The Role Of Leadership And Change Management Essay

The Role Of Leadership And Change Management Essay Key to evolution of an Organization is how well it can adapt to changes be it structural or financial. A good leadership plays a pivotal role in such transitions and will often be the most influential aspect in such changes being implemented successfully. Considering the fact that both Organizational Change and Leadership are very widely defined, for the purpose of the essay I would like to use the following definitions, Leader is a person with vision, energy, authority, and strategic direction ref: (Robert Coffee and Gareth Jones, 2000), Organizational Change is the process of continually renewing an organizations direction, structure, and capabilities to serve the ever-changing needs of external and internal customers- ref: (Moran and Brightman, 2001). Change is one of challenges an organization can face. It, being a continuous process, dealing successful with it is critical to an organizations success- ref: (Kudray and Kleiner, 1997), and certain management levers, such as, strategy, operations, should be constantly altered for the organization to be aligned with the market place. Having said that, it is also very important to critically identify the needed change within the organization. If a certain change is identified as a pivotal one for the growth of the organization, it is also important to consider how the change will be received by the people who will be a part of it. Resistance in our context is opposing to the change. Resistance is very likely with-in the team when the importance of the change is not know. There are various known reasons for someone to resist the change. Some of which are job insecurity and the fear of losing the power. There are existing theories which say that resistance is good and it is related to the individual identity and organizational values. Despite of being a time consuming process, it is very important to overcome resistance to implement the change successfully. Lewins 3 step model for change, Unfreeze, Change and Refreeze: ref ( Lewin, 1951) is considered to be there mother of all change models. The point here was to have organizations prepare initially to ease the process of the change in order to overcome resistance. It has been argued upon, that this theory might not be holding good for the current day situation, as organizations are constantly changing and they will never be having the opportunity to refreeze or attain the new state of equilibrium. Kotters 8 Step Model, ref: ( Kotter, J , 1995) also talks about implementing a change within the organization but considering the present day needs and situation. This model tries to address the developed resistance in the implementation on the change. An effective leadership will always try and overcome resistance and help successfully implement the change, which need not be a top down approach. For a change to be accepted, Nahvandi (2003), believes that you need to first motivate those in y our guiding collation or transformational leadership team. This, per him, is the best achieved through inspiration of the team, which enables them to enact change. Transformational leadership includes inspiring them with a charm and charisma, challenging the team to solve the problems rather than we doing it ourselves and developing personal relationship with each one of them. A combination of these 3 attributes is the best known vehicle to overcome resistance. ref( Nahvandi, 2003). Transformational leadership is that which à ¢Ã¢â€š ¬Ã‚ ¦ facilitates a redefinition of a peoples mission and vision, a renewal of their commitment and the restructuring of their systems for goal accomplishment. It is a relationship of mutual stimulation and elevation that converts followers into leaders and may convert leaders into moral agents. Hence, transformational leadership must be grounded in moral foundations. ref(Leithwood, as cited in Cashin et al., 2000, p.1) . According to Bass (1990b, p. 21) transformational leadership occurs when leaders broaden and elevate the interests of their employees, when they generate awareness and acceptance of the purposes and mission of the group, and when they stir employees to look beyond their own self-interest for the good of the group. Success of transformational leadership has been demonstrated by studies in diverse settings such as schools, corporations etc. -ref(Bryant, 2003, p. 36).Also there are existing studies to prove the effectiveness of transformational leadership regardless of culture ref:(Perttula Xin,2005) . Per Carlson and Perrewe (1995, p. 834), as a result of transformational leadership, changes in the organizations mission, strategy, and subordinate commitment levels are very likely to emerge. Also, Odom and Green (2003) argue that principles of transformational leadership (i.e., intellectual stimulation, idealized influence) applied to ethical dilemmas faced by managers offers the prospect of less litigation and better ethical outcomes than the more common transactional approach to ethics. Though Transformational Leadership is the latest buzz word, there have been many people in the past who have demonstrated the traits of this form of leadership. For instance, Genghis Khan was a transformational leader who, during the late 12th and early 13th centuries, united fiercely independent Mongol tribes to ultimately create one of the largest land empires ever seen ref(Yates, 2002). Lee Iacocca is a transformational leader who is credited with saving the Chrysler Corporation. He took over Chrysler when it was on the brink of bankruptcy and set about transforming the ideals of his closest subordinates. In turn, that began to reshape the corporations culture. Because a transformational leader encourages others to becomes transformational leaders, soon the entire organization was filled with effective leaders (Kelly, 2003). Within military and government contexts, General Colin Powell overcame entrenched racism (particularly in the US military) and low institutional expectations of African Americans to become chairman of the US Joint Chiefs of Staff in 1989. He went further, becoming in 1991 the first African American to become US Secretary of State, a position some said he filled with vision and the qualities of a transformational leader (Chekwa, 2001). Other transformational leaders include Christine Nixon, the current Police Chief Commissioner in the Australian state of Victoria, who is popularly understood to have transformed the culture of that police force for the good, and Sir Richard Branson, responsible for international Virgin enterprises (Lussier Achua, 2004). These are positive examples of transformational leaders but as critics (e.g., Yukl, 1989) point out, transformational leadership is not without its dark side and other flaws. The morality of transformational leadership has been questioned, especially by libertarians and organizational development consultants (Griffin, 2003). A key criticism is that within it transformational leadership has potential for the abuse of power (Hall, Johnson, Wysocki Kepner, 2002). Leaders here, motivate followers by engaging them to strong beliefs, irrespective of the effects on them .Transformational leaders can exert a very powerful influence over followers, who offer them trust and respect. Some leaders may have narcissistic tendencies, thriving on power and manipulation. Moreover, some followers may have dependent characters and form strong and unfortunate bonds with their leaders: ref- (Stone, Russell and Patterson, 2003, p. 4). Yukl describes this as the dark side of charisma and goes on to note that for every example of a positive transformational leader demonstrating charismatic qualities (e.g., Mohandas [Mahatma] Gandhi), there is an equally negative example (e.g., Charles Manson).-ref: (Yukl, 1989) There is an argument that transformational leadership is facilitative of change because it contributes to organizational improvement, effectiveness and institutional culture (Barnett, McCormick Conners, 2001). An interesting study by Barnett, McCormick and Conners (2001), shows that teachers may in fact be distracted from concentrating on learning-and-teaching by, for example, taking time away from students to be involved in the corporate school initiatives an inspirational, transformational principal expects of them. Ref: (Barnett, McCormick and Conners (2001), a study conducted on 12 schools in New South Wales and Australia) Related Bibliography Robert Coffee and Gareth Jones, HARVARD BUSINESS REVIEW, September-October 2000 Moran, J. W. and Brightman, B. K. (2001) Leading organizational change, Career Development International, 6(2), pp. 111-118. Gary Yukl Journal of Management 1989. Vol. 15, No. 2, 251-289 Bennis, W, (1994), On Becoming a Leader. Addison-Wesley, Reading, MA, ISBN:0-201-40929-1. Lucey, J.J, Why is the failure rate for organization change so high?, Management Services Winter 2008 Evans, M.G. (1970). The effects of supervisory behavior on the path-goal relationship. Organizational, Behavior and Human Performance. 5, 277-298 House, R.J. (1971). A path-goal theory of leader effectiveness. Administrative Science Quarterly, 16, 321-339. House, R.J., Mitchell, T.R. (1974). Path-goal theory of leadership. Contemporary Business, 3, 81-98. Dansereau, E, Jr., Graen, G., Haga, W.J. (1975). A vertical dyad linkage approach to leadership within formal organizations: A longitudinal investigation of the role making process. Organizational Behavior and Human Performance. 13. 46-78. Kudray, L and Kleiner, B, Global trends in managing change, Industrial Management; May/Jun 1997; 39, 3; ABI/INFORM Global pg. 18 Lewin, K, Field Theory in Social Science, Harper and Row, 1951. Nahavandi, A. (2006). The art and science of leadership. Upper Saddle River, NJ: Prentice Hall. Hay, Iain, Transformational Leadership: Characteristics and Criticisms# Leithwood, K. Jantzi, D. (2000). The effects of transformational leadership on organizational conditions and student engagement with school. Journal of Educational Administration, 38(2), p. 112. Bass, B.M. (1990b). From transactional to transformational leadership: learning to share the vision. Organizational Dynamics, 13, pp. 26-40. Bryant, S.E. (2003). The role of transformational and transactional leadership in creating, sharing and exploiting organizational knowledge. Journal of Leadership and Organizational Studies, 9(4), pp. 32-44. Spreitzer, G.M., Perttula, K.H. Xin, K. (2005). Traditionality matters: an examination of the effectiveness of transformational leadership in the United States and Taiwan. Journal of Organizational Behavior, 26, 205-227. Carlson, D.S. Perrewe, P.L. (1995). Institutionalization of organizational ethics through transformational leadership. Journal of Business Ethics, 14(10), pp. 829-839. Odom, L. Green, M.T. (2003). Law and the ethics of transformational leadership. Leadership and Organization Development Journal, 24(1/2), pp. 62-69. Yates, M. (2002) Genghis Khan. LeaderValues. Retrieved August 3, 2006 from Kelly, M.L. (2003, January 1). Academic advisers as transformational leaders. The Mentor. Retrieved August 3, 2006, Chekwa, E. (2001, July 12-14). Searching for African American transformational leaders. Academy of Business and Administrative Sciences 4th International Conference, Quebec City, Canada. Manuscript available from the author. Lussier, R.N. Achua, C.F. (2004). Leadership: theory, application, skill development (2nd ed.). Eagan, MN: Thomson-West. Yukl, G.A. (1989). Leadership in Organizations (2nd ed.). Englewood Cliffs, NJ: Prentice Hall. Stone, A.G., Russell, R.F., Patterson, K. (2003). Transformational versus servant leadership a difference in leader focus. Servant Leadership Roundtable October 2003. Retrieved August 3, 2006 Hall, J., Johnson, S., Wysocki, A. Kepner, K. (2002). Transformational leadership: the transformation of managers and associates. Retrieved August 3, 2006

Advanced practice nurse role within palliative care Essay

The purpose of this assignment is to compare and contrast the current literature related to advanced nursing practice. And to relate this literature to my practice and the role of the palliative care nurse across clinical settings. In my current role as a pain nurse specialist, I am involved in the care and management of patients with intrathecal (IT) catheters mainly for patients with intractable cancer pain. Patients who have been tried and failed on escalating doses of various opiates, and continue to have unsatisfactory pain management with intolerable side effects are often referred to our service for consideration for an intrathecal catheter. Intrathecal catheters have been used for many years now in effort to target the specific pain pathways within the spinal cord, as the medication is delivered directly into the Central nervous system, only small doses are required, and therefore patients experience less side effects, with improved pain control (Myers, J. Chan, V., Jarvis, V., Walker-Dilks, C., 2010). The majority of these patients are approaching the end stages of their disease process, therefore we work quite closely with the hospital Palliative care service when the patient in an inpatient. However post discharge we visit the patients weekly in their own homes, this often involves working at an advanced nursing level, working autonomously, assessing the patient and titrating medication via their IT pump, with some direction from the doctor at Auckland hospital. However this role also involves providing the patient and their family with an element of palliative care also, they often require additional emotional support at this stage. In 2002 the World health organization (WHO) defined palliative care as † An approach that improves the quality of life of patients and their families facing he problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.† Advanced nursing practice refers to nurses working at an expanded level of practice within a specialized area. Advanced practice is generally defined as the integration of practical knowledge, clinical experience, theoretical knowledge and research base, education, and may involve organization leadership (ANA, 1995). The term advanced practice has been given to various roles within nursing, such as Clinical nurse specialists (CNS), nurse practitioners (NP’s) and other specialized roles within nursing, such as the anaesthetic nurse (Davies, Hughes, 1995). The literature related to advanced nursing practice and palliative care was reviewed using online databases, such as Medline, Ovid, Pubmed and the Cumulative index for nursing and allied health literature (CINAHL). Key words used in the search, were ‘advanced practice nursing’, ‘Clinical nurse specialist’, ‘nurse practitioner’, ‘palliative care’ and ‘nurse prescribing†. After reviewing the literature, three articles were selected, and will be summarized below. Article one In 2004 Aigner et al did a comparative study of nursing resident outcomes between care provided by NP/Physicians, compared to Physicians only. The study was based in Texas, USA. The main objective of the study was to determine how the standard of care for nursing homes residents compares when provided by either NP/Physician, or physician only. Eight nursing homes were evaluated, and two hundred and three residents were randomly blinded. Chi-squared tests were used for comparison for the data analysis. Four outcomes were selected to assess the quality of the care provided by the two groups, they were, patients charts were retrospectively reviewed and the following outcome assessed- Number of presentations to the emergency department (ED), the cost of the visit, and the diagnosis. Number of hospital admissions in general, and the cost of being admitted to hospital. The number of acute visits and diagnoses for that visit. The completion of progress notes, patient histories and assessments. Also the average number of medications used by each subject and the number of telephone calls and / or beeps relayed to the nurse practitioner, was collated. Comparisons were also made between the two groups regarding, diagnosis made during acute visits compared to during hospital admissions, and the comparison between the cost of recurrent admissions versus hospitalization (Aigner, M., Drew, S., Phipps, J., 2004). The results overall did not show a significant difference of care provided by either the NP/physician group compared to the physician only group. No decrease was found in the amount of ED presentations and the costs were approximately the same. There was however a significant difference in the amount of acute visits made by the NP/Physician group , which was likely related to an increase presence of the NP in the nursing homes (P If a similar study was to be conducted again, it would interesting to explore patient satisfaction between the two groups, and the satisfaction of the other staff working within each clinical area. And also to look more into cost effectiveness. Article 2 Macmillian nursing was first introduced to the UK in 1975, and today there are over 2000 Macmillan nurses. The role of the Macmillan nurse is a specialist palliative care nursing role that involves expert clinical skills, consultation, education, teaching and leadership (Corner et al, 2002). In 2007 Ryan -Woolley, McHugh, G. and Lucker, K. conducted a study in Manchester, looking at Macmillan nurses view on nurse prescribing in cancer and palliative care medicine. It looked at the perceived motivators of why specialist nurses felt nurse prescribing would benefit them and their patient groups, and also explored the potential barriers to training for the implementation of this extended role. A national postal survey was sent out to 2225 Macmillan nurses throughout the UK, 70% response rate was achieved (1575), 11% of Macmillan nurses who responded were already trained as extended formulary independent nurse prescribers. Half of the nurses (88 of 168) were able to prescribe from the extended drug formulary. The mean age was 43.9 years (SD 7.3), with a range 26-63 years. The majority of the nurses that responded were either working as palliative care clinical nurse specialists (CNS) (772, 49.0%) or tumour site specific CNS (413, 26.2%). Others were either working as different types of CNS in the community (83, 5.3%), oncology (61, 3.9%) and chemotherapy (19, 1.2%) or as a lead cancer nurse (45, 2.9%) (Ryan-Woolley et al, 2007). Extended formulary independent nurse prescribing (EFINP) was initiated in the UK in 2002, to allow patients to get improved access to medicines and also  make the best use of nurses clinical skills and experience. This differs from independent nurse prescribing, as independent nurse prescribers may need to assess and diagnose and treat patients (Ryan-Wooley et al, 2007). 21% or nurses who completed his survey had completed the EFINP course., some had completed other relevant courses that enabled them to be independent prescribers, and 2% were in the process of completing the EFINP course (Ryan-Wooley et al, 2007). In the surveys the overall agreement was that nurse prescribing improved patients care by enabling them to receive their medication in a timely fashion. One quarter of the prescribers felt there were issues around training, and that the medical mentoring was not adequate. Some felt that the training provided was not specific enough for cancer and palliative care nursing. Out of 88 of the nurses who were already prescribing, 44 were community based, 28 were hospital based, and the other 15 were based in both the hospital and community. The majority of the nurses had been prescribing regularly throughout the past month. The qualifications of Macmillan nurses were mixed with around half having a first degree (57%) but only a minority (244 of 1504, 16.2%) having a Masters degree. Some of the barriers for nurse prescribing that were identified in the survey were; Having a supportive organization and team Having medical support Clinical supervision/mentorship Multi-disciplinary team (MDT) support Appropriate guidelines Financial incentive Supported practice and training once practicing Access to GP computer systems (Ryan-Wooley et al, 2007). Article 3 In 2012 Steiner, K., Carey, N, Courtney, M., did a study on the profile and practice of nurses who prescribe pain medication throughout the United Kingdom (UK). They looked at the nurse backgrounds, experience, work setting and prescribing practice. 214 nurses throughout the UK that were on the Association for nurse prescribing (ANP) website were sent a questionnaire. All participants were qualified as nurse independent /supplementary prescribers (NIP/NSP). The questionnaire included fixed choice and open-ended questions. The questionnaire had four sections; Section 1 covered demographic information (age, job title, area of practice, geographical area, type of services provided, how many nurse prescribers the service had, and what future provisions they had in place for nurse prescribers within that clinical area. Section 2 looked at prescribing qualifications, levels of experience and the area they practiced in. Section 3 focused on nurse prescribing within pain management, including the type of medications prescribed and the number of pain medications that would be prescribed during a typical week. Section 4 asked the nurses about the level of training they had received to become a nurse prescriber, and if they were satisfied with the training program that they had undergone, and if they had any unfulfilled training needs. It also asked them what there preferred training method was. Out of the 214 nurses that responded, 35% were in primary health care and nurse practitioners, 11.7% were pain or palliative care nurses and 10% in emergency care. The nurses worked across a variety of settings, both  primary, secondary and tertiary care. 43.1% prescribed pain medications up to 5 times per week, and 42.6% prescribed between 6-20 times per week, and remainder prescribed upto 50 times per week. The main category nurses prescribed medication for was patients in acute pain post surgery (40.6%), 12% prescribed for patients with cancer or advanced illness (palliative care), 12.1% prescribed for chronic pain. A further 33.6% prescribed for patients with a overlap of different pains. The main types of medication prescribed were as follows- Paracetamol and Non steroidal anti inflammatories (95.3%) Opioids (34.6%) Other medications to treat side effects, such as antiemetic’s, were also prescribed by the nurses. The nurses who worked within a pain service or palliative care service were significantly more likely to prescribe opiates than the other participates (p  The lack of training at an appropriate level (n=9) The lack of support for role development (n=1). The preferred learning methods of the nurses surveyed were: Elearning (74.3%) Journals (69.6%) Formal study days (62.6%) Prescribing forum (57.5%) Work-based learning 45.3%) (Stenner et al, 2012). Despite the relatively low sample size, this study clearly identifies that nurses working in a wide variety of settings throughout the UK are prescribing pain medications. It also identifies that nurses in pain specialist or palliative care roles are more likely to have post graduate education in pain management, and also more likely to prescribe strong opioids. Training and development issues were highlighted. DISCUSSION By 2051, it has been predicted that there will be over 1.14 million people aged 65 years and over in New Zealand (NZ statistics, 2000), by 2051 there is likely to be about half as many older people than children (NZ Stats, 2000). In the last decade, the number of people being diagnosed with cancer has increased by 24% (Ministry of health 2001). Therefore there will need to be sufficient palliative care services to meet the needs of an increasing number of people with cancer. Introducing more NP’s into specialist palliative care services would possible be a good way of managing the increased workload predicted. More NP’s in the community and residential care facilities may also take the strain off tertiary centre’s, by  preventing hospital admissions. To assist with the predicted increase having NP or CNS that can prescribe will help ease the burden. The Acute pain service nurse specialists at Auckland city hospital are currently in the process of applying for expanded practice roles, to allow nurses with the correct post graduated training (according to NZ nursing council framework) to prescribe a limited number of medications, working alongside a designated prescriber. In 2013 the NZ nursing council put together a consultation document for expanded/extended nurse prescribing, it stated â€Å"that the reason for this consultation is to improve patient care by enabling registered nurses to make prescribing decisions so patients receive more accessible, timely and convenient healthcare. The role of the Nursing Council is to ensure public safety in reaching that goal. The reasons for extending nurse prescribing are to: †¢ improve patient care without compromising patient safety; †¢ make it easier for patients to obtain the medicines they need; †¢ increase patient choice in accessing medicines; and †¢ make better use of the skills of health professionals† (NZ Nursing council, 2013). In order for nurses to obtain expanded practice roles, professional development and recognition programs (PDRPs) are being introduced, so nurses have a framework to work to (Kai Tiaki, 2009). As discussed in both articles 2 and 3 there are likely to be some implications to the introduction of this new role, such as financial/time restraints, lack of medical support, standardization of training and on going education needed to remain up to date on current practice (Ryan-Wooley at el, 2007, Stenner at el, 2012). However with the continued shortage of doctors and the continued increase for healthcare, especially within the older population, expanding the role of the nurse is a necessary initiative, which is likely to improve patient outcomes (World health organization, 2006). Introducing expanded nurse roles and designated prescribing into palliative care services within New Zealand, especially in primary and residential home settings, may be a good way of managing the predicted increased need for more palliative care services in the future, secondary to the rise in the older population and the number of people being diagnosed with cancer. As mentioned in the above articles it will provide patients with a more effective service that they can access easily, decrease the burden on doctors, provide a more cost effective service, and likely a more holistic approach to patients (Aigner, M et al, 2004). Also more nurses may be inclined to train for the role as the expectation and education required is less than what is required to be an NP. In relation to my role as a pain nurse specialist and caring for palliative patients with intrathecal catheters, I believe the implementation of expanded practice nursing with designated prescribing and or a Nurse Practitioner role would without a doubt improve patient outcomes. Pain is the most concerning aspect for patients (and their family) facing the end stages of their life, and currently cancer pain is under-treated in nearly 50% of patients (Joshi, M., Chambers, W., 2010). At diagnosis 20-50% of cancer patients present with pain and 70 % of patients with advanced disease will require large doses of strong opiates for pain management (Joshi, M., Chambers, W., 2010). These patients will often end up being admitted into hospital for pain management, and management of associated side effects, and the quality of there life is often very impaired due to the side effects of opiates (drowsiness, nausea, pruritis etc ). According to recent figures from Auckland hospital, the cost of an inpatient bed is over $4000 a day. When patients have intrathecal catheters inserted for their pain management, they require significantly less opiate, and therefore side effects are less. With good pain control and minimal side effects these patients can often  return to there homes and have a better quality of life, and not require recurrent hospital admissions for poor pain control, which therefore saves thousands of dollars to the health service. However due to the possible dangerous complications related to Intrathecal analgesia (infection, catheter migration, overdose) (Sjoberg, L., et al, 1991), specialized nursing management is required in the community (Myers et al, 2009). If there were more specialized Nurse practitioners or CNS with delegated prescribing rights, in the primary care setting, patients could be discharged from hospital sooner and medications titrated and symptoms treated within the patients home, without requiring a Doctor to make changes to prescriptions and therefore providing the patient with more effective and timely treatment. Aside from pain and symptom management, having the advanced knowledge and skills to provide the necessary psychosocial, emotional and spiritual support to both patients and their family is also very important in this patient group (O’Connor, M., Lee, S., Aranda, S., 2012). Often time listening and counseling these patients can be more important than the medications (Meier, D,.Beresford, L., 2006) CONCLUSION According to WHO, 56 million people die throughout the world each year, 60% of these people would benefit from palliative care. With the amount of older people in New Zealand predicted to increase so rapidly in the next 50 years, the need for more advanced practice nurses within this specialty is obvious. A comprehensive framework is required to allow nurses to have a sound professional development plan and providing good clinical support and continued opportunities for learning is necessary. Primary health care settings have been highlighted as an area were NP and CNS are in shortage and likely investment in training nurses with the necessary advanced skills to manage palliative patients in the community will be a cost effective investment in future years by keeping patients out of tertiary care, and likely improve patient and family satisfaction by providing a more holistic  approach to the end stages of life. REFERENCES Aigner, M., Drew, S., Phipps, J.,. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. _JAMDA_, 16-23. ANA. (1995 ). _Advanced nursing practice_. Davies, B. H., A.,. (1995). Clarification of advanced nursing practice:characteristics and competence. _Clinical nurse specialist, 9_(3), 156-160. Joshi, M., Chambers, W., (2010) Pain relief in palliative care:a focus on interventional pain management, _Expert review of neurotherapeutics, 10,5,_ 747. Meier, D., Beresford, L., (2006) Advanced practice roles in Palliative care:a Pivotal role and perspective, _Journal of palliative care medicine, 9 (3),_ 624-627 Ministry of Health. (2001).The NZ _Palliative care strategy_. Myers, J., Chan, V., Jarvis, V., Walker-Dilks, C.,. (2010). Intraspinal techniques for pain management in cancer patients:a systematic review. _Support cancer care, 18_, 137-149. Nursing council of New Zealand. (2013). Nurse prescribing consultation document. O’Connor, M., Lee, S., Aranda, S. (2012) _Palliative care nursing-A guide to practice.,_ Ausmed publications, North Melbourne , Austrailia. World health organisation. (2002). _Palliative care plan_. Ryan-Wooley, M., G., Lucker, K. (2007). Prescribing by specialist nurses in cancer and palliative care:results of a national survey. _Palliative medicine, 21_, 273-277. Sjoberg, M., Appelgren, L., Einarsson, S., Hultman, E., Linder, L., Nitescu, P., Curelaru, I., (1991) _Long -term intrathcal morpine and bupivicaine in â€Å"refractory† cancer pain. I. Results from the first series of 52 patients, Acta Anaesthesiology Scand, 35_, 30-43 Statistics, N. Z. (2000). _Population ageing in NZ_. Stenner, K., . Carey, N., Courternay, M.,. (2012b). Prescribing for pain-how do nurses contribute? A national questionnaire survey. _Journal of clinical nursing, 21_, 3334-3345.

Where to Find Academic Essay Example

Where to Find Academic Essay Example SWOT analysis of GAP is a powerful method that the business applies in determining the way it can survive in the current market, while also growing revenue base. The organization has experienced resounding success that doesn't appear to end any time soon. Through effective online campaigns and shopping, it can easily attract new customers for its products and brands across the globe. It may also use predictive documents to evaluate the current situation and give some recommendations as for the best positioning in the future within an excellent report. Occasionally an excellent illustration of what you're attempting to achieve is well worth a 1000 words of advice! There are difference contexts that could be used within the identical subject so that you must make certain you will be clear in regards to identifying the section of the topic that you're likely to chat about. 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The course materials that you want to speak about within an academic e ssay can reflect your degree of understanding about the matter. An academic essay always must be relevant. Our sample essay has an easy but great introduction in which it demonstrates that the examinee has knowledge of the subject and clearly states the writer's position to prepare the remainder of the essay. Always bear in mind your academic essay ought to be playful it must not bore your audience. A well-structured essay has a great introduction, body paragraphs that are simple to follow and connect with each other, and a great conclusion. From time to time, the story can be entirely made-up. At the start or introduction, you must offer your readers everything they will need to learn about the central subject of the essay. Writing a leadership essay isn't as complex as it appears. The Hidden Facts on Academic Essay Example Blended learning has turned out to be quite affective in programs which are more academically rigorous. There are lots of benefits to a blended learning atmosphere. Academic writing ought to be approached as an item that encompasses lots of considerations. A wonderful illustration is doctoral programs. What to Expect From Academic Essay Example? Quite often the on-line component will consist of discussion forums after class to talk about ideas in addition to chatroom-based group work. The absolute most essential information ought to go first. Do the editing when you have prepared your draft file, revise the content twice. There's nobody way to compose a winning scholarship application. The Bizarre Secret of Academic Essay Example The negative effect of tourism in the economy of Thailand demonstrates that there's an imperceptible export that makes a stream of foreign exchange in the nation. 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Workplace leadership is vital in the workplace for a positive effect on the interaction among employees and relies on several facets. You have to comprehend who a leader is before it is possible to write about them. Media literacy is important for all of the parents too as they must have the understanding of parenting on issues of the media. For that reason, it's important to adopt decent leadership skills at work.

Marijuan The Gateway Drug - 1595 Words

Cannabis; the gateway drug to harder narcotics or mankind’s unused saviour? Is cannabis as bad as we are led to believe or is it an untapped natural resource that the higher powers refuse to acknowledge? Since 1928 cannabis has been illegal in the United Kingdom. However it is also the most extensively used drug within the UK. This naturally found plant is known around the world, mainly for giving its users a ‘high’ however what many people don’t know is that this plant has also been tested and proven to give a positive effect on society; economically, medically, industrially and morally. Growing up you are told, â€Å"Drugs are bad for you† over and over again, however until you are a little older you never really understand why, you just†¦show more content†¦Coffee. Matthew Lazenka, a researcher at Virginia Commonwealth University Health System, proved that our beloved coffee is more addictive than cannabis. So even though both caffeine and alcohol’s causes to our health can do more harm than good and may often cause disturbing effects on our behaviour, it is still sold over the counter in a majority of countries around the world whilst cannabis, with so many benefits, is illegal. So if people need those small pleasures in life, would it not benefit everyone for them to use something that causes little to no risk as opposed to something that could be the UK’s biggest killer. There are many reasons why many people support the legalization of cannabis, one of those reasons being that cannabis has medicinal advantages. Studies carried out by the National Institute of Drug Abuse (NIDA) have confirmed that cannabis can neutralize cancer cells and also has the potential to shrink cancerous brain tumours. A 33 year old bowel cancer patient, David Hibbitt, was told he only had 18 months left to live. Being diagnosed in 2012, he went through chemotherapy, radiotherapy and surgery. However he was told that the cancer was terminal and as a result of trying everything with no results he resorted to trying cannabis oil. The 33 year old only paid  £50 for a gram of cannabis from a local dealer and he is now cancer free and looking forward to life with his soon to be wife. Over the last few years cannabis