In January of 2010, the reporters of NPR News in cooperation with Planet Money have purchased a toxic asset to learn more about the 2008 financial crisis. Toxic assets are usually financial assets that have lost their value due to mortgages not being paid and cannot be sold at a good price anymore. The reporters acquired one of these and decided to look into its history, and learn the stories of the people who invested in it. After conducting their investigation, the events were documented in audio, text, and video form, which garnered a significant audience. One of the unique features of this project is the video presentation made by Planet Money, as the creators chose to portray the toxic asset as an anthropomorphized creature named “Toxie”.
When recounting the story of Toxie, the reporters explain how “she” came to be, and how her life began at the peak of the housing market, progressed through the years. They visually show how subprime loans from banks made Toxie worse, with many borrowers being unable to or deciding not to pay their mortgages, abandoning the accumulated debt and property. With many people not paying the banks, the investors also did not get their money back, and quickly tried to get rid of their assets while they still have value. This shift is represented in the animated video as Toxies becoming weird and getting sent to the pet store to get sold at a large discount. The cuteness of the simplified presentation helped me to acknowledge the timeline and to get a better understanding of the more difficult parts of this event. The association of a toxic asset with a pet was useful for showing how different involved organizations influenced it, as well as to help the viewer base engage with the content.
The Incorporation Of Evidence-Based Practice Into The Nursing
Abstract
The issues of quality and patient safety have increasingly become the focus of nursing practice in contemporary society. The purpose of this paper is to highlight the significance of incorporating evidence-based practice (EBP) in nursing care. EBP involves the incorporation of scientific knowledge into care processes to enhance healthcare quality and safety. The introductory section of this essay will provide the background information regarding EBP, including the thesis statement. Part A will underscore the goal of utilizing evidence-based practice in nursing. Part B will explore the rationale for teaching students and practice nurses research methods as a prerequisite for EBP. Part C will appraise a nursing journal that illustrates how Australia is using EBP to manage the catheter-associated urinary tract infections in nursing homes. The final section (Part D) will summarize the main ideas presented in the entire paper.
The issues of quality and patient safety have increasingly become the focus of nursing practice in contemporary society. The provision of efficacious and safe care is essential to facilitate quality improvements and healthcare reforms (You et al., 2013). Evidence-based practice (EBP) has emerged as the principal prerequisite that is now driving the patient care processes. According to Polit and Beck (2008), EBP entails the incorporation of the best available research evidence into nursing decisions to optimize the caring process. Polit and Beck have argued that EBP informs clinical decisions based on scientific proof rather than personal intuitions. As such, it is imperative for every nurse to employ the evidence-based practice as the foundation for improving health care quality and enhancing clinical outcomes.
Evidence Based Practice
The transition towards EBP has played a fundamental role in bridging the quality chasm between the conventional practices and the most effective health care. One of the critical concerns of healthcare has been the irrational disparities in the delivery of care (You et al., 2013). Titler (2007) has identified these variations as the underlying risk factors for the unpredictable clinical outcomes. Thus, the EBP movement encourages all the health care professions, particularly the nurses, to integrate the best scientific knowledge of care processes (Lubejko, 2014). The EBP standardizes healthcare practices to improve quality (Finkelman & Kenner, 2013). The evidence-based practice is core to nursing care for various reasons.
Firstly, EBP has played an instrumental role in establishing the tenets of accountability both at the public and professional levels. Medication errors, coupled with the rising incidences of hospital-acquired infections (HAIs) have moved to the forefront the issues of quality and safety (Polit & Beck, 2008). Titler (2007) has found out that the traditional practices of nursing care may be harming patients inadvertently. Thus, the Institute of Medicine (IOM) has generated reports that have consistently underscored the role of evidence-based interventions in addressing these concerns. The continuous use of the untested interventions is unjustifiable in ethical terms (Finkelman & Kenner, 2013). The best available evidence is crucial because it helps the nurses to make rational decisions when developing and implementing care plans (You et al., 2013).
Secondly, EBP eliminates the unnecessary and ineffective practices that compromise the quality and safety of nursing care. Nurses have traditionally employed the trial-and-error approach when providing care to patients. Nonetheless, this methodology is not only time-consuming but it is also counter-productive (Polit & Beck, 2008). EBP has addressed these critical concerns by facilitating the process of developing the tools for managing patient care. The nurses are now using different sources of research evidence to formulate care maps, protocols, and critical pathways. The patient management tools reduce the inherent variability in nursing care and practices (Armola et al., 2009).
Thirdly, EBP supports the implementation of person-centered care in nursing practice. One of the core competencies developed by the IOM is the delivery of personalized and holistic care. Conversely, the uniqueness of individual patients may discourage nurses from using the best evidence (Finkelman & Kenner, 2013). Lubejko (2014) has acknowledged the uncertainty that is inherent in the nursing care processes. The integration of scientific evidence from these procedures quantifies these uncertainties. The uniqueness of patients mandates the caregivers to apply the best available evidence critically and appropriately (Polit & Beck, 2008).
Research Methods to Implement EBP
The effectual translation of research findings into nursing practice necessitates the systematic analysis of the scientific evidence. In practice, the EBP challenges the nurses to review the current procedures and practices critically prior to identifying the best strategies for quality improvement (Lawrence, 2007). The nurses will not always find pre-appraised literature to find quick answers to their questions. By contrast, they have to conduct either design unit-based studies or systematic reviews (Polit & Beck, 2008). This information is essential to make sound judgments concerning clinical practices and decisions (Armola et al., 2009). It is imperative for the nurses to understand research methods to implement EBP adequately.
The evidence that supports EBP is always in the form of multiple levels of quality. For instance, the research findings from randomized clinical trials (RCTs) are more superior to those from expert opinions (Lawrence, 2007). Consequently, practicing nurses must appraise the research evidence to ascertain its methodological rigor and strength before utilizing it decision-making processes. An in-depth understanding of the nursing research methods enables the nurses to grade the scientific evidence based on various components (Armola et al., 2009). These aspects include the study design and methodologies. The clinicians should also possess the requisite skills to evaluate both the benefits and risks of using the research findings (Kent & Fineout-Overholt, 2008).
The successful implementation of EBP mandates the nurses to locate the research evidence that is both reliable and valid. The initial step of this process entails the formulation of a research question. According to Lawrence (2007), research questions enable the nurses to conduct a literature search of the most relevant studies from the nursing databases. Thus, the nurses require analytical skills to identify and synthesize the best available evidence (Gallagher-Ford, 2008). Kent and Fineout-Overholt (2008) have warned clinicians against the indiscriminate use of the information published in internet sources. The sagacity of this statement is that some information may be based on personal intuitions rather than sound scientific methodologies.
The clinical research designs are crucial elements of evidence-based practice in nursing. The multiplicity of these approaches may be confusing to the majority of nurses. For instance, some clinicians may not comprehend the differences in quality between experimental and observational designs (Gallagher-Ford, 2008). Polit and Beck (2008) have indicated that the most nurses lack the self-efficacy to incorporate EBP into nursing practice. One of the barriers to the effectual use of EBP is limited training and education. Kent and Fineout-Overholt (2008) have highlighted the significance of ensuring that nursing students develop the scientific underpinnings for EBP. The introduction of continuing education enables the practicing nurses to update their skills and knowledge (Gallagher-Ford, 2008).
Utilizing EBP Around the World
Urinary tract infections (UTIs) represent one of the most severe hospital-acquired infections (HAIs) among the elderly living in residential care (Beveridge, Davey, Phillips, & McMurdo, 2011). The indwelling urinary catheters inherent in this population group increase the risk of the urinary-associated UTIs (Flanagan et al., 2014). As such, hospitals across the globe have started using evidence-based practice to improve the quality of care. Yu, Traynor, and Hailey (2014) developed a mixed method research to explore the assessment and management of urinary continence in five Australian nursing homes.
The authors identified significant differences in evaluation and management practices across the hospitals. Accordingly, Yu et al. (2014) have used the findings from their research to formulate evidence-based practices. Some of the areas that require improvements include enhanced training for effectual continence care in the Australian nursing homes and compliance with care plans. The authors have also underscored the need to improve person-centered care to facilitate the efficacious assessment and management of urinary continence. Other nursing homes across the world could also use this evidence to enhance their healing practices.
Conclusion
The demands for accountability in nursing practice have increasingly shifted focus toward patient safety and quality. As such, it is imperative for every nurse to employ the evidence-based practice (EBP) as the foundation for improving health care quality and enhancing clinical outcomes. EBP has been instrumental in EBP supports the implementation of person-centered care in nursing practice. Secondly, EBP eliminates the unnecessary and ineffective practices that compromise the quality and safety of nursing care. Thirdly, EBP has played a critical role in meeting the demands for healthcare safety and quality. Nonetheless, the successful realization of these goals requires the nurses to have sound research skills. Thus, it is essential for both the student and practice nurses to gain in-depth knowledge of research methods to implement EBP adequately.
References
Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L.,… Medina, J. (2009). AACN levels of evidence: What’s new? Critical Care Nurse, 29(4), 70–73.
Beveridge, L. A., Davey, P. G., Phillips, G., & McMurdo, M. E. T. (2011). Optimal management of urinary tract infections in older people. Clinical Interventions in Aging, 6, 173–180.
Finkelman, A., & Kenner, C. A. (2013). Learning IOM: Implications of the IOM reports for nursing education. Washington, DC: American Nurses Association.
Flanagan, L., Roe, B., Jack, B., Shaw, C., Williams, K. S., Chung, A., & Barrett, J. (2014). Factors with the management of incontinence and promotion of continence in older people in care homes. Journal of Advanced Nursing, 70(3), 476-496.
Gallagher-Ford, L. (2008). Nurses’ skill level and access to evidence-based practice. The Journal of Nursing Administration, 38(11), 494–503.
Kent, B., & Fineout-Overholt, E. (2008). Using meta-synthesis to facilitate evidence-based practice. Worldviews on Evidence-Based Nursing, 5(3), 160–162.
Lawrence, J. (2007). Techniques for searching the CINAHL database using the EBSCO interface (Cumulative Index to Nursing and Allied Health Literature). AORN Journal, 85(4), 779–780,782–788, 790–791.
Lubejko, B. G. (2014). Improving the evidence base of nursing education programs. Journal of Continuing Education in Nursing, 45(8), 336-337.
Polit, F. D., & Beck, T. C. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Titler, M. (2007). Translating research into practice, models for changing clinician behavior. American Journal of Nursing, 107(6), 26–33.
You, L. M., Aiken, L. H., Sloane, D. M., Liu, K., He, G. P., Hu, Y.,… Sermeus, W. (2013). Hospital nursing, care quality, and patient satisfaction: Cross-sectional surveys of nurses and patients in hospitals in China and Europe. International Journal of Nursing Studies, 50(2), 154-161.
Yu, P., Traynor, V., & Hailey, D. (2014). Urinary continence care in Australian nursing homes. Australian Journal of Advanced Nursing, 32(2), 39-46.
Sexual Abuse Factors And Protection
Sexual abuse refers to the act of forcing an individual to take part in a sexual behavior against their own free will. It can also be referred to as sexual molestation. The most common mode is rape, which is defined as forced sexual intercourse initiated by one person or a group of people against another person without the individual’s consent and will.
Rape is sometimes referred to as sexual assault and is classified according to the various forms through which it takes place. For instance, date rape takes place between two individuals who are well acquainted with each other, hence the victim knows the rapist. This form of rape majorly involves close friends or people who are dating, although in most cases the rape victim is drugged to incapacitate them so as to ensure they do not offer resistance.
Rape can also occur in times of war where soldiers take advantage of the helpless women and children thus forcing them to have intercourse. It also takes place where the ruling authority forces individuals to be involved in prostitution. More so, rape can also take place after the consent of the other person, but through lies and fraud. This form of rape is referred to as deceptive rape.
Gang rape occurs when a group of people conspires to rape an individual. It is common among drug users, especially drunkards (Sobsey, 2012). The two final forms of rape are spousal and infant rape. Spousal rape is where a partner forcefully involves the other partner in sexual intercourse, while statutory rape occurs when an adult forcefully initiates sexual intercourse against children below the age of eighteen. Incest rape involves cases where relatives are raped by close relatives.
Certain social factors can be assumed to be the predisposing factors for rape, especially in societies that are deeply rooted in beliefs of male sexual entitlement. This also goes hand in hand with societies that associate physical strength and male dominance over women thus promoting male chauvinism.
In such social settings, women have no option but always give in to men’s sexual demands, and any attempt by women to resist sexual advances from men is regarded a taboo. Other societies regard marriage as an obligation by women to relentlessly offer intercourse to men without excuses or whatsoever (Sobsey, 2012). These societies encourage male sexual dominance and in the process making women prevalent victims of rape since men are justified to use force and violence to achieve their objectives. The other social factor for rape is that most people associate rape with women and hardly understand rape against men. Men are generally regarded superior and masculine, thus they fail to seek assistance when they fall prey to rapists for fear of being mocked and ridiculed.
Personal and psychological state of mind can also be a predisposing factor for rape. Men who are naturally sexually hostile and violent are mostly the culprits of rape as they are antisocial and rarely associate with others (Sorenson, 2007). Research shows that such men are usually violent towards women and even fellow men since they have a false feeling of having excess energy. They do not perceive the effects of rape on the victim, hence will always associate sex and aggression.
The most commonly reported forms of rape are date and acquaintance rape. These two forms are committed by culprits well known to the victim and can easily be avoided through self-respect and developing a sense of caution and keenness. The first step towards protection against these kinds of rape is by avoiding secluded places, including your own house. This reduces chances of abrupt and unaware approach by anybody. An individual should also state the type of relationship they are willing to be part of so as to know the outcome from such relations. This will shun off any queer sexual advances and acts that may drag one into sexual acts by constantly keeping you within the limits of the relationship.
People under the influence of alcohol easily fall prey to rapists. For this reason, one is advised to always stay sober and avoid excessive consumption of alcohol (Baur, 2009). When going to parties where drinks are served take what you are used to and in less quantities. Futhermore, ensure you attend the party in the company of friends so that you watch over each other. A common drinking observation has it that one should never taste any of his drinks once you lost sight of it.
During first and blind dates, it is advisable to have company and avoid secluded places for such occasions (Sorenson, 2007). This ensures that there is always an active third party watching over and ready to help should anything arise. Again, once you feel uneasy or suspect anything that may threaten your sexual security, it is advisable to walk out. Although prevention is always encouraged and practiced, sometimes date rape or acquaintance rape may still occur despite all these precautions. In such cases, instinctive actions such as running, screaming and fighting back are encouraged so as to avert any impeding rapist and in the process alert the general public.
References
Baur, S. (2009). The Intimate Hour: Love and Sex in Psychotherapy. Boston: Houghton-Mifflin Company.
Sobsey, D. (2012). Violence and Abuse in the Lives of People With Disabilities: The End of Silent Acceptance? Baltimore: Paul H. Brookes Publishing Company.
Sorenson, S. (2007). Violence and Sexual Abuse at Home: Current Issues in Spousal Battering and Child Maltreatment, New York: Haworth Press.