team, hereinafter known as ET. The ET’s primary function is to perform an annual review of the CC’s performance. Using a particular client benchmark, the ET discovered a “decrease in client satisfaction scores related to courtesy and friendliness of the staff at the said Care Clinic”, and it was not a welcome development. The following pages describe the strategy that will be implemented to reverse the trend and increase the client satisfaction rating in terms of staff courtesy and friendliness.

Identify Why the Low Scores Have Been Attained

Two scenarios were analyzed to have a deeper understanding of CC’s reported low performance and decreasing client satisfaction in terms of courtesy and friendliness. The first scenario focuses on the interaction between a patient named Mr. Hawk and an unnamed nurse (Whitemouse Productions, 2016a). In this sequence, the nurse was supposed to get Mr. Hawk’s vital signs. However, she did not have the skills to make the patient comfortable and willing to cooperate with her, to get the needed health measurements. Also, the nurse was distracted by the things that she needed to do and she forgot to get the patient’s vital signs.

Complicating the scenario was the presence of a senior nurse that also seemed to function in an administrative capacity. The superior did not exhibit any semblance of a relationship-based care type of leadership. There was no warm and friendly relationship between the nurses as exemplified by the fact that the more senior nurse seemed to monitor the situation using her computer. When she confronted her subordinate she did not elicit the appropriate response. The expected response was for the subordinate to provide accurate information and report that the task was done and that the protocols were followed. On the contrary, the subordinate lied, and she said that Mr. Hawk’s vital signs were already encoded into the computer. At the end of the video clip, it was made clear why the head nurse did not inspire excellence from the support staff. She did not have the prerequisite skills to perform her expected duties as revealed by her unprofessional actions.

The second scenario focuses on the interaction of a nurse and a patient suffering from obesity and medical complications related to obesity. The physician on duty did not behave in a way that communicates that her undivided attention was for the benefit of the patient (Whitemouse Productions, 2016b). Her questions seemed hurried and she did not make appropriate follow-up questions. When the patient answered one of her questions she did not acknowledge it, she did not make additional comments and she did not make any clarifications. This gave the impression that she was extremely busy and she wanted the consultation to end so that she could attend to her other duties. This was confirmed at the end of the exchange when she told the patient that she will assist him in their next meeting provided that she was not working on other important things.

The reported decrease in client satisfaction scores related to courtesy and friendliness of the staff was rooted in three major factors. First, there was a problem in this area, because of the absence of an organizational culture that promotes excellence in the workplace. Second, there was an absence of an organizational culture that promotes relationship-based care. Finally, there was an absence of an organizational culture that promotes the importance of improving client satisfaction ratings. To affect change, it is imperative to establish specific components of an appropriate organizational culture.

The Leadership Dynamics

It is important to point out that any significant changes that must be achieved in the next few months are dependent on superior leadership. It is imperative to appoint someone with the necessary skills to initiate changes and motivate the health workers assigned to the CC to make the necessary adjustments to improve the said benchmark for change. In this regard, there is a need to provide an overview of the six values of the system leadership framework: 1) the mindset that “we” are all in this together; 2) significantly decrease the importance of superiors and subordinates in terms of working together and providing excellent service; 3) the need to access reliable information; 4) need for honest and open communication; 5) the need to focus on the process; and 6) the concept of no success or failure, focus on the process because change is a journey.

With regards to values 1 and 2, there is a need to break down the walls between superiors and subordinates, because of the need for greater collaboration. This mindset also promotes the fair sharing of the workload and inspires people to give more than expected. Value number 3 requires training and empowerment of the workers so that they get quality information on how to perform their duties and upgrade their skills. Value number 4 encourages health workers to make clarifications and make suggestions creating a free-flowing stream of ideas that helps improve the system. Value number 5 promotes a long-term commitment and inspires people to be patient and not get easily discouraged along the way. Value number 6 prevents the establishment of a culture of blame and prevents subordinates from reporting and admitting mistakes due to the fear of reprisals.

Aside from having the right mindset fostered by the six values leadership framework, it is also critically important to develop and apply key leadership skills, such as, foresight, visioning, developing partnerships, and the ability to motivate CC’s healthcare workers. Change begins with a realization borne out of foresight. In other words, the leaders see the problems down the road and make the necessary changes before the organization reaches that problematic area. Visioning or the ability to cast a strategic or corporate vision is an ability that allows the leader to illustrate a mental picture of the goal and the change process required to achieve that goal. The leader also needs to develop partnerships or collaborate with key personnel to accomplish stated goals. Finally, the leader must possess the capability to motivate CC’s healthcare workers and support staff to help them endure the challenges up ahead and prevent a high turnover rate.

The skills described earlier are useless if these are not applied in the context of a relationship-based care framework. In other words, the leader must not demand change and force corporate-wide adjustments as if he or she is a military officer issuing stern commands. It does not mean that the leader must refrain from being strict and stern, but the mode of communicating and inspiring change from within requires a diplomatic approach that values workers as important resources within the organization, and not as mere tools that are utilized to achieve a certain goal.

The Change Model

Kurt Lewin’s Change Management Model provides an appropriate framework to improve CC’s client satisfaction in the aforementioned benchmark for change. Applying the model can help improve client satisfaction in the context of courtesy and friendliness. Lewin’s model for change is comprised of three major phases. The first phase is the “unfreeze” stage. The second phase is the “change” stage (Connelly, 2016). Finally, the third phase is the “freeze” stage. Lewin’s model was selected due to its practical applicability (McCalman & Potter, 2015). Consider for instance the model’s three stages that quickly identify the starting point, the things that needed to be done while in transition, and how to develop an exit strategy or a termination phase.

The so-called “unfreeze” stage of the model requires the deliberate decision to make the necessary changes. It paves the way for self-examination and the need to honestly acknowledge mistakes before the process of change may take its course. This may cause conflicts and disorientation as the organization is forced to examine every facet of the group’s business processes or client-related services. Thus, it suggests the idea of unraveling or unfreezing of something that was inadvertently established as the current organizational culture or the company’s status quo.

The second phase requires the implementation of change. The most important thing to focus at this stage is the elements of transition, making the people aware that they are applying changes to certain areas and that they are adopting new principles or new mindsets needed to affect a positive change in their respective behavior. Furthermore, the leader must manage the expectations as well as the people’s anxiety on the perceived consequences of the applied intervention or correction strategies. CC’s workers must have the assurance that they are going through a process and not a magic formula that instantly guarantees positive results (McGrath & Bates, 2013). This type of attitude prevents discouragement and disillusionment when change does not occur at an expected time.

The third and final phase is the “freeze” stage. This final stage requires the application of principles and leadership to sustain change or make the change permanent. The second most important component of this phase is the leader’s demonstrated ability to eliminate or reduce the uncertainties and confusion that came about as the result of implementing new guidelines, new rules, and new ideas (Cummings & Worley, 2014). At this point in the process, the leader must have the ability to receive feedback and analyze the information that was gathered. The leader must know how to make the necessary adjustment to adopt new strategies or new ways of doing things. To achieve a higher probability of success, it is imperative to apply leadership skills based on the aforementioned six values framework, as well as the ability to benefit from leadership foresight, vision casting, collaboration, and inspiring co-workers.

Describe the Course of Action

To make the necessary changes and improve CC’s client satisfaction ratings in the context of courtesy and friendliness, it is exigent to implement a seven-step change process based on Lewin’s Change Management Model. The first step requires the identification of the problem and the root cause of the problem. The second step calls for stakeholder analysis. The third step involves vision casting or the illustration of the mental image of the changes needed to effect CC’s client satisfaction metrics. The fourth step compels the leader to collaborate with the identified stakeholders in implementing a specific plan to initiate changes within the organization. The fifth step requires the re-education of healthcare workers on the fine points of relationship-based care. The sixth step calls for the implementation of strategies and testing methods to apply the lessons learned through seminars, mentoring, and other information dissemination techniques. There is also the need for the leader to model the principles described in the relationship-based care framework of providing excellent care and client-related services. Finally, the seventh stage requires constant evaluation of feedback and providing feedback to the stakeholders and the key personnel expected to drive forward the expected change strategies and change processes.

The change process is translated into a 12-month program. The first month involves the analysis of the situation. This also requires interviewing the different stakeholders and developing appropriate questionnaires to determine clients’ perceptions and expectations when it comes to courtesy and friendliness. In the second month, the leader must complete an in-depth analysis of stakeholder’s participation and impact. In the third month, the leader must develop a practical plan involving the participation of the identified stakeholders. For example, the determination to involve the participation of the nursing staff and various support staff leads to the implementation of a strategy that boosts their morale, increases their collaboration and the collection of information relayed via their feedback. The plan may also include various ways of shaping a new organizational culture. The fourth to nine-month period will be spent on the re-education or the training of the healthcare workers.

The training phase involves seminars, video presentations, distribution of reading materials, and mentoring programs. During these six months the leader does not only ensure the delivery of information concerning relationship-based care, he or she must also demonstrate or model how these changes are ought to be applied in a clinical setting. It also requires the leader to develop relationships with various stakeholders, especially key personnel helping him or her drive change within the organization. The mentoring program provides an avenue for the leaders to teach critical principles and other important ideas to key personnel, and in the process developing a team that can help the leader make sustainable improvements to the CC’s business processes. The leader must develop a sensitivity to the impact of his or her actions. The leader must realize that his or her words have little value if he or she cannot model behavior that others can follow. The last two months will be spent on evaluation and the application of various “freezing” strategies to embrace and preserve practical and effective change strategies and stabilize the organization to reap the benefits of a sustainable strategy designed to affect positive change and improve a specific benchmark for change.


CC’s leadership and executive team can implement change and improve ratings when it comes to client satisfaction in the context of courtesy and friendliness. It is important to identify applicable leadership skills and a change management model. Lewin’s Change Management model is a perfect fit due to its simplicity and clarity of the stages that help leaders initiate change and implement an exit strategy or terminate the change process. It is also important to embrace the principles of relationship-based care. It is also exigent to not only teach change but also to model the principles through mentoring programs and demonstration of how to apply the said ideas in a hospital or healthcare facility setting.


Connelly, J. (2016). Kurt Lewin change management model. Web.

Cummings, T., & Worley, C. (2014). Organizational development and change. San Francisco, CA: Cengage Learning.

McCalman, J., & Potter, D. (2015). Leading cultural change: The theory and practice of successful organizational transformation. Philadelphia, PA: Kogan Page.

McGrath, J., & Bates, B. (2013). The little book of big management theories. London, UK: Pearson.

Whitemouse Productions. (2016a). Customer services score and staff. Web.

Whitemouse Productions. (2016b). Customer services scores and staff – video clip 2. Web.

Nuclear Industry And Physics


The nuclear industry provides the modern world with rather substantial amounts of energy. However, all processes that are involved in the production of this energy result in equal amounts of waste and are highly radioactive in general. Learning from mistakes of the past, modern science operates with an extensive number of nuclear waste disposal methods and continues to design new ways and technologies to secure nuclear energy production. Nuclear catastrophes in Chernobyl and Fukushima gave an impetus to numerous studies of nuclear fusion that present a profitable alternative to nuclear fission. The international science community’s search for safe nuclear fuel processing methods will eventually lead to success in this sphere because even at the present moment there are numerous ways of advantageous nuclear waste treatment as well as successful studies of nuclear fusion.

Sources of Nuclear Power

Nuclear plants use uranium fuel in order to produce energy through a process of nuclear fission. As a rule, the fission of the uranium nucleus provides 200 MeV of energy, which is a rather significant amount (Sharrad et al. 40). With the high energy density of nuclear fuel and small volumes of this fuel that are required to produce the energy, the nuclear industry proves to be very profitable. Nuclear fission largely depends on the thermal neutron fission of the natural isotopes 235U and 238U that have approximately 0.025 eV of energy (Sharrad et al. 41). By neutron irradiation, these isotopes are processed into artificial isotopes such as 239Pu, which are used in the production of energy. Thus, nuclear fuel has to undergo four stages of processing before being used in a reactor: mining, enrichment, conversion, and fabrication.

Uranium ore that may be extracted in open and closed mines serves as the main source of uranium fuel. In the process of leaching with sodium carbonate solution or sulfuric acid, uranium is extracted from the crushed ore. After that, with the help of ion exchange or solvent extraction, it is concentrated from the obtained leachate (Sharrad et al. 41). When uranium is extracted and concentrated, it undergoes the process of enrichment in which the initial proportion of natural isotopes is increased and converted into UF6 fuel. Enrichment results in two products: enriched and depleted uranium. The amounts of the latter are rather significant, but, in present days, science only studies the ways of its practical implementation. After the enrichment, UF6 is shipped to the nuclear facilities where it is reconverted into UO2 and formed into solid pellets. Only after the pellets are loaded into stainless steel tubes they can be used in reactors for the production of energy (Sharrad et al. 42).

Given that uranium ore contains not only natural isotopes 234U, 235U, and 238U, but also other radioisotopes, uranium mining and extraction result in significant radionuclide wastes, especially when low-grade ore is used for the extraction. Besides that, the process of enrichment is also radioactive and implies plenty of wastes. With this consideration in mind, the processes of nuclear waste utilization and its possible minimization should be considered.

The Problem of Nuclear Waste

Although the nuclear power industry allows obtaining high amounts of energy from a small amount of fuel with an equally small amount of wastes, the latter is radioactive and must be treated as hazardous. The nuclear industry has to deal with different types of radiation, namely, alpha, beta, and gamma radiation (“Waste Management” 10). The most dangerous type is gamma radiation that penetrates into the body causing severe damage to the central nervous system and inner parts. To protect people from this radiation, several inches of concrete and lead as well as three feet of water should be used.

Basing on the amount and types of radioactivity, science distinguishes low-level, medium-level and high-level wastes. The time during which wastes remain hazardous also plays an important role in their treatment. It depends on half-life characteristics of the type of radioactive isotopes that are contained in wastes. Some isotopes have half-lives of a second, some – of centuries. However, the level of radioactivity tends to decline with time and wastes become stable and non-radioactive.

There are three approaches to nuclear waste treatment: concentrate-and-contain, dilute-and-disperse, and delay-and-decay (“Waste Management” 7). The first two approaches are employed in the handling of both radioactive and non-radioactive wastes. In these approaches, wastes are processed and secluded, or attenuated to appropriate levels of radioactivity and then let out to the environment. Delay-and-decay approach implies the storage of wastes until their radioactivity is naturally decreased through the radioisotope decay.

The problem of nuclear waste has another method of solution. Scientists stress the necessity of nuclear waste minimization that implies both the reduction of generated waste and volumes of waste that exist already. There are three approaches to waste minimization: reduction of the source, recycle and reuse, and optimization of waste processing (International Atomic Energy Agency 4). The reduction of the source means the elimination of waste in the process of nuclear fuel extraction and use. Recycle and reuse imply the utilization of valuable materials from generated waste in the original nuclear production process. Optimization of waste processing requires special technology that improves the quality of generated waste and minimizes its volume for storage and discharge into the environment.

Cases of Chernobyl and Fukushima

Accidents in Chernobyl, Ukraine, and Fukushima, Japan in 1986 and 2011 have one common reason – problem with reactors. One of the Chernobyl Nuclear Power Plant reactors was destroyed by the steam explosion. In the case of Fukushima, the Tohoku earthquake destroyed the cooling system of three reactors at the Fukushima Nuclear Power Plant which resulted in the nuclear meltdown and the discharge of radioactive products in the environment. Further, there is a detailed study of the exact reasons for these nuclear tragedies.

On 26 April 1986, the reactor staff of the Chernobyl Nuclear Power Plant conducted a series of planned technical tests in Unit 4, during which the power level was accidentally decreased. The concentration of xenon-135 that absorbs neutrons in order to balance the reaction rate in the nuclear reactor thus increased, which led to the xenon poisoning of the reactor (Steinhauser et al. 801). Initially, all attempts of the reactor stuff to increase the power level failed. However, as a result of the subsequent sharp increase of the power level, xenon was burned out, and the voids of cooling water were disabled (Steinhauser et al. 801). Because of the latter, the reaction rate sharply increased. Thus, the reactor was destroyed by sudden power excursion caused by the steam explosion and inflammation of graphite moderators.

On 11 March 2011, the Tohoku Earthquake occurred in the Pacific Ocean, 163 km northeast of the Fukushima I Nuclear Power Plant, causing a tsunami that created immense destructions along the coastline. The three of six boiling water reactors were automatically shut down, the diesel generators of the three others were severely damaged, leaving the main cooling systems disabled. As a result, the partial meltdown of the fuel elements occurred (Steinhauser et al. 801). In addition, the high temperatures lead to the oxidation-reduction reaction between water and zirconium, which caused the generation of extreme amounts of hydrogen gas. In order to release the overpressure, the staff initiated urgent ventilation. As a result, hydrogen gas and radioactive products were discharged into the lower level of the reactor facilities. This caused three oxy-hydrogen gas explosions that destroyed four nuclear power plant buildings (Steinhauser et al. 801). Thus, the reactors were destroyed due to the loss of cooling caused by the earthquake.

Problems of Safety

The previous section makes it possible to conclude that the problem of nuclear power reactors security is essential for the safe operation of nuclear facilities. After the tragedies in Chernobyl and Fukushima, specialists became concerned with the question of the possibility to make nuclear power reactors safe or at least safer than they were. Apparently, in the nuclear industry, as in other industries of energy production, the matter of safety addresses the questions of intelligent planning, high-quality equipment, proper design of the supporting systems, as well as the well-developed safety culture of operational performance.

In response to these requirements, Western science developed the “defense-in-depth” approach which principles are expressed in the triple slogan “Prevention, Monitoring, and Action” (“Safety of Nuclear Power Reactors” 28). This approach considers such aspects as the design and construction of nuclear power facilities that allow for the prevention of mechanic disturbances as well as human mismanagement; complex monitoring programs that are based on a regular equipment testing; diverse systems of damage control and radioactive release prevention; and systems that provide certain limits to significant fuel damage (“Safety of Nuclear Power Reactors” 30).

Three main functions should be performed in the facility in order to provide safety of a nuclear reactor: control of reactivity, fuel cooling, and the containment of radioactive substances.

The most important factors for the safety of reactors are the negative temperature and void coefficients. The majority of existing reactor safety systems require active participation, that is, the mechanical operation via command. However, some of reactor safety systems operate passively. There is a common misconception that inherent reactor safety designs depend on the operation of engineered components. In fact, they depend on various physical phenomena such as gravity, convection, and high-temperature resistance. Although the majority of existing reactors operate with the help of inherent safety elements, the design of active cooling systems may help to eliminate the risk of accidents similar to the Fukushima tragedy, in which the electrical power loss resulted in the loss of cooling.

Fusion Power

The idea of nuclear fusion was introduced back in 1920 when science had a rather small understanding of the atomic nucleus nature. Arthur Eddington, the British theoretical physicist, expressed the belief that someday people will learn how to release and use the sub-atomic energy. Nuclear fusion is almost a limitless source of safe, pure, and self-sustaining energy. However, in almost a century, science made only one little step towards nuclear fusion. The problem with fusion power is that fusion reactions occur at immensely high temperatures because atomic nuclei must have a large amount of energy to collide, overcome the Coulomb repulsion, and near to the powerful nuclear force that merges them. There are many possible fusion reactions; however, practically all present-day fusion studies are aimed at obtaining power from the deuterium-tritium reaction because it is the easiest reaction to initiate (Cowley 385).

Currently, nuclear science faces two problems: initiation and maintenance of the reaction. As of today, it has managed to heat nuclear fusion plasma to 900 million degrees Fahrenheit and maintain it for almost four minutes, although with the help of different reactors (Cowley 387). The studies are performed in the United States, the United Kingdom, Japan, India, France, etc. The main problem that is common for all countries is funding because nuclear fusion is the sphere of scientific research that has a prolonged timescale. Although the benefits of nuclear fusion research are rather obvious since they address the issue of energy scarcity that is important for the modern world, the international community will not perceive them in a prolonged time.


The nuclear industry is superior to other energy production industries since it allows us to produce large amounts of energy using small amounts of fuel. The problem of the radioactivity of nuclear waste has a set of methods helping to solve it. Nuclear accidents in Chernobyl and Fukushima initiated the number of researches aiming at the design of secure nuclear facilities. As a result, Western science has developed a defense-in-depth approach to the maintenance of nuclear power plants. Currently, nuclear power production is based on nuclear fission. However, scientists continue their research in a nuclear fusion that provides pure and self-sustaining energy. There is much that has to be done, but with essential funding and governmental support, nuclear science will eventually progress.

Works Cited

Cowley, Steven C. “The quest for fusion power.” Nature Physics, vol. 12, no. 5, 2016, pp. 384-386.

International Atomic Energy Agency. “Minimization of Waste from Uranium Purification, Enrichment and Fuel Fabrication.” IAEA Scientific and Technical Publications. 1999, Web.

“Safety of Nuclear Power Reactors.” World Nuclear Association, 2016, Web.

Sharrad, Clint A., et al. “Nuclear Fuel Cycles: Interfaces with the Environment.” Nuclear Power and the Environment, edited by Roy M. Harrison and Ronald E. Hester, Royal Society of Chemistry, 2011, pp. 40-56.

Steinhauser, Georg, et al. “Comparison of the Chernobyl and Fukushima Nuclear Accidents: A Review of the Environmental Impacts.” Science of the Total Environment, vol. 470, no. 1, 2014, pp. 800-817.

“Waste Management: Overview.” World Nuclear Association. 2012, Web.

Patient Medication Education For Chronic Diseases

PICOT Question

In elderly patients with chronic diseases, (I) do patient education intervention, (C) compared with only medication treatments, (O) increase their health knowledge and improve their health status (T) in a period of 6 months?

To answer the PICOT question, it is necessary to conduct a study that will observe a particular group of people with chronic diagnoses. The group must be educated as to the use of appropriate medications for six months. As people will be capable of treating themselves with particular medicaments, the results will either prove or refute the questions above.

Another sound suggestion to the study would be to make the education classes not more than twice a week. Otherwise, an informational overload might be possible in case if all this knowledge is delivered to patients who have chronic diagnoses. Also, an individual approach must be considered here because all the participants will have different diseases that require varying treatment processes and outcomes.

Evidence Synthesis

The Lancet Study #1 Study #2 Study #3 Study #4 Study #5 Synthesis
(p) Population Nursing professors and practitioners from the United States of America Nursing programmers and educators employed by the Department of Medicine and Community Health Sciences, the Cumming School of Medicine, and the University of Calgary in Canada Nursing professionals and scholars from the Patient Education Research Center, the School of Medicine, and Stanford University situated in the USA. Medical professors from the University of Washington and employees of the Group Health Research Institute. Nursing practitioners who work at the Department of Economics at the Canadian University of Saskatchewan. As all the articles are performed and released by professional educators in the sphere of medicine, their observations and conclusions can be trusted and considered reliable.
(i) Intervention Educating groups of patients to prevent the development of their chronic diseases. Intervention 1will be enrolment in a new drug formulary (operationalized through their existing government drug insurance) that will eliminate copayments for high-value preventive medications (those which prevent myocardial infarction, strokes, hospitalizations and delay the progression of kidney and other vascular diseases)” (Campbell et al., 2015). Performance of the CDSMP (Chronic Disease Self-Management Program) will be organized to help people with serious diagnoses to overcome their health issues with the help of activities that they will be taught during the upcoming lectures. The impacts of what is called mHealth on patients’ understanding and the use of appropriate medicaments. Education of groups with diagnoses of asthma and COPD (chronic obstructive pulmonary disease). All the interventions imply programs and courses aimed at educating people with chronic diseases.
(c) Comparison The results regarding the patients’ knowledge were evaluated after the study The participants’ knowledge was assessed before and after the experiment No evaluation The participants’ knowledge was assessed after the experiment Results were evaluated at the end of the study The major part of the conclusions was made at the end of the research.
(o) Outcome Participant understand when it is necessary to take medications Changes in medication self-efficacy and adherence to acquired knowledge (Campbell et al., 2015). The study participants have enough knowledge to treat themselves mAdherence showed positive results regarding patients’ self-treatment. COPS and asthma patients can now utilize their chronic diseases. “The study suggests that effective patient education and increasing access to spirometry increases the utilization of chronic disease management drugs among asthma and COPD patients” (Sari & Osman, 2015). Participants of almost all studies benefited from their education sessions.
(t) time Not stated 6 months Not stated 6 months 2 months The chosen authors had enough time to answer the PICOT question.

Evaluation Table

Citation Design Sample size: Adequate? Major Variables: Independent and Dependent Study findings: Strengths and Weaknesses Level of Evidence Evidence Synthesis
1. Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. The Lancet, 384(9937), 45-52. doi:10.1016/s0140-6736(14)60648-6 A qualitative study that evaluates results and other authors’ observations The sample size is not stated. However, it can be claimed adequate because all participants had various chronic diseases, which makes a decent diversity among the sample members. The Independent variable implies chronic disease in the patients (Bauer, Briss, Goodman, & Bowman, 2014).

The dependent variable is their level of knowledge regarding self-treatment

Strengths: Identification of many factors impacted by self-treatment.

Weaknesses: Many uncertainties and unmentioned facts as to the treatment of patients.

Level III Although patients were not approached during the study, the importance of collaborative education sessions is evident as only one nurse is not able to provide appropriate knowledge to all his or her patients efficiently (Bauer et al., 2014).
2. Campbell, D. J., Tonelli, M., Hemmelgarn, B., Mitchell, C., Tsuyuki, R., Ivers, N.,… Manns, B. (2015). Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS)—Study protocol for a 2×2 factorial randomized trial. Implementation Science, 11(1), 25-46. doi:10.1186/s13012-016-0491-6 A quasi-experimental study that assessed the patients’ knowledge at the end (Campbell et al., 2015). 4714 people took part in the study. Hence, the results are adequate. The Independent variable is the difference in medical adherence (Campbell et al., 2015).

Dependent variable: methods of education and analyses.

Strengths: an extended sample.

Weaknesses: no weaknesses were identified in the study

Level IV Patient interaction appears to be one of the most important factors in education practices as it helps them remember the learned information much quicker than usual.
3. Lorig, K. (2015). Chronic disease self-management program: Insights from the eye of the storm. Frontiers in Public Health, 2(1), 36-54. doi:10.3389/fpubh.2014.00253 A literature review was performed by the author No patients participated in the study because it only implied a literature review. The Independent variable is the location of participants (Lorig, 2015). The dependent variable is their implementation of the acquired knowledge. Strengths: The provision of useful and unique information that was never discussed before (Lorig, 2015).

Weaknesses: the lack of real-life examples.

Level IV The evidence of the study cannot be claimed relevant because this source is the first one to discuss approaches presented in it (Lorig, 2015). However, this knowledge is useful, and hence, can be implemented in practice.
4. Hamine, S., Gerth-Guyette, E., Faulx, D., Green, B. B., & Ginsburg, A. S. (2015). Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. Journal of Medical Internet Research, 17(2), 52-88. doi:10.2196/jmir.3951 The article presents a quantitative study based on survey results. According to the authors, sample sizes varied tremendously (from 4 to approximately 710) (Hamine, Gerth-Guyette, Faulx, Green, & Ginsburg, 2015). This example is not adequate due to the sample size’s uncertainty. The Independent variable was presented by a wide range of study objectives, methods, and results. In turn, the dependent variable explained what were the benefits of mHealth to the patients. Strengths: a prolonged experiment with considerations of previous studies’ results (Hamine et al., 2015).

Weaknesses: no weaknesses were identified in the research.

Level IV The use of m Health is now known all over the world because its efficiency in the education of old people with chronic diseases was confirmed by many European and American scholars.
5. Sari, N., & Osman, M. (2015). The effects of patient education programs on medication use among asthma and COPD patients: A propensity score matching with a difference-in-difference regression approach. BMC Health Services Research, 15(1), 91-126. doi:10.1186/s12913-015-0998-6 “Using Saskatchewan administrative health databases, the impacts of the intervention on use of asthma and COPD medications were estimated for one to four years after the intervention using a difference in difference regression approach” (Sari & Osman, 2015). 185 individuals with chronic diseases participated in the research, which is adequate The Independent variable implies both the use and prices of prescription drugs (Sari & Osman, 2015). The dependent variable implies their appliance by sample members. Strengths: focusing on a specific category of patients with chronic diseases (Sari & Osman, 2015).

Weaknesses: no weaknesses were identified in the study.

Level IV The auricle revealed the significance of adherence to appropriate medications by patients with both COPD and asthma (Sari & Osman, 2015). Otherwise, they might have to stay in hospital settings for an extended period.


Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. The Lancet, 384(9937), 45-52. Web.

Campbell, D. J., Tonelli, M., Hemmelgarn, B., Mitchell, C., Tsuyuki, R., Ivers, N.,… Manns, B. (2015). Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS)—Study protocol for a 2×2 factorial randomized trial. Implementation Science, 11(1), 25-46. Web.

Hamine, S., Gerth-Guyette, E., Faulx, D., Green, B. B., & Ginsburg, A. S. (2015). Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. Journal of Medical Internet Research, 17(2), 52-88. Web.

Lorig, K. (2015). Chronic disease self-management program: Insights from the eye of the storm. Frontiers in Public Health, 2(1), 36-54. Web.

Sari, N., & Osman, M. (2015). The effects of patient education programs on medication use among asthma and COPD patients: A propensity score matching with a difference-in-difference regression approach. BMC Health Services Research, 15(1), 91-126. Web.

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