Contraband Management On Inpatient Psychiatric Unit
Western Governors University
College of Health Professions
Abstract
The issue of patient safety continues to inform the psychiatric care of inpatients suffering from mental illness through the institutionalization onto the modern practices of psychiatric nursing. In most cases, confinement will arise from safety out of both the fear or public safety and societal stigma. Others will include benevolently aims in protecting these individuals from any kind of body harm. The main challenge for many hospitals however has been detection and confiscation of such items. The following project argues that within the environment of a psychiatric unit, safety should be maintained as one of the predominant value and management of risk in psychiatric nursing and care.
The aim of this project is to develop a standardized list of items deemed to be unsafe from entering a locked-down inpatient psychiatric hospital and to educate staff, patients, and visitors about the listing. With the guidance of the Director of Nursing, an inter-professional team used evidence-based practice to identify items considered to be unsafe. The project also identified how unsafe items were entering the unit, and determined strategies that could be used to prevent these items from entering a psychiatric hospital. This project was done through a standardized search process as part of the best practice to avoid items from reaching the psychiatric unit.
The capstone project was done for a period of five weeks. Where the researcher conducted a literature review of credible sources, and best practices were obtained to come up with a contraband management protocol. To complete the project, the student came up with a team of professionals who supported the implementation process, conducted meetings, made presentations, created posters, and came up with a checklist to educate staff, patients, and visitors about banned objects from entering the units. The team was also trained with a nurse educator and developed competency sessions for the staff. The implementation resulted in a standardized contraband management process that was designed based on evidence-based practice. The student collaborated with various stakeholders and, through the application of this project, was able to affect change within the organizational practice.
CHAPTER ONE
1.0 INTRODUCTION
Then chapter provides an introduction to the development of search protocol as a way of improving the management of contraband in psychiatric institutions. The section will come up with the background to the problem, objectives of the project statement and rationale.
1.1 Background to the Problem
The entry of contraband items in a mental hospital is unavoidable. However, it is worth all staff efforts to try to stop what will inevitably enter the unit. Tracking process for contraband is consistent from unit to unit in the hospital. One staff may give a patient an item that another team member deemed contraband; therefore, it requires every staff effort and cooperation to keep these items out of the facilities. There are various reasons why nurses and paraprofessional personnel are not consistent with the current contraband process involving patients and visitors at the pavilion. Some of the causes identified were variation in items staff considered to be contraband, inconsistency of admission process, the high turnover rate for direct care staff and frequent movement of personnel to work in an unfamiliar population of patients with different rules and cultural norms. According to Chizh (2015), when a team member is familiar with the milieu it is very critical to maintaining safety (p.63). A retrospective review of all contraband reporting was read. A significant factor was staff interpretation of what was considered contraband and the rules surrounding contraband confiscation and accommodation. Woodthrope, Bakhsh, and Paton (2013) states, “The lack of a commonly shared definition of quality or patient safety are consistent with the lack of prominence of these concepts in training" (p.388). Vincent advised, “until you have the concepts, the practice will elude you" (as cited in Woodthropet et al., 2013 p.388).
Problem Statement
Detecting prohibited items within the Pavilion is essential in maintaining the safety of patients, staff, and visitors. However, detecting such banned items can be very problematic. These unsafe items can contribute to dangerous behavior towards self and others. Without a clear and concise process currently defined, the gap in the current contraband process jeopardizes the safety of patients, staff, and visitors.
Practice Change, Quality Improvement, or Innovation
This project aims to improve safety and management of contraband on the inpatient psychiatric unit. For the hospital to achieve the contraband management process, the hospital must prevent the entry of items that are potentially hazardous to patients, staff, and visitors to the floors by implementing a standardized search process.
There are several proposed solutions to prevent potentially hazardous items from entering the units. The proposed change which forms the primary focus of this project entails developing a standardized process for a contraband search that can be applied to every patient by every staff working at the front line at the pavilion. Winokur, Loucks, and Raup (2018) state the use of a standardized procedure or protocol is an effective way to have consistency in practice from unit to unit. The collaboration of a master prepared nurse and other behavioral health leaders will be utilized to approve the proposed change and offer insight on how to engage key stakeholders. It will be critical to identify the key stakeholders and comprehend how they will affect the process of change throughout the organization
The rationale for the Practice Change, Quality Improvement, or Innovation
Contraband is defined by Webster dictionary "as smuggled goods." In most Psychiatric hospitals, contraband is an item that is potentially hazardous to patients, staff, and visitors. According to Abela-Dimech, Johnson and Strudwick (2017), the safety of staff, patient and visitors on psychiatric inpatient units is compromised by unsafe items entering the unit, (p.104). The procedures for searching patients and their belongings vary among staff and units. Policies can also be involved in guiding the entire process. There was an instance where on one unit a patient was given items confiscated by another staff and put away. However, on the next shift, another staff gave the patient access to the confiscated item without any reservation for safety. This patient gained access to a cigarette, a lighter, and proceeded to the bathroom to smoke. Another staff from a different unit gave a patient a bag from the restricted area without checking the content of the bag. This action allowed the patient to have access to a razor blade, scissors, and a lighter. These items are in the current policies and procedures for a contraband check as items not allowed without supervision. There seems to be a breakdown in the compliance and consistency of the contraband check process. According to Abela-Dimech et al. (2017), when implementing a process to improve safety on a psychiatric inpatient unit, there must be "clear and consistent communication of the rule" (p. 104). There is an increase in contraband found in patients' possession in the hospital. This trend compromises safety for the patients, staff, and visitors. Evidence-based practices and best practices will be required to effectively reduce unsafe items (contraband) from entering the inpatient psychiatric unit. This plan of action consists of identifying the problem, the cause(s) of the problem, and developing a clinical nurse search approach process for stakeholders to increase buy-in and motivation.
Chapter 2: Review of the Literature
Credible Sources
A literature review was conducted of 30 reliable sources regarding security rules, banned items and milieu safety improvement process through various databases including WGU library, Google scholar, free full PDF, and PubMed. All articles were published in the last five years and reviewed based on inclusion, evidence grade and applicability to the project. The database sources were peer-reviewed, and a general appraisal of findings and significance for the project. These sources are in Appendix A, Credible Sources.
Best Practices
Based upon the literature review, best practice identification for contraband search and creating and maintaining a safe environment for staff and patient is creating interventions involving standardized communication. The proposed change which forms the primary focus of this project entails developing a standardized process for a contraband search that can be applied to every patient by every staff. The literature review also supports a standardized procedure or protocol as an effective way to have consistency in practice.
Evidence Summary
Standardized practice
Abela-Dimech et al. (2017) support incorporating a safe search protocol showing that standardized method fosters consistency in care, staff, and patient safety, recognizes leadership, reduces the risk of unsafe items entering the unit and reduces the confrontation from patient and visitors on an inpatient psychiatric unit. Chizh (2015) argues that staff who are familiar with the standardized process of their work area will know how to respond to patient's needs accordingly and prevent conflict to the team. The model allows learning about group behaviors in its unique setting through observation as a unit rather than a separate entity (Batra, Duff, Smith, 2014, p.2). Plsek and Greenhalgh advised because complex adaptive systems require that, for organizations to maintain equilibrium and survive, the organizations must respond to an ever-changing environment as (cited by Wojciechowski et al., 2016, p.1).
Abela-Dimech et al. (2017) argue that having a standardized search protocol to improve patient’s safety is a critical element that distinguishes organization where patient and staff maintain a safe unit. Establishing a high performing culture of effective communication among staff, patients, and visitors would reduce the risk of contraband entering the floors. Woodthrope et al. (2013) reveal that the lack of commonly shared definitions of quality or patient safety is consistent with the lack of prominence in these concepts. Therefore, education and training are vital to maintaining contraband safety on the inpatient psychiatric unit. Winokur et al. (2018) concluded that the use of a standardized procedure or protocol is an effective way to have consistency in practice from unit to unit. Standardized proceedings instituted by nursing staff reduced the use of restraints by more than 50%, allowing staff nurses to participate in knowledge-based decision making through clinical opportunities for collaborative work within the organization.
Establishing a high performing culture of effective communication among staff, patients and visitors would reduce the risk of contraband entering the floors. Woodthrope et al. (2013) reveal that the lack of commonly shared definitions of ‘quality' or ‘patient safety' is consistent with the lack of prominence in these concepts. Therefore, education and training are vital to maintaining contraband safety on the inpatient psychiatric unit. Hoke (2015) suggests that people with mental illness most likely misunderstand because of the lack of awareness of mental illness. Marcus, Herman, Frankel, and Cullen (2017) indicated that 94.9% of the altercation in a mental health hospital resulted in “little or no harm and could have been prevented” (para.2). Laidlaw et al. (2017) suggested strategies which included the use of mental detecting technologies to facilities search for unsafe items entering the units. D’Lima et al. (2016) explained that the “social stigma surrounding mental illness issues “affect safety on the unit. To keep the environment safe, one must improve communication and understanding among staff and patients (para 2). Evans, Wojda, Jones, Otey, and Stawicki (2015) recommended that early detection of unsafe objects is one of the best practice strategies to avoid an incident with dangerous items in the inpatient setting. For organization to prevent contraband or hazardous items from entering inpatient psychiatric unit, the organization must ensure that their communication is defined and consistent. According to Abela-Dimech and Johnson (2017), sharing of discussion about a process by leaders is an effective way to implement change. A study by Metse et al. (2014) revealed that there must be a joint effort from the inpatient and outpatient community mental health centers to communicate the health benefits to these patients. This study implies that the staff and community should offer more focused intervention on the communication of the addictive behaviors and its impact on the patients' reactions and safety.
The Mental health staff is at high risks of being assaulted by patients than any other inpatient setting. Novice mental health staff is at higher end risks of being assaulted by patients. Some studies have examined systematic approaches to improve safety on the inpatient psychiatric unit. Chizh (2015) suggested that knowing the surrounding is “critically important" to maintaining security in the inpatient setting (p. 63). Abela-Dimech et al. (2017) suggested that the education of the staff patient and family is the key to keeping unsafe items of the units. The risk reduction is higher for banned objects when all are aware. Moreno-Poyato et al. (2016) agreed that the therapeutic connection from patient to staff or vice versa is the bedrock for maintaining safety in psychiatric hospitals. Wykes et al. (2018) suggested that educating the staff further improves the perception of the environment, hence benefiting both staff and patient to maintain security. A study conducted by Olsson, Audulv, Strand, and Kristiansen (2015) revealed that most of the patients on the inpatient psychiatric setting want to have a safe, trusting relationship with staff. Slemon, Jenkins, and Bungay (2017) identified strategies for risk reduction associated with the care provided to patients in a psychiatric hospital. Applying these strategies to staff and patient can maintain a safer environment. According to Marcus et al. (2017), safety on the psychiatric unit outside the VA hospital has been overlooked for research. Ridenour et al. (2015) argued that psychiatric employees are at higher risks of violence than other healthcare staff. Stevenson et al. (2015) Concluded that most psychiatric employees are complacent with the intensity of violence they encounter on their jobs.
Recommended Practice Change, Quality Improvement, or Innovation
Contraband is defined by Webster dictionary "as smuggled goods." In most Psychiatric hospitals, contraband is an item that is potentially hazardous to patients, staff, and visitors. According to Abela-Dimech et al. (2017), "The safety of staff, patient, and visitors on psychiatric inpatient units is compromised by unsafe items entering the unit" (p.104). The procedures for searching patients and their belongings vary among staff and units. Policies are also involved in guiding the entire process. There was an instance where on one unit a patient was given items confiscated by another staff and put away. However, on the next shift, another staff gave the patient access to the confiscated item without any reservation for safety. This patient gained access to a cigarette, a lighter, and proceeded to the bathroom to smoke. Another staff from a different unit gave a patient a bag from the restricted area without checking the content of the bag. This action allowed the patient to have access to a razor blade, scissors, and a lighter. Some of these items are listed in the current policies and procedures for a contraband check, as items not allowed without supervision. There seems to be a breakdown in the compliance and consistency of the contraband check process. According to Abela-Dimech et al. (2017), when implementing a process to improve safety on a psychiatric inpatient unit, there must be "clear and consistent communication of the rule" (p. 104). There is an upward trend in contraband found in patients' possession after the admission process. This trend compromises patient, staff, and visitors’ safety. Evidence-based practices and best practices would be required to effectively reduce unsafe items (contraband) from entering the inpatient psychiatric unit. This plan of action would consist of identifying the problem, the cause of the problem and developing a clinical nurse search approach process for the stakeholders to increase buy-in and motivations. The team addressed the problem with contraband entering the hospital because of the risk it poses to the safety of patients, staff and visitors’ safety. West (2014) argued that it is the facility responsibility to keep documentation of all patient's safety screening.
In conclusion, understanding the process of patient searches, as well as the responsibilities of those involved in completing the contraband band search required all team members to have the same understanding of what is contraband, and the impact it has on patients, visitors, and staff’s safety. From the literature reviews, there is evidence for the proposed solution to support fixing the problem through standardization of protocol, improving communication, and relationship between patient and staff. Stocking, Clancy, Bowman, Terry, and Wye (2014) revealed in their study that employee's perception and attitude toward patient could have an impact on their cooperation with the treatment plan.
Chapter 3: Implementation
Capstone Project step
During the first week, the advanced practice nurse approved the proposed change. The advanced practice nurse articulated the stakeholder's effectiveness in implementing the change throughout the hospital. During the second week, a literary review of thirty- plus sources was conducted to determine the best evidence-based practice articles on contraband search protocol, and security on a psychiatric inpatient unit. The Director of Nursing met with her management team about the topic of safety and contraband entering the hospital. A standard search process and a list of contraband items were identified based on a literature review. The third week was used to determine the best evidence-based practice for the contraband search process to improve patient safety on the unit which would align with the organization's goals. The contraband search process was assessed on the fourth and fifth weeks, and competency was written and reviewed with the Nurse Educator. The stakeholders conducted a meeting with the student. There was a presentation given by the student on identifying safety concerns of contraband items on the unit. The student and unit managers created a poster and other visual aid to educate staff, patients, and visitors about the process.
Changes made to the original implementation plan.
Most of the original implementation plan stayed on course. The contraband management protocols steps were all completed as stated by the student.
The Barrier associated with the implementation of the plan.
The barriers to the contraband management process were identifying and gathering all the necessary information to assess the hospital accommodation. The obstacle to the proposed change was due to a stall in communication with stakeholders. The Nursing Director had several meetings with senior leaders during the implementation phase of the student capstone.
Overcoming barrier
The student overcame most of the barriers of this project by exercising patience, resourcefulness, and good communication. Staff resistant to change was another barrier to the implementation. The team expressed their concerns about learning a new process. The student overcame this barrier by focusing on the safety for staff, patients, and visitors based on the evidence-based practices from the literature review.
Trans professional Relationships
By conducting the capstone project, the student was able to develop professional relationships with various leaders at the hospital. The student collaborated with the Director of Nursing, all four-unit managers, and the front-line staff in facilitating the implementation of the proposed change in contraband management. The Director granted the permission and provided access to resources and equipment to heighten the student's knowledge of working with the hospital system. The unit managers worked with the student by giving various details and information about patient populations at the hospital. This kind of collaboration allowed the student to have an insight into the strategic plan of the hospital to provide the best care for the patient and maintain its financial stability.
How relationships facilitated implementation plan
The Director of Nursing is a vital member of the implementation process of the contraband management project for the psychiatric hospital. She introduced the student to key stakeholders that would have a direct impact in the organizational change. The Director of Nursing created the culture of buy-in from the key stakeholders in the organization by showing support and interest. The Director of Nursing guided the student by developing a culture of standardization that could have a positive impact on the safe outcome of the patient while aligning with the mission and values of the organization. The risk manager and the unit managers helped identify possible risks associated with the implementation. Their experiences and knowledge gave the student the confidence that was needed to lead the front-line staff. The mentoring of all the nursing leaders involved with the implementation gave the student the support that was required to develop the contraband search management program that was attainable for the future participants and hospitals.
Chapter 4 Post capstone Project Considerations
Capstone Successes
Successful aspects of the capstone was triumphant in several ways. It gave the student and the leadership team at the hospital the opportunity to improve patient safety on a psychiatric inpatient unit through professional leadership with the organization and the patient population. The Capstone was an opportunity to reduce items that were deemed unsafe from reaching the patient or the staff by implementing a standardized search process. The number of incidents of contraband item reaching the pilot units decreased significantly after the implementation of the new method.
Impact on future projects
The capstone has created awareness of safety and the need for change at the hospital. Acknowledging the need for change is the first excellent steps in fostering change. The Director of Nursing and the unit managers were impressed with the capstone project that they want to create a safety coach committee to continue the safety alertness and awareness using current evidence-based practice. All stakeholders recognized the Director of Nursing for creating the buy-in environment for the staff to promote safe patient outcomes. The Director of Nursing can create positive change with future project by creating this buy-in effect.
Capstone Challenges
Aspects of the capstone that did not go well. The most challenging part of the capstone project was the period when communication was delayed from the student to all stakeholders due to scheduling conflicts. The meetings scheduling process with stakeholders were complicated.
Impact on future projects
The Director of Nursing and all the stakeholders recognized and agreed that patient, staff and visitor's safety was necessary to create an environment that is providing a positive patient outcome, and financial sustainability. As a result, from the piloted units, senior stakeholders requested implementation of the contraband management process across all the units.
Evidence and Current Practice
The capstone project was able to bridge the gap between evidence and current practice by first identifying the need to maintain and ensure milieu safety on an inpatient psychiatric unit. The literary research conducted during the capstone project supports standardized procedure and protocol as effective ways to have consistency in practice. Winokur, Loucks, and Raup (2018) encouraged the use of a standardized process, or protocol as an effective way to have consistency in practice from unit to unit. Chizh (2015) argued that staff who are familiar with the standardized process of their work area would know how to respond to patient’s needs and accordingly prevent conflict with them. Abela-mech et al. (2017) revealed incorporating a safe search protocol showing that standardized practice reduces the risk of unsafe items entering the unit. Woodthrope et al. (2013) explained that the lack of commonly shared definitions of ‘quality' or ‘patient safety' is consistent with the lack of prominence in these concepts. According to Abela-Dimech et al. (2017), when implementing a process to improve safety on a psychiatric inpatient unit, there must be “clear and consistent communication of the rule" (p. 104). Slemon, Jenkins, and Bungay (2017) identified strategies for risk reduction with care provided to patients in psychiatric hospitals. Applying these strategies to staff and patients, they can maintain a safer environment. The evidence suggested that the need to create and maintain a safe milieu on an inpatient psychiatric unit was a needed practical change for the hospital to preserve patients’ safety and remain financially stable. A good contraband management process based on improved patient outcome, evidence-based practice, and the organization’s mission and values can improve and increase the organization’s reputation within its surrounding communities.
Post Implementation plan
Implementation of the capstone project on contraband management process was a success. The short-term goal for the hospital and the organization is to continue using this process on the current units for three months while collecting data. The goal is to get approval for this capstone project to be a mandatory part of all new employee orientation. The long-term goal of the capstone is to become part of the hospital expected standard for patient care. To maintain the credibility of the process, the leadership team has decided to develop a safety committee team to monitor and retain the contraband management process as part of the long-term goal. The safety committee will be responsible for reviewing and updating the process as needed based on evidence-based practice.
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Resources Required for Post-Implementation Support
To implement the project, the leaders of the units would need to identify front-line staff to be part of the safety committee to monitor and uphold the practice of safety in the hospital. Staffing of the units would need to be on an ongoing revision process to allow time off for the selected staff members would attend meetings about safety coaches’ best practices. Since there are nine units within the hospital with a different population of patients at various stages of mental illness, it would require planning for staff meetings to update each other, which is part of keeping standardization and consistency in the process and training of staff. The project would create some additional work for individuals who are chosen to be on the committee. The leaders would ask for more funding for individuals who are working on safety and contraband management project as a change agent.
Chapter 5: Reflection
Integrate clinical reasoning with organizational, patient-centered, culturally appropriate strategies to plan, deliver, and evaluate-evidence-based practice.
The capstone enabled the student to research best evidence-based practice to develop a safe search contraband management while using a standardized protocol to deliver patient-centered care that is measurable. The contraband management process included areas that focus on patient-centered-care employing the evidence-based practice. The performance improvement area involves the participation of participants in at least one performance improvement project (PI) that is clearly defined to a clinical practice area and focuses on one of the national patient safety goals established by the joint commission. The Joint Commission standards are the highest standards of an objective evaluation process to help health care organizations assess,, measure, and improve performance centered on their patients. The student applied the PDSA cycle to the project for evaluation. The PDSA cycle is an organized plan which allows the project leader to plan, do, study and act on a change within the clinical focus area. According to the Improvement of Health Institute, the PDSA cycles is a model for improvement by providing a framework for developing, testing, and implementing change leading to improvement. (“Plan-Do-Study”, 2018).
Construct inter professional teams to communicate, coordinate, collaborate, and consult with other health professionals to advance a culture of excellence.
The capstone allowed for the design of an organization and leadership team that promotes high-quality care through constructing interprofessional team to communicate, coordinate, collaborate, and consult with other health professionals to advance a culture of excellence. Abela-Dimech et al. (2017) suggested that the education of the staff, patient, and family is the key to keeping unsafe items from entering the units. Plsek and Greenhalgh advised because complex adaptive systems require that, for organizations to maintain equilibrium and survive, the organizations must respond to an ever-changing environment as (cited by Wojciechowski et al., 2016, p.1). Moreno-Poyato et al. (2016) agreed that the therapeutic connection from patient to staff or staff to patient is the bedrock for maintaining safety in psychiatric hospitals. Wykes et al. (2018), suggested that educating the staff about safety improves the perception of the environment, hence benefitting both staff and patient to maintain safety. A study conducted by Olsson, Audulv, Strand, and Kristiansen (2015) revealed that most of the patients on the inpatient psychiatric setting want to have a safe, trusting relationship with staff. The support of the senior leaders was necessary to ensure that the capstone project was implemented and carried out. The collaboration, coordination, and communication of the various stakeholders were vital to the success of the project. The implementation of the contraband management search process allowed the leaders to provide safe, high-quality practice for best patient care and outcome.
Appendix A 28
Credible Sources
|
Author(s) (Formatted as an in-text citation) |
Database (CINAHL, EBSCO, Cochrane, Pro-Quest) |
Peer-Reviewed (Yes/No) |
Applicability
(Yes/No) |
Evidence Grade (Strength/ Hierarchy) |
Appraisal (Summary of findings; how findings inform your project?) |
Inclusion
(Yes/No) |
|
Abela-Dimech, & Johnson (2017) |
WGU library |
yes |
yes |
6/Single qualitative studies |
Explores Failure mode and effects analysis framework to develop a standardized search protocol. Shows analysis benefits and opportunities for improvement in safety. |
Yes |
|
Abela-Dimech, Johnson. & Strudwick (2017) |
WGU library |
yes |
yes |
7/expert opinion |
The article describes a standardized approach for safe searches implementation. Reveals that managers' and staff nurses' knowledge of the model must align for safety on the unit. |
Yes |
|
Batras, Duff, & Smith. (2016). |
Google Scholar |
yes |
yes |
1/systematic review |
This study reveals the understanding of organizational changes strategies for trans formational leadership theory. |
yes |
|
Chizh, (2015) |
PubMed |
yes |
yes |
7/expert opinion |
Describes a standardized approach for ensuring the milieu is safety for patients and staff by providing a step by step approach. |
yes |
|
D’Lima, et al. (2016) |
PubMed |
yes |
yes |
1/systematic review |
A systematic review of patient safety in a mental health setting. Exploring the existing research based on patient safety in an inpatient setting. |
yes |
|
Winokur, Louck& Raup (2018) |
WGU Library |
yes |
yes |
6/single qualitative studies |
Meeting the complex needs of the BH patients in an ED environment presents a continuing challenge. Developing a coordinated approach that involves all stakeholders using an STP to focus interventions and responses provides optimal chances for success in achieving progress toward key performance outcomes |
yes |
|
Laidlaw et al. (2017) |
Sage pub med |
yes |
yes |
2/ Randomized trial |
Randomized trial of different security devices to detect contraband items in mental health hospitals. |
yes |
|
Ellis, Rufino, Allen, Fowler& Jobes (2015) |
WGU |
yes |
yes |
3/quasi experiment |
Utilized the CAMS assessment to keep patient safety and to reduce suicidality |
no |
|
Moreno-Poyato et al., (2016) |
Google Scholar |
yes |
yes |
1/ systematic review |
Describes how therapeutic relationship inpatient psychiatric care is essential to keeping the unit safe. The relationship is built on trust and respect allowing the caregiver to care for the patient and allowing the patient to receive the care. |
yes |
|
Kelly, Fenwick, Brekke & Novaco (2016) |
WGU |
yes |
yes |
6/Descriptive study |
A study conducted to measure if staff well-being (depression, anger and physical health effect the safety of the unit. The study concluded that the creation of a therapeutic environment should be an essential goal for a psychiatric to reduce violence. |
no |
|
Marcus, Hermann, Frankel, & Cullen (2017) |
Google scholar |
no |
yes |
2/ Randomized sample |
Results indicate that the patient’s safety events in the psychiatric unit were relatively common, but most of the incidents resulted in little or no harm to the patient |
yes |
|
Stevenson, Jack, O’Mara& LeGris (2015) |
WGU |
no |
yes |
4/Non -experimental design descriptive study. |
Describes how the experiences of nurses on inpatient psychiatry hospitals can influence understanding of patient violence and influence interventions to prevent the violence |
yes |
|
Metse et al. (2014) |
PubMed |
yes |
yes |
2/Randomized study |
This protocol describes a randomized controlled trial that aims to assess the efficacy of linking mental health inpatients to community-based smoking cessation supports upon discharge as a means of reducing smoking prevalence. |
yes |
|
Margaret (2015) |
WGU |
Yes |
Yes |
1/ Systematic review |
The study concluded that nurses are the target of both verbal and physical violence by patients. The nurses need and support from their organization to do their jobs |
No |
|
Smith, Lynch, Stephens &Kistner (2014) |
WGU |
Yes |
Yes |
4/descriptive review |
Describes how the best facet to predicating aggression and violence on an inpatient psychiatric unit is the patient's self-perception reporting. |
No |
|
Hoke (2015) |
WGU |
No |
Yes |
7/ expert opinion |
Addresses the concerns of educating the public about mental illness and the population that is affected. |
yes |
|
Jeffrey (2014) |
WGU |
Yes |
No |
7/ expert opinion |
Evaluates the effectiveness of solitary confinement to the federal prison system and how it increases the risk of violence. |
No |
|
Ridenour et al. (2015) |
WGU |
Yes |
No |
4/non-experiment |
Study result showed that to prevent violence in the workplace is being aware of the risk and knowing which risk factors are significant. |
yes |
|
West (2014) |
WGU |
yes |
yes |
7/ expert opinion |
Describes the steps in making the environment safe for patients and staff by removing contrabands once the patient was noted to be a danger to self and others. |
yes |
|
Stockings, Clancy, Bowman, Terry & Wye (2014) |
PubMed |
no |
no |
1/randomized controlled trial |
Describes community centers involvement with mental health patients to help reduce violence and contraband on inpatient psychiatric hospital |
yes |
|
Evans, Wojda, Jones, Otey,& Stawicki (2015) |
WGU |
No |
Yes |
7/expert opinion review |
Explores the practice of intensive monitoring and prevention plan to reduce the risk of intentional patient ingestion of contraband objects |
Yes |
|
Oster, Gerace, Thomson&Mur-Cochrane (2016) |
Free full PDF |
yes |
Yes |
7/Expert opinion |
Compare the hours of restraint and seclusion internationally and the behaviors that lead to these interventions. |
NO |
|
Woodthorpe, Bakhsh &Paton (2013) |
WGU |
Yes |
Yes |
4/nonexperimental |
Develop recommendations for improving patient safety within mental healthcare |
Yes |
|
Sebergsen, Norberg &Talseth (2016) |
WGU |
yes |
Yes |
6/ Descriptive study |
Nurses’ openness and sensitivity to the changing care needs of persons who suffer from psychotic illness create moments of confirmation within caring acts that concretely help the persons to feel better, and that may enhance their health. The results show the importance of taking the experiential knowledge of persons who have experienced psychotic illness seriously to develop and increase the quality of mental health care in acute psychiatric wards. |
NO |
|
Pileno, Morello & Losa-Iglesias (2016) |
WGU |
Yes |
Yes |
6/Qualitative study |
Explored the nurse's concepts of working as a team to keep patients safe in an inpatient psychiatric hospital |
NO |
|
Martin (2015) |
Google Scholar |
yes |
No |
|
Explored the value of having a physical exam for mental health nursing. |
No |
|
Giarelli et al. (2017) |
Google Scholar |
yes |
yes |
5/meta-synthesis |
Findings from this study can be used to improve high-quality care for hospitalized patients with acute mental health problems. Findings confirmed that nursing staff must be continually vigilant primarily for self-protection as they were the principal target of violence and aggressive acts. |
NO |
|
Wykes et al. (2018) |
Free full PDF |
yes |
yes |
1/Randomized controlled trial |
A discussion of improving staff perception of mental illness can improve patient compliance with rules and regulation of the unit. |
yes |
|
Fellinger, Waldhor, Bluml, Williamsb& Vyssoki (2018) |
Free full PDF |
yes |
No |
4/ case-control studies |
The study concluded that women spent more time being hospitalized than men. |
No |
|
Olsson, Adudulv, Strand&Kristiansen (2015) |
Free Full PDF |
Yes |
yes |
6/Qualitative study |
Description of how patients use different strategies to reduce violence on the unit, therefore, increasing self-esteem and accepting the current situation allowing the staff and patient to co-exist in creating a safer environment. |
Yes |
|
Slemon, Jenkins & Bungay (2017) |
Free full PDF |
yes |
yes |
7/Expert opinion |
Explores the use of effective risk assessment of the client and how it impacts the invention utilization to create and maintain a safer environment for both staff and patients |
Yes |
Read PDF: Contraband Management On Inpatient Psychiatric Unit
Learning Competency
Competency in nursing looks at the abilities that they required to fulfil their roles as nurse. In the nursing course, it becomes very important for them institution to clearly define their competency as by establishing a foundation for the nursing and education curriculum. It is thus very important that nursing students and the whole educator program competencies and outcomes are in addition to the competencies and outcomes the will see the student meeting the requirement of their whole nursing graduate program during the first year and recurrent years of study (Alvarado, Alfaro, Rivas, & Rodriguez, 2016). The competency statements also provide the educator and the student with guidance on what to focus on during the preparation of nursing educators and scholars (Alvarado, Alfaro, Rivas, & Rodriguez, 2016). Also while the nursing practice competency may not be the direct result of education program, it provides the foundation of what is to be taught by all educators.
According to the National League for Nursing the four main competencies include:
- Human Flourishing – where nursing educators are supposed to use the learning skills to ensure the enhancement of human flouring for their colleagues, fellow students, communities and most importantly their patients.
- Sound Nursing Judgment - Here nursing educator and learners should demonstrate a sound nursing judgement in actions or decisions which are related to the quality of education and care for patients (Gould, 2019).
- Professional Identity – here the growth in the nursing profession is very integral in regard to the development of the nurse educator as being a leader that follows and values the personal and professional advancement (Gould, 2019).
- Spirit of Inquiry- it indicates that the nursing profession is very vital in regard to the reforms on health care systems, and will functions with the spirit of inquiry to the continued reforms as a way of informing practice and education (Gould, 2019).
Explanation
- Human Flourishing
When it comes to the human flourishing competency, it looks at the effort to achieve the part of self-fulfilment and self-actualization in the nursing practice within the context of the broader community of individuals. It looks at the right of each member in the community to pursue their personal efforts. It will assess traits like diversity, dignity, uniqueness, happiness and the holistic wellbeing of the individual in respect to a larger family, population of community (Gould, 2019). As one achieves a human flourishing trait, it means that one is able to become and live the life long journey that is full of achievement, hope, losses, regrets, suffering, illness and coping. The nurse will be educated to learn how to help individuals in reclaiming or coming up with a new pathways to their human flourishing. The concepts of nursing foundation will look at human dignity, health and illness, vulnerability, compassion, ethnic and cultural diversity of each individual (Alvarado, Alfaro, Rivas, & Rodriguez, 2016). It is also important to understand the issue of flourishing as to mean having vigour, thriving, growing vigorously and being successful.
- Nursing Judgement
The competency of nursing judgement on the other hand looms at three processes in nursing education that includes; clinical judgement, critical thinking and integration through best practice exchange. This means that the nurse is supposed to employ the required processes as they make decisions regarding their clinical care, application of research and development and the broader dissemination of research findings among other insights to the management and community and allocation of resources. In addition, the utilization of required professional judgement in education for nurses will entail the process of acquiring and disseminating information, critically thinking about it, evidence evaluation application or required knowledge, the use of problem solving skills, using and reflecting on the clinical judgement as a way of selecting the best course of action in response to educational strategies and learning competencies.
In the nursing professional judgement this is about the ability for the student to apply the highest order of their cognitive skills (evaluation, conceptualization and analysis) and being in a position that it become deliberate to apply critical thinking (where the nurse is required to be open minded by very wise when it comes to decision making) in the end leading to action that is appropriate and logical. The development of nursing public policy, advocacy skills and evidence based practice will also assist the nursing educator in formulating a close linkage on how they can be able to teach their students, how they can ensure that students are able to learn and improve the outcomes of patient care (Gould, 2019). The connections are very important as they ensure the delivery or require health care and education.
- Professional Identity
The third competency from NLN is professional identity which focusses on both the professional and personal development, it will look at the internalization of the main perspectives and values that are realized as the integral part to the art and the science of the nursing education. It will also be social constructed, as the core values will have become self-evident on the basis that the nurse will gain experience (Alvarado, Alfaro, Rivas, & Rodriguez, 2016), lean and reflect and grow high in the profession. In manner, the nurse will also learn to internalize the various fundamental values in each aspect of the nursing practice while at the same time the learner keeps on working in the improvement of patient outcomes as they promote the ideals in the nursing profession. The most integral part of this program is the commitment by the nurse to ensure advocacy for the improvement and access to health care and delivery of health services for the most vulnerable of populations including sustainability and growth of the nursing profession.
This competency is very important as it is addressed during the individual’s educational experience in addition to mentors and teachers with whom the person will interact with or influence the development of their professional identity. It is thus important that the academic nurse assumes ownership regarding the development of their professional identity in addition to that of the students who depend on their, even if the student is at the initial level. By incorporating the right ethical standards which are inspired by the existing national and international codes of ethics will also reflect on the said ownership (Gould, 2019). It is not only important that the academic nurse education accepts all the important attributed in regard to the nursing profession, by they also need to ensure that they are familiar to the perspectives and values of the discipline of education which also includes the ones found in the nursing education. The other issue critical to the nursing professional identity looks ways that that the education curriculum will influence the way the students look at the changing healthcare visits, include the different occurrence of various values, the processes of refinement and professional identity which could also be enhanced through positive interaction with colleagues and communities of interest (Gould, 2019).
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- The spirit of Inquiry
The fourth competency is the spirit of inquiry which looks at the persistent sense of curiosity that during the education session would inform both the practice and the learning process. In this regard, the nursing student will at the end of the day be required to provide a type of inquiry through raising questions during the end of education session, or clinical practice. The nursing student will also be require to challenge the existing and traditional practices, and come up with a new and creative approach to solving clinical care problem. In the nursing profession, the inquiry competency will also come in the way of innovative thinking and will allow for the possibilities of students coming up with new solutions for those predictable and unpredictable situation during practice ("Evaluation beyond Examinations," 2014). Among the contexts that this can be found to work is when it is required for academic educators to challenge and question how they were themselves taught, including how they were able to teach their students.
It is also important that nursing educators teach and seek acquisition of new knowledge or seek understanding and clarity and be able to come up with a spirit of inquiry to their students. The intellectual curiosity of these students will also include the enhanced or heightened dimension in regard to motivational state, cognitive stimulation and the desirable process of cognition (Clark, Raffray, Hendricks, & Gagnon, 2016). Nursing educators are also required to present a learning environment for the nursing student to allow the challenge what they are being taught. This is part of the natural progress in the spirit of inquiry from the foundational or master’s preparation of the educator and the practice, including nursing research. By fostering, stimulating or sustaining the spirit of inquiry will also begin from the foundational or master’s level in addition to the analysis of evaluation of evidence and knowledge (Clark, Raffray, Hendricks, & Gagnon, 2016). Among the preparation competencies of the nursing educator for the nursing students will include being able to translate pedagogical evidence so as to come up with new and transferable knowledge to other practice settings and the system’s level. Being able to cultivate the spirit of scholarly inquiry for students also means having to engage them in the science of discovery through the implementation and design of the nursing research and come up with a new knowledge that will be used to improve the nursing education or reform agenda.
- Learning Objectives for the Spirit of Inquiry
- To assess whether the learning is following the curriculum.
- To find out the level of interest of the student in the learning process.
- To come up with new innovation in nursing practice.
A). Criterion to use:
According to the National League for Nursing, the spirit of inquiry looks at the persistent sense of curiosity which will inform both the practice and during the learning process. A nurse can depict the spirit of inquiry when they are able to raise questions and doubt some factors in a way to try and do something differently or come up with new approaches to various problems during the learning process and nursing practices.
The first important step will be to clarify the educational objectives so that one can establish the criterion to which the students are likely to make an inquiry in some areas of study. For example, if an individual is satisfied it will be easy for the educator to know what exactly his or her educational objectives are, and if these objectives are couched together with traditional aims, the learning outcomes form in regard to the inquiry competency ("NLN Releases A Vision for Achieving Diversity and Meaningful Inclusion in Nursing Education," 2016). After this it will be important for the tutor to move on to the next criterion, however, if he has not discovered the educational objectives, the tutor will have to make reference to the course module descriptor (or any that is equivalent) and find out what the student learning objectives are. In case the detailed objectives of the student do not exist readily then the student should be asked to come up with theirs in whatever format they may consider as being appropriate by specifying the student learning outcomes to help guide the course session for the student ("NLN Releases A Vision for Achieving Diversity and Meaningful Inclusion in Nursing Education," 2016).
To help with the inquiry, the tutor can the select a provisional teaching or learning methods. For example, in the inquiry competency, it is important to makes use of Evidence Based Learning. For an experience tutor, one can be able to choose an appropriate method, in regard to the student or use various methods differently so long as they are able to achieve a particular object for the student or the group on the grounds of ‘instinct’ or ‘gut feeling’. If this is so, they can the proceed directly to the third stage; if this still does not work then it is important for the tutor to look for outside assistance from various referees in the field.
For the lower cognitive objectives, the tutor will utilize the most common method, which is the normal lectures and may as well be the best method if the tutor’s objective is meant to provide the student with an introduction to the nursing subject or to provide them with an overview of a particular area of interest, this will also allow them to deal with some of the main questions that they may want to inquire regarding the topic (Kim, 2014). During this time one needs to consider using an individualized learning method of different form, like using upon learning materials, following directions from a textbook, CBL, mediated self-study or multi-media and an assignment project.
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Traditional Approaches to nursing course
The Traditional approaches to nursing curriculum design was fist laid out by Ralph Tyler in 1949 from his influential book that later came to be known as the ‘Basic Principles of curriculum and instruction’. From the book, his method in general is seen as though the principle way of forming a concept of the developing a curriculum. This is due to its wide use in schools and around the world, many students and teachers find this being a familiar concept. Perhaps it is due to the fact that it is a subject centred approach, especially for the first years of student as it is a presents a set of ‘experts’ who pre-determine the subject matters that are also mastered by each student. The curriculum in this manner will also be structured around the content and units and the sequence of what is taught, what follows and the logic behind the subject matter (Kim, 2014). In this method thus, the systemized ideologies, are also demonstrated in the introduction of Tyler’s book and will categorize the nursing school as the controller of the study to decide what is to be given to the student and how this is going to be delivered. For example, the tradition method of curriculum development will ask questions like; how can learning experiences of students be selected that are likely to be useful to attain the required learning objectives, what educational purpose should the school aim at attaining?, how can each student learning experience be organized to ensure effective instruction, and how will this effectiveness of the learning experience be evaluated in the long run? (Kim, 2014).
In reference to the traditional method by Tyler, a learning curriculum is supposed to be an ongoing process, over the course of the nursing educational years and educational experiences will thus accumulate to exert the profound change to the learner, like the way that water deeps in a stone so should education be transferred from the tutor to the student. In the traditional method, the tutor needs to express the fact that knowledge and skill should not be photocopied, but should in its place be taught in a particular sequence over time (Harrison, 2014). There should be a spiral approach in which the learner will return to the topics in a more complex form over time, this will also be considered as a traditional approach. In either case skills based, or competency based instructions, which is common in adult basic education will often draw upon a traditionalist approach to the curriculum in which student mastering the nursing skills and procedures in an instruction cycle (Kim, 2014).
Although the traditional approach to the design of syllabus design that his critic, it also has several supporters that maintain the view through mentioning the following advantages.
Some examples of the subject centred curriculum include:
Discipline design – The discipline design will promote knowledge that is gained through a method which the scholar will be using to study a particular content in the nursing profession. The main disadvantage of this design is that only an in depth study of the main areas of specialization will be taking place.
Subject Design – in the subject design of the curriculum, more effort will be put on the content, where learning is also very much categorized. Among the disadvantages of this is that it will not account for the interest of the learner, tendencies and experiences.
Correlated design- the correlated design in the traditional approach will usually link the individual learner to the subject design as a way of reducing fragmentation. Here subject will be related to one another but will also ensure individual identities are retained.
Broad Field design / interdisciplinary – this is the most liked design, in the traditional approach of curriculum development. The design is important as it prevents the categorization of subjects allowing students to be free to choose what to learn and what to take away from the course (Harrison, 2014). The design will also integrate the contents that are relate to one another.
Advantages
The main advantage of this approach is that the student is likely to benefit and will easily adapt to the different methods of teaching and learning so as to promote the elasticity of learning required knowledge. This is also something that students will be fond of, as it recognizes what they like and do not like, in the end they will have been brought up with what they liked from the beginning of their first year (Clark, Raffray, Hendricks, & Gagnon, 2016). The other advantage of this method is that learning distinct skill in a more systematic fashion will provide itself with traditional form of testing. It is also easy to come up with test scores and to calculate them, this is also explained to the funders as part of the program results. In addition, program administrators are able to use the results from traditional tests to defend what they have achieved from the whole course program (Harrison, 2014). Tutors, students and lecturer will also direct to confirmed progress which is undoubtedly motivating.
The other advantage from the traditional method of curriculum development include curriculum lending itself well to the mass production (Clark, Raffray, Hendricks, & Gagnon, 2016). Here publishers are able to print books which break down reading and case studies, including evidence based practice into the whole process of learning. In the end this will make the information much easier for the student as they work on comprehending and for the teacher to learn to explain where it is evident that resources have been found to be limited and the traditional approach is much more competent. In addition, teachers are allowed to expand on the information that they already have by looking at the guidance from the methods and materials provided from the traditional approach ("International Family Nursing Association Develops Position Statements on Pre-Licensure Family Nursing Education and Generalist Competencies for Family Nursing Practice," 2016). The approach is also much easier from the tutor volunteers and teachers as they will easily teach from the existing curriculum. In addition, the tradition method is good as it is usually available to learners that re interested in independent studies (Tilak, 2017). The information is easily attained from books, the internet, social media groups among other forms of transmission (Gould, 2019). Here students do not need to way for the lecturer sessions to begin or fit in their schedules, especially for first years that are also professionals, or adult learners who mostly study at home.
- Strategies To Evaluating Nursing Outcomes
Role Playing - Role Playing is a form of evaluation, especially during experiential learning. In nursing education, role play evaluation will require the students to take on different roles for various nursing requirements by assuming a profile of a personality or character and participate or interact in complex and diverse nursing situation. The idea of role play is at times used interchangeably or inconsistently. However, it will involve some form of simulation, where the student may realize some realistic situation in which the role of the participant many not be as distinctive or prominent as it should be during role play. In most frequent situations, role play cannot perform well without simulations and will require the practice of role-playing simulation.
Advantages - Role plays are important as they also function as the main learning tools for the groups and teams or individuals since they can play face to face or online, one taking the position of the patient and the other of the nurse. They will in the even alter their power ratios in learning and teaching relationships or between the educator and the student, this is because students most learn through their viewpoints and explorations of the character or of the personality which they imitate ("International Family Nursing Association Develops Position Statements on Pre-Licensure Family Nursing Education and Generalist Competencies for Family Nursing Practice," 2016). During role play. Students will also enable the learner oriented assessment where the task design will be created for the active learning of students.
Disadvantage - It may not work well for students will esteem issues as it requires them to be actively involved in both the peer and the self-assessment and come up with sustainable formative feedback.
Oral Questioning
An oral questioning form of evaluation is a direct means which the tutor will use to assess the learning outcomes of the student by the means of questioning them. Unlike the one used in interviews, that are usually made of a structure question list, in oral questioning evaluation, there is not structured list of questions. This means that assessors will ask questions and request responses depending on the circumstances.
Advantage - In oral questioning evaluation, the chances of the student cheating is very minimal, in addition, there is less case of plagiarism that can occur during this type of assessment.
Disadvantage - It may present difficulties for foreign students who take English as a second language, thus they may fail not because they do not know but due to communication barrier.
- Criterion and Norm Referenced Tests
In nursing, criterion and norm referenced tests look at how the results of the nursing assessment will be presented. In the criterion referenced test, it means that the test is related to some unit of measure, which reports the grade level that is equivalent to the scores, where the individual learner will be measured with to determine if they are ready to move to the next level.
In the norm referenced test, it will look at the percentage ranking of the student in comparison to the average population. For example, a student will be referred to as being 70 percentile, meaning he or she is ranked at 70 in comparison to the total number of students in the nursing class. Most role play assessments are norm- referenced.
- Construction of Test Items
- Advantages of using true-false test items - The major advantages of using the true-false test items is that it provides the learning competency for the student since it clearly indicates what the students understands and believes (Tagliareni, 2019). It also ensures that deviation from learning is avoided.
- Disadvantages of using true false test items - In most cases students may not pay attention to the purpose of the question, it also deters the student to be creative and become critical about the test question.
-Advantages of using multiple choice test items - it provides the students which a chance to critically think about the question and weigh out options before selecting, this is one of the best ways to prove that students understand the subject in question.
-Advantages of using multiple choice test items - some students may not pay attention to the question thus, it is possible a student may pass the test but still not qualify as a learner.
- Multiple Choice Item
- What are the new innovations in learning the Nursing Practice?
Key considerations in identifying stem is- Nursing theories, Evidence Based practice.
Key considerations in developing responses is – current nursing practices and the traditional nursing practices.
How post-test reviews benefit students- They help the student to learn and understand the materials better, in this way, they can understand their strengths and weaknesses.
- Cultural and societal factors affecting student learning
Some of the cultural and societal factors that may come in the way of the student learning will include the family structure, education history especially if the student comes from a family with a tradition of learning of not. Society factors will also depend on how the student’s community views the nursing practice, including religion and traditional practices.
- Facilitating learning through objectives
The most expected scenario for this type of learning through objectives is when the nursing educators while using a sound and professional judgement would use the objectives to come up with educational issues in which he will need to collaborate with other members of the nursing educational and professional team, later the educator will continue with the selection, appraisal and the integration of evidence in respect to evaluation regarding the learning outcomes. In this regard, the educators is also required to reliably integrate the evidence they find from multiple ways of knowing how they can improve the nursing education practice and the judgment made by nurses during practice. The educator will also be required to identify different gaps in education through evidence based practice and formulate the research questions that will address these gaps (Tagliareni, 2019) (Warren, Breman, Budhathoki, Farley, & Wilson, 2016,). It is also important that the nursing educator is prepared with the new health care issues that they can use in creating a diverse and strong nursing workforce.
- Important of critical thinking skills through collaborative learning
When the educator is able to ensure that the capacity of the spirit of critical thinking during learning on all student is the result requiring a follow up as development of knowledge and the science of nursing education looks at the exploration, discovery, learning and experimentation. By ensuring there is some form of collaborative learning to the role of nursing, including having to critically brainstorm over various aspects in the profession as an important part of creating a scholarly environment for new students and provides them with an opportunity to be innovative, imaginative and formulate new ways of nursing practise that can be adopted by the practice or the educator (Warren, Breman, Budhathoki, Farley, & Wilson, 2016,).
Through collaborative learning, as a nursing student, one is able to find answers to questions that may not be directly answered by the tutor, collaborative learning also encourages the learner to believe in their thoughts and add to the existing knowledge.
- Best practices of providing learning feedback
Among the best practices of providing students with feedback of their learning process can be realized through recurrent tests and assessment. Students can also learn about their development when they are given different roles or are allowed to play a particular role again and, meaning that they are being perfected on the identified role (Warren, Breman, Budhathoki, Farley, & Wilson, 2016,).
Read PDF: Learning Competency
World View Reflection
Christian perspective of spirituality
According to Christian perspective, spirituality is based on the search for the meaning of life while they continue to have a relationship with oneself and God. Spirituality thus looks at the yearning to experience God’s blessings and kindness while bringing about transcendence. In the Christian faith, spirituality is usually practised exclusively in their relationship to music, nature, arts and a number of philosophical beliefs or their relationship with their friends and family (Yenor, 2016). For Christians spirituality will look at the quality of the individual relationship with God as it strives for their inspiration, to be redeemed, to find purpose and meaning, awe and to find faith and grace in God (Yenor, 2016). The spiritual dimension of Christianity calls for harmony between man and God, where human beings are required to respect God’s word and find grace about the infinite and comes to focus in regard to physical, emotional, loss, illness and bereavement and death.
In the context of postmodernism relativism it can be said that postmodernism views the issue of spiritualism in regard to ethical affiliation (Balserak, 2016). This is because postmodernism is an intellectual movement in which the interpretation of an individual’s thoughts means everything and reality will come about through the individual’s view of the world. In this way, postmodernism relativism, does not agree with Christian spiritualism as they view the world from the way it is (Balserak, 2016). According to postmodernism, the modern mind looks at spirituality as being all relative to the individual’s personal experience. This means that the individual’s spirituality should not be tied to a form of a higher being, but a personal choice that embraces relativism where all points of view are equally valid (Yenor, 2016). Postmodernism can thus be said to be based on science, which is in contrast to spiritualism. Harmony in this way needs to exist outside the individual’s body, both the issue of spirituality and science which needs not be viewed separately but also complement each other towards interconnectedness through the body, mind and soul.
Scientism
Scientism is based on an ethical system that is rooted on various scientific reasons and facts with no possibility of supernatural powers. According to the features of modernism, scientism is viewed as an intellectual movement in which interpretation of an individual’s thoughts is everything and reality will come about through the way one interprets the view of the world (Yenor, 2016). The concepts of scientism are thus going to affect the individual’s view of the word and their spiritual orientation. The individual thought is basically about a personal choice that embraces relativism in which all points of view will be equally accepted. However, there are arguments that science alone may not give the true meaning of life. There needs to be existence of harmony within and outside of the individual body (Yenor, 2016). Thus by integrating science to the topic of spirituality cannot be seen as two separate views but should be able to complete one another towards interconnectedness of the mind, body and soul.
The second problem with the scientism view of the world is that it often proponents are based on philosophical thoughts that are put to make people feel good about their situations when the reality is kept away from them. Followers of scientism do not contribute to anything, as everything is about their derivative and will be interpreted to various versions of logical positivism, Hume without the understanding of various critiques (Yenor, 2016). Also when looking at various phenomenon like language, it is radically contingent as it depends on cultural history and cultural memory in regard to its continuation and existence. In addition, a block on the frictionless plane is not path dependent in the same manner.
Ultimate reality
Ultimate looks at another belief which strongly ties the world view with God. This is because God is the ultimate creator of reality. According to humanity, they understand and recognize the existence of reality. This is about the existence of the past as a guide to the present way that people live (Balserak, 2016). There also exists a beginning and an end to every, however the way that people interpret it will show how they embrace the reality of life. The sinful or bad actions committed by the humanity is often considered as being evil. Here humanity does not possess evil but all also decide in regard to actions that they perform. There also exists a way of goodness in reality (Yenor, 2016). The supernatural real also equal nature of God, which is love, according to the realm of God. In ultimate reality thus, God interacts and prepares human being until the day that they will die and go to heaven to confront their creator and recognize him with no barriers.
Various teachings on theology looks at ultimate reality as two types of belief that people strongly depend on, however epistemology is the final belief which identified what people know about the Supreme Being. For example in Christianity, through revelation, people are able to know God. There are also two types of knowledge, these realities are absolute knowledge and ultimate reality (Yenor, 2016). He also created the use of actual facts from nature. The human mind is meant to make judgements, God gives people a sense of trust and the mind to understand the world that revolves around humanity. Realism thus looks at the realistic approach of connecting humans with nature.
Nature of the Universe
By definition, the nature of the universe is defined by time and space, which in other words is collected referred to as space-time and time (Balserak, 2016). These contents also comprise of all energy displayed in different forms and their contents. These contents also comprise of all energy in its different forms, including matter and electromagnetic radiation thus all the moons, planets, galaxies, stars and the contents of intergalactic space (Yenor, 2016). According to scientists, the universe is also made of physical laws which influence matter and energy, like laws on conversation, classical mechanism and the issues of relativity. The common definition of the universe is the totality of existence or everything that exists in space, and that which has existed or will exist.
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This means that the idea of some philosophers and scientists hold it that the inclusion of abstract and ideas and concept like mathematics and logic in regard to the definition of the universe. Here the idea of the universe will also refer to the concept like the world, cosmos and nature (Balserak, 2016). In the religious point, any universe will begin from the assumption on the nature and what exist, the main defining character of these assumptions is that they will themselves not be able to prove. Even when looking at the universe from the view of material science is not about to exempt from the necessity of logic for the epistemological first move, with in regard to materialistic atheist is the main idea same to ironically, a religious leap of faith (Snoby, 2001). The nature of the universe motivates individuals to ask themselves what is life, why do we exist, what is the meaning of humanity, and where does all these end.
What is a human Being?
In human being is considered as being the most unique and intelligent animals on earth, according to Christian religion a human being is the best and most empowered creation of God. The way that human beings view themselves, is very special and unique, as they are individual who have been able to manage to adapt to all forms of habits, social structures and subsistence pathways even on the view of evolutionary heritage (Balserak, 2016). A human being is the most successful creation in ever habitat on the planet become of development of technology and adaptation to forming themselves in to the desires and needs of the human species (Snoby, 2001). However the nature of humanity continues to change with the advancement of technology, and most human beings are slowly turning to their own innovations and being enslaved by technology. Humanity is slowly losing its existence as people continue to adapt modernity and the nature that comes with it.
In this regard, to be a human being is not only about having a heart, eyes, a face or being able to make use of different technologies. Being a human being is more about the deeper and more passionate nature of individuals. Being a human being is also about possessing and actually practicing the ability to know what is right and what is wrong, or being rational enough in ones thoughts and think deeply about the tangible things in life and the world. To be a human being is about finding own worth (Snoby, 2001). To be a human being is also about finding what is important, finding meaning in life and pursuing it to the end. To be a human being is to really live and thrive and build a society or a race.
What is Knowledge?
Knowledge is about being familiar, or being aware and understanding something or someone. It is about getting information, or acquiring information, skills, descriptions and facts through experience, learning, and education (Balserak, 2016). Knowledge is very important for human being as it defines who we are and what our purpose in life is all about. Knowledge is also important as it ensure that individual understand the nature of the world, and are able to add more about a theoretical and practical understanding of various subjects (Snoby, 2001)
Basis of the ethics
The basis of the ethics is meant to resolve different questions on human morality by looking at the different concepts like good and evil, vice and virtue, right and wrong or crime and justice. Ethics is about intellectual inquiry, it looks at individual moral philosophy that is also related to other fields of descriptive ethics, moral psychology and value theory (Snoby, 2001).
Purpose of existence
The purpose of human existence should be looked from the view of the nature of the universe. When looked at it from the religious and scientific point of view, human beings exist to look over the world and other living things (Balserak, 2016). The purpose of existence thus to ensure that the universe is well protected and that the creation of God is watched over (Snoby, 2001). Human beings exist thus to serve the purpose of protecting the earth and to continue the nature of life.
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Karen immigrants and mental health
Cardiovascular risk scores in relation to age and gender.
Cardiovascular is something relating to the heart hence the term cardiovascular disease when referring to an illness that hinders proper heart function. Cardiovascular disease is a collective term for different problems of the heart or blood vessel to prevent proper pumping and flow of blood to all body parts. Below are some examples of cardiovascular diseases:
- Heart failure
- High blood pressure (hypertension)
- Cerebral vascular disease (stroke)
- Coronary heart disease (heart attack)
- Congenital heart disease
- Rheumatic heart disease
- Cardiomyopathies