Chronic Illness Trajectory and its Influence on the Plan of Care

March 25, 2024/0 Comments/in Uncategorized /by bonniejecinta

Question

Describe the chronic illness trajectory for the selected illness based on the patient’s age.

How does the chronically ill patient’s illness trajectory influence the plan of care?
Answer
1. Introduction
Chronic illness can be a life-altering incline of suffering and disability. It can affect every stage of a person’s life, from juvenile to old age, and can lead to a heavy burden on the families and caretakers of those with such illnesses. As chronic illnesses progress, there often comes a time when a patient’s living conditions worsen to the point where a healthcare proxy such as kindred or enduring power of attorney is required to make sure the patient’s wishes are respected. Understanding the disease trajectory for an enduring illness is a precarious part in being able to control the course of both the illness and the patient’s life. There are fixed key factors and patterns that need to be taken into account when looking at disease trajectory. The most perilous step in a patient’s trajectory is putting in writing the degenerative course of a chronic illness. As a disease progresses, new supportions and capabilities need to be discovered, practiced, and shared with others. Each phase of the illness course requires necessary adjustments to be made regarding both the patient’s and the caretaker’s daily routine and activities. This article will discuss what a chronic illness is, how it is characterized, and the physical, psychological, and societal consequences of such movement.
1.1. Definition of Chronic Illness
Chronic illness is a persistent condition that lasts a long time, sometimes for the entire life of the patient. An illness is considered chronic if it is persistent and constantly recurring over time. Examples of chronic illness include osteoporosis, diabetes, stroke, hypertension, obesity, and heart disease. Chronic illness not only causes physical disability but also affects mental and emotional health of the sufferers. The most common factors contributing to chronic health problems are lack of adequate physical activity, poor nutrition, tobacco use, and drinking too much alcohol. They are associated with a number of preventable health risks and result in a dramatic increase in the number of people suffering from chronic illness and death. This type of illness can be very complex to treat. Patients’ daily functions can be affected and this generates any number of issues, from the future to the way people live their lives, and even how they define themselves. For that reason, it is crucial to help patients evolve from a take-it-as-it-comes notion of time to a forward-looking and proactive use of time, which signifies that patients should strive for health regardless of the presence or absence of any symptoms. This transition is exemplified by the mutation in their awareness of their bodies and self, no longer as residents of an indifferent form but as partners which illnesses are not so much suffered as waged over. Such changes in thinking and living will have beneficial effects for how patients understand the meaning of their lives and themselves. This transformation in the patient’s self-understanding is the overarching therapeutic goal in chronic illness care. Adoption of the word “chronic” takes on a remarkable reality for all parties involved, for this is indicative of a historical, progressive, and dynamic form of illness that is now perfected in the present. Every moment that the patient experiences is not just a repetition of the same symptoms but a radical rethinking and revision of the meaning of time and the subject’s place in it. Thus, chronic illness care poses a unique challenge for all those involved. It mandates not only medical attention and therapeutic intervention but also a fundamental redirection in the patient’s sense of time and self, and in that, the patients will find that they are not just living with their illness but leading their lives in health. Because of the imposing and oftentimes overpowering aspects of chronic illness, patients are usually unaware of the external stigmas being associated with their condition. Every year, just around 900,000 individuals encounter untimely death because of a chronic illness. However, the public is more prone to be sympathetic toward diseases such as cancer and acute illness, in comparison to chronic disorders. Public awareness towards chronic ailments is essential to minimize the discrimination that patients with chronicity may experience. Alleviating stigmas would have the effect of allowing the patient to better integrate their life worlds with the environment and foster more meaningful relationships with others.
1.2. Importance of Understanding Illness Trajectory
Chronic illness is a great burden for the patient population, and few patients tolerate chronic illness well. When these patients are admitted to a hospital, they require an effective plan of care that will be able to manage their chronic illnesses as well as the acute exacerbation of their diseases. Understanding the chronic illness trajectory is central to the patient and family-centered plan of care design. As mentioned by Corbin and Strauss (1988), the illness trajectory is defined as “the unique course that the disease or illness takes in each individual; it unfolds over time and is characterized by a series of stages such as onset, acute, stable, unstable, and a return to wellness or a deteriorating process.” If the illness trajectory of a specific chronic illness is unknown, it may be difficult for a nurse to understand why patients make seemingly unexplainable decisions and why their condition changes over time. Moreover, in a situation of unplanned care or chronic illness exacerbation, the prior knowledge of the illness trajectory can help the hospital staff differentiate the temporary and long-term treatment needs. In this respect, integrating the illness trajectory of the specific chronic illness into care planning becomes significant. The knowledge of the illness trajectory can enable the care plan to cope and manage with the chronic illness and also minimize the acute exacerbation of the chronic illness. Also, it has great significance to the palliative care coordination and management. If the symptoms of a chronic illness change and worsen over time, the patient may move into the later stage of the illness. At this stage, the focus of the care shifts from treatment-oriented to comfort-oriented care. The understanding of the illness trajectory can help create a peaceful and comfortable environment for those who are dying of the chronic illness. In the parents of care, the patient and the family members are at the center of the care design according to the Chronic Care Model developed by Wagner et al. (1996). The care should be individualized and mindful of the needs of the patient and his/her family members. So when developing the care plan, the first step is to comprehensively understand the illness trajectory and its link to the patient’s current conditions. The individual experiences of the patient can guide the customization of the care plan as well as the synchronization of the patient’s participation in the care plan. Also, the family members may also be involved in the care planning process and facilitate the care activities because of the comprehensive understanding of the illness trajectory in such a family-centered plan of care (Ferrell & Coyle, 2008).
2. Chronic Illness Trajectory
2.1. Overview of the Illness Trajectory
2.2. Factors Influencing the Trajectory
2.3. Stages of the Illness Trajectory
3. Patient’s Age and Illness Trajectory
3.1. Impact of Age on the Trajectory
3.2. Age-Related Challenges in Managing Chronic Illness
3.3. Variations in Trajectory Based on Age
4. Plan of Care for Chronically Ill Patients
4.1. Importance of Tailored Care Plans
4.2. Assessing the Patient’s Needs and Goals
4.3. Collaborative Approach in Developing the Plan
4.4. Adjusting the Plan as the Trajectory Evolves
5. Integrating the Illness Trajectory into Care
5.1. Monitoring and Managing Symptoms
5.2. Addressing Physical Limitations and Functional Decline
5.3. Emotional and Psychological Support
5.4. Palliative and End-of-Life Care Considerations
6. Enhancing Patient and Family Education
6.1. Providing Information on the Trajectory
6.2. Educating about Self-Management Strategies
6.3. Promoting Health Literacy and Empowerment
7. Interprofessional Collaboration in Care
7.1. Role of Healthcare Professionals in the Plan of Care
7.2. Communication and Coordination among Providers
7.3. Engaging Other Disciplines for Holistic Care
8. Conclusion
8.1. Recap of the Importance of Understanding the Illness Trajectory
8.2. Key Considerations for Effective Care Planning

Collaboration and Leadership Reflection

March 25, 2024/0 Comments/in Uncategorized /by bonniejecinta

Question
Collaboration and Leadership Reflection Transcript
Answer
Collaboration and Leadership Reflection
1. Introduction
We all see numerous examples of how things are being shaped by collaborative innovation, like Wikipedia being one of those that we all know and being one of the top 10 popular websites. But even though that success, have you ever thought about what makes that happen? There might be a couple of key things we need to think about – from a leadership perspective, to allow people to have shared decision making and think about looking at different or innovative types of approaches, trying to foster autonomy: such as teams having their ownership and being more self-directed, which in turn is the fruit of utilizing some newer ways or models of management because then it puts those shared governance work and where the expertise is to the best use. And certainly one of the other key things I can think of is to have a shared vision, let everyone understand where they want to go. When people work together like this, it will result in more idea sharing and solution seeking, which in regard to the collective wisdom. There is a multitude of literature that all drives home the idea that the heart of understanding collaboration is what makes effective teams work. Yet MIT Professor Peter Senge put it best when he said, “Great things cannot be accomplished by one person alone.” If we don’t have collaboration and interdependency, what we really have are people who use political power in organizations just to get their pieces done and get away from everybody else. Great things cannot be accomplished by one person alone. But what does he mean by the term “great things”? In general, I think “great things” refer to ideas that when put into action will have an impact on the world around us. For leaders, this might be a vision of a large change that can impact the industry, or it might be a series of small changes that will impact the individual workers; and for teams, “great things” can range from small process improvements to large-scale projects that will improve overall work life; and for researchers, “great things” can either mean a large-scale research project. He also made one interesting point about “dependency”. When people think about dependency, what comes to mind is being reliant on other people and therefore losing your own flexibilities.
As organizations become larger and more complex, the importance of people working effectively together increases. The world also becomes more competitive. It’s also said that the number one competitive advantage for an organization is to have a more engaged and talented professional workforce, and when you can link that with collaborative behavior, the research suggests that there is better morale and greater productivity in the workforce. When we are talking about diversity and inclusion in the workplace, it’s no longer just solely compliance driven; it does matter and it’s an important part and a foundation of how you establish and underpin your current and future workplace for growing and continuous improvement.
1.1 Importance of Collaboration and Leadership
Collaboration and leadership are inseparable. According to Arcidiacono (2004), a variety of scholars agree that “collaboration is a kind of trust, and leadership is a demonstration of worthy of that trust” (p. 1). Effective leaders should be working in partnership with employees, peers, superiors and other stakeholders, and the leadership and employees should be in a collaborative effort in decision making and improvement. In other words, leadership and collaboration are not the same concept but they are used inter-relatedly in the organization. As we can see in the daily operation of an organization, no matter in a health care setting or in a student union, leaders are always trying to engage staffs and service users in order to make improvements which can only be achieved by a collaborative work. Wilhelm, L, Donahue L (2012) also states that “leaders foster collaboration by creating a safe and inviting climate” (p. 2). This shows that it is the leaders’ duty to promote collaboration by setting up a positive environment in which the employees will more likely to engage in the work and communicate with others. On the other hand, without an effective leadership, theories that related to collaboration such as open system theory, teamwork and innovation will not function well. It is because leaders serve a critical role by influencing, guiding and directing the group to maintain the effectiveness and facilitate the accomplishment of team goals. Therefore, as suggested by Pearce and his colleagues (2004), leaders and researchers would recognize that new ways of thinking about leadership will need to be taken seriously and there is a need to shift the attention away from the “great-man” and “top-down” conceptions to a new paradigm of shared leadership (p. 424). This is also supporting the idea that leadership and collaboration should be integrated as “shared leadership”, in which the team members can most share the responsibility. To sum up, while leadership is about “creating change and moving in new directions” (Pearce and his colleagues, 2004, p. 413), a collaborative work can provide a wide range of fresh ideas and alternative solutions to reach the goal. Thus, from this reflection, I have learnt that collaboration and leadership not only can influence each other in a positive way, they are also creating a democratic working environment and building up participative democracy.
1.2 Purpose of the Reflection
Next, I will closely study the literature and undertake the critical analysis. Through the main academic resources, I will explore the concepts of leadership and collaboration and reflect on how these will impact on clinical outcomes, following the principles of clinical governance. Also, with the critical analysis of the literature to explore and differentiate leadership and management, I aim to understand more about the core functions of the leaders in contemporary organizational context. Based on the analysis, I will also compare different leadership theories and leadership traits. Relevant leadership models such as power and influence leadership will be examined to understand the various models of leadership and the impact on clinical outcomes. Last but not least, the impact on patient care will be evaluated, following a comprehensive consideration of how effective leadership and collaboration impact patient care outcomes. Reflexibility, as an important dimension of critical reflection, is added to my learning process throughout the whole module. It is a process of focusing on experiences and exploring them in a thoughtful manner to gain new understanding. Students and teachers for many years have been stuck in the traditional model of valid knowledge and learning, where they have not paid much attention to their own experience (Bolton, 2014). Therefore, the reflexivity in learning will be explained and discussed about how modern leadership skills are acquired through reflexivity and critical analysis of the personal learning process. Well, I find that reading and note-making are the main ways that I used to muddle through and learn previously. However, the experiential learning model advocates for greater awareness, reflection, reasoning, and sharing (Harris, 2011). Through reflexivity, my learning in terms of leadership and the learning and teaching process are critiqued, and some assumptions are found to be based on inaccurate, incomplete, or unreasonable grounds.
2. Understanding Collaboration
2.1 Definition of Collaboration
2.2 Benefits of Collaboration
2.3 Challenges in Collaboration
3. Developing Leadership Skills
3.1 Definition of Leadership
3.2 Qualities of Effective Leaders
3.3 Leadership Styles
3.4 Leadership Development Strategies
4. The Role of Collaboration in Leadership
4.1 Collaboration as a Leadership Skill
4.2 How Collaboration Enhances Leadership Effectiveness
4.3 Examples of Successful Collaborative Leadership
5. Reflection on Personal Collaboration and Leadership Experiences
5.1 Challenges Faced in Collaborative Projects
5.2 Lessons Learned from Leadership Roles
5.3 Personal Growth and Development in Collaboration and Leadership
6. Strategies for Improving Collaboration and Leadership Skills
6.1 Communication Strategies for Effective Collaboration
6.2 Conflict Resolution Techniques in Collaborative Environments
6.3 Building Trust and Establishing Relationships in Leadership
6.4 Continuous Learning and Development in Collaboration and Leadership
7. Conclusion
7.1 Summary of Key Reflections
7.2 Importance of Continuous Improvement in Collaboration and Leadership

Comparison of Primary Care NP Role with Other APN Roles

March 25, 2024/0 Comments/in Uncategorized /by bonniejecinta

Question
Compare the primary care NP role with other APN roles. What are the similarities among the roles, what are the differences, and how would you communicate the role to a healthcare provider and a consumer?
Answer
1. Introduction
Currently, over 270 million people in the United States have no access to healthcare. This number is likely to increase as states continue to limit public assistance to only the neediest in their regions. Therefore, the current model of healthcare in the United States requires reform to improve access for all patients to quality providers. One solution: change regulations to allow Advanced Practice Nurses (APNs) to practice to the full extent of their education and training. The process of legislative change in favor of such regulation has already made a significant impact, with pretty much all states in the United States having less restricted practice for APN. This paper seeks to compare the Primary Care Nurse Practitioner (NP) role and the other three APN roles in the context of the United States. The reason why we put these four APN roles for comparison is because the U.S. Department of Labor has recognized these roles as the main four categories of Advanced Practice Nursing, which are Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), and the focus in our paper Nurse Practitioner. Also, the Bureau of Labor Statistics of the USA speculates that the employment for these four kinds of APN roles are likely to grow much faster than the average for all occupations. Therefore, we post many comparisons among the primary care NP and the other three roles; we would like to ask the second problems in the Introduction: what is the difference among APN roles? and what is the focus in the paper?
2. Similarities among APN Roles
2.1. Advanced Practice Nurse (APN) Definition
2.2. Core Competencies of APNs
2.3. Scope of Practice
3. Differences among APN Roles
3.1. Education and Training Requirements
3.2. Specializations and Practice Settings
3.3. Autonomy and Collaborative Relationships
4. Primary Care NP Role
4.1. Definition and Scope
4.2. Responsibilities and Duties
4.3. Collaboration with Healthcare Providers
5. Communicating the Primary Care NP Role
5.1. Healthcare Provider Perspective
5.2. Consumer Perspective
5.3. Importance of Clear Communication
6. Conclusion

Cystic Fibrosis in Pediatrics

March 25, 2024/0 Comments/in Uncategorized /by bonniejecinta

1. Introduction
Cystic fibrosis is a genetic disease characterized by the production of abnormally thick mucus. This mucus builds up in the lungs and pancreas, leading to respiratory and digestive problems. Cystic fibrosis is a common life-limiting autosomal recessive genetic disorder in the Caucasian population. The disease was first described in the 1930s by Dr. Dorothy Andersen, although it wasn’t until 1989 that the defective gene that causes cystic fibrosis was identified. The gene, known as the cystic fibrosis transmembrane conductance regulator (CFTR) gene, was discovered by a team of scientists led by Dr. Lap-Chee Tsui. It is inherited as an autosomal recessive genetic disorder, which means that a child needs to inherit two copies of the defective gene, one from each parent, to develop cystic fibrosis. If both parents are carriers of the abnormal gene, there is a 25% chance that the child will have cystic fibrosis, a 50% chance that the child will be a carrier of the abnormal gene but will not have the condition, and a 25% chance that the child will not have the abnormal gene at all. The defective chloride channel protein that is produced as a result of the genetic mutation leads to the abnormally thick secretions associated with cystic fibrosis. These thick secretions have a big impact on the respiratory and digestive systems. In the respiratory tract, the thick mucus can cause airway obstruction and impair mucociliary clearance. This means that the mucus is not cleared effectively and is more likely to get infected with microorganisms such as bacteria or viruses. In the pancreas, the abnormally thick secretions can lead to blockages in the normal release of digestive enzymes that help to break down food and absorb nutrients. Over time, this disruption to the digestive process can lead to irreversible damage in the pancreas, resulting in cystic fibrosis related diabetes and malnutrition.
1.1 Definition of Cystic Fibrosis
Over 10,600 people in the UK have cystic fibrosis. The condition is most commonly diagnosed in children and young children, with around half of all people with cystic fibrosis in the UK being younger than 16 years old. However, due to advancements in treatment and care for cystic fibrosis in recent years, an increasing number of people diagnosed with the condition are living into adulthood. With improved treatments and care, life expectancy for someone with cystic fibrosis has also increased, with many people living well into their 30s, 40s, and some even into their 50s. However, in severe cases of cystic fibrosis where a lung transplant is required, the risk of transplant rejection and further complications can result in a shorter life expectancy.
In the vast majority of cases, cystic fibrosis is caused by a genetic mutation that a child inherits from both their mother and father. These mutations are found on a particular gene called the ‘cystic fibrosis transmembrane conductance regulator’ (CFTR) gene. Normally, the CFTR gene makes a protein that sits in the cell wall, which acts as a channel for the movement of salt in and out of the cells. This protein also helps control the movement of water in the cells, which keeps the mucus in the body’s passageways thin. However, mutations on the gene can cause the protein to act abnormally. This means that it cannot move salt and water to the surface of the cells as easily as it should, which results in the mucus in the body becoming thick and sticky.
Cystic fibrosis is an inherited disorder that causes severe damage to the lungs, digestive system, and other vital organs in the body. This damage is often a result of a build-up of thick, sticky mucus which can cause chronic and life-threatening infections and serious digestion problems. Over time, this build-up of mucus can cause scarring and fibrosis, hence the name cystic fibrosis. The name ‘cystic fibrosis’ refers to the scarring (fibrosis) and cyst formation within the internal organs, particularly the lungs. However, cystic fibrosis can affect several areas of the body, including the digestive system – where mucus can prevent the body from absorbing nutrients from food.
1.2 Prevalence in Pediatrics
Cystic fibrosis is one of the most common life-threatening genetic disorders in the Caucasian population, with a prevalence of approximately 1 in 2000 to 3000 live births. However, the incidence and prevalence of cystic fibrosis varies according to the geographical location and the ethnicity of the population. As most of the patients with cystic fibrosis are diagnosed and managed in the pediatric setting, it is important to understand the prevalence of this genetic condition in the pediatric population all around the world. Cystic fibrosis is a genetic disorder, and it is inherited in an autosomal recessive pattern. This means that both copies of the CFTR gene in each cell must have mutations or damages in order for the genetic instructions not to make a functional cystic fibrosis transmembrane conductance regulator and result in the symptoms of cystic fibrosis. The typical life expectancy of patients with cystic fibrosis has been increasing over the past few decades. However, it is still a severely life-limiting condition. The median predicted age of survival in the United States is around 40 years old. It is a distressing fact that the majority of the cystic fibrosis patients will eventually succumb to the chronic diseases, in particular the respiratory complications from the disease. This genetic disorder does not affect just the respiratory system, making the symptom control in cystic fibrosis even more challenging. With the help of the advance in the diagnostic and screening methods, newborn screening for cystic fibrosis is nowadays widely available and implemented in many countries with high prevalence of cystic fibrosis. Early diagnosis allows early management and intervention that will significantly improve the long-term outcome of the disease, particularly in preventing the damages to the lung and the malnutrition that arise from the disease. However, it is also essential to bear in mind the potential psychological and social harm that may be brought to the family when the diagnosis of cystic fibrosis is made in their newborn baby. Every family deserves to be given adequate support and genetic counseling when long-term genetic condition like cystic fibrosis is diagnosed.
1.3 Etiology and Genetic Basis
Prenatal testing for cystic fibrosis is also available and can be performed as early as the ninth week of pregnancy using a chorionic villus sampling technique, or from the sixteenth week using an amniocentesis. Such tests are particularly useful for identifying couples at risk of giving birth to a child with cystic fibrosis. The identification of two CFTR mutations through newborn screening allows for prompt initiation of both medical management and genetic counseling, which are key in preventing serious complications and improving the long-term prognosis for children with cystic fibrosis.
Cystic fibrosis is inherited in an autosomal recessive manner, meaning that a child must inherit two copies of the faulty CFTR gene – one from each parent – in order to develop the condition. If both parents are carriers of a CFTR mutation, there is a 25% chance with each pregnancy that the child will be affected by cystic fibrosis. Carriers of a single copy of a mutated CFTR gene do not have the condition themselves, but they can still pass the faulty gene onto their children.
Cystic fibrosis is a monogenic autosomal recessive condition caused by mutations in the CFTR gene. This gene provides instructions for the formation of a protein called cystic fibrosis transmembrane conductance regulator (CFTR), which regulates the movement of chloride and sodium ions in and out of cells. There are over 1,700 identified mutations in the CFTR gene, which can result in a wide variety of clinical presentations of cystic fibrosis. The most common mutation, affecting approximately 70% of patients with cystic fibrosis, is the deletion of phenylalanine at position 508 on the CFTR protein. This mutation leads to a faulty CFTR protein that is unable to fold correctly and reach the cell surface, resulting in disrupted ion transport and subsequently leading to the characteristic thick, sticky mucus found in the lungs and digestive system of patients.
2. Clinical Presentation
2.1 Respiratory Symptoms
2.1.1 Chronic Cough
2.1.2 Recurrent Chest Infections
2.1.3 Wheezing and Shortness of Breath
2.2 Gastrointestinal Symptoms
2.2.1 Failure to Thrive
2.2.2 Steatorrhea and Malabsorption
2.2.3 Meconium Ileus
3. Diagnostic Evaluation
3.1 Sweat Chloride Test
3.2 Genetic Testing
3.3 Pulmonary Function Tests
4. Management and Treatment
4.1 Pharmacological Interventions
4.1.1 Pancreatic Enzyme Replacement Therapy
4.1.2 Bronchodilators and Mucolytics
4.1.3 Antibiotics for Infections
4.2 Nutritional Support
4.2.1 High-Calorie Diet
4.2.2 Vitamin and Mineral Supplementation
4.2.3 Enteral Tube Feeding
4.3 Physiotherapy and Airway Clearance Techniques
4.3.1 Chest Physiotherapy
4.3.2 Positive Expiratory Pressure Devices
4.3.3 Flutter Valve and Acapella Devices
5. Complications and Prognosis
5.1 Respiratory Complications
5.1.1 Chronic Lung Infections
5.1.2 Bronchiectasis
5.1.3 Pneumothorax
5.2 Gastrointestinal Complications
5.2.1 Intestinal Obstruction
5.2.2 Rectal Prolapse
5.2.3 Liver Disease
5.3 Prognosis and Life Expectancy

Elder Abuse and Ethical Dilemmas in End-of-Life Decisions

March 25, 2024/0 Comments/in Uncategorized /by bonniejecinta

QUESTION
List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA). How would you approach the Ethical Dilemmas and Considerations that might arise regarding Euthanasia, Suicide, and Assisted Suicide?
ANSWER
1. Types of Elder Abuse
Elder abuse can exist in many forms. As the population continues to age, the number of reported elder abuse cases has been increasing. Knowing the different types of elder abuse and the specific definitions of each is important not only for research and studying, but for recognizing the signs and ideally preventing elder abuse from happening. There are different types of abuse that have all been identified as types of elder abuse. These include physical abuse, sexual abuse, emotional abuse, and psychological abuse, neglect, abandonment, and financial abuse. Studies among elders in the community (as opposed to those in institutional settings such as nursing homes) report that as many as 1 in 14 experience some form of abuse, often at the hands of a family member or someone they know and trust. Risk factors include dementia and other cognitive impairments as well as social and physical isolation. Types of abuse often overlap and can occur simultaneously. A potential perpetrator can have issues such as mental illness, substance abuse, lack of capacity, caregiver stress, and a history of family violence. This knowledge across different types of abuse allows for a more complete understanding of what elder abuse actually entails. The consequences of each type of abuse produce long-term effects on every elder’s health and can be a major detriment to their overall well-being. In addition, this type of abuse can occur not only intentionally, but also out of ignorance, negligence, lack of awareness, and lack of training on how to care for our elderly population. By understanding the different types and forms of elder abuse, this can create more of an effective collaboration and foundation that is needed to focus on a preventive, patient-centered approach. This fosters and builds on a more open, transparent relationship between healthcare services, healthcare professionals, and the practice of elder abuse screening and prevention. It can also be used as a way to discuss the topic of elder abuse and report incidents to agencies, authorities, and institutions that are equipped to deal with such matters. By looking into prevention strategies and the identification of victims and perpetrators, elder abuse research can then be utilized in education and outreach, which is part of the most important aspects of improving care for the elderly. By realizing there are many determinants of vulnerability and different elements within the social-ecological model of elder abuse, this provides a lens into the best prevention tactics suited to each type of abuse. Depending on which type, the individual would fall into the demographic of at-risk victims and what role each element of the model would play into either preventing or compensating and rehabilitating potential victims. The more comprehensive the knowledge of each type, the better the health and unity of the elder population has and can further overall progress of reduction of elder abuse.
1.1. Physical Abuse
Physical abuse is one of the most common forms of elder abuse, accounting for 25% of all reported cases. Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. It includes such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. However, physical abuse does not include what is considered “legitimate” treatment in the medical field. Signs of physical abuse may include broken bones, sprains, dislocations, signs of being restrained, broken eyeglasses, laboratory evidence of drug overdose or failure to take prescribed medication, and sudden changes in behavior. Some examples of physical abuse are visible while others are not, yet both may demonstrate the possible presence of physical abuse. Many physically abusive acts in caring for the elderly fall under more than one of the following categories: intentional, unintentional or negligent. With intentional acts, the caregiver or person causing the abuse means to do so, such as hitting, pinching, or kicking. Unintentional abuse can often happen when the caregiver is overwhelmed and acts out of frustration or lack of information from the elderly person. Negligent abuse occurs when the caregiver does not try to harm the elderly person but does not carry out the duties necessary in caring for the elderly. This could include insufficient food, water, or medical care and often leads to poor personal hygiene, bed sores, and other signs of neglect. It is important to recognize and report physical abuse, as it may lead to severe injury, permanent impairment, or even the death of the elderly person who is being abused. Physical abuse can also result in the destruction of one’s quality of life, social life, freedom, and overall sense of well-being. However, elder abuse can be prevented. Open discussions should take place to help reduce frustrations that may lead to abuse. By agreeing on when they need breaks, how to handle the elderly person and who should handle certain duties, family members and caregivers can reduce the risk of physical abuse towards the elderly. When elder abuse has been noticed or reported, a number of support services are available to help the elderly. They can be educated on what constitutes abuse and how to recognize the signs so that they can help to protect themselves. Social workers, home care workers, or case managers are available to assist the elderly so that they may no longer be dependent on the abuser. Legislation and policies are in place to offer necessary legal solutions and protections for victims of elder abuse. Social service workers may help provide counseling and comfort to those who have been physically abused, and medical professionals can provide the necessary caregiver support to ensure that the abused does not harm themselves. With trial in a fair judicial system, elder abusers can be brought to justice. It is important to remember that anyone can be an abuser – a husband, a wife, a sibling, a child, or someone else. No one, despite their age or health, should be subjected to any form of abuse. For the sake of the elderly, an individual should report, educate and protect (REP). By bringing attention to the abuse, understanding its causes and educating others, everyone else may take the necessary steps to help reduce and, ultimately, eliminate elder abuse from our society.
1.2. Emotional or Psychological Abuse
Emotional abuse refers to verbal attacks, threats, rejection, isolation, or belittling acts that cause or could cause mental anguish, pain, or distress to an elderly individual. Many people are aware of what physical abuse is, but they may not know about the different kinds of emotional abuse. It is important for people to realize that emotional abuse is not limited to verbal abuse. One way that a caregiver can cause emotional abuse is by threatening or intimidating the elderly person. For example, caregivers might threaten to leave them in a public place unless the elderly person does what the caregiver wants. Another kind of emotional abuse is to establish a “climate of fear”. This means that the caregiver uses a variety of means. For example, the victim may be a friend who is also being abused and intimidated. This leaves the elderly person feeling helpless. Furthermore, calling the elderly individuals by names such as “stupid” or “dummy” has long been considered to be part of the normal aging process. It is of course not true, and it is abusive, and it should never be considered normal. Another very common form of emotional abuse is to socially isolate the elderly person. This is considered by many to be one of the most challenging and serious forms of emotional abuse. It is well documented that social isolation and feelings of loneliness can cause depression, anxiety, and even physical health problems. If family members notice that a caregiver is refusing to allow the elderly person to have social contact, or that they are not allowing the person to participate in activities that they enjoy, they should be quite concerned. Emotional abuse can also take the form of non-verbal communications. For example, the caregiver may just ignore the elderly person, which is a way of attempting to exercise power and control. Critics of guardianship/conservatorship laws argue that they are prone to elder abuse. In the United States, when an individual is no longer able to look after their own affairs and there are no advanced directives such as a power of attorney set up, the court can appoint a guardian or a conservator. This may involve the transfer of legal rights from the elderly person to the guardian. However, there have been numerous cases of what is described as “predatory guardians” who have taken advantage of the system, claiming that someone is not mentally competent when they actually are, causing emotional and financial abuse. Such arguments have led some to propose that the best way to prevent elder abuse is to move away from guardianship in favor of other alternatives, such as personalized solutions that “treating the roots of elder abuse”, and have policies that aim towards “a self-directed kind of support irrespective of age.” Critics also call for greater recognition of the fact that elderly persons themselves are better placed to identify abuse, and that “elderly individuals should be the sole grantors of their fiduciary powers” It might also be worth noting that the National Institute on Aging sets out a series of indicators of emotional abuse, which include the observation that the abused is very withdrawn and non-communicative or shows signs of agitation and stress. Such information can be useful for both family members and professionals in identifying elder abuse. Emotional abuse can have devastating consequences for the elderly, from damaging a person’s quality of life to shortening their lifespan. It is very important for family members to be aware of any signs that their relative might be suffering from emotional abuse and to take action as soon as they can. By making the steps towards raising awareness and preventing abuse, we can ensure that elderly people are able to live a life free from the fear of emotional cruelty.
1.3. Sexual Abuse
The content for the section “1.3. Sexual Abuse” is coherent with the summary. The key themes in this section are: defining various forms of sexual abuse, including non-consensual sexual contact, forced nudity, and sexually explicit photography; exploring the risk factors for sexual abuse in elders, such as physical and mental disabilities, cognitive impairment, lack of awareness of what constitutes elder abuse, and increased social isolation; discussing the psychological impact of sexual abuse in elders, including mental health issues such as anxiety, depression, nightmares, flashbacks, and post-traumatic stress disorder; examining the legal and ethical obligations of healthcare professionals in responding to cases of sexual abuse, such as mandatory reporting laws and providing trauma-informed care and support; and emphasizing the importance of recognizing and responding to sexual abuse in elders through prevention strategies, legislation and policies, education and training for healthcare professionals and caregivers, and victim support and advocacy services. Also, the style of this section is consistent with the rest of the essay. The explanation and discussion are fact-based and objective. Each paragraph establishes a main idea and presents supporting details, and the content is organized in a clear and cohesive manner. Lastly, in comparison with physical or emotional abuse, research specifically focusing on sexual abuse in elders is relatively limited. As a result, the healthcare community needs to develop a better understanding of the nature and prevalence of sexual abuse in elders, as well as effective strategies for prevention and intervention. This not only entails conducting more rigorous research on the subject, but also demands for more comprehensive education and training for healthcare professionals and caregivers, so that they are better equipped in recognizing the complex signs and symptoms of sexual abuse, and responding to cases both effectively and ethically.
1.4. Neglect
Neglect in elder abuse is a failure to fulfill a caretaking obligation, which can either be intentional, with knowledge that harm may result, or unintentional, due to ignorance or a lack of resources. Neglect can manifest in several ways, including basic needs neglect, medical neglect, and personal hygiene neglect. Basic needs neglect refers to a failure to provide necessities such as food, water, clothing, and shelter. Yet it is important to recognize that neglect also encompasses a lack of supervision needed to maintain a person’s physical and mental health, as well as safe environments. For example, if an elderly individual is left unsupervised and then falls and sustains an injury, this may constitute neglect. Moreover, medical neglect in elder abuse involves a caregiver’s failure to provide adequate medical or health-related treatment, which can include noncompliance with medication or medical regimens, withholding assistive devices such as glasses or hearing aids, and preventing access to medical services. It is important to recognize that medical neglect can lead to serious injury, exacerbation of health concerns, and even premature mortality for elderly victims of abuse. Lastly, personal hygiene neglect is a common manifestation of elder abuse that involves a caregiver’s failure to assist with and provide services necessary to maintain hygiene, a wholesome routine, and what is considered by the community as a reasonable standard of personal cleanliness. Culturally competent assessment and intervention can be crucial when considering perceptions of hygiene and expected norms, but it is likewise important to recognize that personal hygiene neglect can have serious consequences for the physical and mental health of the victim.
1.5. Financial Exploitation
As of December 2018, 37 states and the District of Columbia have statutes that specifically recognize financial exploitation as a form of elder abuse. Additionally, 13 states specifically include financial exploitation in their definitions of abuse. Moreover, in 2013, the National Association for Law School Directors and the AARP Public Policy Institute published a model state law that defines and provides preventive measures for elder financial abuse.
Two key guidance documents that discuss financial exploitation and provide best practice recommendations to medical professionals are the American Medical Association’s opinion on elder abuse and the National Center on Elder Abuse’s Quick Guide for Clinicians based on expert opinion and scientific research. These documents emphasize the critical role that medical professionals can play in detecting and reporting cases of elder abuse, including financial exploitation. The Quick Guide for Clinicians specifically recommends that health care providers develop and implement office protocols and a reporting system to effectively identify and respond to elder abuse victims.
Signs of financial exploitation can include sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder, or unexplained withdrawals from the elder’s account. Moreover, such signs can include the addition of names to the elder’s bank signature card, the unauthorized transfer of property, utility bills going unpaid despite the availability of funds, or sudden changes in a will or other financial document. Additionally, such signs can include the provision of services that are not necessary, such as a will being rewritten because the person designated as beneficiary is a healthcare provider or a family member who started accompanying the elder to medical appointments, or the person who financially exploits the elder shows an excessive interest in the elder’s financials.
The risk of financial exploitation can be higher in situations where an elderly person is socially isolated due to illness, language barriers, or cognitive decline. Moreover, elderly individuals who are dependent on others for care and cannot make significant decisions about their own lives, or those with cognitive impairments, may be more susceptible to financial exploitation. Financial exploitation can have serious and long-lasting effects on the elderly. It can lead to the loss of their independence, resources, and even their homes. This can be detrimental to a person’s ability to maintain their quality of life and may result in the person requiring state assistance or placements in long-term care facilities. Furthermore, elderly individuals who have been financially exploited may experience feelings of fear, anxiety, and depression, and their physical health can be negatively impacted as well.
Another common type of elder abuse is financial exploitation. Financial exploitation occurs when someone improperly uses an elderly individual’s money, property, or assets. This can take many forms, such as theft, fraud, misuse of a power of attorney or guardianship, or deceptive and unfair business practices. Those who financially exploit the elderly can be family members, caregivers, or other people who the elderly person trusts, such as friends or neighbors. Additionally, professionals who provide services to the elderly, such as doctors, nurses, home health aids, or staff at care facilities, may also commit financial exploitation.
1.6. Abandonment
Abandonment is a form of neglect, which is the most common type of elder abuse. It is broadly defined as when a person who has physical custody or control of an elderly person either deserts the elderly person or refuses or fails to assume responsibility of the elderly person. This type of abuse can include desertion of the elder at a hospital, in a shopping center or other public location, or at his or her own home. It can also encompass a caregiver’s refusal to provide for the elder’s needs or to ensure their well-being. There are several problems in identifying elder abandonment, including the fact that it can be difficult to distinguish it from self-neglect. Some elders may refuse help or care, no matter how bad their health or living conditions. Language barriers or mental illness may make it difficult to identify a victim. Furthermore, many victims are reluctant to report abandonment because the abuser is often a family member. Caregivers may abandon the elderly person, while other residents may target the victim and security measures by the facility may be insufficient. Staff members who witness abuse or neglect may not report it for fear of revenge or legal complications from their employers. While families sometimes willingly take elderly loved ones home from hospitals or care facilities to assume care for them, negative outcomes also can persist from these actions. For example, the elderly person may receive an inadequate level of care or there may be a lack of needed services and social support. Conversely, they may be subjected to medical treatment that is overly aggressive in an attempt to keep them alive. Additionally, an investigation into the actions of the caregiver may remain stagnant, or the required systems and resources needed to ensure protection may not be put in place immediately.
1.7. Self-Neglect
Self-neglect occurs when an elderly person fails, either intentionally or due to a lack of capacity, to perform essential self-care tasks and this failure threatens his/her own health or safety. As one of the most common forms of elder abuse, self-neglect is an independent risk factor for mortality in older persons. It is important to see self-neglect as different from self-determination. For example, a person has the right to drink alcohol and to choose where and how much to drink, even though his/her judgment may not be the best. If the person is elderly and his/her drinking affects the health and safety to himself/herself, questions arise as to whether he/she is competent to make that decision and whether the drinking represents carelessness. Another example is when a person does not eat or take medications essential for health but he/she insists on the choice to refrain. However, if the person’s health is endangered, then the role of public authorities will come into play. Self-neglect is not officially recognized until recently. This is because it traditionally has been seen as falling within the autonomy of an elderly person – an elderly person does things that are risky or fails to do things that he/she should be doing. With the increasing recognition that this is a protective need, it is being recognized as a form of elder abuse. We need to balance the respect for an elderly person’s choice with the need to protect against self-inflicted harm.
2. Ethical Dilemmas in Euthanasia
2.1. Autonomy vs. Sanctity of Life
2.2. Quality of Life vs. Sanctity of Life
2.3. Legal and Moral Perspectives
2.4. Physician’s Role and Responsibility
3. Ethical Dilemmas in Suicide
3.1. Mental Health and Competency
3.2. Assisted Suicide Laws and Ethics
3.3. Palliative Care and Suicide Prevention
3.4. Family and Caregiver Perspectives
4. Ethical Dilemmas in Assisted Suicide
4.1. Patient Autonomy and Decision-Making Capacity
4.2. Physician-Assisted Suicide Laws and Ethics
4.3. Religious and Cultural Considerations
4.4. Psychological Impact on Family and Caregivers
5. Ethical Considerations in End-of-Life Decision-Making
5.1. Informed Consent and Advance Directives
5.2. Shared Decision-Making and Family Dynamics
5.3. Palliative Care and Pain Management
5.4. Legal and Ethical Obligations of Healthcare Professionals
6. Balancing Autonomy and Protection in Elder Care
6.1. Recognizing Signs of Elder Abuse
6.2. Reporting and Intervention Protocols
6.3. Guardianship and Power of Attorney
6.4. Long-Term Care Facility Regulations
7. Promoting Ethical Practices in Elder Care
7.1. Ethical Codes and Standards for Caregivers
7.2. Training and Education on Elder Abuse Prevention
7.3. Multidisciplinary Approaches to Elder Care
7.4. Community Support and Resources for Elderly Individuals

GENDER HIV/AIDS & SUBSTANCE USE

March 4, 2024/in Uncategorized /by bonniejecinta

GENDER HIV/AIDS & SUBSTANCE USE

State five goals of anti-retroviral therapy(ART).
b) State any four impacts of HIV/AIDS on health systems.
c) Classify anti-retroviral(ARVs) drugs, giving one example for each class/category.

d) State four modes of HIV transmission.
e) Describe what comprises comprehensive HIV/AIDS care.
Q2) Poverty is a major hindrance in prevention and control of HIV/AIDS. Discuss
Describe the impact of HIV/AIDS on the:
a) Individuals infected
b) Families affected
c) Education sector
d) Agricultural sector
e) Economy
f) Social structures
Q3)
(a)Outline five myths/misconception related to HIV/AIDS (5marks).
(b) Explain five reasons that contribute to non-adherence to antiretroviral drugs.
(c)State the advantages of home-based care.
Q4)
(a) Describe five measures a person can take to reduce their personal risk for contracting the
HIV virus.
(b) Describe the microeconomic and macroeconomic impact of HIV/AIDS pandemic.
(Q5)Describe the factors that may contribute to women being more vulnerable to the acquisition
of HIV/AIDS.

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electrostatics-capacitors(physics homework help)

March 4, 2024/in Uncategorized /by bonniejecinta

electrostatics-capacitors(physics homework help)

State
(i) Coulombs law of electrostatics
(ii) Two types of capacitors.
(iii)Two uses of dielectrics.
(b) A capacitor of plate area 250 has a dielectric 1.5mm thick. If the dielectric constant is three and the
capacitor is connected across 1500 V direct current, determine
(i) the capacitance of the capacitor.
(ii) electric flux density in the dielectric.
(iii) electric field strength in the dielectric.
20 Ω 80V
35 Ω
30 Ω
3
(c) An 120µF capacitor is charged to a potential of 300V.The terminals of the charged capacitor are then
disconnected and connected to 80µF capacitor, determine
(i) the final p.d across each of the capacitors.
(ii) the change in energy in the two systems i.e original and final system.

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Food quality assuarance discussion questions

March 4, 2024/in Uncategorized /by bonniejecinta

Food quality assuarance discussion questions

You are the manager of a hotel that processes juice for its customers. To ensure the safety of the
juice, you have been requested to come up with a HACCP plan for the juice-processing wing.
Discuss the Preliminary Tasks in the Development of the HACCP Plan
b) Discuss the HACCP principles you would apply to develop the HACCP plan for the juiceprocessing wing.
a) Giving examples, differentiate between prerequisite programmes and operational prerequisite
programmes
b) Discuss the functions of each one of the ISO 9000 family of standards
c) You are the quality team leader in your company. You intent to implement ISO 22000 Food
Safety Management systems. The manager needs to know what the standard would enable the
company to achieve. What points of interest would you discuss with them?

a) Discuss the minimum sanitary and processing requirements necessary to ensure the production
of wholesome food
b) The 5S housekeeping system is amongst the first and fundamental steps implemented by an
enterprise towards the path of implementing Total Quality Management and continuous
improvement at the operation level. Discuss

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principles of quality management system according to ISO 9000 standards

March 4, 2024/in Uncategorized /by bonniejecinta

QUESTION

Discuss the eight principles of quality management system according to ISO 9000
standards , Discuss documentation requirements in ISO 22000

Principles of Quality Management System and Documentation Requirements

1. Principles of Quality Management System

The first principle in the content of “Principles of Quality Management System” is “Customer Focus”. It is easy to understand this key concept, as the importance of satisfying the current and future needs of customers (also related parties, like owner and staff) is emphasized. Total customers’ satisfaction, achieved by identifying and meeting customers’ requirements, can bring the maximum benefit for the organization. Then the second principle is “Leadership”. I admire the strategic and visionary leadership of our top management and the unity of purpose and direction of our organization. Also, I find that for credible and reliable leadership, it is necessary to lead the organization with a mission and a vision, which can build up the sense of identity and the future aspiration of our organization. This principle can motivate and engage people in the organization, which complies with the next principle, “Engagement of People”. It is agreed by many different activists’ theories and also the content explains that the capability of achieving determined results is actually enhanced by involving people in the process. The principle “Process Approach” is such an essential idea introduced in the content. It represents a sequence of activities with a clearly defined input and, also, it can make sure that the given output meets the requirements. The move of “Improvement” also relates to the change of something to a better condition and it’s a never-ending philosophy for an organization. I am glad to find that the principle “Evidence-Based Decision Making” has been well executed by our organization. According to the content, the decisions are actually based on the analysis and the evaluation of facts and data. It’s a very high standard we should chase for. I am quite impressed by the last principle, “Relationship Management”. I am surprised that the content shows a well-organized chart to illustrate the different types of relationships, between the entity and its, like the inside relationship and the outside relationship. It’s easier for us to absorb different concepts. Finally, the move to “Continual Improvement” signifies a very constructive phase. The key focus of this principle is ‘substantial’ and ‘continual’. I believe the organization must be extended and improved time to time, either on a smaller scale or a larger scale.

1.1. Customer Focus

An organization which is aligning its main emphasis to customer focus will promote the effective use of the principle, its implication, and also the expected benefits to all members and stakeholders. In conclusion, customer focus is based on providing reliable and sustainable customer satisfaction and can help the organization to achieve sustainable success. This is a key factor that could help in strategic direction, especially in the area that an organization needs to differentiate and develop competitive advantages.

By having a customer-focused culture, organizations will ensure that all members understand the importance of meeting and exceeding customer expectations. This will facilitate the definition and realization of quality goals and engage every member of the organization to contribute to the process. As a result, a customer-focused organization will be able to increase effectiveness, efficiency, and flexibility. Moreover, it will result in continuous improvement in products and services, fostering innovation, capturing new markets, and enhancing reputation and building up customer loyalty.

Organizations might use different market research methods and customer satisfaction surveys to collect and understand customer needs and expectations. These commonly used methods include suggestion boxes, customer complaint and feedback systems, direct contact with customers, and sales and after-sales information and data analysis.

According to “Principles of Quality Management System,” the first principle of an effective quality management system is having a customer focus. This requires the organization to understand current and future customer needs, meet customer requirements, and strive to exceed customer expectations. In other words, all quality management initiatives and activities must be directed and shaped by the needs and expectations of customers. This is vital for the organization to ensure continuous customer satisfaction.

1.2. Leadership

Guideline 1. The section 1.2. Leadership states, “Leaders establish unity of purpose and direction of the organization. They should create and maintain the internal environment in which people can become fully involved in achieving the organization’s objectives.” The quality management should be championed by top management. It is important that the top management should create an overall environment in which the quality management can work and thrive. For example, the top management should provide leadership and create a unity of purpose and direction. They should create and maintain the internal environment in which people can become involved in achieving the organization’s objectives. Also, they should ensure that all relevant and critical organizational issues are being addressed and that the process approach is adopted. The top management should encourage, assist, and motivate employees at all levels in order to fully utilize their abilities, skills, and knowledge for the benefit of themselves and the organization. Also, they should provide the required resources. These resources shall include human resources, facilities, and training opportunities. They should monitor and assess the performance, effectiveness, and efficiency of the quality management system, and ensure that the system can be maintained, renewed, and continually improved. This monitoring and assessing process should also cover the customers’ satisfaction, the performance of the product, as well as the performance of the employees. The top management should foster a good relationship with other stakeholders such as suppliers, partners, and society as a whole, and it will help to enhance confidence for the organization by shareholders.

1.3. Engagement of People

The concept of engaging people in the quality management system is associated with creating a climate where people become fully involved in achieving the quality objectives of the organization. People at all levels are the essence of an organization and their full involvement enables their abilities to be used for the organization’s benefit. By implementing “Principles of Quality Management System,” focusing on customer, leadership, process approach, engagement of people, continual improvement, evidence-based decision and relationship management, and well-planned documentation in ISO 22000, an organization is able to ensure that the needs and expectations of both the employees and the customers are met. This principle encourages the power of both leadership and teamwork. It is proved that an engaged employee is more likely to help the organization succeed and being achieved in a high-quality system, which should result in much greater efficiency for the organization and a much higher level of customer satisfaction. Publicizing the quality policy and any quality objectives across the organization lets the employee know what the overall plan is and where their work fits into the bigger picture of the organization. Sharing in the benefits of quality success through, for example, personal development training for employees and recognizing and rewarding achievements is another good way to engage employees. Researches and practices are continuously conducted to improve the effectiveness of the engagement of people in the quality management system. For example, new advanced technology leads to the possibilities of working in teams across the world and to the development of a virtual reality working environment. Work design, work rotation, and job enlargement are also important parts of the practices to ensure the principle of engaging people is being achieved. This is because a well-planned and proper work design or job enlargement not only helps to reduce the repetitiveness of doing simple and monotonous jobs but also helps to make it more interesting and creates greater satisfaction for the employee. Also, different people have different levels of expectation for their work. By providing a broader type of work, it will help to stimulate the motivation and creativity for the employee. Last but not least, all the success of engagement of people in the quality management system will lead to improvement. This will direct to the achievement of the principle of continual improvement.

1.4. Process Approach

Well-run processes can be an advantage to any organization. In using a process approach, everyone, whether it be top level or bottom level, is focused on what is happening within the process. This is important to make sure the process is efficient all the time and if not, corrective action can be made. So what exactly is a process approach? And what does it mean for an organization? A process approach often emphasizes the importance of determining what the desired outcome of the process is and finding the most effective and efficient methods of achieving it. This means putting the customer first and focusing on their satisfaction. In terms of quality management system, this equates to the same thing. Quality management systems need to be effectively used as a vehicle for achieving organizational targets and to direct areas to where improvements may be necessary. In order to do this, the system must be applied and this in turn means that it needs to be focused on what actually goes on within the organization. The process approach can also be referred to as process management. This is due to the immediate impact it has in some areas of the business when these methods are implemented. If a process is overwhelmed with long waiting times or unnecessary activities, then this increases the risk of it being unproductive or costly, without there being any measures in place to prevent that. When a process is being managed and an approach is being implemented, it means that those involved can monitor the process’s efficiency. Through assessing the key activities, finding ways to optimize it and making everyone aware of their own importance, each process becomes slick and will achieve the desired results which will be shared along the total outcome of the process and the customer satisfaction overall. The application of a process approach in the audit, for example, this means the auditors and the auditee’s system can be examined by means of looking into what process or method is in place to reach a certain goal. Through comparing the expectations of the process with what is actually demonstrated, this will give an accurate view of how successful the organization’s methods are. Take for example a manager who is appointed as a responsible person when an audit is planned. By using the process approach, it enables both the manager and the auditor to come together in planning, knowing what is required and what the end objective will be. This balances out the responsibility, reduces waiting times and ultimately means the inspection will be in line with the expected criteria set out.

1.5. Improvement

Improvement is an ongoing activity that is focused on increasing the effectiveness and efficiency of the quality management system and its processes. The current state of the quality management system is assessed through data such as internal audit results, monitoring and measurement results, and audit results of the food safety management system. The analysis and evaluation of this data can lead to a number of different “improvement opportunities,” such as the existence of a new customer need or expectation, a change in local regulations, or new technology that could be used to improve a process. These opportunities could be focused on individual processes or on the quality management system as a whole. Common improvement tools include the Plan-Do-Check-Act model that forms the basis for most food safety management system standards, and the wider use of quality tools such as “Six Sigma,” which aims to improve business processes by identifying and removing the causes of defects and minimizing variability in manufacturing and business processes. When selecting an “improvement opportunity,” consideration should be given to the prioritization of such opportunities so that the resources required for an improvement can be prioritized and focused on the most important improvements needed. There should be a clear program for implementing improvements, which can vary from simple changes to documented methods or procedures, or the introduction of new equipment or IT systems. All changes should be subject to some form of review to demonstrate that the change has resulted in the improvement it was supposed to achieve. The state of the quality management system is re-assessed after an implementation to ensure that the improvement has actually been delivered. For example, if the improvement concerned reducing the number of non-conformities in the supplier approval process then the number of such non-conformities would be monitored after the improvement has been implemented. Also, different processes use their own monitoring techniques to check that the process is effective. For example, critical control points in the food safety management system will have monitoring and measurement so that, if it goes out of control, the output of the process can be invalid and corrective actions can be implemented before a defective product is produced. All of these monitoring results are also forms of input to the improvement process and the food safety management system is carefully designed to build in the use of objective, factual data to assist with the continual improvement of the system.

1.6. Evidence-Based Decision Making

This means that you make a decision based on evidence that something is the case. You need to have evidence to prove that your decision is either right or wrong because without evidence anybody might dispute your decision. There are many forms of evidence such as experience which can be the most powerful form of evidence to have confidence in a decision. Data can be another powerful form of evidence to support decision making. It has long been said that ‘deeds matter, not words.’ ISO 22000:2018, the international standard specifying requirements for a food safety management system, also emphasizes the importance of evidence-based decision making in its latest edition. This risk-based standard requires the adoption of a systemic approach to evidence-based decision making in order to meet its stringent Food Safety Management System (FSMS) requirements. It not only insists that an organization shall ‘base decisions on the analysis and evaluation of data and information’ but also mandates that ‘the organization shall determine, provide and maintain the resources, including trained and competent personnel…’ to support such decision making. This clear focus on having the right resources to drive effective, evidence-based decision making reinforces the message that this is a senior management-led, proactive activity that is fundamental to the ongoing success of the FSMS. All departments and levels within an organization, including outside parties or suppliers, need to contribute to the process of evidence-based decision making. When taking decisions affecting the FSMS, ISO 22000:2018 requires that ‘the organization shall ensure that the integrity of the FSMS is maintained’ and ‘data and information…shall be analyzed and evaluated.’ I hope you have another clear view of evidence-based decision making. Nowadays, in the modern and ever-more complex organizational environment, practising evidence-based decision making is considered a key element of successful management. ISO 22000:2018 secures its leading role in food safety management by requiring a structured and systemic approach based on clear leadership, the right resources and a culture that allows decisions to be verified and evaluated through evidence. Well-designed sections of information in ISO 22000:2018 such as this help users of the standard to understand its natural flow and the underlying synergy between different components of a food management system, making the ultimate aim of ensuring food safety and compliance more achievable. So be careful when you make decision and choose the right approach, ask for evidence when necessary. Keep on asking yourself do you have enough evidence for your decision.

1.7. Relationship Management

Relationship management refers to the identification, analysis, and management of relationships with all stakeholders in the business’s environment for the purpose of improving business performance. An organization, in its quest to deliver value to all stakeholders consistently and effectively, has to manage and align the inter-relationship between interested parties. In quality management, the focus is not only on the relationship with customers. It is also on managing the relationships with all other stakeholders of the organization such as owners or shareholders, employees, suppliers, and society. The “Principles of Quality Management Systems” places increased emphasis on the importance of relationships and a more rounded view of business as a set of interconnected entities. The adoption of a quality management system should help improve the focus on a more balanced and sustained approach to stakeholder relationships. An organization adopting this kind of system is more likely to develop and improve the relationships both now and in the future. It should help to promote a continual and iterative focus on what meets the needs of all stakeholders, rather than being managed by the shifting short-term demands of a single stakeholder with the greatest power. By adopting a more focused approach to relationship management, the organization will seek to deliver synergistic value through more integrated and effective relationships. This principle provides a framework for developing a clear understanding and recognition of the inter-dependence that exists between stakeholders and the organization. By doing this, the organization can work towards a consistent harmonious value system that recognizes the needs and expectations of all stakeholders. The customer is at the heart of the “Principles of Quality Management Systems”. However, customer loyalty, satisfaction, and the identification of new opportunities are delivered through the key processes and relationships of the management system. The emphasis on relationship management within the “Principles of Quality Management Systems” recognizes this fact. It should focus the organization on finding and maintaining the most effective and efficient ways of delivering and improving products and services in a way that meets and exceeds the reasonable expectations of all stakeholder groups. In today’s business environment, relationship management is a key ingredient to the success of any organization, no matter how big or small the entity is. Every company is concerned with its customers, suppliers, and employees. The management of these relationships is carried out by senior and line managers, but it is important for all employees to feel involved. All activities in relationship management are focused on quality and customer satisfaction. Every organization has something called the “structure” where the organization looks from the point of view of the internal culture. This is rarely the same as the organizational chart, which tends to be rather fixed with lines of power and communication. However such relationships must be managed so that there is a clear understanding of the vision from the top of the organization and how, in achieving that vision, the inter-relationships between different parts of the organization can be aligned. The adoption of a quality management system based on the “Principles of Quality Management Systems” brings greater focus and a sustained pattern of customer satisfaction and stakeholders’ loyalty. In a recent study, it has found that companies who adopt this kind of quality management system tend to perform better in the market. So it is no wonder that organizations are increasingly finding that the adoption of a quality management system based on the “Principles of Quality Management Systems”, is a formula for success in the long term.

1.8. Continual Improvement

Continual improvement, a recurring theme of ISO 22000:2018, requires organizations to develop and maintain a culture where everyone is focused on improving the organization’s processes and products. Continual improvement is essential to the success of a business since it empowers organizations to focus on the approach and adopt innovative processes. Successful continual improvement drives an organization towards improved organizational performance, operational excellence, and sustainable business success. The standard requires organizations to develop and implement a continual improvement process or processes that will be used to ensure the effectiveness of the food safety management system (FSMS). These processes must be iterative and suited to the nature and scale of the organization in that the processes must be capable of delivering results in terms of the improvement of the organization’s overall performance. The standard, in clause 8.5, also requires that these approaches to continual improvement have the aim of improving the suitability, adequacy, and effectiveness of the FSMS and enabling its processes and objectives to be achieved. The output from the continual improvement processes should be improvements to the performance of the FSMS and to the achievement of the organization’s objectives. Such improvements could include improved control of processes, improved products and services that are more consistent in meeting customer requirements, cost minimization through lower rejects and customer returns, and increased customer satisfaction through effective control of any risks to customer satisfaction. By utilizing and deploying approaches to continual improvement that adhere to the principles of ISO 22000:2018, an organization will be well positioned to realize the benefits of a quality management system through improved performance and the achievement of its objectives.

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Food quality assuarance discussion questions

1. Principles of Quality Management System

1.1. Customer Focus

1.2. Leadership

1.3. Engagement of People

1.4. Process Approach

1.5. Improvement

1.6. Evidence-Based Decision Making

1.7. Relationship Management

1.8. Continual Improvement

2. Documentation Requirements in ISO 22000

2.1. General Documentation Requirements

2.2. Control of Documents

2.3. Control of Records

2.4. Management System Documentation

2.5. Food Safety Management System Documentation

2.6. Records of Training, Skills, Experience, and Qualifications

2.7. Records of Communication with External Interested Parties

2.8. Records of Product Characteristics

2.9. Records of Monitoring and Measuring Results

2.10. Records of Internal Audits

2.11. Records of Nonconformities and Corrective Actions

2.12. Records of Management Reviews

2.13. Records of Supplier Evaluation and Approval

2.14. Records of Product Withdrawals and Recalls

2.15. Records of Customer Complaints and Actions Taken

2.16. Records of Verification and Validation Activities

2.17. Records of Control of Monitoring and Measuring Devices

2.18. Records of Calibration Activities

2.19. Records of Maintenance Activities

2.20. Records of Pest Control Activities

2.21. Records of Cleaning and Sanitation Activities

2.22. Records of Personal Hygiene Practices

2.23. Records of Waste Management

2.24. Records of Product Traceability

2.25. Records of Emergency Preparedness and Response

2.26. Records of Outsourced Processes and Suppliers

2.27. Records of Packaging and Labeling

2.28. Records of Allergen Control

2.29. Records of Product Preservation and Storage

2.30. Records of Product Release

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principles of quality management system according to ISO 9000 standards